Medi-Cal

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State Health Reform in California

May 9, 2011 in Medicaid | No comments

Health Reform made a number of changes for State’s health care policies. But states themselves have also been enacting legislation to alter health care payment policies and regulations. The CHCF describes some examples of legislative changes in California:

  • Safety Net Care Pool (SNCP) – covers uncompensated costs in public hospitals and finances other state health care programs.  This Section 1115 Waiver designated California public hospitals (including University of California hospitals) continue to able to draw down funding from the SNCP for uncompensated care through their own expenditures.
  • Low Income Health Program (LIHP) provides Medi-Cal Coverage to uninsured adults under 200% of the federal poverty line.  This initiative is basically an early-stage implementation Medicaid expansions required by Health Reform.
  • Delivery System Incentive Reform Payments (DSIRP) support infrastructure development and redesign in public hospitals.  Examples of initiatives covered by DSIRP include telemedicine and improved interpretation services.

 

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Trends in Medi-Cal Reimbursement

March 22, 2011 in Medicaid | No comments

Medicaid provides a safety net for the poorest Americans.  Although eligibility criteria vary from state to state, the health service Medicaid provides are often life saving.  One of the main problems Medicaid beneficiaries experience, however, is access to care.  Many physicians do not accept Medicaid because the reimbursement rates are much lower than those paid by either Medicare or private insurers.

California’s Medicaid program, named Medi-Cal, certainly has some of these access problems.  According to CHCF, California ranked 47th in the generosity of their Medicaid fees when these figures were adjusted for geographic differences in the cost of providing health care.

This same CHCF study revealed the following conclusions:

  • Overall, Medi-Cal fees were 83% of the Medicaid national average in 2008. Among the ten largest state Medicaid programs, California ranks 9th.
  • Considerable variation exists in Medi-Cal fees across procedures in relation to national averages, with relative fees ranging from less than 70% to more than 140% of the national average.
  • From 2003 to 2008, Medi-Cal physician fees grew, on average, by only 2%. This compares to 15% growth in average Medicaid fees nationwide and 21% general inflation during this period.
  • In particular, while evaluation and management (E&M) fees increased 20% nationwide between 2003 and 2008, Medi-Cal fees only rose by 4% over this time period.  National fees for vision services increased by 21%, but decreased by 15% in California.
  • Low average Medi-Cal reimbursement extends to dental care, with fees for most procedures falling short of those for Medicaid nationally.

Source:

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Safety Net Patients in California

October 21, 2010 in CHIP, HC Statistics, Health Insurance, Medicaid | No comments

The California Health Care Foundation (CHCF) reviews how California’s safety net residents receive medical care.  Safety Net patients are considered those who have incomes below 300% of the federal poverty line.  Below is a list of governmental and non-governmental programs which serve California Safety Net residents.

This graph shows public program eligibility by poverty level for different types of residents.  These eligibility levels are from 2009 and will change once health reform is implemented.  In particular, Medi-Cal will be extended to more individuals.

One interesting point is that while adults with children are currently eligible for Medi-Cal if their income is below the poverty line, adults without children can only receive subsidized medical services through county programs.

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Eligibility Requirement for California Government Health Insurance Programs

January 19, 2010 in Medicaid/Medicare, Public Health, Public Policy | No comments

The California HealthCare Foundation has an almanac entry on Children’s Health Coverage Facts and Figures.  Eligibility requirements for these programs is described in this table.  Other key findings include:

  • The proportion of children without health insurance continued to decline through 2007, though the pace of improvement has slowed.
  • Nearly 80 percent of California’s uninsured children are eligible for coverage under either Medi-Cal, Healthy families, or Healthy Kids.
  • Medi-Cal and Healthy families are key sources of coverage for children in low-income households that together have closed the coverage gap among families with incomes up to 250 percent of the federal poverty level.
  • Healthy Kids programs are also important for children’s coverage. twenty-four counties operate Healthy Kids programs and four others rely on California Kids.
  • Children are less likely to have employment-based coverage than adults and are more likely to be enrolled in public programs in California.

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Medi-Cal Facts

December 9, 2009 in Medicaid/Medicare | No comments

California’s Medicaid program, known as Medi-Cal, is the largest in the nation.  The California Health Care Foundation offers some interesting facts about the program in this report. For instance:

In just two years, Medi-Cal’s share of the state’s General Fund spending increased from 17% to 19%. If not for provisions in the federal stimulus bill that provide California with an estimated $10-$11 billion in additional federal Medicaid matching funds, state lawmakers likely would have made much deeper cuts to Medi-Cal.

Key facts include:

  • Beneficiaries.  One in six Californian receive health insurance through Medi-Cal.  Further it is the major source of care for one out of every three California children and for nearly all individuals with AIDS.
  • Expenditure. California spending on Medi-Cal was $47 billion in 2009.  This makes Medi-Cal the second largest area of state expenditures behind education.  However, California spends 25% less per Medicaid beneficiary than the national average.
  • Expenditure Growth.  Over the past decade, Medi-Cal spending per beneficiary has grown at a much slower rate than private health insurance premiums (36% and 114%, respectively), and only slightly faster than general inflation (29%).  Medi-Cal spending is growing most rapidly among adults with disabilities, with outlays for personal care services (i.e., in-home supportive services) rising at the fastest rate. The program’s spending on prescription drugs has dropped, however, as Medicare is now the primary source of drug coverage for those beneficiaries eligible for both Medicaid and Medicare.
  • Expenditure Concentration.  Medi-Cal spending is highly concentrated among a small subset of beneficiaries: just 10% of fee-for-service beneficiaries account for 81% of expenditures.

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