California To Become First State Offering Health Care To All Undocumented Residents

California Poised to Extend Health Care to All Undocumented Immigrants -  The New York TimesSource: The Sacramento Bee, by Mathew Miranda

California will become the first state to remove immigration status as a barrier to health care, making all low-income undocumented residents eligible for state-subsidized insurance regardless of age.

Gov. Gavin Newsom late Sunday announced a budget deal he struck with the Legislature included a new Medi-Cal expansion that would cover more undocumented adults.

The program’s launch, starting no later than Jan. 1, 2024, is expected to provide full coverage for approximately 700,000 undocumented residents ages 26-49 and lead to the largest drop in the rate of uninsured Californians in a decade.

“This historic investment speaks to California’s commitment to health care as a human right,” said Sen. María Elena Durazo, D-Los Angeles.

The state already allows many undocumented residents to join Medi-Cal. In 2015, California began allowing undocumented children to join Medi-Cal. Four years later, eligibility broadened to those younger than 26. And in May, the state started covering people aged 50 and over.

The Medi-Cal expansion is expected to cost $2.6 billion annually.

Californians generally are eligible for Medi-Cal coverage based on their income. The income cap for a family of four this year is $36,156.

California also opens Medi-Cal eligibility to people with certain medical conditions. It’s available to people who are pregnant, blind, disabled, under age 21, living in a nursing home or are a recently settled refugee.

Opening up Medi-Cal to all undocumented Californians has been a goal for health and immigration advocates for years. “This budget investment reflects California’s values of inclusion and fairness and should be a model for the rest of the nation,” said Sarah Dar, director of Health and Public Benefits Policy at the California Immigrant Policy Center. “All Californians, regardless of their age or where they were born, should have access to basic necessities like food and fair, steady wages.”

Undocumented residents remain the largest group of uninsured in California, according to a recent analysis from the the Center for Labor Research and Education at the University of California, Berkeley.

A disparity and “historic wrong” that will be fixed with the expansion, said Assemblyman Miguel Santiago, D-Los Angeles.

“This is a game changer,” said Santiago. “It’s one of the most important pieces of legislation that’s gonna go through this house because the ability to give health care means the ability to live life without pain.”

Popular State Worker Health Insurance Plan Projected To Go Up In Price 17% Next Year

Popular state worker health insurance plan projected to go up in price 17% next  year

Source: The Sacramento Bee, by Wes Venteicher

Premiums are projected to grow an average of about 7% for CalPERS health insurance policyholders next year, with two popular PPOs spiking by more than 14%, according to preliminary prices posted online Tuesday by the retirement system.

The California Public Employees’ Retirement System provides health insurance for about 1.5 million people, including roughly 750,000 state and local public employees and retirees and about 770,000 dependents.

The system introduced changes two years ago that boosted PPO premiums while lowering costs for two expensive plans with the richest benefits. The changes are aimed at preserving the top-tier plans and stabilizing prices over the long term.

The plans that will go up in price are the PERS Gold and PERS Platinum PPOs. Together they cover about 278,000 people.

PERS Gold, covering about 124,000, is projected to increase in price by 17.8%, reaching $766 per month for an individual starting Jan. 1, according to preliminary figures.

PERS Platinum, covering about 153,000, is projected to go up 14.5%, to $1,084 per month next year, according to the figures.

The most popular plan by far that CalPERS offers is a Kaiser Permanente HMO that covers about 556,000 people. The Kaiser HMO is slated to go up about 6% next year, reaching about $853 per month.

The preliminary rates posted online are subject to further negotiation, and could change slightly before they are approved by the CalPERS Board of Administration next month. California pays about $650 per month toward individual state workers’ plans, and offers an additional $260 health insurance stipend to members of SEIU Local 1000.

Two years ago, the CalPERS board approved a new rate-setting methodology on the recommendation of its health insurance experts, who said the system needed to make changes to save three of its best plans.

Those plans — Anthem Traditional HMO, Blue Shield Access+ and a plan formerly known as PERS Care — attract people who spend the most on medical treatment. Insurers kept raising their premiums to cover large bills, driving healthy people away and prompting more price hikes.

That pattern, known as a “death spiral,” would have made the plans unsustainable, experts told the board two years ago.

So the board adopted a structure that, in oversimplified terms, essentially shifts money from plans with lower health risk to those with higher risk. As a result, the prices for the Anthem and Blue Shield plans are projected to go down by nearly 7% each next year, in a second year of price drops.

Plans formerly known as PERS Select, PERS Choice and PERS Care were combined into two plans, the Gold and Platinum plans, which under the new methodology are supposed to level off in price starting in 2024.

CalPERS also offers Medicare Advantage policies and Medicare supplemental plans for those who qualify.

Included in the offerings are Medicare supplement plans called PERS Gold and PERS Platinum that cover about 150,000 seniors. The Gold plan premiums are going up 4% and the Platinum premiums are going up about 10%.

Other popular Medicare plans will go up by a couple percentage points or be reduced. A Kaiser Permanente Senior Advantage policy covering about 111,000 seniors will drop in price by about 6.4%.

Open enrollment, during which policyholders may switch plans, will run from Sept. 19 to Oct. 14.

State Reaches Settlement in Pharma Pay-for-Play Scheme

The California Dept. of Insurance and whistleblowers reached a $23.2 million settlement with pharmaceutical company, Warner Chilcott. Three former employees said that Warner Chilcott paid kickbacks to doctors and falsified prior authorization forms to increase the number of prescriptions for several medications. Whistleblowers alleged that Warner Chilcott used illegal kickbacks to influence treatment decisions. They said that the company often hosted events at high-end hotels and spas with little or no educational content in order to encourage physicians to write more prescriptions for Warner Chilcott medications.

As part of the settlement, Warner Chilcott will refrain from promoting its pharmaceutical products identified in the complaint and sold in California. Of the $23.2 million state settlement, California will get $11.8 million, which is to be used for enhanced insurance fraud investigation and prevention efforts.

Scott Simmer, the whistleblowers’ lead counsel said, “The federal False Claims Act allows whistleblowers to sue for fraud related to government health plans, but only California and Illinois have statutes that allow whistleblowers to bring claims alleging illegal kickbacks to health care providers for the purpose of defrauding private health insurance plans.” In California, private citizens can sue and get a share of the recovery. The whistleblower’s share of a federal recovery in a non-intervened case is 25% to 30%.

“This case really should get the attention of state insurance commissioners around the country. To put things in perspective, the federal False Claims settlement returned a net of around $2.3 million to California’s Medicaid program, but this settlement will bring in a net of $11.8 million to the state’s general fund. Most importantly, drug companies have received a clear message not to engage in drug marketing fraud in the state of California,” he said.

A separate lawsuit was filed in federal court in Massachusetts alleging that Warner Chilcott violated the Federal False Claims Act. Also, the Dept. of Justice announced a settlement of the federal allegations on October 29, in which Warner Chilcott pleaded guilty to healthcare fraud and agreed to pay $125 million to resolve federal civil and criminal liability for alleged activities that violated the federal anti-kickback and HIPAA statutes, and for false claims submitted to Medicare and Medicaid.

Pregnant Women to Get Full Medi-Cal Coverage

The Centers for Medicare & Medicaid Services has approved California’s waiver to extend full Medi-Cal coverage to pregnant women. The amendment authorizes the state to provide full-scope Medi-Cal benefits to low-income pregnant women with incomes above 109% to 138% of the federal poverty level. The amendment also authorizes California to require pregnant women with incomes up to 138% of the federal poverty level to enroll in a Medi-Cal managed care health plan in counties in which such plans are available.

Medicaid Poses Increasing Risks to State Budgets

A rebound in healthcare spending and a shift in federal support will put more pressure on U.S. states’ long-term budgets, Fitch Ratings says. While state and local Medicaid spending growth will remain below historical levels, Fitch believes it will still outpace revenue growth, forcing states to make challenging budgetary decisions. Fitch expects most states to accelerate efforts to slow Medicaid spending and take other budgetary actions. If they do not, they face long-term budget imbalances.

The Centers for Medicare and Medicaid Services (CMS) expects state and local Medicaid spending growth to average 6.3% annually from 2014 to 2024. The increase is partially due to normalization after recession era rates bottomed at 5.2% in 2007, as well as the downshift in federal funding for the Medicaid expansion that will begin in 2016.

However, spending growth will remain below historical trends.  Fitch says that states have had some success in controlling growth in Medicaid spending, though the challenge remains substantial. Implementing managed care has been a key initiative for a number of states. From 2001 to 2013, Medicaid managed care spending increased at nearly double the rate of total Medicaid spending. Fitch says that the shift toward managed care is likely to continue.

Several states have reported net budgetary gains from ACA expansion that could offset those increased costs. CMS expects overall health spending growth to accelerate to 5.8% annually through 2024, up from 4% in 2007. The recession and its aftermath played a key role in suppressing costs in recent years.

The Public Supports Creating State Insurance Exchanges

Fifty-five percent of American say that creating state-based health insurance exchanges is their state’s top of the health priority this year, according to a survey by the Kaiser Family Foundation, the Robert Wood Johnson Foundation, and the Harvard School of Public Health. Drew Altman, president and CEO of the Kaiser Family Foundation said, “Governors are largely splitting along partisan lines on the exchanges, but the public is not. People like the idea.”

While some Republican governors are balking at the optional expansion of Medicaid under the ACA, 52% of Americans say their state should expand its Medicaid program. Sixty-six percent of Republicans prefer to keep their state Medicaid program as is; 75% of Democrats are seeking a state expansion; and Independents are evenly divided.

So far, 18 states and the District of Columbia plan to create their own state-based exchanges; seven other states will establish exchanges in partnership with the federal government; and 25 will default to a federally-run exchange.

Fifty-two percent of Americans (including 78% of Republicans) say that opponents of the ACA should continue trying to change it so that the law has less impact on taxpayers, employers, and health care providers. Forty percent say that those opposed to the health care law should accept that it is now the law of the land and stop trying to block its implementation.

Policy makers involved in budget deficit negotiations face a conundrum. Sixty-five percent of Americans say that Washington should act quickly to bring down the deficit, but there is little public appetite for major reductions in federal health care spending. “In a climate heavily focused on reducing the federal budget deficit, the public still places a high priority on federal spending on veterans’ health care, medical research, health-related responses to disasters, and preventing chronic and infectious diseases,” said Robert Blendon of the Harvard School of Public Health. Fifty-eight percent oppose any cuts to Medicare and 46% oppose any cuts to Medicaid.

Americans support only two of six proposals to trim Medicare. Eighty-five percent say drug companies should be required to give the federal government a better deal on medications for low-income people on Medicare. Fifty-nine percent say that high-income seniors should have to pay higher Medicare premiums. Fifty-one percent oppose gradually raising the age of Medicare eligibility for from 65 to 67 – an idea that’s making the rounds in Washington. Sixty-one percent strongly oppose requiring all seniors to pay higher Medicare premiums. The poll also found a widespread view that Medicare cuts are not really needed; the public believes that there are better ways to reduce the deficit, such a reducing funding for foreign aid and reducing spending in Afghanistan.

For more information, visit http://www.kff.org/kaiserpolls/8405.cfm.

Last Updated 06/29/2022

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