Medi Cal

A Ventura County commission is trying to keep secret the details of a state-ordered investigation into the management and claims procedures of a healthcare plan designed to serve the county's neediest residents. Complaints about alleged late payments and poor management prompted the Department of Health Care Services to request that auditors step in and examine the plan's financial condition and claims practices. Gold Coast Health Plan was launched last year to switch an estimated 110,000 Ventura County Medi-Cal beneficiaries into an HMO-style healthcare plan.  Previously, doctors and hospitals were free to charge Medi-Cal directly on a fee-for-service basis.

Health and Human Services Secretary Kathleen Sebelius on Sunday threw cold water on Gov. Jerry Brown's plan to ask California's poor to contribute to their federally subsidized healthcare — payments the governor has proposed to save the state more than $500 million a year. Brown met with Sebelius for 45 minutes in Washington, where he renewed his pitch for more flexibility in how the state handles Medi-Cal, its health-insurance program for the poor. The governor wants co-pays from recipients for emergency-room visits as well as routine trips to the doctor and dentist, beginning in October.

Reporting from Washington -- Gov. Jerry Brown delivered a message to the Obama administration this week in Washington: Back off. The governor wants the federal government to let him make more cuts in the Medi-Cal program that serves low-income Californians and to exempt state schools from new sanctions that could cost hundreds of millions of dollars. Brown said he raised the issues in a White House meeting with President Obama and 11 other Democratic governors Friday morning and in a private meeting with Education Secretary Arne Duncan on Thursday.

A years-long legal fight over cuts in California's multibillion-dollar healthcare program for the poor took another twist Wednesday as the U.S. Supreme Court kicked the case back to a lower court. The high court's 5-4 decision allows medical providers to continue suing to stop the cuts, which would lower reimbursement rates for doctors who participate in the state's Medi-Cal program. But it did not affirm the lower court's decision to block the reductions, leaving the state another opportunity to argue for the right to implement them to help balance its depleted budget.

In his new spending plan, Gov. Jerry Brown has proposed further cuts in state health and social programs. Some examples: $946.2 million from welfare $842.3 million from Medi-Cal $446.9 million from child care $163.8 million from in-home health aid Source: California Department of Finance

State health officials have failed to adequately or promptly review the finances of publicly funded managed-care plans responsible for serving millions of Medi-Cal recipients, according to a report released Tuesday by California's s tate auditor. The state departments of Managed Health Care and Health Care Services also didn't conduct timely medical checks, intended to ensure that Medi-Cal recipients receive high-quality care, according to the report by State Auditor Elaine M. Howle.

For more evidence that the Golden State has lost some of its luster, consider this news from the federal government: California spends less per person on healthcare than all but eight states. New data show that total spending by insurers, government agencies and individuals amounted to $6,238 per resident in 2009, well below the national average of $6,815. That puts California on a bottom tier with Arkansas, Georgia, Texas, Utah, Nevada, Arizona, Colorado and Idaho. Healthcare analysts blame the low spending largely on the fact that the state has more than 7 million people who are uninsured, or about 1 in 5 Californians.

Just weeks before the planned closure of adult day healthcare centers throughout California, state officials and disability rights attorneys reached a legal settlement Thursday that preserves services for those low-income seniors and disabled residents most at risk of being institutionalized. The state, which faces a $3.7-billion revenue shortfall, had targeted the centers as part of a plan to reduce spending on Medi-Cal, the government health program for the poor and disabled. Adult day healthcare centers provide nursing care, occupational therapy, physical therapy, meals and exercise to people with serious disabilities, brain injuries and chronic illnesses.

The trade group for California's hospitals has sued state and federal officials to block a 10% cut in government reimbursements for some healthcare providers who treat low-income patients. The California Hospital Assn. said in its lawsuit, filed in U.S. District Court in Los Angeles, that cuts to the Medi-Cal insurance program will threaten the ability of many hospitals to continue operating skilled nursing facilities. As a result patients, particularly those in rural communities and other medically underserved areas, are likely to face delays or gaps in healthcare services, the lawsuit contends.

The Obama administration will allow California to cut hundreds of millions of dollars from Medi-Cal, a move doctors and experts say will make it harder for the poor to get medical treatment. California plans to reduce rates by 10% to many providers, including physicians, dentists, clinics, pharmacies and most nursing homes, the Centers for Medicare and Medicaid Services announced Thursday. The cuts "will have a real impact on Medi-Cal patients" because fewer doctors will be willing to see those covered by the program, which serves 7.6 million poor and disabled Californians, said Anthony Wright, executive director of Health Access, a consumer group.