California State Auditor Expresses Concerns About Access to Denti-Cal Services

This week, the California State Auditor released a report evaluating California’s Medi-Cal Dental Program and the Department of Health Care Services’ (DHCS) effectiveness in fulfilling their mandate to serve child beneficiaries. In their findings, the California State Auditor described inefficiencies by DHCS in establishing utilization criteria, properly assessing provider participation and complying with state and federal reporting requirements.

Despite California having enough participating providers in the aggregate, DHCS data indicated at least 5 counties had shortage of participating providers, 11 counties did not have providers accepting new Medi-Cal patients and 16 counties had a provider to patient ratio exceeding 1:2,000. In addition, the Medi-Cal Dental reimbursement rates for the 10 most authorized procedures were found to be lower than the national average. Dental reimbursement rates have not been increased since 2001 and most dental providers were subject to the 10 percent state-mandated payment reductions implemented in September 2013, effectively making California’s provider rates some of the lowest in the nation.

The California State Auditor estimates that recent changes to state and federal law could increase the numbers of individuals utilizing dental services from 2.7 million to roughly 6.4 million individuals. In order to address the increase in utilization and the identified inefficiencies, the California State Auditor provided a number of recommendations, most of which the Department of Health Care Services agreed to. Additional information, including the full report can be found here.

Waiver Renewal Expert Stakeholder Workgroups – Update

As part of the stakeholder engagement process for California’s Section 1115 federal Medicaid Waiver renewal, the Department of Health Care Services (DHCS) created five expert stakeholder workgroups. CSAC has been invited to participate in two, the Safety Net Financing workgroup and the Housing/Shelter workgroup.

On Tuesday, December 9, DHCS convened their first Safety Net Financing expert stakeholder workgroup. The purpose of this workgroup is to discuss safety net care pool (SNCP) and disproportionate share hospital (DSH) funds under the waiver construct -both critical funding sources for California’s public hospital systems. In the current waiver, only public hospital systems receive SNCP funds, while DSH funds are allocated to public hospitals, non-designated public hospitals and a small portion is allocated to the private hospitals.

During the convening, DHCS presented the history of both DSH and SNCP funding and provided an overview of their concept to establish a statewide pool of funding for the remaining uninsured by combining DSH and SNCP for the public hospitals. DHCS also expressed concerns regarding the appetite of the federal government to approve SNCP funds in the waiver renewal and the possibility of a reduced DSH allotment to California. CSAC remains engaged as DHCS continues to work with stakeholders to further develop this concept.

The Housing and Shelter Workgroup will meet on Tuesday, December 16 from 10:00 a.m. to 3:00 p.m. at the USC Capitol Center, Room E. CSAC, along with our county affiliates, continue to develop the concept of Whole Person Care and are seeking to broaden DHCS’ vision for housing/shelter through these discussions.

Materials and additional information related to the expert stakeholder workgroups can be found here.

Legislation

SB 36 (Hernandez) – Medi-Cal: demonstration project Pending

Senate Bill 36, as introduced by Senator Ed Hernandez, is the legislative vehicle to implement the Department of Health Care Services’ (DHCS) application to the federal Centers for Medicare and Medicaid Services for California’s successor Section 1115 Medicaid Waiver. SB 36 as currently written would also require the Department to consult with interested stakeholders and the Legislature in developing the waiver application.
The existing Section 1115 “Bridge to Reform” Waiver expires in October 2015. DHCS released their waiver renewal concept paper in July 2014 and have initiated stakeholder workgroups to discuss and further develop the concepts introduced by the Department. CSAC remains engaged in those discussions and will advocate for a five-year successor waiver that provides funding to counties at the current levels.

SB 11 (Beall) – Peace officer training: mental health Pending

Senate Bill 11, as introduced by Senator Jim Beall, would declare the intent of the Legislature to enact legislation to increase the minimum mental health training standard for California Peace Officers. CSAC is supportive of peace officers having adequate training to ensure they are fully equip to handle encounters with individuals suffering from mental illness. However, CSAC is aware that mandating additional training requirements could create unintended consequences to the public safety community, specifically related to having adequate officers in the field. Additionally, many counties have already incorporated mental health training into their training curriculum.

SB 4 (Lara) – Health care coverage: immigration status Pending

Senate Bill 4, as introduced by Senator Ricardo Lara, would declare the intent of the Legislature to establish access to affordable health coverage and care to all Californians regardless of immigration status. Currently undocumented immigrants are not eligible for subsidized health care coverage under Covered California and are only able to receive emergency and pregnancy-related services through Medi-Cal.

This bill would eliminate immigration status as a qualifier for health care coverage.

AB 50 (Mullin) – Nurse-Family Partnership Pending

Assembly Bill 50, as introduced by Assemblymember Kevin Mullin, would declare the intent of the Legislature to develop a means to leverage public and private dollars to substantially expand the scale of the Nurse-Family Partnership in California. The bill would also revise requirements related to the award and use of the Nurse-Family Partnership grants, including the elimination of the requirement for nurse home visitors and supervisors to receive certain training in effective home visitation techniques.

The Nurse-Family Partnership is an evidence-based community health program that improves pregnancy outcomes, improves child health and development, and improves economic self-sufficiency.

AB 11 (Gonzalez) Employment: paid sick days: in-home supportive services Pending

Assembly Bill 11, as introduced by Assembly member Lorena Gonzalez, would revise the definition of an employee under the Healthy Workplaces, Healthy Families Act of 2014 to include providers of in-home support services beginning July 1, 2016. The Healthy Workplaces, Healthy Families Act of 2014 enacted by AB 1522 (Statutes 317, Statutes of 2014) – also authored by Assemblymember Gonzalez –provided employees paid sick days accrued at one hour for every thirty hours worked starting July 1, 2015.

During negotiations with the Brown Administration, in-home supportive services (IHSS) workers were excluded from the Act; AB 11 seeks to reverse this exclusion.