GOOD AFTERNOON. THIS IS THE
ASSEMBLY BUDGET SUBCOMMITTEE
NUMBER ONE ON HEALTH AND HUMAN
SERVICES. TODAY'S HEARING IS
FOCUSED ON THE MEDICAL PROGRAM.
ONE NOTE ABOUT TODAY'S HEARING
IS THAT ARE HEARING ON APRIL
17TH WILL COVER BEHAVIORAL
HEALTH ISSUES AND THEREFORE,
MEDICAL BEHAVIORAL HEALTH ISSUES
WILL BE COVERED AT THAT HEARING,
AND NOT TODAY. WE WILL HAVE
PANEL PRESENTATIONS ON THE 1ST
15 ISSUES ON TODAY'S AGENDA,
WHILE THE REMAINING FIVE ARE NON
PRESENTATION ITEMS, MEMBERS ARE
WELCOME TO ASK QUESTIONS ON ALL
ISSUES ON THE AGENDA, INCLUDING
NON PRESENTATION ITEMS, AND WE
WELCOME PUBLIC COMMENT ON THEM
AT THE END OF THE HEARING.
SHOULD THERE BE AN I WANT TO
REMIND EVERYONE THAT ALL PUBLIC
COMMENT ON ALL ISSUES IN THE
AGENDA WILL BE TAKEN AT THE END
OF THE HEARING AFTER THE LAST
ISSUE IS PRESENTED. WE WILL
FIRST TAKE PUBLIC COMMENT FROM
INDIVIDUALS WHO ARE HERE IN THE
HEARING ROOM, FOLLOWED BY PUBLIC
COMMENTS FROM INDIVIDUALS WHO
ARE ON THE PHONE. THE PUBLIC.
COLIN NUMBER IS ON THE
SUBCOMMITTEE'S WEBSITE, AND IT
WILL ALSO BE ON THE LIVESTREAM
SCREEN ONCE PUBLIC COMMENT HAS
STARTED. AND I WILL ALSO SHARE
IT RIGHT NOW. THAT PHONE NUMBER
IS 877692. AND THE PUBLIC ACCESS
CODE IS 131512 7. WITH THAT. LET
US PLEASE BEGIN WITH PANEL ONE.
FIRST ISSUE IS AN OVERVIEW OF
THE HCS BUDGET AND THE NOVEMBER
2022 MEDICAL ESTIMATE INCLUDED,
INCLUDING COVID 19 IMPACTS WE
WILL BEGIN WITH D. H. C S
DIRECTOR MICHELLE BOSS TO
PRESENT THIS ISSUE AND PLEASE
BEGIN WHEN YOU ARE READY. GOOD
AFTERNOON. THANK YOU, MR CHAIR
MEMBERS. MICHELE BOSS, DIRECTOR
OF THE DEPARTMENT OF HEALTH CARE
SERVICES. THE DEPARTMENT HELPS
MILLIONS OF CALIFORNIA'S GAIN
EQUITABLE ACCESS TO AFFORDABLE,
INTEGRATED AND HIGH QUALITY
PHYSICAL BEHAVIORAL HEALTH CARE
, INCLUDING MEDICAL, DENTAL,
PHARMACEUTICAL, MENTAL HEALTH,
SUBSTANCE, USE TREATMENT AND
LONG TERM SERVICES AND SUPPORTS
THE GOVERNOR'S BUDGET PROPOSES
ABOUT 144 BILLION FOR THE
DEPARTMENT, UH, AND OF
CORRESPONDING ABOUT 4700
POSITIONS TO SUPPORT THE
DEPARTMENT. OF THAT ABOUT 1.3
MILLION IS FOR OUR OPERATIONS.
SO FOR THE OPERATIONS TO RUN THE
DEPARTMENT, THE DEPARTMENT'S
LARGEST PROGRAM IS THE MEDICAL
PROGRAM, AND IT PROVIDES
SERVICES TO ABOUT 15 MILLION
CALIFORNIANS INCOME ELIGIBLE WHO
ARE DISABLED FAMILIES AND
CHILDREN, SENIORS AND PERSONS
WITH DISABILITIES, FOSTER CARE,
PREGNANT WOMEN AND OTHER
INDIVIDUALS. CALIFORNIA IS
TRANSFORMING THE MEDICAL PROGRAM
TO ENSURE CALIFORNIANS GET THE
CARE THEY NEED WHERE THEY NEED
IT. MANY OF THESE TRANSFER
TRANSFORMATIONS WILL BE SPOKEN
TO IT LATER IN TODAY'S AGENDA,
INCLUDING CALAIS MAR LONG TERM
COMMITMENT TO OFFER PERSON
CENTERED CARE THAT GOES BEYOND
THE WALLS OF A DOCTOR'S OFFICE
OR A HOSPITAL AND REALLY MEETS
OUR MEMBERS WHERE THEY ARE TO
PROVIDE NOT ONLY HEALTHCARE
SERVICES, BUT SOME OF THOSE
SERVICES THAT MEET THEIR SOCIAL
DRIVERS OF HEALTH. OUR
COMPREHENSIVE QUALITY STRATEGY,
WHICH INCLUDES QUALITY METRICS
REALLY SPECIFICALLY FOCUSED ON
ALL OF OUR DELIVERY SYSTEMS WITH
IT, BUT WITH THE CLINICAL FOCUS
OF PRIMARY CARE, OUR CHILDREN'S
PREVENTIVE CARE, BEHAVIORAL
HEALTH INTEGRATION AND MATERNITY
CARE IN OUR COMPREHENSIVE
QUALITY STRATEGY. WE HAVE OUR
BOLD GOALS 50 BY 2025, WHICH
REALLY FOCUSES ON THOSE
POLITICAL DOMAINS. OUR NEW
MANAGED CARE CONTRACT THAT GOES
LIVE IN 2024 CREATES MORE VALUE
, TRANSPARENCY AND
ACCOUNTABILITY FOR OUR MANAGED
CARE PLANS WHO COME? 2024 WILL
BE SUPPORTING 99% OF THE MEDICAL
POPULATION. WE WANT TO THANK THE
LEGISLATURE AND FOR ITS
PARTNERSHIP OVER THESE LAST FEW
YEARS, THERE'S BEEN A
SIGNIFICANT INVESTMENT IN THE
MEDICAL PROGRAM OVER THESE YEARS
AND WANT TO THANK THE
LEGISLATURE FOR ITS PARTNERSHIP
ON THAT. WE ALSO ADMINISTER
OTHER PROGRAMS FOR SPECIAL
POPULATIONS, INCLUDING THE
GENETICALLY HANDICAPPED PERSONS
PROGRAM, CALIFORNIA CHILDREN'S
SERVICES PROGRAM AND THE NEWBORN
SCREENING PROGRAM FOR LOW INCOME
IN SERIOUSLY ILL CHILDREN AND
ADULTS WITH SPECIFIC GENETIC
DISEASE. OUR OFFICE OF TRIBAL
AFFAIRS IS RESPONSIBLE FOR
COORDINATING AND DIRECTING THE
DELIVERY OF CARE TO CALIFORNIANS
IN RURAL AREAS AND UNDERSERVED
POPULATIONS THROUGH VARIOUS
PROGRAMS. WE HAVE A LICENSING
AND CERTIFICATION PROGRAM FOR
DRIVING. UNDER THE INFLUENCE
NARCOTIC TREATMENT PROGRAMS, UH
, VARIOUS MENTAL HEALTH
FACILITIES, AND WE ALSO OVERSEE
AND CONDUCT COMPLAINTS FOR
ALCOHOL AND OTHER DRUG
COUNSELORS. FINALLY WE HAVE OUR
COMMUNITY MENTAL HEALTH PROGRAMS
, WHICH WILL BE COVERED AT THE
APRIL 17TH HEARING, AND THEN
VARIOUS PUBLIC HEALTH PREVENTION
AND TREATMENT PROGRAMS, SUCH AS
EVERY WOMAN COUNTS PROGRAM,
PROSTATE CANCER TREATMENT
PROGRAM AND THE FAMILY PLANNING
TO ACCESS TO CARE AND TREATMENT
AS BACKGROUND FOR THE DEPARTMENT
ARE LOCAL ASSISTANT ESTIMATE IS
DONE EVERY, UH TWICE A YEAR FOR
THE JANUARY BUDGET AND THE MAY
REVISION AND ARM. A REVISION
WILL INCLUDE UPDATES TO CASELOAD
AND PROJECTIONS BASED ON
UTILIZATION AND MORE RECENT
DATA. FOR THE CURRENT YEAR. THE
GOVERNOR'S BUDGET PROJECTS 4.2
BILLION LESS GENERAL FUND WILL
BE NEEDED TO SUPPORT MEDICAL AS
COMPARED TO THE 22 BUDGET ACT.
THIS IS A 12.9% DECREASE IN
GENERAL FUND EXPENDITURES
COMPARED TO THE BUDGET ACT, AND
YOUR AGENDA INCLUDES A DETAILED
LIST OF THE FACTORS THAT
CONTRIBUTE TO THIS, I WILL FOCUS
ON THE MOST SIGNIFICANT AH, WE
HAVE A DELAY OF ABOUT 481
MILLION FOR ROUND SIX OF THE
BEHAVIORAL HEALTH CONTINUING
INFRASTRUCTURE PROGRAM. A DELAY
OF 378 MILLION FOR THE
PREVIOUSLY APPROVED BUYBACK OF A
LONG OUT LONGSTANDING TWO WEEKS
. HOLD ON A FEE FOR SERVICE
CHECK, RIGHT? UM SOME OTHER
TECHNICAL CHANGES ARE RELATED TO
A TWO POINT A DELAY IN 2.4
BILLION IN REPAYMENTS TO THE
FEDERAL CMS RELATED TO STATE
ONLY POPULATIONS. 774 MILLION
NET REDUCTION IN COSTS RELATED
TO COVID 19. AND THEN FOR THE
BUDGET YEAR WE PROJECT 138.9
BILLION TOTAL FUNDS FOR THE
MEDICAL MEDICAL PROGRAM. THIS IS
A 1.2 BILLION TOTAL FUND
INCREASE AND A 6.4 BILLION
GENERAL FUND INCREASE. SOME OF
THE FACTORS BEHIND THIS INCLUDE
, UH THE EXPANSION OF OUR
UNDOCUMENTED PERSONS AGED 26
THROUGH 49 375 MILLION ON A ONE
TIME BASIS REGARDING THE CALEN
BEHAVIORAL HEALTH PAYMENT REFORM
. A NET SAVINGS OF 113 MILLION
RELATED TO OUR DESIGNATED STATE
HEALTH PROGRAM. UM AND THEN
SAVINGS RELATED TO OUR MANAGED
CARE ORGANIZATION TAX. UM THE
DHC S BUDGET HAS A NUMBER OF
IMPACTS RELATED TO COVID 19
PANDEMIC AND RELATED FEDERAL AND
STATE POLICIES. THIS INCLUDES
THE IMPACTS OF CASE INCREASED
CASELOAD AS THE STATE HAS BEEN
UNDER CONTINUOUS ENROLLMENT
REQUIREMENT, SIGNIFICANTLY
LIMITING THE CIRCUMSTANCES IN
WHICH INDIVIDUALS ARE
DISCONTINUED FOR MEDICAL AND I
KNOW THAT THIS IS ANOTHER TOPIC
FOR LATER TODAY. THE IMPACTS OF
INCREASED FEDERAL MEDICAL
ASSISTANCE, PERCENTAGE OR MAP,
WHICH SHIFTS COST OF FOR THE
MEDICAL PROGRAM FROM THE STATE
TO THE FEDERAL GOVERNMENT AND
THE IMPACT OF VARIOUS PROGRAM
FLEXIBILITIES, SUCH AS INCREASED
RATES FOR CERTAIN PROVIDERS AND
SERVICES. BASED ON THE
INFORMATION AVAILABLE AT THE
TIME OF BUDGET DEVELOPMENT, THE
GOVERNOR'S BUDGET ASSUMED THAT
THE FEDERAL PUBLIC HEALTH
EMERGENCY WOULD CONTINUE THROUGH
MID APRIL. 2023 THAT REEDIT
TERMINATIONS WITH START MAY 2023
WITH THE CASELOAD PEAKING IN
JULY OF THIS YEAR INCREASE F MAP
WOULD BE AVAILABLE THROUGH THE
END OF JUNE. 2023. IN DECEMBER,
THE END OF DECEMBER, THE
PRESIDENT SIGNED THE
CONSOLIDATED APPROPRIATIONS ACT
OF 2023, AMONG OTHER THINGS THAT
DECOUPLED THE REGION TERMINATION
PROCESS. THE CONTINUOUS
ENROLLMENT PROCESS FROM THE END
OF THE FEDERAL PUBLIC HEALTH
EMERGENCY, SO WE NOW KNOW THAT
ELIGIBILITY RE DETERMINATIONS
WILL START IN APRIL 2023 SO OF
THIS YEAR AND WE'VE BEEN, YOU
KNOW, IT'S ANOTHER AGENDA ITEM
FOR LATER TODAY THAT WILL BE
GETTING INTO. ADDITIONALLY IN
LATE JANUARY, THE FEDERAL
ADMINISTRATION ANNOUNCED ITS
INTENT TO EXTEND THE PUBLIC
HEALTH EMERGENCY FOR THE LAST
LAST TIME THROUGH MAY. 11TH 2023
BECAUSE THESE FEDERAL ACTIONS
WERE NOT DONE IN TIME TO BE
INCORPORATED INTO THE GOVERNOR'S
BUDGET. WE WILL BE TAKING
ACCOUNT TO THESE ACTIONS AS PART
OF A REVISION, HAPPY TO ANSWER
ANY QUESTIONS. DEPARTMENT OF
FINANCE. ADITI HAVE ALEADY
DEPARTMENT OF FINANCE AND NO
FURTHER COMMENTS, ELIO. THANK
YOU TOMORROW WITH THE
LEGISLATIVE ANALYST'S OFFICE AS
A ADMINISTRATION NOTED THERE
WERE A NUMBER OF FEDERAL ACTIONS
THAT HAPPENED IN DECEMBER. THAT
HAPPENED KURT TOO LATE TO BE
RECOVERING INTO THE BUDGET
PROCESS. UM AS A RESULT OF THESE
FEDERAL ACTIONS, AS WELL AS OUR
OWN ASSESSMENT OF CASELOAD,
BASED ON MORE RECENT CASE LOAD
DATA THAT WAS AVAILABLE TO THE
MINISTRATIONS AT THE TIME THEY
PUT TOGETHER THE BUDGET. WE
ESTIMATE THAT THE GENERAL FUND.
NEED FOR MEDICAL WILL BE ABOUT
$1 BILLION LOWER ON NET IN 23 24
. WE DO NOTE, HOWEVER, THAT
WHILE THE GENERAL FUND NEED WILL
BE LOWER ON THIS SIDE OF THE
SPENDING, FORMATTED COW, IT'S
POSSIBLE THAT THE REVENUE
FORECAST WILL BE LOWER IN A THAN
WE ANTICIPATED. AND AS SUCH,
THIS MAY NOT TRANSLATE INTO
ADDITIONAL FUNDING AVAILABLE TO
BE SPENT. THANK YOU. THANK YOU.
WE'LL BRING IT UP TO THE DIOCESE
TO SEE IF ANY MEMBERS HAVE
QUESTIONS. I WILL KEEP IT HERE
AT THE CHAIR IF I CAN. I'LL GET
A LITTLE INTO THE DETAILS. THERE
WAS A BIT OF VOLATILITY WE SAW
BOTH IN THE PROP 56 EXPENDITURES
AS WELL AS WITHIN CAL R X.
SPECIFICALLY THE ESTIMATE. UH
SHOWS SIGNIFICANT SAVINGS FOR
PROP 56 IN THE CURRENT YEAR. AND
SIGNIFICANT NEW EXPENDITURES IN
THE BUDGET YEAR. FOR KELA REX
AND SHOWS INCREASED COSTS IN THE
CURRENT YEAR WITH SIGNIFICANT
SAVINGS IN THE BUDGET YEAR THAT
I'M TRYING TO GET A SENSE WITH
THAT MUCH VOLATILITY. HOW ARE WE
MAKING OUR ESTIMATES? OR IS
THERE A BETTER WAY FOR US TO BE
DETERMINING SO WE HAVE MORE
ACCURACY. UM, THANK YOU. J. C.
COOPER A STATE MEDICAID DIRECTOR
. SO ON THE PROPERTY SIX, WE
HAVE WHAT'S CALLED THE TWO SIDED
RISK CORRIDOR WITH PROP 56
BETWEEN US AND OUR MANAGED CARE
PLANS. IT IS A LITTLE HARD FROM
A DATA TIMING OF WHEN THE PROP
56 IS DONE. THERE'S 12 MONTHS
AFTER IN ORDER TO FILE ALL OF
THOSE CLAIMS, AND THEN WE HAVE
DATA ON OUR SIDE, TOO, THEN
DETERMINE THE RISK ORDER, WHICH
ALLOWS FOR US TO KNOW WHAT WE'RE
CLAWING BACK IF THE MANAGED CARE
PLANS HAVEN'T PAID ALL OF THAT
THOSE FUNDS BACK AND SO IT
USUALLY IS. A TIMING THING IS
THAT'S WHAT YOU'RE SEEING THE
SHIFT BETWEEN CURRENT YEAR AND
BUDGET YEAR WE ARE ACTUALLY
PUTTING IN PLACE A NUMBER OF
MEASURES BECAUSE IT'S ALSO ON
OUR SIDE. WE'RE FEELING LIKE
IT'S NOT PREDICTABLE ENOUGH. AND
SO WE WILL BE RELEASING GUIDANCE
. ACTUALLY TOUR MANAGED CARE
PLANS TO IMPROVE SOME OF THE
TIMELINESS OF REPORTING TO US SO
THAT WE CAN HAVE SOME MORE
INFORMATION TIMELY. WE'RE HOPING
THAT WILL HELP WITH SOME OF
THESE PIECES WHERE WE HAVE TO
DELAY NOT HAVING ENOUGH
INFORMATION FOR BUDGET
PROJECTIONS BECAUSE WE KNOW
THOSE SWINGS CAN BE LARGE. ON
THE ON THE MEDICAL RX, REALLY,
SINCE WE JUST FINISHED OUR FIRST
YEAR. UM IT'S JUST A DELAY. WE
THINK AT THIS POINT IN REGARDS
TO TIMING ALSO, AS YOU KNOW, AT
THE BEGINNING OF 2022, WE HAD A
PRETTY BIG DISRUPTION IN REGARDS
TO MEDICAL RX. THERE ARE IMPACTS
TO THAT IN REGARDS TO SOME OF
THE FLEXIBILITIES. WE PUT IN
PLACE TO MAKE SURE THAT NOBODY
HAD HARM IN REGARDS TO THAT
TRANSITION AS WE'RE STARTING TO
HAVE. WE'VE BEEN ANNOUNCING THE
PHASES OF THOSE TO GO AWAY.
WE'RE SEEING THAT THIS WILL
PROBABLY CHANGE IN 23. SO RIGHT
NOW YOU'LL SEE THOSE PIECES
EARMARKED. THIS YEAR'S BUDGET IN
THE NEXT YEAR, AND WE'RE HOPING
AFTER A LITTLE BIT MORE TIME
WILL BE ABLE TO BE IN A BETTER
PLACE FOR BUDGET PROJECTIONS.
SINCE THAT IS NEW. APPRECIATE
THAT, JUST TRYING TO FIGURE OUT
WHAT THE TRAJECTORY IS AND WHEN
YOU HAD THOSE CONTRARY FUNDING
STREAMS APPRECIATE THAT
TRANSPARENCY. NEXT QUESTION I'D
LIKE TO ASK IS GOING TO BE
RELATED TO THE HOSPITAL QUALITY
ASSURANCE FEE. UM WITHIN THE
AGENDA. WE TALK ABOUT THE
TRANSFER, AND YOU MAY NOT HAVE
ANSWERS FOR TODAY AND REALLY
WOULD JUST APPRECIATE A FOLLOW
UP WITH MY OFFICE. I'M TRYING TO
UNDERSTAND THE STRUCTURE AND
FUNDING. OF THE DISTRIBUTION OF
THE QUALITY ASSURANCE FEE. IS IT
CONTAINED WITHIN THE SYSTEM, OR
IS IT WITH THE HOSPITAL THAT IT
WAS GENERATED AT AS THERE IS A
SIGNIFICANT DIFFERENCE BETWEEN
THOSE TWO AND SHIFTING THAT MAY
OCCUR. I'D LOVE TO FOLLOW UP OFF
LINE AND FIGURE OUT. I THINK AN
OFFLINE CONVERSATION WOULD BE
GREAT. PERFECT WITH THAT. WE
WILL THANK VERY MUCH CHANNEL ONE
AND WE WILL MOVE ON TO PENALTY.
SECOND ISSUE IS AN OVERVIEW OF
THE FAMILY HEALTH ESTIMATE.
DIRECTOR BOSS PLEASE BEGIN WHEN
YOU ARE READY FOR THE BUDGET
YEAR. THE GOVERNOR'S BUDGET
ESTIMATES EXPENDITURES OF 87
MILLION TOTAL FRIENDS FOR THE
CALIFORNIA CHILDREN'S SERVICES
PROGRAM, THREE MILLION INCREASED
COMPARED TO THE CURRENT YEAR.
THE CCS PROGRAM FOR BACKGROUND
PROVIDES DIAGNOSTIC AND
TREATMENT SERVICES AND MEDICAL
CASE MANAGEMENT AND PHYSICAL AND
OCCUPATIONAL THERAPY SERVICES TO
CHILDREN UNDER 21. WITH CCS
ELIGIBLE MEDICAL CONDITIONS, 136
MILLION TOTAL FUNDS FOR THE
GENETICALLY HANDICAPPED PERSONS
PROGRAM OF FOUR MILLION
INCREASED COMPARED TO THE
CURRENT YEAR. JANET GENETICALLY
HANDICAPPED PERSONS PROGRAM IS A
HEALTH CARE PROGRAM FOR ADULTS
WITH SPECIFIC GENETIC DISEASES.
37 MILLION TOTAL FUNDS FOR THE
EVERY WOMAN COUNTS PROGRAM. A
ONE MILLION INCREASED COMPARED
TO THE CURRENT YEAR, AND EVERY
WOMAN COUNTS PROGRAM PROVIDES
FREE BREAST AND CERVICAL CANCER
SCREENING AND DIAGNOSTIC
SERVICES TO CALIFORNIA'S
UNDERSERVED POPULATIONS. THE
FAMILY HEALTH ESTIMATE PROJECTS
. 14 MILLION LESS GENERAL FUND
IS NEEDED NEEDED TO SUPPORT THE
FAMILY HEALTH PROGRAMS IN THE
CURRENT YEAR COMPARED TO THE
2022 BUDGET ACT. UM AND THEN,
UH, THIS IS BECAUSE THE
ASSUMPTIONS ON THE PUBLIC HEALTH
EMERGENCY AND DATES AND SO THESE
WILL BE ADJUSTED AT MAY
REVISION. HAPPY TO ANSWER ANY
QUESTIONS. DEPARTMENT OF
FINANCE. THE DEPARTMENT OF
FINANCE. NO FURTHER COMMENTS.
JULIO. NO FURTHER COMMENTS.
THANK YOU BRING IT UP TO THE
DIET MEMBERS QUESTIONS WE WILL.
THANKS VERY MUCH. THIS PANEL WE
WILL MOVE ON TO ISSUE THREE. OF
COURSE, THIRD ISSUE IS AN
OVERSIGHT ISSUE ON THE HEARING.
AID COVERAGE FOR CHILDREN
PROGRAM. WE WILL BEGIN WITH
MICHELLE MARCINIAK. WHO IS THE
CO CHAIR AND CO FOUNDER OF LET
CALIFORNIA KIDS HERE, WELCOME
AND PLEASE BEGIN WHEN YOU ARE
READY. HI MY NAME IS MICHELLE
AND, UM, JUST TO GIVE A LITTLE
BIT OF BACKGROUND I HAVE MY
MASTER'S IN PUBLIC HEALTH FROM
U. C L A AND WORKED IN THE
UNITED STATES SENATE WORKED FOR
THE AXELROD'S CURE EPILEPSY AND
, MOST RECENTLY, CHILDREN'S
HOSPITAL LOS ANGELES AND I LEFT
SHORTLY AFTER MY DAUGHTER WAS
DIAGNOSED WITH HEARING LOSS. I
WANT TO THANK THE CHAIR FOR HIS
CONTINUED LEADERSHIP AND
COMMITMENT TO CALIFORNIA, STEFAN
HARD OF HEARING KIDS AND ALL THE
LEGISLATURES. CONTINUE TO STAND
WITH US TO HELP FAMILIES IN
CALIFORNIA AFFORD HEARING AIDS
FOR THEIR CHILDREN. THEIR
HEARING AID COVERAGE FOR
CHILDREN PROGRAM WAS LAUNCHED BY
THE HCS IN JULY. 2021. IN
ADDITION, WE'RE HAPPY THAT
ELIGIBILITY WAS EXPANDED THREE
MONTHS AGO TO INCLUDE
UNDERINSURED CHILDREN AND
CHILDREN UP TO THE AGE OF 21.
THANK YOU. WHEN THE CCP PROGRAM
WAS LAUNCHED IN 2021 DHC S
STATED IT WOULD SERVE 7000,
CALIFORNIA CHILDREN THREE MONTHS
SHY OF THE PROGRAMS TWO YEAR
ANNIVERSARY HEARING AIDS HAVE
ONLY BEEN PROVIDED TO 170
CHILDREN, THE YO THE LOW
UTILIZATION NUMBERS ARE A DIRECT
RESULT OF A SLOW PROGRAM ROLLOUT
AND DOES NOT REFLECT THE NEED OF
OUR CALIFORNIA. CHILDREN AND
FAMILIES. OUR COALITION IS
DEEPLY CONCERNED THAT THESE LOW
NUMBERS HAVE BEEN USED TO
JUSTIFY HUGE DEPARTURE FROM THE
PRIOR 10. MILLION BUDGETED FOR
SERVICES DOWN TO 1.6 MILLION.
WHILE THE PROGRAM WAS LAUNCHED
UNTIL I WON THE BULK OF
REIMBURSEMENT CODES SPECIFIC TO
PEDIATRIC AUDIOLOGY SERVICES
WERE NOT IN PLACE FOR THE 1ST 12
MONTHS, AND IT'S SIGNIFICANTLY
HAMPERED PROVIDER PARTICIPATION
WELL, THE HCS MAINTAINS THAT THE
MEDICAL FEE FOR SERVICE
PROVIDERS ARE ELIGIBLE TO
PARTICIPANT PARTICIPATE IN THE
PROGRAM. VERY FEW ARE QUALIFIED
TO SEE CHILDREN HAVE OPTED IN TO
THE DIRECTORY OR HAVE PROVIDED
CARE THROUGH THE PROGRAM. WILL
THE PROGRAM IS MAKING STRIDES?
THERE IS STILL MORE WORK TO DO
TO ENSURE CHILDREN CAN TAKE THIS
BENEFIT TO A LOCAL PROVIDE.
WRITER. FOR EXAMPLE, ACCORDING
TO THE HTC CP PROVIDER DIRECTORY
TODAY, THERE ARE NO PROVIDERS IN
SACRAMENTO ZERO AND CENTRAL
COAST, ONE IN CENTRAL VALLEY,
AND THE FIRST MAJOR CENTER JUST
CAME ON IN JANUARY. SO UM, AND
IN L A, UM UM IN THE CENTRAL
VALLEY. UM, THE HOSPITAL.
THEY'RE TAKING KIDS FROM L. A,
UM ADDITIONALLY, KAISER IS THE
LARGEST HEALTH SYSTEM IN
CALIFORNIA AND DOES NOT DIRECTLY
PROVIDE HEARING AIDS TO THE TWO
STATE PROGRAMS THAT PROVIDE
HEARING AIDS FOR CHILDREN. CCP
MEDICAL CCS, REFERRING CHILDREN
OUTSIDE THEIR MEDICAL HOME TO AN
ALREADY OVERBURDENED COMMUNITY
PROVIDERS AND CREATING DELAYS IN
CARE. THE ADMINISTRATION'S NEW
FINANCIAL ESTIMATES FOR THE CCP
SERVICES WILL LIKELY CREATE
FINANCIAL ISSUES THAT COULD
IMPEDE SUCCESS IN ENSURING
ACCESS TO QUALIFIED PROVIDERS.
THE CCP IS STILL IN ITS EARLY
STAGES OF IMPLEMENTATION AND
ACCESS TO CARE IS IMPACTED BY
TOO FEW QUALIFIED PEDIATRIC
PROVIDERS PARTICIPATING PAINTING
IN THE PROGRAM TODAY. WELL THE
ACTION PLAN DHD ASKED, RELEASED
FOUR WEEKS AGO IS A STEP IN THE
RIGHT DIRECTION THEY NEED TIME
TO EXECUTE ON CRITICAL
COMPONENTS BEFORE DRASTICALLY
CUTTING THEIR ESTIMATES ON THE
NUMBER OF CHILDREN THAT ARE IN
NEED. AT THE ONSET OF THE
PROGRAM, STAKEHOLDERS ASKED THEM
TO COORDINATE WITH THE NEWBORN
HEARING SCREENING PROGRAM. WHILE
WE APPRECIATE THAT IS NOW
INCORPORATED INTO THE ACTION
PLAN, IT IS IMPERATIVE THAT DHC
S HAVE A DETAILED PLAN TO
COORDINATE WITH NEWBORN HEARING
SCREENING PROGRAM AND THE EARLY
START INTERVENTIONISTS THAT
COULD BE ACTION IMMEDIATELY.
THESE STATE SPONSORED PROGRAMS
SUPPORT THE CHILDREN. CCP IS
TARGETED TO SERVE. AND THE LACK
OF TRAINING CRASH PROMOTION TO
DATE IS THE PRIMARY CAUSE OF LOW
ENROLLMENT. WHILE WE APPRECIATE
THE PLAN OUTLINES THAT WILL
TRANSLATE MATERIALS INTO OTHER
THRESHOLD LANGUAGES FOR THE
RENEWAL PLAN ALSO NEEDS TO
TRANSLATE THE MATERIALS THAT
PROMOTE THE PROGRAM TO FAMILIES
. THE SPANISH FLORIDA PROMOTE.
THE PROGRAM WAS ONLY AVAILABLE
LAST MONTH. FURTHER THE ENTIRE
SOCIAL MEDIA CAMPAIGN FOR
OUTREACH TO PARENTS IS ONLY IN
ENGLISH, EVEN THOUGH OVER 30% OF
CALIFORNIA RESIDENTS SPEAK
SPANISH. WELL THE PLAN
ACKNOWLEDGES A SHORTAGE OF
PEDIATRIC AUDIOLOGIST STATEWIDE
AND STATES THAT IT IS NOT
PROGRAM SPECIFIC BUT DOES IMPACT
CCP. THERE'S NO PLAN TO OVERCOME
THE BARRIERS TO PARTICIPATION
NOW BETWEEN THE CCP AND MEDICAL
CCS BOTH RUN BY TH CS THE
MAJORITY OF DEAFENED HARD OF
HEARING CHILDREN IN CALIFORNIA
QUALIFY FOR HEARING AIDS AND
STATE PROGRAMS. CHILDREN ACROSS
THE STATE ARE FACING 3 TO 6
MONTH WAIT TIMES IN BOTH
PROGRAMS. IN CALIFORNIA C A C A
SURVEYED TYPE A B AND C CENTERS
TO FIND A 60% REDUCTION AND
PROVIDERS TAKING MEDICAL AND CCS
FOR PEDIATRIC HEARING AIDS
PROVIDERS STATE THE LARGEST
REASON IS INSUFFICIENT MEDICAL
REIMBURSEMENTS, WHICH IS UTC. P.
SORRY, UM. I NEED TO GO QUICKER
, SO I'M GOING TO SKIP A COUPLE
OKAY, UM WE NEED TO EXAMINE HOW
BEST INCREASE THE PEDIATRIC
AUDIOLOGY WORKFORCE THAT WOULD
BENEFIT THE CCP MEDICAL AND CCS
. OUR COALITION HAS BEEN WORKING
REALLY CLOSELY WITH THE
DEPARTMENT TRYING TO GET ANSWERS
TO CERTAIN ITEMS AND RE
INSURANCES. WE HAVEN'T GOTTEN
THOSE RE INSURANCES. THAT'S WHY
I'M HERE TODAY. I WANT TO KNOW
THEY'RE DOING EVERYTHING THEY
CAN TO SPEND THE 10 MILLION
EFFECTIVELY. AN EFFECTIVE UM AND
DEPLOYING THE SIX MILLION
ANNUALLY. THEY ASKED FROM THE
LEGISLATOR TO ADMINISTER THE
PROGRAM INCLUDES HAVING MONEY
THERE IF IT'S NECESSARY,
COORDINATING WITH STATE
AGENCIES. PROACTIVELY ENGAGING
THESE PROVIDERS. I WORRY THAT
THOSE KIDS WON'T BE ABLE TO
ACCESS THIS PROGRAM THAT
FAMILIES WITH A NEWLY DIAGNOSED
INFANT OR CHILD WHO REQUIRES
HEARING LOSS IN ELEMENTARY
SCHOOL AND NOT HAVE ACCESS TO
THE SUPPORT AND TREATMENT THIS
PROGRAM WAS INTENDED TO PROVIDE
. I WANT TO KNOW THE DHC S WILL
DO EVERYTHING THEY CAN REACH THE
CHILDREN WHO NEED THIS PROGRAM.
THERE'S 27 STATES THAT MANDATE
THIS FOR CHILDREN. THERE ARE 27
STATES THAT HAVE IT IN THEIR
EXCHANGE. CALIFORNIA HAS NEITHER
IN THIS PROGRAM NEEDS TO WORK.
OUR BIGGEST CONCERN WHEN THE
GOVERNOR OFFERED THIS PROGRAM AS
AN ALTERNATIVE. THE MANDATE IS
IT WOULDN'T BE RECESSION PROOF
THE MOST VULNERABLE FAMILIES. DR
DYLAN CHAN AND YOU SEE IF THAT
TESTIFIED IN 2019, THERE IS
OVERWHELMING EVIDENCE THAT
FAILURE TO PROVIDE APPROPRIATE
INTERVENTION TO DEATH AND HARD
OF HEARING CHILDREN BY 6 TO 3.
MONTHS OF AGE, REACHED THE
SPEECH LANGUAGE, COGNITIVE,
EDUCATIONAL, SOCIAL, EMOTIONAL
AND PERMANENT DELAYS. FOR THIS
REASON, HEARING LOSS IS
CONSIDERED A DEVELOPMENTAL
EMERGENCY, REQUIRING TIMELY
INTERVENTION TO PREVENT
PERMANENT DELAYS. GOAL OF THIS
PROGRAM IS SIMPLE TO PROVIDE
INFANTS AND CHILDREN TIMELY
ACCESS TO HEARING AIDS AND
SERVICES FIND APPROPRIATE
PEDIATRIC PROVIDER. WE NEED TO
MEASURE OURSELVES AGAINST THAT
GOAL. AND WE NEED TO START WITH
ACCESS WITH SOME URGENCY, SO
FAMILIES NO FINANCIAL ASSISTANCE
IS AVAILABLE, AND PROVIDERS ARE
IN PLACE TO FIT THE HEARING AIDS
THANK YOU FOR CARING ABOUT OUR
FUTURE. THANK YOU FOR YOUR
ADVOCACY AS WELL. YOU DID A
GREAT JOB. JC COOPER STATE
MEDICAID DIRECTOR HCS THANK YOU
. FIRST OF ALL, THANK YOU VERY
MUCH FOR YOUR TESTIMONY. BOTH OF
YOU. UM AND I THINK WHAT I WOULD
JUST START BY SAYING IS, THE
DEPARTMENT IS VERY FOCUSED ON
DOING WHAT WE CAN TO IMPROVE
THIS PROGRAM. ADD MORE
PROVIDERS, AND I'LL GIVE AN
OVERVIEW OF SOME OF THE ACTIONS
THAT WE'RE TAKING AND HOW WE'RE
COMMITTING TO CONTINUING TO
IMPROVE THIS PROGRAM. UM AS WAS
MENTIONED ON THE PROGRAM DID
LAUNCH IN JULY OF 2021 FOR 0 TO
17 WITH HOUSEHOLD INCOMES UP TO
LESS THAN 600% OF THE FEDERAL
POVERTY LEVEL AND NOT OTHERWISE
ELIGIBLE FOR MEDICAL OR CCS.
JANUARY ONE OF THIS YEAR WE
INCREASE THAT AS WELL. SO JUST
MENTIONING THAT EARLIER THIS
MONTH DHC S DID WORK. SINCE LAST
YEAR IN ALL THE FEEDBACK THAT WE
RECEIVED FROM ADVOCATES ACROSS
THE ENTIRE STATE TO REALLY THINK
ABOUT WHAT THAT ACTION PLAN
COULD LOOK LIKE, AND WE TRIED TO
PUT ACTIONABLE PIECES ON PAPER
THAT WE ARE COMMITTING TO
WORKING TOWARDS AND HOLDING
OURSELVES ACCOUNTABLE TO
IMPROVING THIS PROGRAM THAT WAS
RELEASED IN MARCH. THE BEGINNING
OF THIS THIS MONTH. I'M INCLUDED
BOTH AN ACTION PLAN AS WELL AS
THE COMMUNICATIONS TOOLKIT AS
WAS MENTIONED. ON THE ACTION
PLAN IS REALLY FOCUSED ON HOW WE
CAN TAILOR PROGRAMMING
EDUCATIONAL MATERIALS, INCLUDING
BROCHURES FOR MEDICAL
PROFESSIONALS AND HEARING
SPECIALISTS COLLABORATE, UM WITH
OUR COMMUNICATIONS WITH OUR
CHILDREN'S SERVICES PROGRAMS,
NEWBORN HEARING PROGRAMS AND
REALLY DEDICATE TO THOSE
INTERVENTIONS, ESPECIALLY IF WE
CAN DO TIMELY REFERRALS COMING
OUT OF THOSE SYSTEMS VERY
IMPORTANT, AND WE'RE COMMITTED
TO THAT. WE ALSO UPDATED NEW
REFERRAL FORMS TO MAKE IT EASIER
FOR PROVIDERS TO BE GETTING THAT
INFORMATION INTO US. MANY OF
THESE SCENES JUST LAUNCHED ARE
IN THE PROCESS OF BEING
LAUNCHED. AND SO WE ARE HOPEFUL
THAT MANY OF THESE TYPES OF
ACTIONS THAT WE ARE PUTTING IN
PLACE WILL HELP INCREASE THE
UTILIZATION OF THESE SERVICES.
THE TOOL KITS MENTIONED, UM, WE
HAVE LAUNCHED. WE HAVE PRINTABLE
MATERIALS SUCH AS FLYERS AND
DISTRIBUTION TO OUR COMMUNITY
PARTNERS. ADVOCATES FAMILY AGREE
THAT WE CURRENTLY NEED IT TO BE
TRANSLATED INTO MORE THRESHOLD
LANGUAGES, AND WE ARE IN THE
PROCESS OF DOING THAT AND
COMMITTED TO DOING THAT.
CURRENTLY THE ONLINE APPLICATION
PORTAL IS LIVE IN SEVEN
THRESHOLD LANGUAGES AND THE
OTHERS WILL BE COMING UP. ONLINE
AS WELL. SO REALLY TRIED TO WORK
WITH OUR STAKEHOLDERS, EVEN IN
REGARDS TO FEEDBACK TO OUR
ACTION PLAN IN REGARDS TO STEPS
THAT WE ARE TAKING TO IMPROVE
THIS PROGRAM. REALLY. THE GOAL
IS TO GET THESE SERVICES TO
CHILDREN THAT NEED THESE
SERVICES, AND WE ARE COMMITTED
TO CONTINUING TO ITERATE ON THE
PROGRAMS. BOTH POLICIES
PROCESSES EDUCATION TO PROVIDERS
AND FAMILIES TO BE ABLE TO
ACHIEVE THAT. WE ALSO WANT TO
MAKE SURE THAT WE ARE MAKING THE
PROGRAM EASIER FOR ENROLLMENT AS
WELL AS AUTHORIZATION, AND WE'VE
BEEN LOOKING AT A NUMBER OF
TWEETS IN REGARDS TO MANY OF
THOSE THOSE PIECES, INCLUDING
ONE OF THE EXAMPLES OF MAKING IT
EASIER ON THOSE REFERRALS, FOR
EXAMPLE, THAT WE MENTIONED
EARLIER AND PUTTING THOSE
PROCESSES IN PLACE FOR OUR
PROVIDERS. I DO JUST WANT TO
NOTE BUT WAS AS MENTIONED AS OF
MARCH OF 2020 TO 195 CHILDREN
HAVE BEEN ENROLLED IN THE
PROGRAM. UM SINCE ITS INCEPTION
IN 61 PROVIDERS HAVE OPT INTO
THE PROVIDER LOCATOR UM, I WOULD
MENTION THOUGH, AS WE'RE TALKING
TO PROVIDERS, SOME HAVE BEEN
HESITANT TO JOIN THE PROGRAM.
THEY WANT TO KNOW IN ADVANCE HOW
MANY REFERRALS THEY'RE REALLY
GOING TO GET FROM THE PROGRAM,
AND WE DON'T REALLY HAVE A SENSE
TO BE ABLE TO GIVE THOSE NUMBERS
TO PEOPLE. WE'VE ALSO BEEN
ACTIVELY ENGAGING WITH KAISER ON
A VERY REGULAR BASIS OVER THE
LAST SIX MONTHS OR SO TO SEE
WHAT BARRIERS WE CAN REMOVE FOR
KAISER FOR THEM TO JOIN THIS
PROGRAM BECAUSE THAT HAS BEEN
ONE OF THE LARGEST NUMBER OF
PIECES THAT HAS BEEN RAISED TO
US AS A CRITICAL PROVIDER TO BE
AT THE TABLE. THE DEPARTMENT IS
COMMITTED TO CONTINUING TO WORK
WITH KAISER IN REGARDS TO THOSE
PIECES AND AS HAS BEEN REQUESTED
BY ADVOCATES AND IN FAMILIES. UM
ADDITIONALLY WHEN IT COMES TO
SOME OF THE BARRIERS AROUND THE
APPLICATION DATA THAT WAS
PRESENTED, WE JUST WANTED TO
KNOW TATE ON WHAT WE'RE ALSO
SEEING IS SOME OF THE
DUPLICATION NEW APPLICATION THAT
IS ALL APPLICATIONS, NOT UN
DUPLICATED INDIVIDUALS, AND SO
WE'LL BE WORKING ON SOME BETTER
TRANSPARENCY IN REGARDS TO
APPLICATION. UM IN SERVICE
REQUEST DATA, SO PEOPLE ARE ABLE
TO TRACK THAT. IN REGARDS TO
YOUR QUESTIONS IN THE BUDGET ON
THE BUDGET ITSELF. WE DID UPDATE
THE BUDGET ON THERE WAS UP TO
$10 MILLION ALLOCATED TO THIS
PROGRAM AS ORIGINALLY
APPROPRIATED IN 2021. HOWEVER AS
YOU KNOW, WE TYPICALLY RIGHT
SIZE OR BUDGET TO ACTUAL
UTILIZATION AND WE ARE
PROJECTING UTILIZATION WITHIN
CURRENT YEAR AND BUDGET YEAR. WE
TYPICALLY DON'T JUST EARMARK A
DOLLAR AMOUNT AS YOU ARE AWARE
IN REGARDS TO HOW THE BUDGETING
WORKS. AND SO AS THE UTILIZATION
INCREASES IN THE PROGRAM, WE
WOULD, OF COURSE, MAKE THOSE
ADJUSTMENTS IN THE BUDGET AS
WELL. I'M I WOULD KNOW TATE,
THOUGH THAT WAS CORRECT IN
REGARDS TO THE SIX MILLION BEING
SPENT IN REGARDS TO
ADMINISTRATIVE SERVICES THAT
ALSO IS BEING RENEGOTIATED WITH
THE VENDOR BECAUSE THAT WAS ALSO
DRIVEN OFF OF THE ORIGINAL 7000
. AND THAT WAS 7000 TOTAL. WE
KNOW THAT ALL MEMBERS WILL NOT
BE RECEIVING SERVICES AT ONE
TIME IN REGARDS TO THE SERVICES
, SO WE HAVE RENEGOTIATED OUR
CONTRACT WITH MAXIMUS, THE
VENDOR TO ALSO RISE SITE THEIR
BUDGET TO BE DRIVEN BY CASELOAD
IN THOSE VARIOUS FACTORS. AND WE
WILL BE MAKING AN UPDATE IN THE
MAY REVISION. ONCE WE HAVE A
BETTER NUMBERS IN REGARDS TO
THOSE PARTICULAR PIECES AS WELL
. AND THEY DO, THOUGH, ARE
RESPONSIBLE FOR CASE INTAKE, ALL
OPERATING CALL CENTERS. ALL OF
THE VARIOUS MATERIALS RELATED
THAT WE'VE BEEN TALKING ABOUT
THE PROVIDER OVERSIGHT AND
VARIOUS PIECES DISCUSSED AND SO
THAT WILL DRIVE THOSE RESPECTIVE
CHANGES AS WELL. UM SO REALLY,
AT THE END OF THE DAY, WE ARE
VERY COMMITTED TO WORKING WITH
STAKEHOLDERS THE LEGISLATURE TO
SEE RUSSIAN AND MAKE SURE THAT
ALL CHILDREN THAT NEED THESE
SERVICES ARE RECEIVING THEM.
DEPARTMENT OF FINANCE. A
DETAILED LED DEPARTMENT OF
FINANCE. UM WE HAVE NO FURTHER
COMMENTS. BUT WE DO CONCUR WITH
DCS IN THE ADMINISTRATION IS
ALIGNED WITH ACHIEVING THE GOALS
OF THE PROGRAM. JULIO. ALRIGHT
TOMORROW WITH THE L A. OH, WE
DIDN'T HAVE ANY COMMENTS ON
THIS, BUT WE ARE AVAILABLE FOR
ANY QUESTIONS YOU MIGHT HAVE.
THANK YOU. THANK YOU. I'LL BRING
IT UP TO THE DIET. SO
ASSEMBLYMEMBER'S COLUMNS. YOU
MENTIONED THE SOME OF THE
PROVIDERS NOT GETTING ON BOARD,
OR DO YOU HAVE ANY ANY ANY
INCENTIVE PROGRAMS TO GET THEM
ON BOARD? UM NO, NOT NECESSARILY
. WE'VE BEEN TRYING TO EDUCATE
THEM ON THE PROGRAM. SOME OF IT
IS WE'RE TRYING TO GET AS WAS
MENTIONED. MANY OF OUR MEDICAL
PEOPLE SERVICE PROVIDERS.
THEY'RE FAMILIAR WITH THE
AUTHORIZATION PROCESS IN MEDICAL
, UM AND THAT IS REQUIRED. WE'RE
USING OUR AND THAT WAS AGREED TO
WITH THE LEGISLATURE THAT WOULD
USE THE MEDICAL AUTHORIZATION IN
THE MEDICAL FEE SCHEDULE. UM AND
SO WE'RE TRYING TO GET MORE ON
BOARD GET THEM IN ENCOURAGING
THEM TO SIGN UP FOR THE LOCATOR
. TECHNICALLY IN THE WAY IT WAS
IN STATUTE THAT CAN PROVIDE THE
SERVICE AND THEY WOULD BE
REIMBURSED EVEN IF THEY DON'T
OPT TO BE ON THE PROVIDER
LOCATOR LIST, WHICH IS THOSE WHO
HAVE COMPLETELY OPTED INTO THE
PROGRAM. UM SO WE'RE GOING TO
CONTINUE TO DO THAT EDUCATION,
BUT NO. AT THIS TIME, WE DO NOT
HAVE INCENTIVE PAYMENTS FOR THAT
, AND WOULD NEED TO MAKE SURE WE
HAVE THE AUTHORITY TO DO
SOMETHING OF THAT NATURE. OKAY
AND THE OTHER THING IS, JUST IS
THERE IS WHAT'S THE MAJOR HOLD
UP ON THIS? WHY ARE THERE WHY IS
THERE NOT SO MANY KIDS GETTING
THE SERVICES ARE GETTING HEARING
AIDS THAT THEY SHOULD BE
GETTING? YOU KNOW, I THINK WE
ARE TRYING TO GET THE
INFORMATION OUT THE BEST THAT WE
CAN. I THINK IT'S A SMALLER
PROGRAM, WHICH IS ALWAYS HARDER
TO KIND OF GET THAT INFILTRATED
INTO POSITIONS, OFFICES SO THAT
PHYSICIANS UNDERSTAND HOW TO
REFER. WE ALSO KNOW A LARGE
NUMBER OF REFERRALS COME FROM
SCHOOLS, BUT THEY DON'T ALWAYS
WHEN THE WHEN THE APPLICATION
COMES IN, FOR EXAMPLE, UM
OFTENTIMES, INCOME INFORMATION
IS LEFT OFF OF THOSE
APPLICATIONS, WHICH IS CRITICAL
FOR US TO HAVE TO EVALUATE FOR
SOMEBODY TO BE ELIGIBLE, SO WE
HAVE TO DO BACK AND FORTH. OR
THE E N T EVALUATION HASN'T BEEN
COMPLETED AT THE TIME OF THE
REFERRAL AS WELL, WHICH IS ALSO
REQUIRED PIECE OF THE PROGRAM.
SO WE'RE TRYING TO EDUCATE ALL
THE BARRIERS REFERRAL POINTS IN
REGARDS TO WHAT'S NEEDED, UM, ON
EITHER THE APPLICATION OR THE
VARIOUS AUTHORIZATION PIECES TO
MAKE SURE WE HAVE EVERYTHING TO
BE ABLE TO APPROVE THAT. SO
WE'VE REALLY FOCUSED ON THESE
PROVIDER. EDUCATION MATERIALS.
FLYERS BROCHURES. STREAMLINING
THE APPLICATION, AND WE'RE
REALLY HOPING THIS WILL HELP SEE
THESE UTILIZATION INCREASE IN
THE FUTURE. OKAY I THINK THE 1ST
12 MONTHS THERE WEREN'T
PEDIATRIC CODES IN PLACE, SO
THEY WEREN'T ABLE TO DISPENSE
THE HEARING AIDS. WE WORKED WITH
THE DEPARTMENT. THEY DIDN'T
EXCELLENT JOB. WE'VE GOT ALL THE
PEDIATRIC CODES IN PLACE NOW. SO
UM, SO I THINK THE FIRST YEAR
SOME PROVIDERS DISENGAGED. IT'S
STARTING TO GET BETTER CONTINUED
. WE JUST GOT YOU CLOCK ON BOARD
. WE'RE WORKING WITH YOU WORKING
ON USC RIGHT NOW. UM I THINK
THAT I THINK THE OTHER THING IS
THAT, UM RATES. HAVEN'T I MEAN
ACROSS THE BOARD EVERY ANY ISSUE
THAT YOU TALK ABOUT IN MEDICAL,
AND THAT'S WHAT IT'S BASED ON
RATES HAVEN'T BEEN INCREASED AND
OVER 20 YEARS AND SO IT HASN'T
KEPT PACE. SO WE SAW A NUMBER OF
THESE CLINICS GO BANKRUPT IN LOS
ANGELES AND NUMBER OF YEARS AGO
. SO YOU KNOW, UM, RATES RATES
ARE AN ISSUE. UM, IN IN IN
SERVING. THIS POPULATION. THANK
YOU. THANK YOU. CHAIR I'LL BRING
IT UP TO THE CHAIR IF I CAN. WE
HEARD ABOUT THE ACTION PLAN. HOW
WILL WE MEASURE SUCCESS WITH
THIS SECTION PLAN? HOW MANY
PEOPLE ARE WE ESTIMATING, WILL
THEN ENROLL IN THE PROGRAM
BECAUSE OF THAT ACTION PLAN? YES
SO WE DO ANTICIPATE, UM, IN
INCREASE, UM AND I WOULD HAVE TO
GET YOU THE EXACT NUMBERS IN
REGARDS TO DRIVING THAT. I MEAN,
THAT'S WHY WE PUT THE ACTION
PLAN OUT. WE WANTED TO BE ABLE
TO HOLD OURSELVES ACCOUNTABLE
AND HAVE MEASURABLE PIECES THAT
WERE WILLING TO REPORT SO WE
REPORTING THE NUMBER OF
PROVIDERS WERE EDUCATING ON THE
NUMBER OF APPLICATIONS AND
HOPEFULLY THE GOAL IS THE NUMBER
OF CHILDREN ACTUALLY RECEIVING
SERVICES. AND SO WE ARE
COMMITTED TO REPORTING THOSE, UM
THOSE OUTCOMES BASED ON THE
ACTION PLAN THAT WE RELEASED
EARLIER, YOU SAID THAT THE
VENDOR WOULD RECEIVE DECREASE
BASED ON CASELOAD. WILL IT BE
PROPORTIONAL, BASED ON THE
ESTIMATES. SO IF IT WAS 100 AND
75 OUT OF 7000 WHILE THEY BE
RECEIVING A PROPORTIONAL AMOUNT
, I CAN'T SPEAK COMPLETELY TO
WHERE WE ARE IN THE REGARDS TO
FINALIZE AND THE NEGOTIATIONS,
BUT THE IDEA IS TO RIGHT SIZE IT
WITH THE ACTUAL CASELOAD THAT
WE'RE SEEING IN THE PROGRAM. IT
WAS ORIGINALLY ESTIMATED BASED
ON THE 7000 CHILDREN. BUT I
THINK THAT THAT WAS ALL THE
INFORMATION THAT WE HAD AT THE
TIME AND WE'VE DUG INTO WHAT
DROVE THAT NUMBER SIGNIFICANTLY
TO BETTER RIGHT SIZE. THE
APPROXIMATE NUMBER OF CHILDREN
AND SO IT WOULD BE DRIVEN BY
CASELOADS SIMILAR TO OUR
UTILIZATION ON THE SERVICES
SIDE, BUT HAPPY TO ONCE WE HAVE
IT IN A BETTER PLACE. IT MAY
REVISE, GIVE YOU A BETTER UPDATE
AS WELL. I UNDERSTAND BECAUSE
I'D LIKE TO FOLLOW UP. WE HEARD
THAT THE ADMINISTRATION HAD SOME
TREPIDATION REGARDING THE
AFFORDABLE CARE ACT.
IMPLEMENTING A MANDATE FOR
COMMERCIAL PLANS. AND YET WE SEE
SO MANY OTHER STATES THAT ARE
DOING THIS THAT I'D LIKE TO
UNDERSTAND WHAT IS IT THAT
THEY'RE DOING? OR BEING ALLOWED
TO DO THAT ALLOWS THEM TO HAVE
THIS MANDATE THAT OUR STATE IS
NOT ABLE, OR THUS FAR HAS BEEN
UNWILLING TO DO. UM I PROBABLY
GOING TO NEED TO TAKE THAT ONE
BACK AND BRING YOU A BETTER
ANSWER IN REGARDS TO THE
ADMINISTRATION'S POSITIONS IN
REGARD TO THAT MANDATE. YEAH, I
UNDERSTAND AT THE TIME AND 2019
WHY THAT WAS DISCUSSED. BUT
SINCE WE'VE BEEN TRYING TO RUN
THIS OUT PUBLICLY AND HAVE NOT
SEEN THE SUCCESS, I HOPE WE CAN
HAVE AN HONEST CONVERSATION
ABOUT WHETHER IT'S TIME TO READ.
OPEN. THE DISCUSSION ABOUT.
PURSUING THAT MANDATE FOR
COMMERCIAL PLAN SAYS I'D LIKE TO
REALLY UNDERSTAND HOW THOSE
OTHER STATES ARE. ALLOWED THAT
FREEDOM IF WE'RE NOT ABLE TO, UM
WITH THAT I WILL. THANKS VERY
MUCH THIS PANEL AND WILL ELEVATE
IF I CAN THAT THIS IS A
DEVELOPMENTAL EMERGENCY THAT
REQUIRES TIMELY INTERVENTION AND
REQUIRES OUR URGENCY AND FOCUS
AND I LOOK FORWARD TO WORKING
WITH THE ADMINISTRATION. BUT IT
TAKES REAL ADVOCACY AND
ADVOCATES TO STAND UP AND GIVE
VOICE TO IT AND WANT TO
APPRECIATE THE TIME THAT YOU
TOOK TO COME HERE TODAY. THANK
YOU. IS THAT WE WILL THANKS VERY
MUCH THIS PANEL AND MOVE ON TO
ISSUE FORTH. ISSUE FOURS
OVERSIGHT ON CALAIS CAME FIRST
IS JASON COOPER, WHO WILL
PROVIDE AN OVERVIEW ON CALAIS.
PLEASE BEGIN WHEN YOU ARE READY.
SURE. SO, UH, HELLO, EVERYONE.
UM I WAS ASKED TO GIVE A
COMPREHENSIVE UPDATES. SO I'M
GOING TO DO THAT AS FAST AS I
CAN TO. THEN TURN IT OVER TO THE
OTHER PANELISTS SO YOU CAN HEAR
UPDATES FROM OTHER PEOPLE AS
WELL. AS YOU KNOW, CALLUM IS A 5
TO 7 YEAR ROADMAP OF JUST
TRANSFORMATION FOR THE MEDICAL
PROGRAM LIKE WE HAVE NEVER SEEN.
I TRY TO REMIND PEOPLE THAT
CALLIE WHILE CERTAIN PIECES GET
A LOT OF AIR TIME IT BY FAR CUTS
OVER ACROSS ALMOST EVERY SINGLE
PART OF OUR ENTIRE PROGRAM TO
REALLY SEE IMPROVEMENTS IN BOTH
ACCESS TO CARE AS WELL AS JUST
OVERALL IMPROVING OUTCOMES FOR
THE, UH, RIGHT NOW 15.5 MILLION
BENEFICIARIES THAT WE SERVE IN
THE STATE OF CALIFORNIA. UM I
ALSO WOULD LIKE TO SAY THAT YOU
KNOW, IT WAS DONE OVER EXTENSIVE
STAKEHOLDER FEEDBACK FROM 2018
TO 21, A GREAT NEGOTIATION WITH
THE LEGISLATURE AND WHERE WE
LANDED UNDER 81 33, SO I KIND OF
GO THROUGH AND PROVIDE VARIOUS
UPDATES OF WHERE WE ARE AND THE
VARIOUS PIECES THAT WITH NUMBERS
AND OUTCOMES JUST TO EMPHASIZE
WHERE WE'VE BEEN GOING. I'M
GOING TO START WITH THE
POPULATION HEALTH MANAGEMENT
BECAUSE IT REALLY IS THE
CORNERSTONE OF CALLUM, AND IT
WAS JUST LAUNCHED IN JANUARY.
ONE OF 2023 REALLY? THIS IS
AROUND FOCUSING AROUND HOW WE
ARE ENGAGING MEMBERS AS OWNERS
OF THEIR OWN CARE HOW WE ARE
ENSURING THEY'RE GETTING THE
PREVENTATIVE SERVICES THAT THEY
NEED. HOW WE ARE DOING EARLY
INTERVENTIONS FOR RISING RISK.
AND THEN, OF COURSE, THOSE MOST
VULNERABLE. HOW ARE WE
CONNECTING THEM TO THE ENHANCED
CARE MANAGEMENT COMMUNITY
SUPPORTS THAT THEY NEED AND
REALLY WORKING TO ENSURE THAT
THE FULL CONTINUUM IS WORKING AS
INTENDED AND THAT WE'RE INFUSING
THAT INTO THE DELIVERY SYSTEM,
OF COURSE, IN PARTNERSHIP WITH
OUR MANAGED CARE PLANS, SO THE
POPULATION HEALTH MANAGEMENT
PROGRAM WAS LAUNCHED IN JANUARY
OF THIS YEAR, MANAGED CARE PLANS
BUILT OUT A COMPREHENSIVE
POPULATION HEALTH STRATEGY. UM
THIS INCLUDES THEIR OWN RISK
STRATIFICATION SEGMENTATION IN
TEARING PROCESS AND THEN, AS YOU
KNOW, IN THE FUTURE, WE'LL ALSO
BE DOING A STATEWIDE RISK
STRATIFICATION FOR ALL OF OUR
MEDICAL MEMBERS, SO THERE'S IT'S
IN REGARDS TO WHOSE HIGH RISK
MEDIUM RISING RISK LOW RISK,
ETCETERA. AND WE'LL CONTINUE TO
WORK WITH OUR MANAGED CARE PLANS
IN REGARDS THAT WE ALSO ROLLED
OUT NEW DEFINITIONS IN REGARDS
TO WHAT BASIC POPULATION HELPED
MEANS CARE MANAGEMENT IN THE
VARIOUS TIERS OF CARE MANAGEMENT
FROM KIND OF BASIC CARE
MANAGEMENT, TOO COMPLEX CASE
MANAGEMENT AND THEN ENHANCED
CARE MANAGEMENT REALLY MAKING
SURE THAT THE COORDINATION OF
SERVICES IN OUR PROGRAM IS
CLEAR. WHEN SOMEBODY RECEIVES A
BIG CARD, WE KNOW THAT THEY CAN
BE ACCESSING UP TO SIX OR SEVEN,
DEPENDING ON THE COMPLEXITY OF
THE INDIVIDUAL, DIFFERENT
DELIVERY SYSTEMS AND MAKING SURE
THAT WE ARE COORDINATING THAT
ACROSS OUR SYSTEM IS CRITICAL.
WE ALSO ANNOUNCED IN JANUARY
THIS YEAR, A FULL REASSESSMENT
OF ALL MEDICAL REASSESSMENTS
WHEN WE WENT ACROSS THE STATE,
ONE THING WE HEARD FROM MEMBERS
AND PROVIDERS WAS THIS CONCEPT
AROUND ASSESSMENT FATIGUE,
ASKING OUR MEDICAL PATIENTS OVER
AND OVER THE SAME QUESTIONS AND
HAVING DUPLICATE ASSESSMENTS
ACROSS WE STREAMLINE THAT AND
REDUCED AND IN GOT RID OF MANY
OF THE OLD ASSESSMENTS, REALLY
RELYING ON PROVIDERS TO DO THE
WORK THAT THEY DO EVERY WELL
WITH CLEAR GUIDELINES IN REGARDS
TO WHAT WE'RE EXPECTING ON
PREVENTATIVE SERVICES, CHRONIC
DISEASE MANAGEMENT. ETCETERA. SO
WE WERE REALLY HAPPY TO HAVE
THAT ROLLOUT IN ORDER TO DO
THAT. D H CS HELD 26 ALL COMERS,
OFFICE HOURS AND PUBLIC
STAKEHOLDER ENGAGEMENTS TO
REALLY INFORM THAT WORK TO HEAR
FROM PROVIDER GROUPS TO HEAR
FROM ADVOCATES AND YOU HEAR FROM
OUR MANAGED CARE PLANS. SO NOW
I'LL GO INTO AN UPDATE IN
REGARDS TO ENHANCE CARE
MANAGEMENT COMMUNITY SUPPORTS,
UM JUST SO EVERYBODY'S TRACKING
, AND I'M SURE WE ARE ENHANCED
CARE MANAGEMENT IS YOUR HIGHEST
TOUCH HIGHEST NEED MOST
VULNERABLE INDIVIDUALS,
INDIVIDUALS WHO ARE EXPERIENCING
HOMELESSNESS BEING RELEASED FROM
INCARCERATION. HOW UTILIZES THE
EMERGENCY ROOM OFFICES AND THEN
COMMUNITY SUPPORTS. WE HAVE 14
COMMUNITY SUPPORTS ANYTHING FROM
HOUSING TRANSITION SERVICES. UM
CAREGIVER RESPITE SERVICES TO
HOME MODIFICATIONS OR ASTHMA
REMEDIATION IN THE HOME. ALL
THINGS USED TO REALLY PREVENT
EMERGENCY ROOM VISITS, SKILLED
NURSING FACILITY STAYS OR
INPATIENT STAYS OR IN LIEU OF
THOSE VARIOUS PIECES. UM THEY
CAN BE PREVENTIVE, OR THEY CAN
BE IMMEDIATE, UM, ALSO, THIS
APPROACH WAS BUILT OFF OF OUR
WHOLE PERSON CARE PILOTS AND WE
RECENTLY, UH, ROLLED OUT AN
INDEPENDENT EVALUATION THAT
DEMONSTRATED THAT THESE TYPES OF
INVESTMENTS REDUCE EMERGENCY
ROOM VISITS. REDUCED INPATIENT
STAYS. HAVEN'T OVERALL PER
BENEFICIARY COST SAVINGS, WHICH
IS REALLY GOOD FOR US TO HAVE
THAT INDEPENDENT U C L A
EVALUATION DEMONSTRATING SUCCESS
OF THE PILOT. THAT WE USE MUCH
OF TO KIND OF BUILD MANY OF THE
PIECES ON THIS COMPONENT WITHIN,
UM CAL AIM AS OF QUARTER 3 2022
. WE HAVE, UM 956 ENHANCED CARE
MANAGEMENT PROVIDERS, UM AND
OVER 88,000 UTILIZE EAR'S OF
ENHANCED CARE MANAGEMENT ACROSS
THE STATE OF CALIFORNIA FIRST
TIME MEMBER ENHANCED CARE
MANAGEMENT ENROLLMENT INCREASED
SINCE THE ENHANCED CARE
MANAGEMENT BENEFIT AND WE ARE
SEEING SIGNIFICANT INCREASES
EVERY QUARTER IN REGARDS TO
GETTING TO INDIVIDUALS. ALSO
THREE QUARTER THREE. WE HAVE
1212 COMMUNITY SUPPORT PROVIDERS
ACROSS THE ENTIRE STATE OF
CALIFORNIA WITH OVER 27,000
MEMBERS RECEIVING THOSE, UM,
COMMUNITY SUPPORTS ACROSS THE
STATE. AT LEAST SIX COMMUNITY
SUPPORTS ARE AVAILABLE IN EVERY
COUNTY AND THERE AND THERE ARE
38 COUNTIES WITH AT LEAST 10 OF
THE 14 COMMUNITY SUPPORTS IN 13
COUNTIES, WITH ALL 14 COMMUNITY
SUPPORTS ONE OF THE BIGGEST
CONCERNS THAT WE HEARD FROM
PEOPLE WHEN WE ROLLED THIS OUT
AS SINCE IT WAS VOLUNTEER.
REEFER MANAGED CARE PLANS THAT
WE WOULDN'T SEE THE UPTICK IN.
CLEARLY YOU CAN SEE THAT MANAGED
CARE PLANS WERE COMMITTED TO
OFFERING THESE COMMUNITIES
SUPPORTS AND WE HAVE A SCHEDULE
OF THEM ACROSS THE EVERY SIX
MONTHS WHERE WE ARE LIFTING THAT
UP. UM WHAT I WOULD SAY IS WE'VE
RELEASED MASSIVE GUIDANCE. WE
HAVE PROBABLY HELD TOO MANY
MEETINGS FOR PEOPLE IN REGARDS
TO THESE THINGS TO REALLY LIFT
THEM UP. BUT I DO WANT TO JUST
FOCUS ON SOME CHALLENGES THAT WE
ARE HEARING BECAUSE I SAY THAT
BECAUSE THE DEPARTMENT IS VERY
COMMITTED TO WORKING THROUGH
THOSE VARIOUS CHALLENGES ON
ENHANCED CARE MANAGEMENT IN
COMMUNITY SUPPORTS SOME OF THOSE
LARGE FACTORS IS WORKFORCE
SHORTAGES. WE ARE JUST HEARING
AS WE'RE DOING THIS THAT
WORKFORCE SHORTAGES IS SOMETHING
THAT IS A BARRIER FOR PROVIDERS
TO GET UP AND RUNNING TO MEET
THE DEMAND THAT IS OUT THERE. UM
LACK OF AFFORDABLE HOUSING
THROUGHOUT THE STATE IN REGARDS
TO SOME OF THE HOUSING AND
HOMELESSNESS TRANSITION PIECES.
AS WE KNOW THERE'S BEEN MANY
HEARINGS WHERE WE'VE TALKED
ABOUT THOSE TOPICS BEFORE. ALSO
COMMUNITY BASED ORGANIZATIONS
NOT BEING AS FAMILIAR WITH SOME
OF OUR REQUIREMENTS OF WHAT IT
MEANS TO BE A MEDICAL ENROLLED
PROVIDER HAD TO BUILD FOR THESE
SERVICES. THE DEPARTMENT HAS
DEPLOYED EXTENSIVE RESOURCES TO
PROVIDE TECHNICAL ASSISTANCE TO
THOSE COMMUNITY BASED
ORGANIZATIONS. AND THEN WHAT?
WE'RE HEARING RIGHT NOW AND
SPENDING A LOT OF TIME ON IS
REALLY A NEED TO ALIGN
AUTHORIZATION PROCESSES ACROSS
THIS DATA. CALIFORNIA OFTEN
TIMES WHEN A MANAGED CARE PLAN
HAS A SERVICE THAT THEY'RE
AUTHORIZING THERE IS A STANDARD
NATIONAL BEST PRACTICE IN
REGARDS TO IF YOU NEED THIS
SURGERY YOU DO YOU LOOK FOR
THESE TYPES OF THINGS THAT
DOESN'T EXIST FOR ENHANCED CARE
MANAGEMENT COMMUNITY SUPPORTS.
WE HAD A STATEWIDE ELIGIBILITY
CRITERIA, BUT MANAGED CARE PLANS
HAD TO FIGURE OUT HOW TO
SUBSTANTIATE THAT WITH
AUTHORIZATIONS AND WE'VE SEEN
SOME VARIATION ACROSS AND SO
WE'RE REALLY WORKING TO
STANDARDIZE SOME OF THOSE
AUTHORIZATION PROCESSES
PROTOCOLS AND WILL BE ROLLING
OUT A CHUNK OF THOSE PIECES BOTH
IN JULY OF THIS YEAR AND THEN BY
THE END OF THE YEAR, ANOTHER
CHUNK OF POLICY THAT ARE MANAGED
CARE PLANS WILL BE MEETING AND
THAT'S REALLY BASED OFF OF BOTH
MYSELF AND DIRECTOR BOX GOING
AROUND THE STATE OF CALIFORNIA
AND A STATEWIDE LISTENING TO ARE
REALLY LISTENING TO PROVIDERS
AND UNDERSTANDING. WHAT ARE THE
BARRIERS? AND ARE MANAGED CARE
PLANS IN REGARDS TO BARRIERS AND
SO WE'RE LOOKING TO ADDRESS
THOSE VARIATIONS AND PIECES VERY
QUICKLY. AND I WOULD ALSO NOTE
THAT WE HAVE KIND OF TWO MAIN
FUNDING PATHS TO IMPROVE
INFRASTRUCTURE ACROSS THE ENTIRE
STATE OF CALIFORNIA WHEN IT
COMES TO BECAUSE THAT'S THE
OTHER THING IS WE JUST NEED MORE
PROVIDERS. THESE ARE FIRST TIME
ANY OF THESE BENEFITS HAVE BEEN
MADE AVAILABLE IN MEDICAL, AND
SO WE NEED PROVIDERS ACROSS THE
ENTIRE STATE OF CALIFORNIA.
WELL, SOME OF OUR URBAN AREAS
HAVE BEEN ABLE TO COME UP
QUICKLY. WE NEED TO MAKE SURE
IT'S ALSO AVAILABLE IN THE
CENTRAL VALLEY AND IN THE RURAL
NORTH. AND SO WE HAVE DEPLOYED
TO PROGRAMS. ONE IS IN INCENTIVE
PAYMENT PROGRAM THAT WAS
APPROVED IN CAL. CLAIM TO
INCENTIVIZE THE INCREASED ACCESS
ALL OF OUR MANAGED CARE PLANS
DID A NEEDS ASSESSMENT AND A GAP
FILLING PLAN FOR THE ENTIRE
STATE AND HAVE BEEN WORKING VERY
HARD TO CLOSE THOSE GAPS. ONE OF
THE OTHER PIECES THAT WE
COMMITTED ACTUALLY TO THE
LEGISLATURE TO INCLUDE IN THAT
INCENTIVE PROGRAM WAS MAKING
SURE THAT WE WERE TARGETING
INDIVIDUALS WHO HAD LARGER
DISPARITIES AMONGST THESE
POPULATIONS. FOR EXAMPLE, THE
BLACK AND AFRICAN AMERICAN
POPULATION WHO WE KNOW
PROPORTIONATELY AS A HIGHER RATE
OF EXPERIENCING HOMELESSNESS
THAN THE GENERAL POPULATION IN
CALIFORNIA, OR EVEN IN OUR
MEDICAL PROGRAM. AND WHAT I'D
LIKE TO SAY. IS THAT AT LEAST
THROUGH Q TWO AND I'M LOOKING
FOR I'M TO GET UPDATED Q. THREE
NUMBERS. BLACK MEMBERS MAKE UP
APPROXIMATELY 7% OF THE MEDICAL
POPULATION. BLACK MEMBERS MAKE
UP TO 30 TO 40% OF THE HOMELESS
POPULATION. EARLY DATA IS
SHOWING THAT 22% OF ALL ENHANCED
CARE MANAGEMENT IN 33% OF
COMMUNITY SUPPORTS ARE BEING
PROVIDED TO BLACK MEMBERS. I
MEAN, SO, REALLY, WE THINK THAT
THESE VERY CLEAR INCENTIVES
DRIVING TOWARDS CLOSING
DISPARITY GAPS THAT WE'RE SEEING
IS WORKING, BUT WE STILL HAVE A
LOT MORE WORK TO DO. JUST TO BE
FRANK. UM REGARDS TO PATH
DOLLARS WE HAVE DEPLOYED ACROSS
THE STATE OF CALIFORNIA. UM,
LARGE PIECES. IT'S A $1.8
BILLION AND VESTMENTS. YOU DO
GRANTS DIRECTLY FROM THE STATE
TO THESE PROVIDERS TO INCREASE
CAPACITY. UM, WE ALSO ARE DOING
LOCAL COLLABORATIVE PLANNING
GROUPS THROUGH THAT AND THAT
TEAR MARKETPLACE WHERE COMMUNITY
BASED ORGANIZATIONS CAN REALLY
GO AND ACCESS THAT WE RECEIVED
237 APPLICATIONS TOTALLING $559
MILLION FOR JUST ROUND ONE OF
THESE GRANTS. UM AND WE WERE
ABLE TO ANNOUNCE JANUARY 31ST
119 MILLION IN FUNDING TO 98
ORGANIZATIONS. AND ON JUST ON
FRIDAY, WE ANNOUNCED 39
ORGANIZATIONS WILL RECEIVE AN
ADDITIONAL 88.5 MILLION SO NOW
HAVE RECEIVED $207 MILLION
DIRECTLY OUT TO PROVIDERS TO
INCREASE CAPACITY ACROSS THE
STATE OF CALIFORNIA TO 100 AND
37. ORGANIZATIONS AROUND TWO IS
OPEN NOW, AND WE'VE ALREADY
RECEIVED APPLICATIONS WILL BE
OPEN IN THROUGH MAY. I'LL GO
OVER SOME OF THE OTHER LARGE
TRANSITIONS THAT JUST TOOK PLACE
IN JANUARY AS WELL. UM THE
INTEGRATED CARE FOR DUAL
ELIGIBLES AND MANAGED LONG TERM
SERVICES AND SUPPORTS, UM WE HAD
SUCCESSFULLY TRANSITIONED 112
MEDICAL, UM MIDI CONNECT MEMBERS
TO THE MEDI MEDI PLANS. UM UH,
SO MOVING THOSE WE ALSO IN JULY
OF 22 DHC RAISED A FEASIBILITY
STUDY REPORT ON THE DUAL SPECIAL
NEEDS PLANS FOR D SNIPS. TO
INCREASE THE MANY, MANY PLANTS
ACROSS THE STATE REALLY MAKING
SURE THAT WE ARE DOING
EVERYTHING WE CAN FOR OUR DUEL.
INDIVIDUALS TO HAVE COORDINATED
PIECES, AND WE'RE WORKING
CLOSELY WITH OUR MANAGED CARE
PLANS ON BRINGING THAT TO
FRUITION AS WELL. ADDITIONALLY
WE D HCS TRANSITION 325,000 DUAL
ELIGIBLE MEMBERS TO MEDICAL
MANAGED CARE PLANS. JANUARY 1ST
OF THIS YEAR. THE TRANSITION
DOES NOT IMPACT MEDICARE
BENEFITS OR ENROLLMENT, AND WE
ARE CONTINUING TO EDUCATE OUR
PROVIDERS ACROSS THE STATE OF
CALIFORNIA. WE DID EXTENSIVE
PROVIDER EDUCATIONS, CHEAT
SHEETS. TALK IT, BUT WE'RE STILL
FINDING POCKETS WHERE PEOPLE
THINK THAT THERE IS AN IMPACT ON
THE MEDICARE BILLING, AND WE'VE
REALLY BEEN TRYING TO EDUCATE
ALL OF OUR VARIOUS PER AVOIDERS
IN REGARDS TO THAT CHANGE. TO
MAKE SURE THAT THERE IS NO
DISRUPTION IN CARE. WE ALSO
TRANSITIONED THE SKILLED NURSING
FACILITY BENEFIT TO MEDICAL
MANAGED CARE PLANS IN 31
COUNTIES, IT WAS ALREADY CARVED
INTO THE OTHER COUNTIES PRIOR TO
THAT TRANSITION. UM D HCS HAS
CONVENED A LONG TERM CARE
SKILLED NURSING FACILITY
WORKGROUP ON THROUGH DECEMBER OF
21 THROUGH SEPTEMBER, 22 TO
REALLY HAVE ALL OF THAT
TRANSITION INFORMED BY
STAKEHOLDERS FOR THAT TRANSITION
OF THE CARBON OF I, C S AND ICDS
AND SUB ACUTE FACILITIES
PROPOSED TO TRANSITION TO
JANUARY ONE OF 2024. THAT IS A
PROPOSAL IN THE GOVERNOR'S
BUDGET FOR CONSIDERATION, BASED
ON EXTENSIVE FEEDBACK FROM
ADVOCATES IN REGARDS TO THAT
CHANGE. WE'VE BEEN WORKING VERY
CLOSELY WITH THE DEPARTED MINT
OF DEVELOPMENTAL SERVICES IN
VARIOUS ADVOCATES TO HAVE A
SLIGHT DELAY FROM JULY TO
JANUARY. 24 TO GIVE US MORE TIME
TO REALLY WORK ON THAT
TRANSITION. GIVEN THE
VULNERABILITY OF THAT
TRANSITION, WE WANT TO MAKE SURE
THAT WE ARE READY. OUR PLANS ARE
READY AND EVERYONE IS READY. UM
WE ARE DOING A NUMBER OF OTHER
PIECES THAT I'LL JUST HIGHLIGHT.
I WON'T GO THROUGH AN OUTLINE OF
THOSE. WE'RE STILL WORKING ON
THE CCS. THE CHILDREN'S THE
CALIFORNIA CHILDREN'S SERVICES
OVERSIGHT IMPROVEMENTS TO MAKE
SURE OUR FIFA SERVICE CCS KIDS
ARE GETTING ALL THE SAME PIECES
IN PLACE LIKE AUTHORIZATION
PROCESS TIMELINES THAT WE SEE IN
MANAGED CARE FOR THOSE KIDS AND
WORKING CLOSELY WITH OUR COUNTY
PARTNERS ON THAT. WE ALSO ARE
CONTINUING. WE'LL LOOK AT THE
COUNTY ELIGIBILITY AND OVERSIGHT
PIECES. WE HAVE DELAYED THAT
UNTIL AFTER THE PUBLIC HEALTH
EMERGENCY. UM D N C O D S
TRADITIONAL HEALERS AND NATURAL
HELPERS IS STILL PENDING WITH
CMS AND WE WILL CONTINUE TO
ADVOCATE WITH TO THEM IN REGARDS
TO SEEING THAT MOVE FORWARD AS
WE THINK IT'S SO CRITICAL. AND
THEN THERE ARE SOME THAT WILL GO
LIVE IN THE FUTURE. UM AND SO I
THINK I ALSO WILL HOLD ANY OF
OUR PIECES REGARDING THE
BEHAVIOR HEALTH OUTCOMES FOR THE
APRIL 17TH AND ANYTHING AROUND,
UM, THE JUSTICE INITIATIVES, SO
REALLY, AS YOU CAN SEE, THIS IS
A MASSIVE EFFORT ACROSS SO MANY
AREAS THAT DOESN'T EVEN TOUCH
DENTAL AND SOME OF THE OTHER
PIECES THAT HAVE ALREADY GONE
LIVE IN JANUARY OF 2022, A
MASSIVE EFFORT ON BEHALF OF THE
DEPARTMENT, AND WE'RE 100.
PERCENT COMMITTED TO MAKING SURE
THAT WE MEET THE GOALS AND
OBJECTIVES OF CAL. I'M SO SORRY.
THAT WAS A VERY LONG OVERVIEW,
BUT THERE'S A LOT PACKED INTO
CALLUM. AND SO I WANTED TO GIVE
AN UPDATE TO THE TO THE
COMMITTEE. THANK YOU. NEXT WE
WILL HEAR FROM LINDA WAY SENIOR
POLICY ADVOCATE WITH WESTERN
CENTER ON LAW AND POVERTY. THANK
YOU. GOOD AFTERNOON, LINDA WAY
WITH WESTERN CENTER ON LAW AND
POVERTY, KALLEN PARTICULARLY
ENHANCED CARE MANAGEMENT AND
COMMUNITY SPORTS CAN AND HAS
IMPROVED THE LIVES OF MEDICAL
MEMBERS. BY PROVIDING
COORDINATED CARE THAT ADDRESSES
THE NEEDS OF THE WHOLE PERSON
WHEREVER THEY ARE LOCATED.
HOWEVER, OUR LEGAL AID ADVOCATES
REPORT CHALLENGES ACCESSING BOTH
ENHANCED CARE MANAGEMENT AND
COMMUNITY SUPPORTS THE REPORT
LONG WAIT TIMES FOR ASSESSMENT
WITH NO TIMEFRAME ON WHEN THEY
MAY RECEIVE ASSESSMENT OR
SERVICES. THEREFORE IT IS
UNSURPRISING THAT THE NUMBERS OF
MEMBERS RECEIVING COMMUNITY
SUPPORTS FROM QUARTER ONE TO
QUARTER TWO OF LAST YEAR INSTEAD
OF INCREASING ACTUALLY DROPPED,
LARGELY DUE TO THE NUMBER OF
WHOLE PERSON CARE PILOT
PARTICIPANTS RECEIVING
COMMUNITIES SUPPORTS DURING THIS
TIME BEING CUT IN HALF. THIS IS
REPORTED AS A GRADUATION OF
WHOLE PERSON CARE. PARTICIPANTS
NO LONGER NEEDING COMMUNITY
SUPPORTS, BUT WE SUSPECT THIS IS
LIKELY DUE TO LONG WAITS. THE
RESULT IN PEOPLE DROPPING OUT OR
NEARER ELIGIBILITY CRITERIA, THE
PLANS AND POSE IN ADDITION,
CLIENTS REPORT DIFFICULTY
ACCESSING AND BEING ASSESSED FOR
ENHANCED CARE MANAGEMENT, WHICH
DIFFERS FROM COMMUNITY SUPPORTS
IN THAT IT IS A BENEFIT, NOT A
PLAN OPTION. FOR ANY MEMBER WHO
QUALIFIES PLANS TAKE REFERRALS
FOR ASSESSMENT AND CLIENTS.
REPORT NO RESPONSE, EVEN THOUGH
ENHANCED CARE MANAGEMENT MIGHT
BE URGENTLY URGENTLY NEEDED. WE
APPRECIATE IT TAKES TIME TO
BUILD PROVIDER CAPACITY, BUT
CONSIDERING THE SIGNIFICANT
INVESTMENTS TO DO JUST THAT, HOW
LONG ARE MEMBERS EXPECTED TO
WAIT TO RECEIVE NEEDED SERVICES?
HOUSING SUPPORT SERVICES, WHICH
LINKS INDIVIDUALS EXPERIENCING
HOMELESSNESS WITH HOUSING
THROUGH HOUSING, NAVIGATION AND
TRANSITION SERVICES, HOUSING
DEPOSITS AND TENDENCIES.
SUSTAINING SERVICES HAVE BEEN
SHOWN TO IMPROVE HEALTH OUTCOMES
AND ARE PARTICULARLY IMPORTANT
CONSIDERING THE RISE IN
HOMELESSNESS. AND THOSE
EXPERIENCING HOMELESSNESS WITH
THE DISABILITY. THE DEPARTMENT
HAS SHARED. ITS GOAL IS TO MAKE
ALL COMMUNITIES SUPPORTS A
STATEWIDE MEDICAL BENEFITS WITH
HOUSING SUPPORT SERVICES. BEING
THE FURTHEST ALONG, WE RECOMMEND
REQUIRING THE STATE REQUESTS
FEDERAL APPROVAL TO MAKE HOUSING
SUPPORT SERVICES AND MEDICAL
BENEFIT WITH A B 10 85 BY
ASSEMBLYMEMBER'S MAIENSCHEIN
BEING THE LEGISLATIVE VEHICLE.
IN ADDITION, WE RECOMMEND THE
DEPARTMENT ARTICULATE, SPECIFIC
, MEASURABLE TARGETS DEFINE A
MECHANISM TO HOLD PLANS
ACCOUNTABLE AND PUBLICLY REPORT
ON PROGRESS TOWARDS THOSE
TARGETS. THESE MEASURES SHOULD
AT MINIMUM INCLUDE PROVIDERS
SPECIFICALLY TRUSTED COMMUNITY
PARTNERS WHO HAVE EXPERIENCE
PROVIDING SERVICES AND THE
NUMBER OF UNIQUE MEMBERS
RECEIVING ENHANCED CARE
MANAGEMENT AND COMMUNITY
SUPPORTS. THANK YOU. NEXT WE
WILL HEAR FROM LINEAGE. KOOPMANS
WHO'S THE CHIEF EXECUTIVE
OFFICER FOR THE LOCAL HEALTH
PLANS OF CALIFORNIA. GOOD
AFTERNOON. THANK YOU FOR HAVING
ME LINEAR EQUIPMENT WITH THE
LOCAL HEALTH PLANS OF CALIFORNIA
WE REPRESENT THE 16 LOCAL
COMMUNITY BASED MEDICAL MANAGED
CARE PLANS ACROSS THE STATE
SERVING OVER 70% OF ALL MEDICAL
MANAGED CARE LIVES. SO PREPARING
FOR AN IMPLEMENTING CALLUM OVER
THE LAST YEAR HAS BEEN A
TREMENDOUS EFFORT INVOLVING
MULTIPLE PARTNERS AT A LOCAL
LEVEL LEVEL. SO I'M GOING TO
SHARE SOME OF THE EARLY
EXPERIENCE, INCLUDING A
SUCCESSFUL TRANSITION FROM
HEALTH HOMES AND WHOLE PERSON
CARE TO E. C. M AND COMMUNITY
SUPPORTS, HOWEVER, REALIZING THE
VISION OF CALLUM, AS YOU HEARD
FROM DIRECTOR COOPER IS GOING TO
TAKE MULTIPLE YEARS. IT'S A IT'S
A LONG TERM EFFORT. SO I'M GOING
TO GIVE YOU A SENSE OF HOW PLANS
ARE DEVELOPING THEIR ECM AND
COMMUNITY SUPPORTS NETWORKS THE
ROLE OF CALLUM FUNDING TO
SUPPORT THAT WORK HOW MEDICAL
MEMBERS ARE BEING IDENTIFIED AND
CONNECTED TO SERVICES AND THEN
FINALLY SOME CHALLENGES AND
CONSIDERATIONS. SO AHEAD OF THE
CALENDAR LAUNCH IN 2022, THE
STARTING POINT FOR LOCAL PLAN TO
DEVELOP NETWORKS FOR E. C M AND
COMMUNITY SUPPORTS WAS REALLY
ASSESSING EXISTING RELATIONSHIPS
WITH COMMUNITY PARTNERS. SO THIS
REQUIRED VERY CLOSE WORK WITH
COUNTIES AND OTHER PROVIDERS, UM
, IN THE COMMUNITY THAT WE'RE
DELIVERING CARE. UM IT ALSO
REQUIRED THAT LOCAL PLANS WHO
HAD PROVIDED SOME OF SOME
SIMILAR SERVICES. PRE CAL AIM
THROUGH GRANTS OR OTHER
INVESTMENTS. UM WORK TO
TRANSITION THOSE PROVIDERS TO
BECOME MEDICAL CONTRACT AND
PROVIDERS, NOT JUST THROUGH
GRANT FUNDED PROJECTS. SO TO
EXPAND CAPACITY TO DELIVER BOTH
E C. M AND COMMUNITY SUPPORTS
LOCAL PLANS IDENTIFY WHICH
PROVIDERS ARE ALREADY SERVING
ECM ELIGIBLE MEMBERS TRY TO
BRING THEM INTO THEIR NETWORKS
AND THEN FOR COMMUNITY SUPPORTS
. PLANS ARE CONNECTING WITH
COMMUNITY ORGANIZATIONS THAT
PROVIDE COMMUNITY SUPPORT LIKE
SERVICES IN THE COMMUNITY, BUT
HAVE HISTORICALLY NOT BEEN APART
NECESSARILY OF THE MEDIC HEALTH
DELIVERY SYSTEM. SO THAT'S BEEN
PART OF THE BIG LIFT OF CALLUM
IS BRINGING SOME OF THESE NON
TRADITIONAL PROVIDERS INTO THE
MEDICAL DELIVERY SYSTEM IN
CONTRACTS WITH PLANS UM, BUT TO
SUPPORT THIS IMPLEMENTATION AND
ALL OF THIS WORK THAT I'VE BEEN
DESCRIBING THE STATE INVESTMENTS
THROUGH MOST IMPORTANTLY FOR THE
PLANS AND THE DOLLARS FLOWING
THROUGH THE PLANS THROUGH THE
CALLUM INCENTIVE PAYMENT PROGRAM
, AS WELL AS THE HOUSING AND
HOMELESSNESS INCENTIVE PROGRAM.
THOSE HAVE BEEN CRITICAL FUNDING
SOURCES FOR THIS WORK. SO TO GET
I PP DOLLARS OUT INTO THE
COMMUNITY. LOCAL PLANS HAVE BEEN
AWARDING GRANTS TO THEIR
PROVIDERS AND OTHER COMMUNITY
PARTNERS TO HELP SUPPORT
STAFFING COSTS, DATA EXCHANGE
INFRASTRUCTURE TA OR TRAINING
AND THEN PHYSICAL INFRASTRUCTURE
. SO FOR EXAMPLE, TO EXPAND
RECUPERATING CARE IN SHORT TERM
POST HOSPITALIZATION, HOUSING,
SOME OF THAT SOME OF THOSE
SERVICES REQUIRE ACTUAL PHYSICAL
INFRASTRUCTURE. AND THEN WITH
THE HOUSING AND HOMELESSNESS
INCENTIVE PROGRAM. UM IT'S
REALLY THE BEGINNING OF THAT
PROGRAM. ALTHOUGH IT'S A VERY
COMPRESSED SHORT TERM PROGRAM,
THIS IS AS A REMINDER. THIS IS A
PROGRAM THAT'S A PART OF THE
STATE'S HOME AND COMMUNITY BASED
SPENDING PLAN. UM IT'S REALLY
SUPPORTED STRENGTHENING
RELATIONSHIPS BETWEEN HOUSING
PARTNERS AND PLANS LOCALLY TO
GET EVERYONE AROUND THE TABLE.
UM AND I THINK EARLY PROGRESS IN
EARLY SUCCESS THROUGH THAT
PROGRAM HAS BEEN THAT MANY LOCAL
PLANS ARE NOW RECEIVING DATA, UM
FROM THEIR HOMELESS MANAGEMENT
INFORMATION SYSTEM H M. I S SO
ACTUALLY CAN IDENTIFY WHICH OF
THEIR MEMBERS ARE HOMELESS, UM,
AND IDENTIFY THEM FOR ELIGIBLE
SERVICES SUCH AS E CMR COMMUNITY
SUPPORTS. SO THEN TO ENGAGE
MEMBERS AND ECM AND COMMUNITY
SUPPORTS LOCAL PLANS ARE USING
THEIR AVAILABLE DATA AND RUNNING
ELIGIBILITY LISTS, GIVING THESE
TO THEIR PROVIDERS TO MAKE
OUTREACH AND TRY TO GET THEM IN
FOR ASSESSMENTS. LET THEM KNOW
THEY'RE ELIGIBLE TO RECEIVE THE
SERVICES. UM BUT I WOULD JUST
NOTE THAT THOSE ELIGIBILITY
LISTS ARE LIMITED BY VIRTUE OF
THE DATA WE HAVE AVAILABLE TO US
SO IN THE LONG TERM. UM WE THINK
THE BEST SOURCE OF REFERRALS IS
GOING TO BE THROUGH OUR
PROVIDERS AND OTHERS IN THE
COMMUNITY, SO THERE HAS BEEN A
PROCESS TO EDUCATE PROVIDERS AND
OTHER COMMUNITY PARTNERS ABOUT
THE NEW BENEFITS, THE
ELIGIBILITY CRITERIA AND HOW TO
REFER. AND THEN FINALLY, I WANT
TO ACKNOWLEDGE AS A COUPLE OF
THE REALITIES AND SOME
CHALLENGES WITH KELLY, UM
IMPLEMENTATION, SO, AS HAS
ALREADY BEEN STATED CALLUM IS
NOT IMMUNE TO THE WORKFORCE
CHALLENGES THAT ARE BEING FACED
BY THE REST OF THE HEALTH CARE
SECTOR. IN MANY CASES, WORKFORCE
SHORTAGES HAVE IMPACTED
PROVIDER'S ABILITY TO CONTRACT
OR IF THEY DO CONTRACT, HOW MANY
MEMBERS ARE ABLE TO SERVE SECOND
RURAL AREAS THAT HAVE
HISTORICALLY HAD ACCESS ISSUES
AND LIMITED COMMUNITY RESOURCES
ARE LIKEWISE CHALLENGED IN CAL
AIM AND HAVE VERY FEW PROVIDERS
OR CPS. CBO SO CREATIVITY AND
FLEXIBILITY WILL BE NEEDED. AND
THEN WITH RESPECT TO HOUSING
RELATED COMMUNITY SUPPORTS, UM
AS DIRECTOR COOPER BENCH IN THE
STATEWIDE HOUSING CRISIS IS
REALLY A DETERMINING FACTOR IN
WHETHER NAVIGATION IS SUCCESSFUL
IF AN APARTMENT OR A HOME IS
AVAILABLE, FOR WHICH A HOUSING
DEPOSIT CAN BE PROVIDED, UM AND
THEN THE ABILITY TO THE ABILITY
TO PROVIDE HOUSING SUSTAINING
SERVICES. LASTLY ALTHOUGH E. C M
AND COMMUNITY SUPPORTS ARE TO
CALLUM INITIATIVES, THEY
ACTUALLY REPRESENT 15 NEWS
SERVICES AND MEDICAL MANAGED
CARE OVER THE LAST YEAR AND A
HALF THAT REQUIRE DIFFERING
COMMUNITY RESOURCES AND
INFRASTRUCTURE, SO RAMPING UP
STATEWIDE WILL TAKE TIME. SO IN
CLOSING THE WORK TO IMPLEMENT
THESE INITIATIVES AND SERVICES,
IT'S CRITICALLY IMPORTANT LOCAL
PLANS ARE COMMITTED, AND IT'S
ALSO DIFFICULT. IT REQUIRES
MULTIPLE PARTNERS, SYSTEMS AND
RESOURCES AND WE'RE LOOKING
FORWARD TO CONTINUING TO WORK
WITH OUR PROVIDERS AND OTHER
PARTNERS OVER THE COMING YEARS.
THANK YOU. THANK YOU. NEXT, WE
WILL HEAR FROM KAREN SAVAGE
SINGLE JUAN. EXECUTIVE DIRECTOR
FOR THE CALIFORNIA PAN ETHNIC
HEALTH NETWORK. GREAT THANK YOU
SO MUCH FOR HAVING ME HERE TODAY
. UM JUST OPEN. I WANT TO SAY WE
APPRECIATE THAT EQUITY HAS BEEN
A GUIDING PRINCIPLE OF THE
DEVELOPMENT OF CAL AIM
THROUGHOUT THE PROCESS. AND
COUPLED WITH OTHER MEDICAL
REFORMS, INCLUDING THE NEW
CONTRACT IN 2024, INCREASED PLAN
ACCOUNTABILITY AND EXPANDED
ELIGIBILITY. WE DO BELIEVE IT
HAS THE POTENTIAL TO BE TRULY
TRANSFORMATIVE FOR MEDICAL AND
THEREBY HEALTH EQUITY, BUT
INTENTIONALITY IS NEEDED IN
EVERY ASPECT OF THE DESIGN AND
IMPLEMENTATION. SO AT THIS POINT
, I WOULD SAY SIMILAR TO THE
OTHER SPEAKERS. ONE OF OUR
BIGGEST CONCERNS IS THAT THE
ADEQUACY OF THE UNDERLYING
SERVICE NETWORK UM AND
PARTICULARLY WITH THE 15 NEW
SERVICES THAT LYDIA MENTIONED,
UM, BECAUSE WHILE APPROPRIATE
REFERRALS MAY BE MADE IF THE
SERVICES AREN'T AVAILABLE OR
AREN'T RESPONSIVE TO THE UNIQUE
LANGUAGE, CULTURAL AND OTHER
NEEDS OF THE MEMBER
IMPLEMENTATION WILL FALTER, SO
IT ISN'T JUST THE NUMBER OF
PROVIDERS. IT'S ALSO THE TYPE OF
PROVIDERS AND ARE THEY
CONCORDANT? WITH OUR MEDICAL
MEMBERS. WE ARE VERY
ENTHUSIASTIC SUPPORTERS OF THE
COMMUNITY HEALTH WORKER BENEFIT
, WHICH WE THINK IS A POTENTIAL
GAME CHANGER, PRO RACIAL EQUITY
AND MEDICAL, BUT COMMUNITY
HEALTH WORKERS BY THEMSELVES
CANNOT SOLVE THAT PROBLEM WITH
THE LACK OF AVAILABLE RESOURCES
AND SERVICES. UM FOR TCM AND
COMMUNITY SUPPORTS TO ACHIEVE
EQUITABLE OUTCOMES. THERE MUST
BE A ROBUST AND COMMUNITY BASED
SERVICE NETWORK. AND WHILE THERE
ARE MANY EFFORTS UNDERWAY,
INCLUDING THE PATH PROGRAM, THIS
ALSO REQUIRES TRANSPARENCY AND A
LEVEL PLAYING FIELD FOR SMALLER
, RACIALLY AND ETHNICALLY
DIVERSE COMMUNITY BASED
ORGANIZATIONS. CURRENTLY
COMMUNITY BASED ORGANIZATIONS
THAT WE WORK WITH WHO WOULD BE
IDEAL CCM AND COMMUNITY SUPPORTS
PROVIDERS ARE STRUGGLING TO
BECOME PROVIDERS BECAUSE OF THE
UNCERTAINTY AROUND WHETHER PLANS
WILL PROVIDE OR CONTINUE TO
PROVIDE CERTAIN COMMUNITY
SUPPORTS BECAUSE THEY CAN CHANGE
THEIR ELECTIONS. UM LOW RATES
LIMITS ON THE NUMBER OF BILLABLE
VISITS, AND IN SOME CASES, WHAT
THE CBO'S FEEL IS THE
UNWILLINGNESS OF HEALTH PLANS TO
NEGOTIATE THEIR CONTRACTS WITH
THEM. THIS IS A VERY HEAVY LIFT
FOR THESE KINDS OF ORGANIZATIONS
WHO ARE GOING TO NEED TO CONVERT
THEIR BUILDING STRUCTURES FROM
GRANT BASED SYSTEMS, UM TO THAT
INCLUDE ADMINISTRATIVE OVERHEAD
TO FEE FOR SERVICE BILLING
STRUCTURES, WHICH IS MUCH MORE
SENSITIVE TO MARKET CHANGES. ONE
COMMUNITY BASED PROVIDER SHARED
THAT THEY FEEL KELLY WOULD BE
MORE SUCCESSFUL IF COMMUNITY
PROVIDERS WERE PAID IN A WAY IN
WHICH THEY ARE ALSO REWARDED FOR
IMPROVING THE HEALTH OF THEIR
MEMBERS, RATHER THAN ONLY FOR
THE SERVICES THEY PROVIDE WHEN
THEIR MEMBERS ARE EXPERIENCING
THEIR HIGHEST NEEDS AND THEN
LOSING THE ABILITY TO PROVIDE
SERVICES FOR THOSE SAME MEMBERS
WHEN THEY NO LONGER QUALIFY FOR
ECM. BUT WITH STILL BENEFIT FROM
THE RELATIONSHIP AND SUPPORT
FROM THAT SAME PROVIDER. IN
ADDITION TO BUILDING THAT EQUITY
, FOCUSED SERVICE AND PROVIDER
INFRASTRUCTURE, THE POPULATION
HEALTH MANAGEMENT THAT IS
DIRECTOR COOPER MENTIONED IS
REALLY THE CORNERSTONE OF THE
PROGRAM MUST INTENTIONALLY
HELPED TO ROOT OUT RACIAL
DISPARITIES BY ENSURING THAT
EVERY MEMBER GETS WHAT THEY NEED
WHEN THEY NEED IT, WHERE THEY
NEED IT. UM WE HAD EARLY
CONCERNS ABOUT THE RISK
STRATIFICATION PROCESS IN THE
POPULATION HEALTH MANAGEMENT,
AND IT'S REALLY TOO EARLY TO
KNOW WHAT THE OUTCOME WILL BE
AND WHETHER THERE ARE
DISPARITIES SO IT WILL BE
IMPORTANT FOR THE LEGISLATURE TO
REALLY CONTINUE TO MONITOR THIS
ISSUE. THE ONLY DATA THAT WE'RE
AWARE OF WAS REFERENCED EARLIER
THAT SORT OF ACCOUNTS FOR THE
FIRST HALF OF 2022. AND DURING
THIS TIME PERIOD TO OUR
UNDERSTANDING MOST ENROLLMENTS
FOR ECM, WHERE MEMBERS
TRANSITIONING FROM WHOLE PERSON
CARE AND HEALTH HOMES, SO THEY
HAD ALREADY BEEN IDENTIFIED.
THEY'D ALREADY BEEN CONNECTED
WITH CARE MANAGEMENT, SO IT'S
NOT NECESSARILY REFLECTIVE OF
THE POPULATION. HEALTH
MANAGEMENT RISK STRATIFICATION
PROCESS. UM AND SO THE RACIAL
BREAKDOWN OF THE POPULATION IS
SIMILAR TO THE WHOLE PERSON CARE
OF PARTICIPANTS IN MOST ASPECTS.
SOME OF THE PROVIDERS WE WORK
WITH WHO ARE KI¾M PROVIDERS WHO
SPECIFICALLY SERVE COMMUNITIES
OF COLOR WERE PREVIOUSLY HEALTH
HOME AND THE WHOLE PERSON CARE
PROVIDERS HAVE NOTICED THAT THE
OUTREACH LIST THEY'RE RECEIVING
FROM HEALTH PLANS ARE SMALLER
COMPARED TO WHAT THEY WERE
GETTING FOR HEALTH HOMES AND
WHOLE PERSON CARE, WHICH RAISES
CONCERNS FOR US THAT SOME
MEMBERS ARE BEING MISSED IN THIS
PROGRAM TRANSITION. UM BUT I DO
WANT TO SAY WE APPRECIATE THE
WORK THAT DHS HAS BEEN DOING IN
PRIORITIZING ADDRESSING RACIAL
BIAS IN THE RISK STRATIFICATION
DESIGN, WHICH IS NOT EASY TO DO
, BUT WE APPRECIATE THAT THE HCS
HAS DETERMINED THAT RISK TEARS
MUST BE BASED NOT ONLY ON
MEDICAL OR BEHAVIORAL HEALTH
RISK, BUT ALSO SOCIAL RISK. AND
MOST IMPORTANTLY, MUST CONSIDER
UNDERUTILIZATION OF SERVICES,
WHICH WILL HELP TO REVERSE BIAS
IN THE ALGORITHMS BECAUSE THE
EVIDENCE SHOWS THAT BLACK
PATIENTS IN PARTICULAR
CONSISTENTLY GENERATE FEWER
COSTS THAN WHITE PATIENTS AT THE
SAME LEVEL OF HEALTH. UM SO
AGAIN, WE THINK THAT DHS IS
TAKING THE RIGHT STEPS HERE AND
THIS COULD BE STRENGTHENED BY
HAVING A PUBLICLY REPORTED
DASHBOARD. ROBUST DEMOGRAPHIC
DATA REQUIRING A STRONG
COMMUNITY ENGAGEMENT AROUND THE
POPULATION HEALTH MANAGEMENT AND
THEN I WAS SO GLAD FINALLY THAT
THAT DIRECTOR COOPER DID MENTION
THAT TRADITIONAL HEALERS. UM
PROPOSAL. UM, YOU KNOW, WE
WANTED TO RAISE AS WELL. THAT'S
THE ONE OUTSTANDING COMPONENT OF
KELLY WITH CMS AND APPRECIATE
THE DEPARTMENT'S EFFORTS AND
HOPE TO CONTINUE. THE
PARTNERSHIP WITH THE LEGISLATURE
TO SEE THAT APPROVED NOT ONLY
FOR THE PROGRAMS AND SERVICES
THAT WILL BRING BUT I THINK ALSO
FOR THE EXAMPLE IT WILL GIVE FOR
HOW TO BROADEN CULTURALLY
APPROPRIATE SERVICES IN THE
FUTURE. SO THANK YOU. THANK YOU.
WE WILL HAVE ALI BEARDEN'S WHO
IS THE DIRECTOR OF POPULATION
HEALTH MANAGEMENT FOR THE
CALIFORNIA PRIMARY CARE
ASSOCIATION. RIGHT. THANK YOU.
ALLIE. BURDENS DIRECTOR
POPULATION HEALTH MANAGEMENT,
CALIFORNIA PRIMARY CARE
ASSOCIATION, SO I WANTED TO
FOCUS MY REMARKS THIS AFTERNOON
ON THE WORKFORCE IMPACT OF THOSE
WHO ARE CARRYING OUT THE MISSION
OF CALAIS AND PARTICULARLY
PROVIDERS AT COMMUNITY HEALTH
CENTERS. CPC REPRESENTS 170
ORGANIZATIONS. 1300 COMMUNITY
HEALTH CENTERS THROUGHOUT THE
STATE. UM WHO SERVE A THIRD OF
ALL MEDICAL BENEFICIARIES, AND
IN ADDITION TO INTEGRATED
PRIMARY CARE, BEHAVIORAL HEALTH
, DENTAL SERVICES ARE MEMBERS
ARE ALSO ECM AND COMMUNITY
SUPPORT PROVIDERS AND HAVE BUILT
REALLY INCREDIBLE EXPERIENCE IN
THIS SPACE THROUGH PILOTS LIKE
HEALTH HOMES, PROGRAMS AND WHOLE
PERSON CARE. AND I THINK IT'S
REALLY TIMELY THAT I'M HERE THIS
AFTERNOON, SPEAKING WITH YOU,
BECAUSE LAST WEEK I WAS AT THE
RURAL ROUNDTABLE, WHICH IS A
BIANNUAL EVENT ORGANIZED BY THE
CONSORTIUM, THE RURAL NORTH AND
IT BRINGS PROVIDERS TOGETHER TO
SHARE IMPLEMENTATION BEST
PRACTICES ABOUT, YOU KNOW,
EMERGING ISSUES IN MEDICAL AND
ONE SESSION WAS ON ENHANCED
CARE, MANAGEMENT AND COMMUNITY
SUPPORT WAS OFFERED IN
COLLABORATION WITH THE LOCAL
MANAGED CARE PLAN. PARTNERSHIP
HELP PLANT PARTNERSHIP HEALTH
PLAN IN CALIFORNIA. UM AND AT
THAT EVENT, I WAS BOMBARDED BY
MESSAGES FROM ENHANCED CARE
MANAGERS ABOUT THE BEAUTY OF
THIS BENEFIT BEING AVAILABLE TO
THEM. IT'S WORK THAT THEY WANTED
TO DO FOR YEARS, AND THE SYSTEM
REALLY HASN'T ALLOWED THEM TO DO
THIS UNTIL NOW. ONE SUCCESS
STORY FROM A CARE MANAGER NAMED
CYNTHIA WAS WHEN SHE HELPED A
MEMBER TOO. ACCESS STABLE
HOUSING SO THAT SHE COULD ENROLL
IN COMMUNITY COLLEGE SO THAT SHE
COULD MANAGE HER CHRONIC HEALTH
CONDITION AND THAT SUCCESS STORY
REALLY INFUSE THIS CARE MANAGER
WITH A SENSE OF PRIDE AND JOY,
UM AND HOPEFULLY STAMINA TO KEEP
GOING RIGHT BECAUSE THIS IS HARD
WORK. THIS IS INTENSIVE AND TIME
CONSUMING. AND AS YOU ALL KNOW,
AS WE'VE SAID, WE'RE IN A
WORKFORCE SHORTAGE. UM, YOU KNOW
PROVIDERS ACROSS THE BOARD AND
BEHAVIORAL HEALTH AND PRIMARY
CARE. WE JUST DON'T HAVE ENOUGH
SUPPLY AND CALLUM IS REALLY THE
OPPORTUNITY TO THINK OUTSIDE THE
BOX AND TO BRING IN NON
TRADITIONAL SERVICE PROVIDERS
LIKE COMMUNITY HEALTH WORKERS.
CARE NAVIGATORS, MAMA TORAHS. UM
AND THE GOAL AS WE LOOK AT IT AS
THE RIGHT CARE AT THE RIGHT TIME
BY THE RIGHT PERSON, AND I WOULD
JUST SAY THAT IN TERMS OF
RAMPING UP THESE SERVICES, IT
TAKES TIME, RIGHT? IT TAKES TIME
TO TRAIN SOME OF THESE NEW
STAFF. UM AND WE JUST LOOK
FORWARD TO, UM, INTEGRATING THEM
INTO OUR CARE MODEL. SO AT THE
SAME TIME THAT WE HERE AT LEAST
BENEFITS. I ALSO HEAR SOME REAL
CHALLENGES WITH THE
IMPLEMENTATION OF ECM IN
PARTICULAR. SO THE SAME CARE
MANAGERS WILL BE THE FIRST TO
LAMENT THAT THE DATA BURDEN IS
QUITE INTENSIVE WITH E. C. M
SOME CARE MANAGERS ARE SPENDING
UP TO 30% OF THEIR TIME JUST
DOCUMENTING SERVICES. UM AND
REALLY IT'S BECAUSE THE SYSTEMS
THE TECHNOLOGY SYSTEMS AREN'T
INTEROPERABLE AND ACROSS SOME
INSTANCES BECAUSE THE
REQUIREMENTS AREN'T
STANDARDIZED. UH SO FOR AN
EXAMPLE OF PROVIDER MAY ENTER,
MAY ENTER SIMILAR IN SOME CASES,
THE SAME INFORMATION FIRST IN
THEIR ELECTRONIC HEALTH RECORD.
AND THEN THROUGH THAT TREATMENT
AUTHORIZATION PROCESS, AND ALSO
THEY HAVE TO DOCUMENT IN THE
MANAGED CARE PLANS, ASSESSMENT
AND CARE PLANNING SYSTEM. THE
SAME INFORMATION SO THE SYSTEMS
DON'T REALLY COMMUNICATE WITH
EACH OTHER. UM AND THEN THIS IS
MULTIPLIED EXPONENTIALLY IF
YOU'RE IN A COUNTY WITH MULTIPLE
HEALTH PLANS, BECAUSE THERE ARE
DIFFERENT REQUIREMENTS, AND SO I
JUST WANT TO UNDERSCORE THAT I
DON'T THINK IT'S NECESSARILY
ANYBODY'S FAULT. I THINK IT WAS
JUST AN UNINTENDED CONSEQUENCE
OF US WANTING TO DEMONSTRATE HOW
WONDERFUL THE ECM BENEFIT IS, UM
, BUT IT IS SOMETHING THAT NEEDS
ATTENTION TO MAKE SURE THAT
WE'RE FULLY MAXIMIZING STAFF
TIME. AND THE OTHER BECAUSE IT'S
YOU KNOW, THAT IS A MISSED
OPPORTUNITY. IT'S NOT EFFICIENT
OR EFFECTIVE TO BE SPENDING THAT
MUCH TIME. THE OTHER THING IS
THAT WITH THIS HIGH
DOCUMENTATION BURDEN, UM IT YOU
KNOW THE RATES DO NOT COVER THE
COST OF THE ADMINISTRATIVE
BURDEN. THEY ARE ON PAR WITH
HEALTH HOMES PROGRAM AND WITH
WHOLE PERSON CARE, WHICH IS GOOD
, BUT THOSE PROGRAMS WERE LESS
ADMINISTRATIVELY BURDENSOME, AND
THEY HAD THE BENEFIT OF HAVING A
WIDER ELIGIBILITY POPULATION. SO
YOU COULD KIND OF DISTRIBUTE THE
COST ACROSS MULTIPLE
INTERVENTION INTENSITIES, AND IT
SORT OF CAME OUT IN THE WASH. SO
IN TERMS OF THE THINGS THAT
WE'RE EXCITED ABOUT ON THE
HORIZON, THE POPULATION HEALTH
MANAGEMENT SERVICES, ONE OF THE
ONES THAT WERE EAGERLY AWAITING
, FOR THAT, JUST TO REITERATE,
IS THE ABILITY TO HAVE ALL THE
FUNCTIONALITY TO HAVE DATA
ACROSS DIFFERENT SYSTEMS HOUSED
IN ONE LOCATION, SO STATE DATA
MANAGED CARE PLAN DATA. CBO DATA
PROVIDER DATA, ETCETERA. AND
THAT REALLY HAS THE POTENTIAL TO
BE A GAME CHANGER. WE ARE ALSO
CAUTIOUS ABOUT THE DATA BURDEN
THAT THAT MIGHT, UM COME WITH.
AND SO WE'RE TRACKING THAT VERY
CLOSELY. AND THEN THE OTHER
THING THAT WE REALLY LOOK
FORWARD TO IS CONTINUED
DISCUSSION WITH THE DEPARTMENT
ON STRATEGIES TO ALIGN THE GOALS
OF KELLY WITH A MODERNIZED
PAYMENT SYSTEM THAT REALLY
RECOGNIZES PROVIDERS HEALTH
CENTERS FOR THEIR POPULATION
HEALTH, ESPECIALLY IN PRIMARY
CARE, SO ONE EXAMPLE OF THAT IS
THE FQ HC ALTERNATIVE PAYMENT
METHODOLOGY LAUNCH IN 2024. IT
PROVIDES PARTICIPATING HEALTH
CENTERS WITH THE FLEXIBILITY TO
DO THIS POPULATION HEALTH AND A
CAPITATED MODEL. UM SO I'LL JUST
END BY SAYING IT'S BEEN A
WHIRLWIND. I THINK WE ALL HAVE,
UM, HOPEFULLY ACKNOWLEDGED HOW
MUCH WORK HAS BEEN NONE OF THEM
REALLY SHORT AMOUNT OF TIME AND
IT'S A MONUMENTAL OPPORTUNITY
AND WE'RE JUST REALLY EXCITED TO
PARTNER WITH THE STATE. AND
MANAGED CARE PLANS AND CBOS TO
CONTINUE PRIORITIZING HOPERS AND
CARE, SOCIAL DETERMINES AND
POPULATION HEALTH WHICH ARE
REALLY THE TENANTS OF THE
COMMUNITY HEALTH CENTER MODEL.
THANK YOU. DEPARTMENT OF
FINANCE. ANDREW DUFFY DEPARTMENT
OF FINANCE NOTHING FOR THE AD AT
THIS MOMENT, BUT HERE FOR
QUESTIONS, ELIO. WILL OWNS A LEO
NOTHING. NO COMMENTS ON THIS
ITEM BUT WERE AVAILABLE FOR
QUESTIONS. THANK YOU. I'LL BRING
IT UP TO THE DIASPORA MEMBERS
QUESTIONS. I'LL KEEP IT HERE AT
THE CHAIR FOR A SECOND. MS
KOOPMANS IF I CAN WE HEARD
EARLIER THAT THE ENHANCED CARE
MANAGEMENT SERVICES. SHOULD BE
READY AND ABLE TO PROVIDE
SERVICES BY JULY 1ST OF 2023 BUT
WE ALSO HEARD ABOUT LONG WAIT
TIMES ON ASSESSMENTS THAT I'M
TRYING TO UNDERSTAND OUR ABILITY
TO BE READY BY THAT DATE AND
HELPING YOU CAN PROVIDE SOME
COMMENTS ON THAT. YEAH SO I
THINK E C M HAS BEEN ROLLED OUT
IN PHASES BASED ON DIFFERENT
POPULATIONS OF FOCUS. YOU KNOW,
OF COURSE, THE FIRST WAVE WENT
LAST JANUARY AND 2022 TO YOUR
POINT. THERE WILL BE ADDITIONAL
POPULATIONS GOING LIVE IN JULY.
WHEN I'VE TALKED WITH THE LOCAL
PLANS WERE IT'S ACTUALLY SO KIND
OF PUTTING WHAT TCM IN A
DIFFERENT BUCKET, THEN COMMUNITY
SUPPORT TO THINK THEY ARE
DIFFERENT. SO WITH PCM ACTUALLY
NOT HEARD THAT THERE'S WAIT
TIMES THAT. CONVERSELY IT'S
PROVIDERS REACHING OUT AND
REACHING OUT AND TRYING TO GET
MEMBERS ENGAGED, TRYING TO GET
THEM IN. AND I THINK THAT WE'VE
HEARD FROM OUR PROVIDERS TAKES A
LOT OF TIME. A LOT OF OUTREACH
ATTEMPTS. TO GET SOMEONE IN NOT
ONLY ASSESSED AND THEN TO START
RECEIVING E. C. M. UM SO I THINK
THAT'S ONE PERSPECTIVE ON THE
COMMUNITY SUPPORTS AND TO KIND
OF SPEAK TO THE WAIT. TIME ISSUE
. THE ONLY THE ONLY THING THAT
I'VE HEARD THAT I'VE BEEN ABLE
TO KIND OF PEACE BACK TO
POTENTIAL WAIT TIMES IS ON
HOUSING RELATED SERVICES. IF
SOMEONE'S ON A LIST TO WAIT, YOU
KNOW FOR A WAITING LIST FOR
SUPPORTIVE HOUSING. IT DOES
IMPACT WHAT COMMUNITY SUPPORTS.
YOU CAN PROVIDE TO THEM WHILE
THEY'RE ON THAT WAIT LIST SO HMM
. IN MY MIND, THAT'S WHERE
THERE'S KIND OF A LOGJAM IN AN
ISSUE HAPPENING AGAIN. IT'S A
SUPPLY ISSUE SO THAT THAT'S WHAT
I'VE HEARD FROM THE LOCAL PLAN
EXPERIENCE. UM I'LL ASK US
SOMEWHERE QUESTIONS FOR MS
COOPER IF I CAN RELATED TO THE
PAST PROGRAM UM, WE WERE TO HAVE
JAILS IN PRISONS OFFER ALL THE
REQUIRED SERVICES AS OF JANUARY
OF THIS YEAR AND JUST WANTED TO
GET A SENSE OF HOW WE'RE MEETING
ON THAT TIMELINE AND HOW JAILS
AND PRISONS ARE PREPARED. SO UM,
THE PATH DOES A FEW THINGS. SO
IT DOES THE ENHANCED CARE
MANAGEMENT, BUT IT ALSO IS GOING
TO BE THE STARTUP FUNDS FOR THE
JUSTICE INITIATIVE. WE JUST GOT
APPROVAL FROM CMS IN JANUARY OF
THIS YEAR, AND SO WE ARE
BUILDING THE PATH APPLICATION
FOR OUR PRISONS. OUR JAILS
ENERGY, NOT FACILITIES TO
RESPOND TO GET SOME START UP
FUNDS. TO BE ABLE TO START THE
IMPLEMENTATION OF THOSE IN REACH
SERVICES. UM AT THIS TIME, BASED
ON THE LONG NEGOTIATION WITH CMS
, WE'RE ANTICIPATING THAT, UM,
NO, NO ONE WOULD REALLY START
THOSE INTO REACH SERVICES UNTIL
APRIL OF 2020 FOR THE EARLIEST
AND THEN COUNTIES WILL BE ABLE
TO ELECT TO GO LIVE OVER A TWO
YEAR PERIOD. UM, AND THE
COMMITTEE HAS ASKED FOR ME TO DO
A FULL OVERVIEW OF THE JUSTICE
INITIATIVE, TIMELINES AND PIECES
AT THE APRIL 17TH MEETING, SO
I'LL GIVE YOU MORE DETAILS THEN,
BUT THOSE PAST DOLLARS SOME
DOLLARS HAVE GONE OUT FOR
MEDICAL ENROLLMENT INELIGIBILITY
ALREADY TO OUR COUNTY PARTNERS
AND THEN THE NEXT ROUND WILL BE
RELEASED SHORTLY FOR THEM TO
APPLY FOR ADDITIONAL STARTUP
FUNDS. PERFECT. I'LL ASK ONE
LAST QUESTION IF I CAN, AND THIS
IS WE'VE BEEN APPROACHED BY SOME
OF THE SKILLED NURSING
FACILITIES REGARDING THE ISSUES
WITH PAYMENTS. AND MANAGED CARE
PLANS, AND I'M HOPING TO HAVE
THE PLANS TALK A LITTLE BIT
ABOUT JUST SHED SOME LIGHT ON
THIS PROBLEM IS, IS THERE A
CONTRACT? THERE NEEDS TO BE
SIGNED WITH THE SNIFFS. WITH THE
PLANS TO ENSURE THAT YOU GET
PAYMENT. WHY ARE WE STRUGGLING
TO GET PAYMENT, TOO? OUR SKILLED
NURSING FACILITIES CURRENTLY SO
, UM, I THINK TO SPEAK TO THE
TRANSITION THAT DIRECTOR COOPER
YOU KNOW, SPOKE ABOUT DURING HER
TESTIMONY IN JANUARY. AS YOU
KNOW, THE COUNTIES WHERE LONG
TERM CARE WASN'T ALREADY CURVED
IN, OF COURSE, NEWLY CARVED IN
SNIFF SERVICES. AND SO IN TERMS
OF THE CONTRACTING EFFORTS,
PLANS WERE REQUIRED TO
DEMONSTRATE NETWORK ADEQUACY AND
WANT TO AND ARE INCENTIVIZED OF
HAVE, AS MANY SNIFFS IN THEIR
NETWORK AS POSSIBLE. THEY NEED
TO BE ABLE TO DEMONSTRATE ACCESS
AND PROVIDE ACCESS. SO IT ISN'T
THE PLANS INTEREST TO BE
CONTRACTING WITH THESE
FACILITIES, AND THERE'S BEEN A
LOT OF EFFORTS TO BRING THOSE
FACILITIES INTO INTO THEIR
NETWORKS. THE YOU KNOW FROM WHAT
WE HAVE HEARD ONE OF THE ONE OF
THE CONSIDERATIONS, UM, FOR THE
SNIFFS IS THAT THERE IS A
PAYMENT POLICY IN PLACE FOR THE
FIRST FEW YEARS OF THE CARBON
WHEREIN THEY ARE RECEIVING FEE
FOR SERVICE RATES FROM THE PLANS
. HOWEVER THERE'S ALSO NEW
DIRECTED PAYMENTS AND FOR
QUALITY AND OTHER KIND OF
STAFFING RELATED. UM
MEASUREMENTS, AND SO THOSE ARE
ONLY AVAILABLE TO SNIFF THAT
CONTRACT WITH PLANS AND WE HAVE
BEEN HAVING CONVERSATIONS WITH
THE SNIFFS ABOUT, UM, YOU KNOW
THAT BEING ANOTHER REASON TO
COME INTO NETWORK, SO I SO I
HOPE THAT ANSWERS SOME OF YOUR
QUESTIONS. THERE'S BEEN A LOT OF
EFFORTS TO BRING SNIFFS INTO THE
NETWORK AND THEN IN TERMS OF THE
PAYMENT PIECE. WE HAVE HEARD
SOME SOME CHALLENGES THAT I
THINK ARE A NORMAL PART OF, UM
YOU KNOW, BEING THREE MEN THREE
MONTHS, FOUR MONTHS INTO A NEW
BENEFIT, AND SO MANY OF MY PLANS
HAVE HAD, UM YOU KNOW, T A AND
TRAINING SESSIONS AND HAVE HAD A
DEDICATED SORT OF LIAISON THAT'S
AVAILABLE TO HELP PROBLEM
SOLVING TROUBLESHOOT TO ENSURE
THAT YOU KNOW, CLAIMS THAT
AREN'T THAT NEEDS TO BE FIXED IN
ORDER TO BE PAID, UM, KIND OF
WALK THEM THROUGH THAT PROCESS
SO THAT THEY CAN BE PAID IN THE
DOLLARS CAN FLOW FROM MS COOPER
. CAN YOU COMMENT ON WHETHER OR
NOT YOU'RE HEARING SIMILAR
COMPLAINTS FROM THE SKILLED
NURSING FACILITIES AND WHAT'S
OUR PLAN TO WORK THROUGH THIS
TRANSITION AND GROWING PAINS?
YES. SO WE'RE WORKING. WE HAVE
STARTED HEARING SOME SIMILAR
COMPLAINTS. THE BIGGEST ONES
BEING KIND OF WHAT, UM, LINEAR
JUST WALKED THROUGH DELAY ON
PAYMENT BEING BEING ONE OF THEM
. SOME OF THAT IS DUE TO, UM,
YOU KNOW, PLANS, EDUCATING THEM
ON PRIOR AUTHORIZATION OR TO GET
A CLEAN CLAIM THROUGH. SO IF THE
IF THEY'RE NOT USED TO BUILDING
THE MANAGED CARE PLAN, JUST
MAKING SURE THEY UNDERSTAND AND
WE'VE BEEN REQUESTING THE PLANS
AND I KNOW THEY'VE BEEN DOING
THAT WORKING ON EDUCATING THOSE
PROVIDERS SO THAT PROVIDERS ARE
BEING PAID TIMELY BECAUSE THAT'S
A CRITICAL PART IN A REQUIREMENT
WITHIN THEIR CONTRACT. UM THAT
THAT CLAIMS ARE BEING PAID.
TIMELY UM, THE OTHER PIECES YOU
KNOW, THERE ARE ARE JUST AS AS
WAS MENTIONED NOW THAT THEY IN
ORDER TO GET THE PIECES THAT WE
ALL NEGOTIATED LAST YEAR IN
REGARDS TO A SKILLED NURSING
FACILITY PAYMENT REFORM ON THE
DIRECTED PAYMENTS TIED EQUALITY
, THEY DO HAVE TO HAVE A
CONTRACT WITH THE MANAGED CARE
PLAN, WHICH MEANS THEY HAVE TO
MEET THEIR CREDENTIAL IN THEIR
QUALITY EXPECTATIONS AND THOSE
VARIOUS PIECES AND SO THERE HAVE
BEEN A SIGNIFICANT NUMBER OF
CONTRACTS ALREADY SIGNED JUST TO
BE REALLY CLEAR, BUT THERE ARE
PROBABLY STILL SOME REMAINING
SKILLED NURSING FACILITIES
NEGOTIATING MANAGED CARE PLANS
ON THE DEPARTMENT. DIFFICULTY
DOES NOT GET IN THE MIDDLE OF
NEGOTIATIONS BETWEEN PROVIDERS
AND PLANS. BUT WE'VE BEEN
ENCOURAGING ALL ALL PLANS AND
PROVIDERS TO BRING THOSE
NEGOTIATIONS TO CLOSE SO THAT
THEY CAN HAVE THOSE DIRECTED
PAYMENTS IF THEIR CONTRACTED FOR
THOSE SERVICES. WITH THAT I WILL
THANKS VERY MUCH THIS PANEL AND
WE WILL MOVE ON TO ISSUE FIVE.
OUR NEXT ISSUE COVERS SOME OF
THE NEW KELLY IN PROPOSALS
INCLUDED IN THE GOVERNOR'S 23
BUDGET. WE WILL BEGIN WITH JUICY
COOPER. A GREAT SO, UM, I WILL
DO AN OVERVIEW OF THE
REPRODUCTIVE WAIVER AND
TRANSITIONAL RENT DURING THIS
PARTICULAR ITEM, SO THE
DEPARTMENT IS SEEKING TO
CONTINUE THE STATE'S PROGRESS IN
REGARDS TO ENSURING ADEQUATE
ACCESS TO REPRODUCTIVE AND
SEXUAL REPRODUCTIVE HEALTH
SERVICES. WE ARE PROPOSING TO
MOVE FORWARD AND INVEST 200
MILLION TOTAL FUNDS, WHICH IS 15
MILLION GENERAL FUND IN BUDGET
YEAR, PLUS 2024 FOR DEVELOPING
THE REPRODUCTIVE UM, HEALTH
SERVICES THROUGH AN 11 15 WAIVER
DEMONSTRATION, KNOWN AS THE
CALIFORNIA REPRODUCTIVE HEALTH
ACCESS DEMONSTRATION. UM WHAT I
WOULD KNOW IS THAT WE ARE REALLY
TRYING TO WITHIN THIS PROPOSAL
REDUCED THE GENERAL FUND IMPACT
TO, FOR EXAMPLE, UM, 185 MILLION
OF THAT 200 MILLION WILL BE
FEDERAL FUNDS AND ONLY THE 15
MILLION GENERAL FUND REQUEST.
THE WAIVER REALLY WOULD WORK TO
ADVANCE. YOU KNOW, SUPPORTING
ACCESS TO FAMILY PLANNING AND
RELATED SERVICES, SUPPORT THE
CAPACITY AND SUSTAINABILITY OF
CALIFORNIA'S REPRODUCTIVE HEALTH
SAFETY NET AS WELL AS REALLY
PROMOTE A SYSTEM TRANSFORMATION
FOR CALIFORNIA'S SEXUAL AND
REPRODUCTIVE HELP. UM SAFETY NET
SYSTEM. WE ARE PROPOSING THE
WAIVER TO BE A THREE YEAR
DEMONSTRATION. WE ARE ALSO
PROPOSING THAT IT DOMINATED THE
GRANT BASED, FOR EXAMPLE, THESE
ARE GRANTS DIRECTLY TO PROVIDERS
TO INCREASE ACCESS. TO
REPRODUCTIVE HEALTH SERVICES
ACROSS THE ENTIRE STATE OF
CALIFORNIA. AND SO REALLY, THIS
IS AROUND. HOW DO WE SUPPORT
PROVIDERS TO OPEN UP ON EVENINGS
OR WEEKENDS REALLY INCREASE
ACCESS TO SERVICES TO HELP WITH
WORKFORCE IN REGARDS TO ADDING
WORKFORCE, WHETHER IT'S
COMMUNITY HEALTH WORKERS OR
WORKFORCE WITHIN THEIR THEIR
OFFICES TO EXPAND CAPACITY. WE
ALSO ARE, YOU KNOW, TECHNOLOGY
OR TELEHEALTH EQUIPMENT,
ANYTHING THAT ALLOWS WOMEN OR
INDIVIDUALS TO HAVE BETTER
ACCESS TO SEXUAL HEALTH AND
REPRODUCTIVE HEALTH SERVICES.
ACROSS THE STATE OF CALIFORNIA.
ON MARCH 16TH. THE DEPARTMENT
POSTED A CONCEPT PAPER FOR THE
REPRODUCTIVE WAIVER FOR 30 DAY
PUBLIC HEARING. EVERY 11 15 HAS
TO HAVE AN OFFICIAL 30 DAY
COMMENT PERIOD THAT WILL END
APRIL 17TH ON MARCH 20TH. WE DID
OUR FIRST TRIBAL MEETING AND WE
ARE HOLDING TWO PUBLIC HEARINGS
ONE ON MARCH 29TH IN THE SECOND
ONE ON APRIL 3RD. REALLY
INFORMATION ABOUT THE WAIVERS
ALSO BEEN PUT PUBLICLY POSTED
AND WE WILL BE TAKING COMMENTS
THROUGH THIS PUBLIC HEARING
PROCESS WILL CLOSE THOSE AND
THEN SUBMIT TO THE FEDERAL
GOVERNMENT. OBVIOUSLY THAT WOULD
BE PENDING BUDGET APPROVAL OF
THAT $15 MILLION TO MOVE FORWARD
WITH THAT, THAT OFFICIAL
SUBMISSION IN REGARDS TO
TRANSITIONAL RENT. THE
DEPARTMENT IS REALLY SEEKING TO
AMEND THE CALLUM 11 15 WAIVER TO
ADD TRANSITIONAL RENT. OUR
COLLEAGUES IN OREGON AND ARIZONA
WERE ABLE TO FORGE THROUGH WITH
CMS, WHICH WE LOVE TO GET SIX
MONTHS OF WHAT'S CALLED
TRANSITIONAL RENT ADDED TO THEIR
11 15 WAIVER. UM, I SAY
TRANSITIONAL RENT BECAUSE THAT
IS A CORE COMPONENT OF WHAT THIS
IS. THIS IS REALLY AROUND
SOMEONE TRANSITIONING OUT OF AN
INSTITUTIONAL LEVEL OF CARE,
SKILLED NURSING FACILITY IN
PATIENTS SAY A CORRECTIONAL
SETTING OR TRANSITIONING OUT OF
CHILD WELFARE. WE DO SEE A
NUMBER OF INDIVIDUALS
TRANSITIONING OUT OF CHILD
WELFARE INTO HOMELESSNESS, AND
THIS IS REALLY MEANT TO BE A
TRANSITIONAL INVESTMENT IN
REGARDS TO SIX MONTHS OF RENT,
FOR EXAMPLE, IN THAT POPULATION.
WE ARE REALLY EXCITED ABOUT THIS
PROPOSAL. WE THINK IT IS JUST
ADDING TO THE OTHER COMPONENTS
THAT WE HAVE THE HOUSING
TRANSITION SERVICES, THE
SUSTAINING SERVICES, THE
RECRUITMENT OF SHORT TERM POST
HOSPITALIZATION, HOUSING AND
THEN SIX MONTHS RENT IN REGARDS
TO THIS. WE STILL HAVE A LOT TO
FIGURE OUT IN REGARDS TO WHAT IT
WOULD LOOK LIKE IN CALIFORNIA.
WE ALSO ARE PROPOSING IT NOT
ONLY IN THE CALLUM AMENDMENT,
BUT WE ARE ALSO PROPOSING IN THE
COW. BH CBC ARE BEHAVIORAL
HEALTH WAIVER THAT'S OUT. I
MEAN, BEEN ENGAGING WITH PEOPLE
ONTO THAT OUR COUNTY PARTNERS
ALSO HAVE THESE RESOURCES
CRITICAL, CRITICAL FOR
EVERYTHING. WE'RE TASKING ON
THEM TO DO BOTH IN CARE COURT AS
WELL AS MAKING SURE SOME OF THEM
ARE MOST VULNERABLE INDIVIDUALS
EXPERIENCING HOMELESSNESS WITH
BEHAVIORAL HEALTH NEEDS HAVE
THIS OPPORTUNITY AS WELL. SO
WE'RE PROPOSING IN BOTH OF THOSE
WAIVERS. TO MAXIMIZE THIS ASK
THE GOVERNOR'S BUDGET PROPOSES
17.9 MILLION IN 25 26. SO THIS
ISN'T ABOUT YOUR THING BECAUSE
WE HAVE TO DO AN AMENDMENT
PROCESS IMPLEMENT ITS YOU KNOW,
IT DOESN'T HAPPEN OVERNIGHT, BUT
INCREASING TO A 116.6 MILLION IN
FULL IMPLEMENTATION OF THIS
PROPOSAL. UM AND HAPPY TO ANSWER
ANY QUESTIONS WHEN THE TIME IS
RIGHT. DEPARTMENT OF FINANCE
CANADA, THE DEPARTMENT OF
FINANCE NOTHING FURTHER, THE
FURTHER TO ADD, BUT HERE TO
ANSWER QUESTIONS. YES WILLOW
WINSLOW REGARDING THE
REPRODUCTIVE ACCESS
DEMONSTRATION. NO CONCERNS WITH
THIS PROPOSAL REGARDING THE
TRANSITIONAL RENT UNTIL WE SEE
THE DEMONSTRATION. WE HAVE NO
COMMENTS AT THIS TIME. BRING IT
UP TO THE DIOCESE FOR MEMBERS,
QUESTIONS OR COMMENTS. I'LL KEEP
IT HERE AT THE CHAIR. JUST SAY
HOW PLEASED I AM TO SEE US
SPENDING HEALTHCARE DOLLARS ON
SOCIAL DRIVERS AND DETERMINANTS
OF L. IT'S BEEN A LONG TIME
COMING AND LOOK FORWARD TO THE
ONGOING WORK WITH THE
ADMINISTRATION TO MAKE THIS A
REALITY. WITH THAT WE WILL
THANKS VERY MUCH THIS PANEL AND
MOVE ON TO ISSUE SIX. ISSUE SIX
COVERS ANOTHER OF THE 23 CALLINA
PROPOSAL. THIS IS A PROPOSED
TRAILER BILL ON THE DESIGNATED
STATE HEALTH PROGRAMS AND
DELAYED CARBON OF I, C F, D D
AND THE SUB ACUTE SERVICES AND
MEDICAL MANAGED CARE. MS COOPER
WHEN YOU ARE READY OF COURSE,
THE DEPARTMENT SUBMITTED TRAILER
BILL TO EFFECTUATE ITS RESPONSE
TO AMEND THE CMS APPROVED KELLUM
WAIVER TO INCLUDE THE DESIGNATED
STATE HEALTH PROGRAM OR WHAT WE
CALL AS DISH BE, UM, IN REGARDS
TO THIS PROGRAM KIND OF WALK
THROUGH THAT, UM, THE DISH
PROGRAM WAS COVERING THE NON
FEDERAL SHARE OF THE PATH
PROGRAM, SO THIS INCLUDES AN
ADDITIONAL 646 MILLION
ADDITIONAL FEDERAL FUNDS. TO PAY
AND CONTINUE TO CONTRIBUTE TO
THOSE CRITICAL INVESTMENTS THAT
I WAS MENTIONING PREVIOUSLY IN
REGARDS TO MAKING SURE WE CAN
INCREASE ACCESS TO ENHANCE CARE
MANAGEMENT AND COMMUNITY
SUPPORTS AS A CONDITION FOR THAT
DISH. BE UM, NEGOTIATIONS WITH
CMS, AND THIS IS A NOW NATIONAL
POLICY FOR ALL DISH BE IT
INCLUDES THAT IF YOU YOU HAVE TO
EVALUATE YOUR RATES. YOU'RE
MEDICAID RATES IN YOUR STATE
COMPARED TO 80% OF MEDICARE
ACROSS PRIMARY CARE ACROSS OBI
AND ACROSS BEHAVIORAL. HEALTH
SERVICES IN THAT EVALUATION, IF
YOU HAVE ANY RATES THAT ARE
BELOW 80% OF MEDICARE, AND THEN
YOU HAVE TO AGREE TO A INCREASE
OF THOSE RATES, SO WE DID A
COMPREHENSIVE ANALYSIS OF OUR
PRIMARY CARE, OBI AND BEHAVIORAL
HEALTH RATES IN PRESENTED THAT
TO CMS UM, IN ALL KIND OF WALK
THROUGH WHAT? THAT WHAT THAT
LOOKS LIKE. SO ESSENTIALLY,
WE'RE PROPOSING TO INCREASE
RATES IN BOTH PRIMARY CARE IN
THE FEE FOR SERVICE DELIVERY
SYSTEM, UM, AS WELL AS THE OBI
RATES IN FIFA SERVICE AND
MANAGED CARE, FOR EXAMPLE IN
PRIMARY CARE AND THE FEE FOR
SERVICE DELIVERY SYSTEM. THE
WEIGHTED AVERAGE PERCENTAGE WAS
APPROXIMATELY 68% OF MEDICARE SO
INCREASING THEIR ON THE OBE FOR
BOTH FIFA SERVICE IN MANAGED
CARE THAT WEIGHTED AVERAGES WERE
APPROXIMATELY 65% IN FIFA
SERVICE IN 68% AND MANAGED CARE
SO BELOW THAT 80% THRESHOLD.
THEREFORE INDICATING AN INCREASE
. I WOULD NOTE, THOUGH, WHEN IT
CAME TO OUR BEHAVIORAL HEALTH
RATES WITHIN, UM MANAGED CARE
THE RATES UM WE'RE CLOSER TO 90%
AND SO HIGHER IN THAT REGARD, SO
NO, UM REQUIRED INCREASE FROM
CMS IN REGARDS TO OUR BEHAVIORAL
HEALTH RATES. UM ON THAT FRONT,
SO OUR PROPOSAL BEFORE THE
LEGISLATURE FOR CONSIDERATION IS
JANUARY, 1ST 2024 PRIMARY CARE
WILL INCREASE A 10% INCREASE IN
PRIMARY CARE RATES. FOR A FEE
FOR SERVICE, OF COURSE, ANY
MANAGED CARE PLAN THAT IS USING
FEE FOR SERVICE RIGHT THAT WOULD
THEN CORRESPOND ON THE MANAGED
CARE SIDE AS WELL. UM AND THEN
WE ARE ALSO PROPOSING A 10%
INCREASE FOR OBI ON BOTH FEE FOR
SERVICE AND MANAGED CARE, MOVING
FORWARD. AND SO THAT IS THE
PROPOSAL TIED TO DISH BE IN THE
RATE INCREASES TIED TO BOTH
PRIMARY CARE AND OBESE SERVICES
. OH, I WOULD ALSO NOTE THAT THE
OBI RATE INCREASES IS ALSO FOR
OUR DOULA BENEFITS SINCE WE
MIRRORED THAT THE FEE SCHEDULE
IN REGARDS TO THE PROPOSED
CHANGES FOR THE I, C F D, UM OR
THE INTERMEDIATE CARE FACILITY,
DEVELOPMENTAL, DISABLED AND SUB
ACUTE CARE FACILITY CARBON IN
THE MEDICAL MANAGED CARE PLANS.
WE ARE PROPOSING TO DELAY THAT
IMPLEMENTATION AS I MENTIONED
EARLIER FROM JULY 1ST TO 23 TO
JANUARY ONE. 2024 WE'VE WORKED
VERY CLOSELY WITH THE DEPARTMENT
OF DEVELOPMENTAL SERVICES AND
ADVOCATES AND REALLY JUST FEEL
LIKE THE DELAYS NEEDED TO REALLY
GIVE THE TIME EDUCATION TO
PROVIDERS AND HAPPY TO ANSWER
ANY QUESTIONS THAT YOU MAY HAVE.
DEPARTMENT OF FINANCE. THANK YOU
. WE'LL JUST NOTE THAT THERE'S
UM UH, $175 MILLION GENERAL FUND
BENEFIT WHICH WILL GO TOWARDS
FUNDING PATH. THANK YOU. THANK
YOU, LEO. RYAN MILLER, ELIO. WE
HAVE NO CONCERNS WITH THIS
PROPOSAL WILL BRING IT UP TO THE
DIASPORA MEMBERS. QUESTIONS I
WILL JUST EAT THAT IT SOUNDS
REASONABLE TO HAVE THIS DELAY,
SINCE IT WAS REALLY STAKEHOLDER
FEEDBACK THAT LED TO IT WITH
THAT I WILL THANK THIS PANEL AND
WE WILL MOVE ON TO ISSUE SEVEN.
ISSUE SEVEN IS AN OVERSIGHT
ISSUE ON THE PUBLIC HEALTH
EMERGENCY UNWINDING WE WILL
BEGIN WITH DIRECTOR COOPER.
THANK YOU. UM ALL RIGHT. MY
COLLEAGUES HERE. SO, UM, ON
DECEMBER 29TH 2022 PRESIDENT BY
AN INSIGHT INTO A LOT OF THE
CONSOLIDATED APPROPRIATIONS ACT
OF 2023, BASICALLY WHAT THIS
MEANS IS HE THREW THAT THAT
FEDERAL LEGISLATION IT SEPARATED
THE RE DETERMINATION PROCESS
TIED TO THE PUBLIC HEALTH
EMERGENCY FROM THE END OF THE
PUBLIC HEALTH EMERGENCY. UM AND
AS MANY OF US KNOW, MEDICAL RE
DETERMINATIONS HAVE BEEN ON HOLD
SINCE MARCH OF 2020, SO WE HAVE
NOT ACTUALLY COMPLETED MEDICAL
DETERMINATIONS FOR OVER THREE
YEARS NOW. IN AND NOW WE WILL BE
MOVING FORWARD WITH, UH, YOU
KNOW, RECONVENING THE
DETERMINATION PROCESS. UM
EFFECTIVE APRIL 1ST OF 2023. SO
WE WILL BEGIN OUR CONTINUOUS
COVERAGE UNWINDING AS WE CALL
IT, STARTING APRIL 1ST IN
CALIFORNIA, ELECTED FOR A 14
MONTH UNWINDING PERIOD, SO
RENEWAL'S WILL BEGIN IN APRIL
AND INDIVIDUALS WITH JUNE OF
2023 RENEWAL DATE SO THAT THEY
WILL BE GETTING NOTICES IN APRIL
FOR THE JUNE RENEWAL'S DHC S HAS
PREPARED A VERY COMPREHENSIVE
UNWINDING PLAN THAT IS POSTED ON
OUR WEBSITE. YOU CAN SEE
SCHEDULES FOR THE ENTIRE 14
MONTH PERIOD, WHICH IS REALLY
DETAILS ALL OF THOSE VARIOUS
PIECES. UM IN THAT PROPOSAL, UM
, AS YOU WOULD IMAGINE, THOUGH,
UM, BY NOT RE DETERMINING OR
LETTING DIS ENROLLING ANYONE
FROM OUR PROGRAM. WE ARE NOW AT
15.5 MILLION INDIVIDUALS AND
PROBABLY ACTUALLY OVER THAT, AS
I SAID HERE, BECAUSE THAT'S
EFFECTIVE AS OF DECEMBER OF 2022
MEMBERS, WHICH IS A 24% INCREASE
PRIOR TO COVID. SO A REALLY
SIGNIFICANT INCREASE IN REGARDS
TO TOTAL ENROLLMENT SINCE MARCH
OF 2022, LARGELY OBVIOUSLY TIED
TO THE CONTINUOUS COVERAGE
REQUIREMENT. UM THE DEPARTMENT
HAS MADE A NUMBER OF PIECES IN
PLACE TO SIMPLIFY THE COMPLEXITY
OF THE RENEWAL'S. WE'VE BEEN
WORKING VERY CLOSELY WITH OUR
FEDERAL PARTNERS TO GET VARIOUS
WAIVERS APPROVED, FOR EXAMPLE,
PEOPLE WITH ZERO INCOME
AUTOMATICALLY GOING THROUGH
INCREASING OUR ABILITY TO HAVE
HIGHER X PARTY RATES IN REGARDS
TO COMPATIBILITY THRESHOLDS. WE
REALLY PARTNER DID WITH THE
FEDERAL GOVERNMENT TO MAXIMIZE
MANY OF THE WAIVERS THAT THEY'VE
PUT FORWARD, INCLUDING HOW WE
ARE PROCESSING, RETURNED MAIL
AND ALL OF THE VARIOUS PIECES TO
REALLY MAKE SURE WE'RE DOING
EVERYTHING WE CAN TO MAKE SURE
ANYONE WHO NEEDS COVERAGE
REMAINS ON COVERAGE. WE KNOW
WHAT THIS MANY LIVES NOT HAVING
BEEN TOUCHED FOR OVER THREE
YEARS. THAT WE KNOW SOME PEOPLE
ARE CURRENTLY RECEIVING SERVICES
THAT DON'T NEED MEDICAL COVERAGE
. FOR EXAMPLE, THEY'LL
TRANSITION TO MEDICARE TO COVER
CALIFORNIA OR THEY HAVE EMPLOYER
BASED COVERAGE THAT ARE COVERED
TO OUR GOALS TO MAKE SURE ANYONE
WHO NEEDS COVERAGE REMAINS ON
COVERAGE. BUT WE ARE
ANTICIPATING THAT ANYWHERE
BETWEEN 1.82 POINT EIGHT MILLION
PEOPLE MAY NO LONGER BE ON
MEDICAL AND SO JUST, UH, KIND OF
FLAGGING THAT, HOWEVER, WE'RE
ALSO TRYING TO DO WHAT WE CAN TO
NOT DISRUPT TRANSITIONS.
IMPORTANT TRANSITIONS. FOR
EXAMPLE, WE ARE DEEP
PRIORITIZING THE ANNUAL RE
DETERMINATIONS FOR INDIVIDUALS
AGED OUT OR WILL AGE OUT OF THE
YOUNG ADULT EXPANSION IN EARLY
2024 REALLY MOVING THEM TO START
THOSE HAPPENING AFTER JANUARY
24TH SO THAT THEY DO NOT LOSE
COVERAGE REALLY, REALLY
CRITICAL? WE ALSO KNOW THAT WE
ARE IN CALIFORNIA, PROPOSING TO
ELIMINATE THE ASSET PIECE COME
JANUARY 24, SO WE CURRENTLY HAVE
A PENDING REQUEST WITH THE
FEDERAL GOVERNMENT FOR US TO
ESSENTIALLY BE ABLE TO WAVE
THOSE ASSETS BETWEEN NOW AND THE
END OF THIS YEAR. UM EVERYBODY
WHO'S ON USING ASSETS ON FILE TO
APPROVE THEM TO ALIGN WITH OUR
JAN 1 24 ASSET ELIMINATION IN
CALIFORNIA, AND WE'RE HOPING TO
HEAR BACK FROM THE FEDERAL
GOVERNMENT REGARDING THAT. SO
THESE CRITICAL POPULATIONS WE'VE
REALLY TRIED TO SEE WHAT WE CAN
DO, AND PARTNERSHIP WITH OUR
COUNTIES AND OUR ADVOCATES. TO
REALLY REDUCE ANY DISRUPTIONS OF
COVERAGE WHERE PEOPLE WILL BE
NEEDING IT AS WE MOVE FORWARD.
ADDITIONALLY IN MID FEBRUARY OF
THIS YEAR, WE DID ANOTHER BIG,
LARGE MAILING THE REASON WHY
THAT'S IMPORTANT. WE DID IT
ABOUT A YEAR AGO TO REALLY
UNDERSTAND HOW MUCH OF OUR
CONTACT INFORMATION IS NOT UP TO
DATE WHEN PEOPLE HAVEN'T
NECESSARILY HAD TO FILE THAT FOR
SUCH A LONG PERIOD OF TIME OR
HAVEN'T FILED IT. WE KNEW THERE
WAS A LARGE RETURN MAIL. WE
DON'T HAVE OUTCOMES OF THAT YET
SINCE WE JUST DID THOSE
MAILINGS, BUT WE SHOULD HAVE
OUTCOMES BY MID APRIL, AND WE'RE
HAPPY TO PROVIDE YOU AN UPDATE
IN REGARDS TO THAT. BUT WE DO
KNOW OUR EXPERT TAKE RATES ARE
INCREASING, WHICH MEANS WE ARE
HAVING BETTER INFORMATION, WHICH
IS GOOD. UM AND SO WE WILL
CONTINUE TO BE LOOKING AT THAT.
THE DEPARTMENT HAS ALSO DONE
EXTENSIVE PROVIDER TRAININGS AND
RENEWAL. FRESH REFRESHERS WITH
OUR COUNTY PARTNERS OVER 2022.
WE CONDUCTED OVER TRAININGS FOR
OVER 1000 PLUS COUNTY
ELIGIBILITY WORKERS TO REALLY
MAKE SURE SOME OF THESE COUNTY
ELIGIBILITY WORKERS HAVE NEVER
ACTUALLY DONE A MEDICAL REEDIT
TERMINATION. SO WE REALLY WORKED
WITH OUR PARTNERS TO BE READY.
WE RECEIVED FROM ALL COUNTIES
COUNTY READINESS PLAN THAT
ASSESSES THE COUNTY'S
OPERATIONAL READINESS IN CORRECT
AERATION FOR THE RE
DETERMINATIONS CONTINUING, WE'VE
BEEN PROVIDING EXTENSIVE
TECHNICAL ASSISTANCE AND WE
ACTUALLY HAVE A SMALL WORKGROUP
WITH C W, D A AS WELL AS SOME
COUNTIES TO REALLY HAVE AN
IMMEDIATE GROUP OF PEOPLE TO
HAVE FEEDBACK ON POLICY. WHAT'S
GOING ON THE GROUND? SO AS THESE
THINGS LAUNCH WILL BE ABLE TO
REALLY TRIAGE AND IMMEDIATELY
COME UP WITH JOINT PLANTS ON HOW
WE'RE GOING TO RESPOND TO THOSE
VARIOUS PIECES. WE'VE ALSO
CREATED A ROBUST COMMUNICATION
STRATEGY TIED TO THIS SO AS WAS
APPROVED IN THE BUDGET LAST YEAR
, $25 MILLION STATEWIDE PUBLIC
CAMPAIGN TO REALLY GET THE WORD
OUT. IN REGARDS TO PEOPLE
UNDERSTANDING THAT THEY NEED TO
RESPOND TO THOSE PIECES COMING
IN. SO WE ARE USING YELLOW
ENVELOPES IN CALIFORNIA, SO EVEN
TRYING TO TAG FOR PEOPLE IN OUR
MESSAGING, TOO. IF YOU GET THAT
YELLOW ENVELOPE IN YOUR IN YOUR
MAIL, YOU SHOULD BE LOOKING AT
IT. WE NEED YOU TO RESPOND. NOW
IT'S GOING TO BE CONFUSING FOR
PEOPLE THAT HAVE NOT HAD TO RE
DETERMINE FOR SO MANY YEARS TO
KNOW. OH, THIS YEAR I NEED TO.
SO WE HAVE BEEN DOING A BROAD
BASED COMMUNICATION TOOLS. WE
HAVE IT IN ALL THRESHOLD
LANGUAGES. WE'VE BEEN POSTING
TOOL KITS. MAKING IT EASY FOR
OUR PARTNERS, WHETHER IT'S
COUNTIES, CLINICS, PROVIDERS,
HOSPITALS, ANYONE, UM,
NAVIGATORS OUT THERE REALLY
COMMUNICATING WITH PEOPLE. WE
LAUNCHED THIS ACTUALLY, IN MAY
OF 2022. WE CALLED OUR COVERAGE
AMBASSADOR PROGRAM AND REALLY
WORKING WITH PEOPLE ON THE
GROUND TO GET THE WORD OUT
ACROSS THE ENTIRE STATE OF
CALIFORNIA, AND SO WE LOOK
FORWARD TO GETTING THOSE PIECES
. ALSO IN THAT MEDIA CAMPAIGN,
IT WILL INCLUDE THINGS LIKE THE
TRADITIONAL MEDIA. DIGITAL MEDIA
, AS WELL AS VARIOUS ADVERTISING
PIECES ACROSS THE STATE OF
CALIFORNIA. THE LAST THING I
WOULD NOTE IS OBVIOUSLY THIS IS
A HUGE, UH, LIFT FOR THE STATE
OF CALIFORNIA. WE WILL BE
PUBLICLY POSTING. WE HAVE BOTH
FEDERAL REPORTING WHEN WE WILL
BE POSTING ON OUR WEBSITE,
COUNTY BACK COUNTY INFORMATION
TO KEEP THE PUBLIC VERY AWARE OF
WHAT'S GOING ON AND WHERE WE ARE
IN REGARDS TO THE RES. READ IT
TERMINATIONS AND THE LAST THING
I WOULD MENTION AS WE WERE VERY
PLEASED TO HEAR FROM CMS ON
MONDAY THAT CALIFORNIA HAS MET
ALL OF THE EXPECTATIONS OF THE
FEDERAL GOVERNMENT IN REGARDS TO
INCLUDE KEEPING OUR ENHANCED
MATCH AS WELL AS THE PHASE,
WHICH IS REALLY, REALLY
IMPORTANT. WE ARE ONE OF VERY
FEW STATES ACTUALLY, WHO HAVE
MET ALL OF THE REQUIREMENTS OF
THE FEDERAL GOVERNMENT AND HAD
NO MITIGATION PLAN NEEDED FOR
THEM, SO WE ARE VERY PROUD OF
THAT AS WELL. GIVEN THE TIME AND
EFFORT THAT WE'VE PUT IN PLACE
FOR THIS THAT CONCLUDES MY
COMMENTS. NEXT WE'LL HAVE KATHY
SYNDROME IN MCDONALDS FROM
EXECUTIVE DIRECTOR OF THE COUNTY
WELFARE DIRECTORS ASSOCIATION.
THANK YOU, MR CHAIR MEMBERS.
KATHY SUNDERLAND. MCDONALD'S CWD
A REALLY APPRECIATE THE
OPPORTUNITY TODAY, AS YOU HEARD
FROM MS COOPER COUNTIES IN THE
STATE HAVE BEEN WORKING IN
PARTNERSHIP TO PLAN FOR THE
UNWINDING SINCE THE COVERAGE
REQUIREMENTS WENT INTO EFFECT IN
MARCH, 2020 SINCE WE DIDN'T KNOW
WHAT THAT TIME HOW LONG THEY
WOULD LAST WE HAVE DONE, UM AT
THE POINT IN TIME IN DECEMBER,
WHEN THE CONSOLIDATED
APPROPRIATIONS ACT THE LINKED
THE UNWINDING FROM THE P A G
LIFT. WE HAD DONE MUCH OF THE
PLANNING WORK TOGETHER ALREADY,
AND WE'RE READY TO SWING INTO
ACTION WITH THE COUNTY BASED
PLANS AND MS COOPER MENTIONED
AND THE OTHER ELEMENTS OF THE
PLAN ONE MAJOR ITEM THAT WE'RE
STILL IN PROCESS OF DISCUSSING
IS RELATED TO THE LIKELY
SIGNIFICANT NUMBER OF FAIR
HEARING REQUESTS THAT WE
ANTICIPATE PEOPLE FILING AS THEY
ARE DISCONTINUED AS YOU HEARD OF
THE ESTIMATE IS BETWEEN 1.8 AND
2.8 MILLION. UH, PRETTY MUCH ALL
OF THOSE FOLKS ARE GOING TO BE
ENTITLED TO REQUEST A HEARING
AND BOTH LJ'S WHO ARE HOUSING,
DSS SOCIAL SERVICES AS WELL AS
OUR COUNTY STAFF. WE HAVE
SPECIFIC STAFF WHO WORK WITH
INDIVIDUALS WHO ARE APPEALING
THE DECISION TO HELP FIGURE OUT
WHAT HAPPENED. IS THERE A WAY
THAT WE CAN ADMINISTRATIVELY
ADDRESSED THE ISSUE OR DO WE
NEED TO PROCEED TO A FULL
HEARING IN WHICH CASE THEY
ACTUALLY PREPARE THE STATEMENT?
THAT WILL BE UTILIZED BY THE
ADMINISTRATIVE LAW JUDGE, AND
THEY NEED TO MAKE THAT
AVAILABLE. THERE'S TIMELINES FOR
THESE THINGS, AND TYPICALLY,
INDIVIDUALS CAN RECEIVE AID
WHILE THEIR CASES PENDING, SO WE
HAVE A REQUEST FROM THE
ADMINISTRATION AND OUR MEETING
WITH THE ADMINISTRATION
REPRESENTATIVES ON THIS ONE TIME
INCREASE OF $44.5 MILLION
GENERAL FUND TO COVER COUNTY
STAFF TIME ASSOCIATED WITH DOING
THIS. OUR CONCERN IS BECAUSE WE
ALSO COVER WITH THE SAME STAFF
CALL WORKS, CAL FRESH CHILD WELL
FAIR. I JUST S ANYTHING ELSE
THAT COULD BE APPEALED. WE'RE
GOING TO GET A BIG BACKUP IF WE
HAVE SUDDENLY A HUGE NUMBER OF
THESE DROPPING IN, AND SO WE
APPRECIATE THAT CONSIDERATION.
SO THAT WE CAN TIMELY HANDLED
THOSE CASES AS WELL AS THE ONE
SO YOU WOULD NORMALLY EXPECT TO
HAVE, AND LIKE I SAID, THAT'S A
TIME LIMITED ISSUE, SO IT'S A
IT'S A ONE TIME REQUEST. UM,
WHERE I WAS ALSO ASKED TO, UM,
TALK A LITTLE BIT ABOUT WHETHER
COUNTIES HAVE THE CAPACITY TO
RESPOND TO THE CALLERS THAT WE
ANTICIPATE. UM I'LL SAY
TELEPHONE WAIT. TIMES VARY BY
COUNTY BY DAY, AND EVEN BY THE
TIME OF DAY AND THE TIME OF THE
MONTH, DEPENDING ON WHAT'S GOING
ON, ESPECIALLY BECAUSE OUR CALL
CENTERS COVER NOT JUST MEDICAL
BUT ALSO TYPICALLY HOW FRESH AND
COW WORKS. UM WE, UH ULTIMATELY
WE HANDLE CALLS ON ALL OF THOSE,
AND IT'S IMPORTANT TO REMEMBER
THAT THE COUNTIES AREN'T
SEPARATELY FUNDED FOR THE CALL
CENTERS. WE APPEAL FUNDS OUT TO
STAFF THOSE OUT OF OUR REGULAR
ALLOCATIONS THAT WE RECEIVE FROM
THE STATE. AND SO IT'S
ESSENTIALLY A BALANCING ACT ARE
COUNTIES ARE ABLE TO SEE THE
METRICS THEY CAN SEE WHEN TIMES
ARE BUSY AND NOT AND MAKE
DECISIONS ON WHO TO HAVE IN THE
OFFICE IN THE BACK OFFICE, JUST
WORKING ON THINGS WHO TO HAVE ON
THE PHONE LINES? UM, BUT THEY
MAY OVER OR UNDERSHOOT AND NEED
TO CORRECT THOSE. AND SO IT'S A
KIND OF A CONCEPT DANCE, AS YOU
MIGHT IMAGINE, BETWEEN THOSE
DIFFERENT PLACES THAT THEY MIGHT
BE ABLE TO STAFF ARE COUNTIES
ALL SAY WE KNOW THAT THERE ARE
AT TIMES LONG HOLD TIMES WERE
COMMITTED TO EXCELLENT SERVICE
AND AS NOTED, AND PRETTY MUCH
EVERY OTHER PANEL YOU'VE HEARD,
WE ARE EXPERIENCING VERY SIMILAR
STAFFING ISSUES AS TO WHAT EVERY
SECTOR HER IS AND I'LL ADDRESS
THAT A LITTLE BIT MORE. BUT I'LL
SAY COUNTIES ARE DEFINITELY
DOING WHAT WE CAN TO ENSURE THAT
ALL OF THE DIFFERENT ASPECTS ARE
COVERED AS WE HEAD INTO WHAT IS
OBVIOUSLY GOING TO BE A REALLY
STRESSFUL TIME FOR A LOT OF
PEOPLE. DID I GET A YELLOW
ENVELOPE? WHAT DO I DO? IT'S
BEEN FOREVER OR MAYBE NEVER THAT
I'VE HAD TO DO THAT. IT COULD BE
WE'D EXPECT IF IT'S A LITTLE
ROUGH AT THE BEGINNING THAT IT
WILL GET BETTER BOTH AS THE
MESSAGE GETS OUT, AND AS OUR
WORKERS, MANY OF WHOM, LIKE YOU
HEARD, I'VE NEVER DONE A RENEWAL
THEMSELVES FROM MEDICAL GET USED
TO THAT PROCESS. YES AND KIND OF
GET MORE OF THAT EXPERIENCE
UNDER THEIR BELT. UM I THINK
THAT'S ONE OF THE REAL KEY
REASONS THAT WE WORKED SO HARD
WITH THE HCS PLANS AND OUR OTHER
ADVOCACY GROUPS TO TRY TO NUANCE
. THE MESSAGE OF AS WE THINK
ABOUT CALL CENTERS WE'VE GOT
SAID EVERYBODY CALL YOUR COUNTY
BECAUSE NO, WE DON'T NEED
EVERYBODY TO CALL THE COUNTY. IN
FACT, THAT WOULD MAKE THE WHOLE
TIMES LONGER. HAVE YOU MOVED.
DID YOU TELL US IF YOU DID, AND
YOU'RE GETTING MAIL FROM THE
COUNTY, THEN IT'S OKAY. WE KNOW
AND YOU DON'T NECESSARILY NEED
TO MAKE THAT PHONE CALL. IF
YOU'VE MOVED OR YOUR INFORMATION
HAS CHANGED AND YOU HAVE HAVEN'T
LET US KNOW YOU COULD CALL.
WE'RE ALSO ENCOURAGING AND
THROUGH THE MESSAGING AND THE
MEDIA PLAN. AS MANY PEOPLE AS
POSSIBLE TO CREATE AN ONLINE
ACCOUNT. THEY GOTTA BENEFITS.
CAL DOT COM. WE TALKED ABOUT
THAT AT THE LAST HEARING IN
DEPTH. THEY'RE ABLE TO MAKE
THEIR ACCOUNT AND THEY CAN
UPLOAD THAT INFORMATION. THEY
CAN MAKE CHANGES TO THEIR
ADDRESS. ALL ONLINE OF THAT
AUTOMATICALLY WILL POPULATE IN
OUR SYSTEM. AND SO ARE THE
WORKERS CAN SEE THAT. SO WE'RE
ENCOURAGING PEOPLE WHO ARE ABLE
TO DO THAT SELF SERVICE. WE KNOW
THAT EVERYONE CAN, WHICH IS WHY
WE HAVE THE IN PERSON OFFICES AS
WELL AS THE PHONE LINES, BUT
JUST MAKING SURE THAT THAT'S
THEIR, UM, I'LL JUST MENTION TO
I'D BE HAPPY TO ANSWER. THIS IS
A QUESTION KNOWING THAT I'M
CLOSE TO TIME. THERE ARE A
NUMBER OF CHANGES THAT BENEFITS
CAL WILL BE MAKING, UM, AGAIN
RELATED TO THE CONVERSATION WE
HAD LAST WEEK ABOUT
PRIORITIZATION OF ENHANCEMENTS
TO THE SYSTEM WOULD BE GLAD TO
TALK A BIT MORE ABOUT THOSE, UM
, AND FINALLY, AS DISCUSSED, YOU
KNOW, WE'VE GOT THE HIRING, UM,
ISSUES WE ARE RECRUITING LIKE
CRAZY. SO IF ANYONE DOES NEED A
JOB, PLEASE GET YOUR FRIENDS TO
GO APPLY. WE'RE ALSO TRYING TO
WORK VERY CLOSELY WITH CAL HR.
THEY ACTUALLY RUN THE HR TO
ENSURE THAT ARE SMALLER AND
RURAL COUNTIES THAT DON'T HAVE
THEIR OWN HR OPERATIONS ARE ABLE
TO MEET MERIT SYSTEMS
REQUIREMENTS AND SO WE'RE
WORKING WITH THEM TO TRY TO
STREAMLINE AS MUCH AS POSSIBLE
RIGHT NOW TO ENSURE THAT WE DO
GET THOSE CLASSES IN TO GET
THEIR TRAINING SO THEY CAN
ACTUALLY DO THE WORK BOTH FOR
INITIAL AND ONGOING ELIGIBILITY.
I MEAN, ALL IN ALL, WE ALSO JUST
FINALLY HAVE A PROPOSAL
REGARDING THE WORKFORCE. THAT'S
PART OF THE BUDGET REQUEST THAT
, UM WHAT HELPED COUNTIES CREATE
PIPELINES FOR THOSE WHO ARE
INTERESTED IN GOING INTO PUBLIC
SERVICE AND SO IN HIGH SCHOOL,
COMMUNITY COLLEGE AND IF
POSSIBLE, PARTNERING, ALSO WITH
FOUR YEAR COLLEGES AND
UNIVERSITIES TO GET A PROGRAM
GOING WHERE THEY COULD COME AND
START TO WORK IN THE COUNTY AND
FIND OUT WHAT THAT'S TRULY LIKE
AND THEN BE READY TO KIND OF HIT
THE GROUND RUNNING UPON
GRADUATING OR HOPEFUL THAT IT
WILL ALSO, UM, PROVIDE US WITH
THE OPPORTUNITY THROUGH THAT
TRAILER BILL LANGUAGE THAT WE'RE
PROPOSING TO UPDATE SOME OF
THOSE CAL HR REQUIREMENTS. AT
THE SAME TIME. THE IDEA IS TO
GET THAT PIPELINE OF INDIVIDUALS
GOING WHO ARE INTERESTED AND
WANT TO KNOW MORE AND ALSO
INCREASE THE DIVERSITY OF OUR
WORKFORCE. BECAUSE STARTING IN
HIGH SCHOOL COMMUNITY COLLEGE WE
THINK WILL BE DRAWING FROM A
BASE OF INDIVIDUALS WHO ARE
QUITE SURE YET WHAT THEY MIGHT
WANT TO DO, EVEN IF THEY END UP
IN A DIFFERENT AREA OF THE
COUNTY. IT SEEMS LIKE IT WOULD
BE BENEFICIAL TO HAVE THAT SORT
OF PUBLIC SERVICE TRACK CREATED,
SO THAT'S OUR BIG IDEA FOR THE
YEAR ON WORKFORCE AND LOOKING
FORWARD TO ANSWERING QUESTIONS.
THANKS NEXT WE WILL HEAR FROM
LAURA SHOP. LECHLER DEPUTY
DIRECTOR OF POLICY AND RESEARCH
AFFAIRS AT WITH CALIFORNIA HELP
PLUS ADVOCATES. THANK YOU. LAURA
SHECKLER WITH THE CALIFORNIA
PRIMARY CARE ASSOCIATION AND
CALIFORNIA HEALTH PLUS ADVOCATES
AH, SO THIS MORNING OR THIS
AFTERNOON OF THE DAY NOW I
WANTED TO TAKE A LITTLE BIT OF
TIME TO TALK SPECIFICALLY ABOUT
THE ROLE OF COMMUNITY HEALTH
NAVIGATORS IN THIS PROCESS OF RE
DETERMINATIONS. I THINK THAT
MOST FOLKS ARE REALLY FAMILIAR
WITH THE IMPORTANT ROLE OF THE
COUNTIES AND THAT MEDICAL
APPLICATION PROCESS BUT PERHAPS
A LITTLE BIT LESS FAMILIAR WITH
THE ROLE OF HEALTH NAVIGATORS IN
COMMUNITY BASED SETTINGS, CBOS
BUT ALSO SPECIFICALLY I WANT TO
TALK ABOUT IN COMMUNITY. HEALTH
CENTERS SPECIFICALLY BECAUSE
THOSE ARE PATIENTS. SO FOR SOME
BACKGROUND, THE CALIFORNIA
PRIMARY CARE ASSOCIATION
REPRESENTS OVER 1300 HEALTH
CENTERS. AS MY COLLEAGUE ELLIE
MENTIONED EARLIER AND THAT
INCLUDES 4.8 MEDICAL
BENEFICIARIES, SO THAT'S ONE IN
THREE MEDICAL BENEFICIARIES ARE
SERVED AT OUR HOUSE HUNTERS OF
THOSE 36% HAVE LIMITED ENGLISH
PROFICIENCY. AH 663. ACTUALLY
SORRY ABOUT THAT 336 INDIVIDUALS
ARE EXPERIENCING HOMELESSNESS
AND NEARLY ONE MILLION ARE
AGRICULTURAL WORKERS. SO WHEN
WE'RE REALLY THINKING ABOUT
WHO'S MOST AT RISK OF FALLING
OFF OF MEDICAL DURING THIS
PREDETERMINATION PROCESS, A LOT
OF THOSE PATIENTS ARE REALLY
SERVED IN THE COMMUNITY HEALTH
SETTING. SO WHEN A PATIENT MAKES
AN APPOINTMENT AT A HEALTH
CENTER COMES IN FOR THEIR VISIT
IF THEY AREN'T CONNECTED TO
COVERAGE ALREADY, THEN THEY ARE
SET UP IN APPOINTMENT WITH AN
ENROLLMENT COUNSELOR. THAT
ENROLLMENT COUNSELOR CAN HELP
THEM UNDERSTAND WHAT BENEFITS
PROGRAMS THEY MIGHT BE ELIGIBLE
FOR WHETHER THAT'S MEDICAL FOR A
MUCH SMALLER POPULATION MAY BE
COVERED CALIFORNIA PERHAPS A
LOCAL COUNTY COVERAGE PROGRAM
FOR UNDOCUMENTED ADULTS, WHICH
MANY OF THOSE PATIENTS WILL
TRANSITION TO FULL SCOPE MEDICAL
NEXT YEAR OR PROGRAMS LIKE
FAMILY PACKED OR EVERY WOMAN
COUNTS, ETCETERA. FROM THERE,
THEY CAN ACTUALLY HELP GO
THROUGH THE APPLICATION PROCESS
AND SUBMITTED ON BEHALF OF THE
PATIENT WHILE THERE WITH THEM,
AND IF WE'RE TALKING ABOUT
MEDICAL, THEY CAN ALSO ACT AS AN
AUTHORIZED REPRESENTATIVES. SO
REALLY BE AN INTERMEDIATE MEDIA
AREA BETWEEN THE PATIENT AND THE
COUNTY WORKER. SO IF ANY
QUESTIONS ARISE, MORE DOCUMENTS
ARE NEEDED WHATEVER IS NEEDED TO
MAKE THAT SUCCESSFUL APPLICATION
. IT DOESN'T HAVE TO GO THROUGH.
THE PATIENT THAT CAN ACTUALLY
WORK WITH THAT AUTHORIZED
REPRESENTATIVE AT THE HOUSE
CENTER, AND THIS IS REALLY KEY
AS WE'RE THINKING AND HEARING
ABOUT SOME OF THE WORKFORCE
CHALLENGES AT THE COUNTY. THIS
IS REALLY AN OPPORTUNITY TO
STREAMLINE THAT PROCESS AND MAKE
IT AS EFFICIENT AS POSSIBLE, AND
PARTICULARLY AGAIN. FOR THOSE
PATIENTS WITH IT. THIS MIGHT BE
A MORE COMPLICATED PROCESS. IF
ENGLISH ISN'T THEIR FIRST
LANGUAGE IF THEY'RE EXPERIENCING
HOMELESSNESS IF THEY HAVE A
NONTRADITIONAL INCOME STREAMS OR
A MIXED STATUS FAMILY, THEN
THESE HEALTH NAVIGATORS CAN
REALLY HELP ENSURE THAT THAT IS
A SUCCESSFUL APPLICATION OR
RENEWAL PROCESS FOR THOSE
PATIENTS. SO IN TERMS OF
RESOURCES FOR THIS LAST YEAR,
THE LEGISLATURE DID APPROVE 30
MILLION GENERAL FUND, WHICH HAD
FEDERAL MATCHING SO 60 MILLION
FOR THE MEDICAL HEALTH
ENROLLMENT NAVIGATORS PROJECT.
UM WHICH IS WONDERFUL, AND WE
APPRECIATE THAT, AND WE ALSO
FEEL LIKE IT IS INSUFFICIENT FOR
THE CHALLENGES THAT WE'RE FACING
THIS YEAR. AND THIS REALLY
HISTORIC NEED SO DURING THE
APPLICATION PROCESS LAST YEAR,
MORE THAN DOUBLE THAT AMOUNT WAS
APPLIED FOR UPWARDS OF 140
MILLION FOR THAT 60 MILLION IN
ALLOCATED FUNDS. AND THEN FROM
THERE, THAT PROGRAM LAST YEAR
WAS CREATED OVER FOUR FISCAL
YEARS. THERE WASN'T ENOUGH
FUNDING FOR THAT, SO IT'S BEEN A
REDUCED DOWN TO THREE YEARS. BUT
EVEN AT THAT AMOUNT, THIS
PROGRAM HAS HISTORICALLY BEEN
FUNDED AT THE AMOUNT FOR TWO
YEARS SO EFFECTIVELY, IT'S A 30%
REDUCTION AND HEALTH NAVIGATOR
FUNDING WHEN WE'RE ABOUT TO SEE
THE LARGEST NEED WE'VE EVER HAD
FOR HEALTH NAVIGATION. SO WE ARE
REALLY LOOKING TO DOUBLE THAT
ASKED FROM LAST YEAR TO MEET
THIS NEED AT THIS POINT, AND UM
THEN, PARTICULARLY FOR COMMUNITY
HEALTH CENTERS, WHILE COUNTIES
WERE REALLY ENCOURAGED TO
PARTNER WITH THEIR COMMUNITY
BASED PARTNERS IN THEIR COUNTIES
, ONLY 33 HEALTH CENTERS
RECEIVED FUNDING THROUGH THE
THROUGH THE NAVIGATORS PROJECT
CURRENTLY AND THAT'S OUT OF
ALMOST 200 HOUSE IN OUR
ORGANIZATIONS WITH 1300 SITES.
SO THIS TINY FRACTION OF HEALTH
CENTERS WHO ACTUALLY SEE ONE
THIRD OF MEDICAL AND ROLLEY'S
ACTUALLY ARE FUNDED TO HELP WITH
THIS ENROLLMENT WORK, SO WE JUST
REALLY WANTED TO HIGHLIGHT THAT
KEY ROLE OF THOSE COMMUNITY
HEALTH NAVIGATORS IN THIS
PROCESS, ALONG WITH THE
IMPORTANT WORK THAT HAPPENS AT
THE COUNTIES AS WELL. THANK YOU.
NEXT WE WILL HEAR FROM LINDA WAY
WITH WESTERN CENTER ON LAW AND
POVERTY. GOOD AFTERNOON, LINDA
WAY WITH WESTERN CENTER ON LAW
AND POVERTY. FIRSTLY WE WANT TO
APPRECIATE THE DEPARTMENT'S
STAKEHOLDER ENGAGEMENT IN THE
UNWINDING AND RENEWAL PROCESS.
IN PARTICULAR, WE WANT TO
COMMEND THE DEPARTMENT FOR ITS
WORK TO DE PRIORITIZE YOUNG
ADULTS SO THAT THEY DON'T AGE
OUT AS WELL AS TO MINIMIZE
COVERAGE INTERRUPTIONS FOR
SENIORS AND PERSONS WITH
DISABILITIES. WITHOUT THIS, MANY
SENIORS AND PERSONS WITH
DISABILITIES WOULD HAVE HAD
THEIR MEDICAL TERMINATE. WAITED
FOR FAILURE TO VERIFY THEIR
ASSETS OR FOR BEING ABOVE THE
CURRENT LIMIT. HOWEVER COVERAGE
TERMINATION CONCERNS REMAIN
ADVOCATES FROM ACROSS THE STATE
ALAMEDA CONTRA COST A SANTA
BARBARA, LOS ANGELES AND
SACRAMENTO TO NAME JUST A FEW
REPORT. COUNTY CALL WAIT TIMES
IN EXCESS OF 30 MINUTES AND
OFTEN MORE THAN AN HOUR
DISCONNECT AND DROPPED CALLS AND
OTHER BARRIERS. THIS IS PRIOR TO
UNWINDING AND BEFORE THE
EXPECTED OR THIRD CALL VOLUMES.
WE WORRY THAT INDIVIDUALS WILL
BE TERMINATED NOT BECAUSE THEY
ARE NO LONGER ELIGIBLE, BUT
BECAUSE THEY CANNOT REPORT THEIR
NEW ADDRESS OR OTHER CHANGES. L
A COUNTY CALL ABANDONMENT RATE
AVERAGE 20% LAST YEAR, MEANING
OVER 100,000 PEOPLE A MONTH GOT
TIRED OF WAITING AND HUNG UP.
EVEN WORSE IN ADDITIONAL 150,000
CALLS PER MONTH WERE SIMPLY
DISCONNECTED BY THE COUNTY
BECAUSE CALL VOLUMES WERE TOO
HIGH. IT'S UNCLEAR HOW MANY
PEOPLE GAVE UP COMPLETELY OR TRY
IT AGAIN. BUT THIS DEMONSTRATES
A DISCOURAGING PROCESS THAT IS
EXPECTED TO BECOME MORE
CHALLENGING. WE APPRECIATE ALL
OF THE DEPARTMENTS. EFFORTS TO
HELP MORE PEOPLE KEEP THEIR
MEDICAL DURING RENEWAL'S,
INCLUDING CHECKING OTHER SOURCES
, LIKE THE THEIR MEDAL, CAL PLAN
FOR CONTACT INFORMATION AND
REQUIRING CONTACT BEYOND MEL, AS
WELL AS THE ABILITY TO MAKE
CHANGES ONLINE THROUGH BENEFITS
, CAL, UM AS MISS SANDERLING
NOTED, THOUGH, AND THAT'S
HELPFUL FOR THOSE WHO CAN USE
IT. NOT EVERYONE CAN UM, THESE
IMPROVEMENTS CANNOT GUARANTEE
CALIFORNIANS WILL KEEP THEIR
COVERAGE UNLESS THE STATE STARTS
TO ADDRESS CRITICAL AREAS. FIRST
IN LIGHT OF THE COUNTY STAFFING
SHORTAGES, THE COMPUTER SYSTEMS
AUTOMATIC CUT OFF FEATURE LOOMS
LARGE. BASICALLY IF A CASE IS
NOT MARKED AS RECEIVED THAN THE
MAD COW WILL AUTOMATICALLY IN
COUNTIES ARE UNDERSTAFFED AND
OVERWORKED. THERE'S NO GUARANTEE
THAT SUBMITTED RENEWAL
INFORMATION WILL BE MARKED AS
RECEIVED IN TIME. AS A RESULT,
1000 RISK ERRONEOUS MEDICAL
CUTOFFS DUE TO THE AUTO
TERMINATION FUNCTIONALITY. IN
PAST YEARS LESS THAN 20% OF
MONTHLY MEDICAL RENEWABLES
RESORT RESULTED AND JUST
CONTINUED ELIGIBILITY SINCE THE
VAST MAJORITY OF RENEWALS RESULT
IN CONTINUED COVERAGE. THE STATE
IN THE LONG TERM SHOULD
IMPLEMENT SYSTEM CHANGES THAT
DOES NOT DEFAULT TO TERMINATION.
SECOND AND, MORE IMPORTANTLY,
THERE NEEDS TO BE SOME SORT OF
HOT FUNCTION WHEN MEDICAL
CUTOFFS EXCEED EXPECTATIONS, AS
WELL AS DATA MEASUREMENTS IN
PLACE TO KNOW WHEN TO STOP
TERMINATION. THIS SHOULD INCLUDE
MONITORING. COUNTY CALL CENTER
METRICS REQUEST FOR STATE FAIR
HEARINGS THE VOLUME OF
PROCEDURAL TERMINATIONS AND
COUNTY STAFFING READINESS
REPORTS. THE BOTTOM LINE IS
GIVEN THE KNOWN CHALLENGES TODAY
THE DEPARTMENT SHOULD BE
PLANNING FOR SOME SORT OF SAFETY
VALVE TO PROTECT MEDICAL
COVERAGE. WE'D ALSO SUPPORT
FUNDING FOR NAVIGATORS AS WE
KNOW THAT THE UNWINDING IS A
VERY SIGNIFICANT PROCESS AS WELL
AS NOTING THAT STARTING 2020
FOR, UM. TO THE CREDIT OF THE
DEPARTMENT, THE LEGISLATURE THE
ADMINISTRATION MET ACCOUNT OF
2024 WILL NOT BE THE SAME, UM
ALL INCOME ELIGIBLE ADULTS,
REGARDLESS OF IMMIGRATION
STATUS, REGARDLESS OF AGE,
REGARDLESS OF ASSET LIMITS WILL
BE ELIGIBLE, AND THAT IS
SOMETHING TO BE COMMENDED AS
WELL AS UM, WORKED TO GET THAT
THE WORD OUT, AND SO THANK YOU.
DEPARTMENT OF FINANCE. THE
DETAILS OF THE DEPARTMENT OF
FINANCE NOTHING FURTHER TO ADD
VALUE. BLUE KUSH MORROW, THE L
A. OH NOTHING FURTHER TO ADD.
THANK YOU BRING IT UP TO THE
DIOCESE FOR ANY MEMBERS
QUESTIONS. I'LL KEEP IT HERE AT
THE CHAIR. IF I CAN. I'D LIKE TO
FOLLOW. BUT IT SEEMS THAT WE
HEARD FROM THE COUNTIES CONCERNS
REGARDING WORKFORCE WE HEARD
FROM CONSUMER ADVOCATES ABOUT
CONCERNS REGARDING CALL, WAIT
TIMES AND ABANDONMENT. AND IN
LIGHT OF US HAVING 1.8 TO 2.8
MILLION CALIFORNIANS WILL BE DIS
ENROLLED FROM HEALTH CARE. HOW
DO WE APPROPRIATELY? MAKE SURE
WE'RE WORKING WITH OUR COUNTY
PARTNERS SO THAT WE CAN RE
DETERMINE THE BEST OF OUR
ABILITY. YES SO I THINK MANY OF
THE THINGS THAT I MENTIONED IN
MY OPENING PIECES. WE'VE DONE A
COMPREHENSIVE READINESS PIECE
WHERE EVERY SINGLE COUNTY HAS TO
WALK US THROUGH HOW THEY'RE
GOING TO BE READY TO ANSWER
THOSE CALLS HOW THEY'RE MAKING
CHANGES TO MAKE SURE THAT PEOPLE
ARE AVAILABLE IN THEIR LOBBIES
TO MAKE ANY NECESSARY
ADJUSTMENTS. UM, WE WILL BE
PUBLICLY REPORTING OUTCOMES OF
EACH OF THE VARIOUS PIECES EVERY
SINGLE MONTH ON OUR WEBSITE AND
THAT WOULD BE BROKEN DOWN BY
COUNTY SOMEONE FOR BROAD PUBLIC.
TRANSPARENCY IN REGARDS TO HOW
THINGS ARE DOING, BUT ALSO SO
THAT WE ARE ABLE TO VERY CLOSELY
MONITOR HOW THINGS ARE GOING
ACROSS THE STATE OF CALIFORNIA.
UM YOU KNOW, WE HAVE WORKED VERY
CLOSELY WITH CWD A AND THE
COUNTIES TO BE READY. THERE WAS
AN AUGMENTATION IN THE BUDGET
LAST YEAR WE HAVE ARE IN RECEIPT
OF THE ADDITIONAL $44 MILLION.
ASK SPECIFIC TO THE STATE FAIR
HEARINGS, BUT I THINK WE'LL JUST
HAVE TO CONTINUE TO WATCH IT
VERY CLOSELY WILL BE ON. WE HAVE
A BI WEEKLY MEETINGS SET SO THAT
AS WE'RE HEARING THINGS IS ON
THE GROUND AS WE'RE SEEING DATA.
WE CAN IMMEDIATELY TRIAGED. WE
ALSO HAVE VARIOUS MITIGATION
PIECES IN PLACE FROM A SYSTEMS
POINT OF VIEW. WE LEARNED A LOT
WHEN WE HAD TO TURN THIS OFF
JUST TO BE CLEAR OF YEARS AGO,
AND SO WE HAVE A LOT OF
CONTINGENCY PLANS IN REGARDS TO
HOW WE CAN MOVE PEOPLE INTO
BUCKETS AT FOR SOMETHING HAPPENS
, YOU KNOW INAPPROPRIATELY, FOR
EXAMPLE, UM AND SO WE'VE BEEN
TRYING TO KIND OF PLAN AND
PREPARE FOR ALL OF THOSE THOSE
VARIOUS PIECES, BUT MAY DIFFER
THE TWO TO KATHY IN REGARDS TO
WHAT THE COUNTIES ARE DOING TO
ENSURE READINESS AT THE LOCAL
LEVEL AS WELL. I WOULD LIKE TO
BRING UP THIS MONTH. CENTRAL AND
MCDONALD'S IF I CAN WRITE, THANK
YOU. SORRY ALL RIGHT. AND WHILE
YOU'RE DOING THAT, MISS SENATOR
LYNN MCDONALD, CAN YOU COMMENT
ON WHY THE DEFAULT TO
TERMINATION? CAN YOU EXPLAIN
WHAT THAT MEANS? AND WHY THAT'S
SET UP AS CHOICE ARCHITECTURE IN
THAT WAY, OR IS THERE A
DIFFERENT WAY THAT YOU MAY
RECOMMEND SURE THAT SO THE, UM
THE AUTOMATIC DISCONTINUANCE
THAT MISS WHITE NOTED, IS, UM, I
BELIEVE IT'S BEEN A FEATURE IN
PRIOR SYSTEMS AS WELL. REMEMBER,
WE'RE IN THE PROCESS OF GOING
FROM ORIGINALLY FOR THEN WE WERE
AT THREE. MOST RECENTLY. NOW
WE'RE IN TWO AND THE AND CAL
WIN, WHICH IS THE OTHER SYSTEM
THAT STILL EXISTS. THERE ARE A
COUPLE COUNTIES AT A TIME
MIGRATING IN THROUGH THE REST OF
THE CALENDAR YEAR. AND BY 2024.
WE'LL ALL BE IN CAL SAWS ALL 58
COUNTIES FOR THE FIRST TIME AND
ONE WORKING SYSTEM, SO THE
KELSO'S WAS ALSO PROGRAMMED IN
THAT WAY. THESE ARE
CONVERSATIONS THAT LIKELY HAD
HAPPENED IN THE DEVELOPMENT
SESSIONS IN WHICH THE HCS AND
CDSS ALSO PARTICIPATE. AND THE
IDEA IS THAT JUST AS AS AS MS
WEI NOTED, IF SOMEONE HAS THE
IDEA IS THAT IF YOU HAVE NOT
RESPONDED AS A BENEFICIARY TO
THE REQUEST FOR INFORMATION AT
THE TIME OF YOUR RENEWAL. WE ARE
REQUIRED UNDER FEDERAL AND STATE
LAW TO MAKE ADDITIONAL ATTEMPTS
TO REACH OUT TO SAY, HEY,
REMEMBER, WE SENT YOU THIS. WE
NEED THIS. ARE YOU THERE? HELLO
HELLO. YOU KNOW IT COULD BE
PHONE CALLS BY MAIL. AND SO WE
DO START THE PROCESS. UM ABOUT
90 DAYS PRIOR TO THE PERSON
BEING ACTUALLY DO FOR THAT
RENEWAL. AND SO THE FIRST STEP
IS THIS EX PARTY WE LOOK OUT. WE
SEE WHAT WE HAVE IN THE
DATABASES AND THEN OUR SYSTEM
ALREADY AT FEDERAL DATABASE AND
THAT THE ANSWER IS YES, YOU ARE.
WE CAN TELL THAT YOU'RE
ELIGIBLE. ALL WE DO IS WE SEND
THEM A LETTER THAT SAYS
CONGRATULATIONS. YOU'RE STILL
ELIGIBLE. THAT'S CALLED THE
HAPPY PATH. RIGHT YOU GET YOUR
LETTER THAT IS NOT IN A YELLOW
ENVELOPE. THE IDEA BEING IF YOU
GET THE YELLOW ENVELOPE, YOU
NEED TO DO SOMETHING IN THE CASE
OF THE HAPPY RENEWAL, WHICH IS
THE PERCENTAGE IS GOING UP AS
YOU'RE HEARING, WHICH IS GREAT
NEWS. THAT WOULD BE NO FURTHER
WORK ON ON PEOPLE'S PART. THEY
GET SET OUT A YEAR AND SO THEN
IF YOU WE CANNOT CONFIRM THAT
YOU'RE ELIGIBLE IF WE CAN'T GET
TO, YES, IN THAT PROCESS, WE
WILL SEND IN THAT YELLOW
ENVELOPE, A FILLED OUT PACKET
THAT SAYS TO THE PERSON WE
WEREN'T ABLE TO FIND YOU
ELIGIBLE. HERE'S WHAT WE HAVE.
AND HERE'S WHAT WE STILL NEED OR
WHAT WE NEED YOU TO VERIFY. SO
THEY'RE TOLD, AND THIS IS
DIFFERENT FROM THE PAST. CREATE
A C A. EVERYBODY JUST GOT A HUGE
BLANK PACKET, AND THEY HAD TO
REMEMBER. WHAT DID I TELL YOU
TELL THEM LAST TIME. I DON'T
KNOW. AND NONE OF THAT EX PARTE
A STUFF HAPPENED. JUST EVERYBODY
GOT THE PACKET. SO NOW IT'S
TAILORED. IT'S THE PERCENTAGE
THAT DOESN'T GET THAT AND IT'S
ALL RENEWAL. AND THEN THAT IS
THE GROUP THAT WE'RE WORRIED.
MAYBE SORT OF USED TO BEING TOLD
THE FIGURE. THAT PACKET, WHICH
THIS ACTUALLY STILL BEEN SET
THROUGHOUT THE ENTIRE LAST THREE
YEARS. WE'VE BEEN CONTINUING TO
DO THAT PROCESS AND SEND THE
PACKETS AND THEY'VE BEEN TOLD.
JUST IGNORE THOSE. YOU DON'T
NEED TO SEND THEM IN. AND SO NOW
WE NEED TO SAY, DON'T IGNORE
THOSE YOU NEED TO SEND IT IN. SO
THERE IS A AN IMPORTANT PART OF
THIS MESSAGING AND A REASON WHY
YOU'RE HEARING NAVIGATORS ARE
GOING TO BE HELPFUL IN ENSURING
THAT WE'RE SPEAKING TO PEOPLE IN
THEIR LANGUAGE AND SENDING THEM
INFORMATION IN THEIR LANGUAGE
THAT THEY SPEAK. THOSE ARE
CRITICAL PIECES TO THIS WHOLE
PUZZLE TO MAKE SURE BECAUSE IF
THEY DON'T SEND ANYTHING, THEY
DON'T RESPOND TO THE CALLS AND
UM OR THE COUNTY RECEIVES IT. IT
DOESN'T MARKET AS HAVING BEEN
RECEIVED. UM THE SYSTEM IS SET
UP TO SET A DISCONTINUANCE FOR
THEM. SO WE'RE STARTING IN APRIL
WITH THIS PROCESS. IF YOU COUNT
90 DAYS OUT JULY WOULD BE THE
FIRST POINT AT WHICH PEOPLE
WOULD START TO BE ACTUALLY
DISCONTINUED AND LOSE COVERAGE.
SO IN APRIL, PEOPLE AREN'T
STARTING TO LOSE COVERAGE RIGHT
THAT IT'S THE PROCESS IS
STARTING. AND SO THE QUESTION IS
OF THOSE INDIVIDUALS WHO, UM,
SEND BACK INFORMATION TO US VIA
THE MAIL OR DROP IT OFF AT AN
OFFICE. WILL THE COUNTY'S GET TO
IT CLEARLY MARKING RECEIVED WILL
BE A HIGH PRIORITY FOR THE
COUNTIES AND WILL BE AND I'M
SURE YOU WILL BE REMINDING THEM
OF THAT AS WELL, EVEN IF THEY'RE
NOT ABLE TO FULLY COMPLETE THE
PROCESS IF THEY'RE IN A COUNTY
THAT HAPPENS TO HAVE HIGHER
VACANCY RATE OR A LARGER, YOU
KNOW, KIND OF AVERAGE NUMBER OF
PEOPLE ON MEDICAL OR WHAT HAVE
YOU ENSURING THAT THE SYSTEM
UNDERSTANDS THAT THEY'VE SENT
THAT PACKAGE BACK IS OBVIOUSLY A
VERY BIG CONCERN. THOSE WHO ARE
ABLE TO GO ONLINE AND SUBMIT THE
REGION TERMINATION ONLINE. IT
WILL MARK AS HAVING BEEN
RECEIVED AGAIN, EVEN IF THE
COUNTY HASN'T PROCESSED IT, SO
THAT'S AN AUTOMATIC THINGS. SO
THERE'S UM THE ONLINE IS A
LITTLE MORE AUTOMATIC. WITH THE
PACKETS BEING MAILED SOMEONE HAS
TO MARKET AS HAVING BEEN
RECEIVED. UM WE'LL ALSO BE
LOOKING AT USING CLERICAL STAFF
TO BE ABLE TO DO THAT AGAIN.
THAT'S SOMETHING THAT YOU COULD
PERHAPS DO AS DATA ENTRY THAT
NECESSARILY HAVING A FULLY
PROCESS AND THEN KIND OF GET
THOSE TO THE ELIGIBILITY STAFF
TO ACTUALLY KEY AND CHANGES AND
ACTUALLY DO AND RUN AHEAD OF THE
PROCESS OF THE RE DETERMINATIONS
. SO WORKFLOW IS GOING TO BE
REALLY CRITICAL HERE AND HAVING
THE COUNTY'S MANAGE THAT UM, WE
I MEAN, CREATE A C A. YOUR PRE,
UM, PANDEMIC. WE HAD 12 MILLION
PEOPLE IN THE PROGRAM, SO IT
WASN'T LIKE WE DIDN'T DO THIS ON
A REGULAR BASIS, BUT THIS IS A
UNPRECEDENTED AMOUNT OF PEOPLE
AND OBVIOUSLY HUGE, HIGH STAKES
. GIVEN THAT WE'VE GOT ONE IN
THREE CALIFORNIANS ON THIS
PROGRAM AT THIS POINT, SO IT'S
VERY IMPORTANT. WE GET THAT I'M
GOING TO FOLLOW UP A LITTLE BIT
IF I CAN. UM HOW AND WHEN WILL
WE KNOW WHEN DISCONTINUANCE IS
MAYBE A PROBLEM IN THIS PROCESS
? HOW WILL THERE BE UPDATES FOR
US WITHIN THE LEGISLATURE? AND
WILL THERE BE AN OPPORTUNITY TO
PAUSE OR TO SLOW DOWN THE
PROCESS? AS WE'RE GOING FORWARD
TO ENSURE THAT WE'RE
APPROPRIATELY DOING THE RE
DETERMINATIONS. MY FEAR IS IF WE
AREN'T RECEIVING INFORMATION,
WE'RE GOING TO BE TERMINATING.
HOW DO WE KNOW OUR SYSTEMS OR
DEVELOPED? MAYBE I COULD SAY A
COUPLE THINGS AND THEN DROP IT
OVER TO MS COOPER, UM, TO SPEAK
FOR THE ADMINISTRATION. BECAUSE
IMPORTANTLY, WE'RE GOING TO DO
WHAT THEY INFORM COUNTIES THEY
NEED TO SO THE GUIDANCE COMES
THROUGH. PH YES, SO IT'S VERY
IMPORTANT THAT WE BE IN STRONG
PARTNERSHIP ON ALL OF THESE TO
BE ABLE TO MITIGATE IF WE SEE
SITUATIONS. MS COOPER NOTED, AND
I THINK IT'S A GOOD POINT THAT
WHEN WE GOT THE REQUIREMENT IN,
I DON'T THINK IT CAME DOWN TILL
APRIL 2020 FOR US TO HAVE HOT
LIKE HALTED ALL DISCONTINUANCE
IS STARTING IN MARCH 2020. WELL
WE'VE ALREADY BEEN DISCONTINUING
PEOPLE. WE HAD TO QUICKLY WORK
TOGETHER TO GO BACKWARDS
BASICALLY AND GET PEOPLE BACK
ON. AND SO IT WAS REALLY I WOULD
SAY THE FIRST TIME THAT I'M
AWARE THAT OUR COMPUTER SYSTEMS
HAD TO WORK SO CLOSELY TOGETHER.
TO KIND OF REVERT PEOPLE OR
GOING FORWARD, THEN AVOID
DISCONTINUANCE IS THERE WAS, FOR
EXAMPLE, UM, A PROCESS THAT HAD
BEEN AUTOMATED AND ONE OF THE
SYSTEMS. TO AUTOMATICALLY
DISCONTINUED PEOPLE BASED ON AN
END DATE. UH COUNTED
AUTOMATICALLY. WHEN SOMEBODY WAS
IN AROSA. PEOPLE EVEN COW WORKS
. THEY GET AN EXTENSION OF THEIR
COVERAGE. AND THEN IT WAS, IT
SORT OF WAS JUST ADDED. AND IT
SAID. WELL IF THEY IF IT WAS
JANUARY ONE, THEY GET SIX MONTHS
AND THEN SO JULY ONE, WE'RE
GOING TO KICK HIM OFF. AND IT
JUST BOOM POPULATED THAT WE
DIDN'T REALIZE THAT IT WAS THAT
AUTOMATIC. AND THEN THIS BIG
GROUP OF PEOPLE DROPPED OFF AND
WELL, WHAT JUST HAPPENED, AND WE
HAD TO KIND OF TRACK BACK. THIS
SYSTEMS HAVE BEEN FANTASTIC AND
WORKING IN STRONG PARTNERSHIP TO
PRIORITIZE THAT TO HELP FIGURE
OUT THIS IS WHAT HAPPENED. THIS
IS HOW MANY PEOPLE ARE AFFECTED
, AND THEN THE MEDS SYSTEM CAN,
YOU KNOW KIND OF SIDE LOAD THEM
BACK IN TO THE SYSTEM THERE'S
DOWN. SIDES WITH THAT, BUT THE
UPSIDE IS THAT THE COVERAGES
EITHER NEVER LOST OR RESTORED
VERY QUICKLY. SO THOSE ARE
CERTAINLY I WOULD IMAGINE SOME
THINGS THAT WE NOW HAVE SOME
PRACTICE AT. SHOULD WE END UP
NEEDING TO USE THAT? I MEAN, OF
COURSE, OUR HOPE IS NOT, AND I
THINK ONE OF THE COMPLICATING
FACTORS IN THIS IS THAT WE DON'T
REALLY HAVE THE RIGHT NUMBER TO
SHOOT FOR. WE HAVE 15 MILLION
PEOPLE, AND WE'VE GOT ESTIMATES
. BUT EVEN THE ESTIMATES ARE
RATHER LARGE. AND SO, UM, WITH
THE DATA THAT WE WILL BE
PROVIDING THROUGH THE SYSTEM TO
THE STATE I MEAN, I DON'T KNOW
THAT YOU'LL BE ABLE TO TRACK IT
IN REAL TIME, BUT IT WILL BE
PRETTY CLOSE AND SO I THINK
WE'LL BE WORKING IN CLOSE
PARTNERSHIP TO BE ABLE TO ANSWER
THOSE QUESTIONS. AND IF IT LOOKS
LIKE IT'S WAY MORE BEING
DISCONTINUED, FOR EXAMPLE, THEN
WE WOULD HAVE THOUGHT WE WANT TO
SAY, HEY, WHAT'S GOING ON AND
KIND OF SEE IF SOME OF THOSE
PRACTICES MIGHT NEED TO BE PUT
INTO PLACE, AND THEN WE'D STAND
READY TO HELP IDENTIFY THOSE
CASES CHANGE OUR PROCESSES DIVE
INTO INDIVIDUAL COUNTIES THAT
MIGHT BE HAVING PARTICULAR
ISSUES ARE OR WHAT HAVE YOU
SORRY THAT WAS LONGER THAN I
EXPECTED TO TALK SO YEAH. NO, I
AGREE. I MEAN, I THINK WE
LEARNED A LOT OF THE SYSTEMS
WHEN WE TURN THINGS OFF BECAUSE
THINGS BROKE AND WE FIGURED
IMMEDIATELY ACTIONS TO RESTORE
PEOPLE INTO COVERAGE. SO WE DO
HAVE A NUMBER OF SYSTEM OF FLAGS
THAT WE'VE BEEN TESTING FOR OVER
EIGHT MONTHS. NOW A MASSIVE
TESTING ACROSS ALL SYSTEMS
SHOULD HAVE A BETTER
UNDERSTANDING IF WE DO HIT A
THRESHOLD WHERE FOR SOME REASON
, NUMBERS AREN'T MAKING SENSE.
PEOPLE ARE BEING DINNER. DIS
ENROLLED IN A DIFFERENT NUMBER
SO THAT WE CAN QUICKLY GET IN
AND MITIGATE AND OUR TEAMS ARE
VERY RARE. READY FOR THAT. AND I
AGREE WITH KATHY. EVERYONE CAME
TOGETHER DURING, UM WHEN THIS
FIRST HAPPENED IN APRIL OF 2022
IMMEDIATELY ADDRESSED, SO I
THINK WE HAVE THOSE SYSTEMS AND
PROCESSES IN PLACE NOW, WHICH IS
GOOD. UM AND THE TEAMS ARE WOULD
BE READY TO KIND OF TO ACT IF
NECESSARY. I THINK THAT PUBLIC
REPORTING WILL BE PRETTY TIMELY.
WE'VE ACTUALLY BEEN WORKING OUT
ALL OF THIS. THE DATA FLOWS FROM
THE COUNTIES WHAT THAT LOOKS
LIKE WE'VE BEEN TRAINING PEOPLE
FOR A LONG TIME NOW. UM IN
PREPARATION FOR THIS PIECE AS
WELL, WHICH WILL BE REALLY
IMPORTANT. THERE WILL BE
SOMEWHAT OF A LAG BECAUSE THERE
HAS TO. WE HAVE TO LET THE
PROCESS HAPPEN BEFORE WE POST
BUT WE'LL BE UPDATING THAT. I
THINK THE OTHER THING, THOUGH I
WOULD MENTION IS THAT THERE ARE
FEDERAL EXPECTATIONS IN THE
OMNIBUS THAT WAS PASSED LAST
YEAR IN REGARDS TO HOW FAST WE
MOVE. WE ARE REQUIRED TO
COMPLETE ALL READ IT
TERMINATIONS WITHIN THAT 14
MONTH TIME PERIOD, AND THERE ARE
EXPECTATIONS IN REGARDS TO THE
TIMELINESS OF OUR ACTIONS OR
THERE ARE SANCTIONS THAT CAN BE
PUT ON THE STATE OF CALIFORNIA.
NYA. AND SO WE WILL OBVIOUSLY BE
WATCHING THOSE PIECES VERY
CLOSELY, AND YOU WILL
COMMUNICATE BROADLY WITH PEOPLE
WHERE WE ARE AND HOW THIS IS
ROLLING. UM YOU KNOW, THERE HAVE
BEEN STATES WHO OPTED INTO THE
EARLY PIECES AS EARLY AS
FEBRUARY. I THINK EVERYONE'S
KIND OF WATCHING TO SEE WHAT'S
GOING TO HAPPEN WITH THOSE
STATES IN APRIL AS WE LAUNCH IN
APRIL FOR RE DETERMINATIONS JUNE
AND THE FIRST DISCONTINUANCE IS
JULY AS CATHY MENTIONED, SO I
THINK EVERYONE'S PAYING
ATTENTION TO STATES WHO WENT
BEFORE US AS WELL. SEE IF WE CAN
LEARN FROM THEM. BUT I THINK
EVERYONE IS VERY COMMITTED TO
DOING EVERYTHING WE CAN TO
ENSURE COVERAGE FOR ANYONE WHO
NEEDS IT. IF I MIGHT JUST I'M SO
SORRY. ONE THING ON THE DATA
THAT I DO WANT TO MENTION THAT I
THINK IT'S IMPORTANT THAT PEOPLE
UNDERSTAND BECAUSE OF THE SPEED
WITH WHICH THE FEDERAL
GOVERNMENT AND THAT ACT REQUIRES
THE REPORTING. THERE'S ONE PIECE
OF THE DISCONTINUANCE IS THAT'S
GOING TO BE REPORTED A LOT
FASTER THAN IT USUALLY IS IN THE
DATA THAT YOU SEE PUBLICLY TODAY
, LIKE ON THE DASHBOARD OF THE
OPEN DATA PORTAL. TYPICALLY WE
LAG THE DISCONTINUANCE DATA FOR
90 DAYS. BECAUSE WHEN SOMEONE
HAS DISCONTINUED TODAY, AND
AFTER APRIL TWO, THEY'LL BE ABLE
TO COME BACK WITHIN 90 DAYS AND
SAY IT WAS BECAUSE THEY DIDN'T
RETURN THE PACKET. THEY CAN COME
BACK AND WE ESSENTIALLY PUT THEM
BACK ON NO HARM, NO FOUL AS IF
THE PACKAGE HAD BEEN SENT. AND
SO THEY HAVE THAT 98 USED TO BE
30 BEFORE THE AFFORDABLE CARE
ACT. IT WAS LIKE IN THE
NINETIES. SO IF YOU THINK ABOUT
IT IN APRIL WE START 90 DAYS
EARLY AND THEN IN JULY, YOU HAVE
90 DAYS AFTER SO THE WHOLE
PROCESS COULD ACTUALLY BE SIX
MONTHS BEFORE IT FULLY GETS
PLAYED OUT FOR ONE PERSON OR ONE
CASE BECAUSE THE FEDERAL DATA
REQUIREMENTS THEY'RE MAKING US
REPORT A LOT FASTER THAN 90 DAYS
WILL NOT HAVE LAPSED, SO WE DO
KNOW I THINK HISTORICALLY PRE
PANDEMIC WE COULD LOOK AT THE
TURN. UNTIL YOU HISTORICALLY
EXPERTS THAT WOULD DROP OFF AND
THEN OF THEM THIS MANY PEOPLE
WOULD COME BACK OVER THAT TIME
FRAME SO WE COULD LOOK TO SEE,
YOU KNOW, I THINK THERE'S A LOT
OF HISTORIC DATA THAT WE COULD
LOOK AT, UM, ENVIRONMENT NOT BE
QUITE AS VALID SINCE THE
PANDEMIC KIND OF CHANGED A LOT
OF THINGS THAT THE NUMBERS ARE
SO HIGH RIGHT NOW, BUT AT LEAST
WE HAVE SOMETHING TO LOOK AT.
BUT JUST SO YOU KNOW, YOU'RE
GOING TO GET THE MUCH QUICKER
NUMBER AND THAT DOESN'T INCLUDE
PEOPLE WHO WOULD HAVE JUST ON
THE NATURAL COME BACK BECAUSE WE
ALWAYS HAVE SOME TURNOVER AND
CHURN DURING THAT EXTRA 90 DAYS.
SO HOPEFULLY THAT'S HELPFUL. WE
ACTUALLY STILL POST THE CHURN
REPORT. IT'S A LITTLE DIFFERENT
, BUT WE DO HAVE ALL OF THE
HISTORICAL TURN WITHIN THE 90
DAY OR WITHIN A 12 MONTH PERIOD
. WE LEARNED A LOT DURING COVID
GAVE US A LOT OF TIME TO ANALYZE
THEIR ELIGIBILITY DATA WILL
CONTINUE TO UPDATE THAT MONTHLY,
TOO. JUST SO YOU GET BOTH
PICTURES OF THAT CATCH UP PERIOD
THAT KATHY'S MENTIONING AS WELL
AND I DO APPRECIATE THAT CLOSE
COMMUNICATION WITH THE
LEGISLATURE. I THINK MANY OF US
SHARE THAT CONCERN THAT SINCE WE
FOR OVER EUROPE AND TELLING THEM
NOT TO FILL OUT THIS FORM THAT
WE APPROPRIATELY ARE DOING THAT
OUTREACH AND EDUCATION AND NO,
WE HAVE A CAMPAIGN TO DO IT, BUT
SIMPLY WANT US ATTUNED TO THE
DAILY UM, RE DETERMINATION
PROCESS SO WE CAN UNDERSTAND
WHETHER THERE'S WORKFORCE
INVESTMENTS WE NEED TO BE MAKING
TO ADDRESS WHAT'S HAPPENING IN
REAL TIME. AND SO WITH THAT, I
WILL. THANKS VERY MUCH THIS
PANEL AND WE WILL MOVE ON TO
ISSUE EIGHT. OKAY? ISSUE EIGHT
IS ON THE MANAGED CARE
ORGANIZATION TAX. WE WILL BEGIN
WITH DIRECTOR BOSS. GOOD
AFTERNOON. THE GOVERNOR'S BUDGET
PROPOSES A MULTIYEAR MANAGED
CARE TAX STARTING JANUARY 1ST
2024 THROUGH THE END OF 2026. IT
BRINGS IN ABOUT TWO BILLION IN
ANNUAL GENERAL FUND TO OFFSET
COSTS AND THE FRAMEWORK IS VERY
SIMILAR TO THE MODEL THAT
EXPIRED AT THE END OF 2022. IN
THE IN THE EIGHT PAGES. WE
SIGNAL THAT WE ARE CONTINUING TO
WORK ON THIS MODEL AND REALLY
WANT TO MAXIMIZE OUR OPPORTUNITY
TO DRAW DOWN FEDERAL DOLLARS AND
HAVE BEEN WORKING CLOSELY WITH
CMS ON VARIOUS KIND OF SCENARIOS
AND MODELS AND FRAMEWORK TO
REALLY MAXIMIZE THE OPPORTUNITY
FOR CALIFORNIA AND WE WILL BE
COMING FORWARD WITH A FUTURE
PROPOSAL ON THIS, UH, BY THE MAY
REVISION. DEPARTMENT OF FINANCE.
KENDRA TOLD THE DEPARTMENT OF
FINANCE. I THINK WE JUST WANTED
TO ECHO THE DEPARTMENT'S
COMMENTS. THE ADMINISTRATION
CONTINUES TO WORK TOGETHER TO
EVALUATE THE PROPOSAL TO TAX
PROPOSAL AND, UM YOU KNOW ANY
INCREASE BEYOND WHAT IS PROPOSED
GOVERNOR'S BUDGET AND WE'RE
LOOKING FORWARD TO PROVIDING THE
LEGISLATURE ADEQUATE TIME TO
REVIEW AT MAYOR VISION. THANK
YOU. HELLO JASON KANSEN TOURO,
CELIO. WE HAVE TWO KEY MESSAGES
FOR THE LEGISLATURE. THE FIRST
IS THAT WE THINK THAT THE
ADMINISTRATION'S OVERARCHING
GOAL OF RENEWING THE ATTACKS AS
MERIT AND WARRANTS LEGISLATIVE
CONSIDERATION. THE EMC ATTACKS
HAS BEEN A KEY SOURCE OF SUPPORT
FOR THE MEDICAL PROGRAM AND
HISTORICALLY HAS PROVIDED A
SUBSTANTIAL BENEFIT TO THE
GENERAL FUND AND A RELATIVELY
LOW COST OF THE HEALTH INSURANCE
INDUSTRY. WE ALSO THINK THE
ADMINISTRATION'S INTERESTED IN
INCREASING THE TAX ALSO HAS
MERIT GIVEN THE STATE'S EXISTING
BUDGET PROBLEM. SECOND WHILE WE
THINK THE OVERARCHING PROPOSAL
HAS MERIT KEY DETAILS OF THE
PROPOSAL STILL REMAIN
OUTSTANDING, MOST NOTABLY THE
OPPORTUNITIES THAT THE
ADMINISTRATION IS CONSIDERING TO
FURTHER INCREASE THE TAX. WE
RECOMMEND THE LEGISLATURE
CONTINUE TO WORK WITH THE
ADMINISTRATION TO GET
INFORMATION ON THAT, AND THEN
REGARDLESS OF WHAT THE PROPOSAL
IS, WE RECOMMEND THE
LEGISLATURE. UH GET INFORMATION
FROM THE ADMINISTRATION ON THE
TAXES OVERALL FISCAL IMPACT TO
THE GENERAL FUND AND TO THE
HEALTH INSURANCE INDUSTRY. AND
THEN ALSO, UH, GET UPDATED
ANALYSIS TO ENSURE THAT ANY
PROPOSAL IS LIKELY TO MEET
FEDERAL REQUIREMENTS. THANK YOU.
THANK YOU. I WILL BRING IT UP TO
THE DIASPORA. ANY MEMBERS
QUESTIONS I WILL KEEP IT HERE AT
THE CHAIR. IF I CAN. FIRST I'M
GOING TO BE VERY SUPPORTIVE OF
THE M CEO TAX. I UM I WOULD LIKE
TO SEE IT IMPLEMENTED AS QUICKLY
AS WE CAN AS IT EXPIRED IN
DECEMBER OF THIS PAST YEAR. UM,
AND SO I HOPE THE ADMINISTRATION
IS ABLE TO CLOSE FIND EMC
ATTACKS THAT'S LARGER THAN THE
ONE ORIGINALLY PROPOSED, AS WELL
AS IT GETS IMPLEMENTED SOONER.
AND WITH THAT, I WILL THANK YOU
VERY MUCH THIS PANEL AND WE'LL
MOVE ON TO ISSUE NOW. ISSUE NINE
IS ON A TRAILER BILL RELATED TO
THE CCS, WHOLE CHILD MODEL
EXPANSION AND MANDATORY CARE AND
ROLL MINT OF FOSTER CARE,
CHILDREN AND SINGLE PLAN
COUNTY'S FIRST WE WILL BEGIN
WITH DIRECTOR COOPER THANK YOU
SO MUCH. THE DEPARTMENT OF
HEALTH CARE SERVICES PROPOSES TO
IMPLEMENT THE CALIFORNIA
CHILDREN'S SERVICES WHOLE CHILD
MODEL IN THE 15 COUNTIES,
CONVERTING TO THE COUNTY
ORGANIZED HEALTH SYSTEM OR WHAT
WE CALL COZ AND SINGLE PLANNED
MODELS AS A PART OF THE COUNTY
MODEL CHANGE GOING LIVE IN 2024
, AS WELL AS THE MANDATORY
ENROLLED FOSTER CHILDREN IN
SINGLE PLAN COUNTIES IN ORDER TO
ALIGN THE POLICIES IN ALL
MANAGED MEDICAL PLANS. UM, THAT
HAVE ONE UH PLAN FOR LIKE THE
DESCRIPTION. THERE ARE
APPROXIMATELY 173,000 CHILDREN
IN CCS WITH A LITTLE UNDER
31,000 OR 18% IN THE WHOLE CHILD
MODEL. UM THIS WOULD BRING THE
TOTAL COUNT OF WHOLE CHILD MODEL
COUNTIES TO 36 AROUND 47,000
CHILDREN OR 27% OF THE CCS
CHILDREN AND WHOLE CHILD MODEL.
WITH THE EXISTING WHOLE CHILD
MODEL MANAGED CARE PLAN
SCHEDULED TO EXPAND TO THE NEW
COUNTIES IN 2024. THIS MAKES
SENSE TO FURTHER ALIGN THE WHOLE
CHILD MODEL IMPLEMENTATION WITH
THAT EXPANSION THAT WAS VETTED
AT THE LOCAL LEVEL. ONE THING TO
REMIND THE COMMITTEE OF IS THAT
, UM EACH LOCAL ENTITY OF DID A
FULL VETTING AT THE LOCAL LEVEL
AND PASS AN ORDINANCE IN ORDER
TO CHOOSE TO CHANGE THEIR MODEL
TO EITHER COZ OR TO A SINGLE
PLAN. UM YOU KNOW, AT TWO TO
KIND OF DRIVE IN A LINE ON THAT
REGARD, UM, REQUIRING THE
EXPANDING WHOLE CHILD MODEL
MANAGED CARE PLANS TO OPERATE
TWO SEPARATE DELIVERY SYSTEMS
FOR CCS CHILDREN WOULD WOULD
LIKELY RESULT IN AN INCREASED
OPPORTUNITY OF AIR CONFUSION AND
ALL PLANS. SO FOR EXAMPLE,
PARTNERSHIP HEALTH PLAN HAS A
NUMBER OF COUNTIES THAT ARE
ALREADY CARVED IN TODAY,
PROVIDING THOSE SERVICES AND SO
WE DON'T WANT THERE TO BE
CONFUSION FOR PROVIDERS ON THE
GROUND FAMILIES OR COUNTIES IN
REGARDS TO WHICH COUNTIES ARE
CARVED IN OR OUT FOR ONE MANAGED
CARE PLAN WHO'S CURRENTLY
OVERSEEING, AND THAT'S WHY WE'RE
PROPOSING TO A LINE WHERE THE
COUNTIES HAVE ELECTED TO ADD TO
THOSE CODES ARE MANAGED CARE
PLANS TO ALIGN THE POLICY ACROSS
THOSE VARIOUS COUNTIES. UM WE
PROPOSED TO TAKE A PHASED
APPROACH FOR THE IMPLEMENTATION
BASED ON DISCUSSIONS WITH PLANS
AND DIRECTLY WITH THE COUNTY
PARTNERS IN REGARDS TO THIS.
THIS GIVES THE INDEPENDENT
COUNTIES MORE TIME TO TRANSITION
FUNCTIONS TO THE MANAGED CARE
PLAN, JUST FOR SOME BACKGROUND
THE WAY THE CCS PROGRAM AND
ADMINISTRATIVE WE HAVE
INDEPENDENT COUNTIES AND WE HAVE
DEPENDENT INDEPENDENT COUNTIES
WHERE THE COUNTY'S PERFORM ALL
THE VARIOUS FUNCTIONS THEMSELVES
FOR CCS. DEPENDENT IS WHERE THE
STATE OF CALIFORNIA ACTOR
PROVIDES THE MAJORITY OF THE
SERVICES WHILE SOME SERVICES ARE
BEING PROVIDED JUST SOME CARE
COORDINATION SERVICES BY THE
COUNTY THEMSELVES, BUT IT IS
LIMITED. UM UH, FOR PHASE ONE.
WE WOULD BE IMPLEMENTING WHOLE
CHILD MODEL IN 10 CODE EXPANSION
COUNTIES FOR ANY OF THE
DEPENDENT COUNTIES LESS OF AN
IMPACT TO THE COUNTY PARTNERS,
AND THAT WAS BASED ON THEIR
REQUESTS AND FEEDBACK TO US IN
THE STAKEHOLDER ENGAGEMENT THAT
WE DID FOR THIS PROPOSAL. I
WOULD ALSO NOTE THAT 11 OF THE
15 COUNTIES FOR POSED TO NEWLY
IMPLEMENT THE WHOLE CHILD MODEL
ARE DEPENDENT COUNTY SO THAT
SMALLER IMPACT TO OUR COUNTY
PARTNERS THAT I NOTATED EARLIER
IN PHASE TWO. WE WOULD IMPLEMENT
WHOLE CHILD MODEL EXPANSION INTO
CAS EXPANSION COUNTIES, SO THAT
IS WHERE THE INDEPENDENT
COUNTIES EXIST BY JAN. ONE OF
2025. THE DEPARTMENT IS AIMING
TO RELEASE THE INDEPENDENT
EVALUATION OF THE WHOLE CHILD
MODEL BY THE END OF THIS MONTH
DUE TO DELAYS WITH A D A AND D
IDENTIFICATION. IT IS A VERY
LENGTHY REPORT, AND SO WE DO
APOLOGIZE FOR THE DELAY IN
GETTING THAT POSTED ON TWO D HCS
S WEBSITE DUE TO THE DELAYS OF
RELEASING THE REPORT, HOWEVER,
DHC S HAS SEPARATELY BRIEFED THE
LEGISLATIVE STAFF, THE CCS
ADVISORY COMMITTEE. THE WHOLE
CHILD MODEL PLANS THE LOCAL
HEALTH PLANS OF CALIFORNIA
ASSOCIATION AS WELL AS ARCHIE.
JACK MEMBERS OF THE RESULTS OF
THAT EVALUATION. THE DEPARTMENT
CONTRACT ID WITH THE UNIVERSITY
OF CALIFORNIA, SAN FRANCISCO
INSTITUTE FOR HEALTH POLICY
STUDIES TO CONDUCT AN
INDEPENDENT EVALUATION, WHICH
WAS REQUIRED AS OF SB 5 86. THE
EVALUATION ORGANIZED BY RESEARCH
QUESTIONS THAT ADDRESS EACH OF
THE EVALUATIONS. UH QUESTIONS
IDENTIFIED IN STATUE. THE
DEPARTMENT'S DECISION TO PROCEED
WITH PROPOSING THE
IMPLEMENTATION OF THE WHOLE
CHILD MODEL IN THE ADDITIONAL
COUNTIES WITH SUPPORTED BY THE
RESULTS AND CONCLUSIONS
IDENTIFIED IN THE INDEPENDENT
EVALUATION DONE BY UCSF. THE
EVALUATION REPORT IDENTIFIED
THAT THE WHOLE CHILD MODEL HAD
SIMILAR OR THE SAME RESULTS AS
CLASSIC CCS, UM OR AN IMPROVED
IMPACT TO THE MAJORITY. NOT ALL
BUT THE MAJORITY OF THE CCS
CLIENT PARTICIPANTS ACROSS THE
MAJORITY OF THE VALUATION
MEASURES. AS COMPARED TO CLASSIC
CCS CLIENTS. THE EVALUATION
CONCLUDED THAT THE CCS WHOLE
CHILD MODEL MAINTAINED SERVICES
AND PROVIDED CCS LEVEL QUALITY
OF CARE FOR THE MAJORITY OF CCS
CLIENTS IN THE WHOLE CHILD MODEL
SHOWED INCREASED ACCESS TO CCS
PANEL PROVIDERS. LOWER
GRIEVANCES, STREAMLINED DME
REFERRALS AND TIMELINES FOR CCS
INDIVIDUALS. SATISFACTION WAS
UNCHANGED OR IMPROVED FOR THE
MAJORITY OF MEMBERS. UM QUALITY
, MAINTAINED THE SAME, AND HE
DOES MOSTLY IMPROVED OR STAYED
THE SAME AS COMPARED TO CLASSIC
69% WERE USUALLY OR ALWAYS ABLE
TO GET AS MUCH HELP AS NEEDED OR
WANTED. I WOULD NOTE THAT WHILE
THERE WERE SOME VERY POSITIVE
OUTCOMES OF THE WHOLE CHILD
MODEL, THERE ARE TWO AREAS OF
IMPROVEMENT THAT THIS DEPARTMENT
WILL BE FOCUSED ON IN REGARDS TO
THE OUTCOMES. THE FIRST ONE HAS
TO DO WITH CCS ENROLLMENT. ON
AVERAGE, THE APPLE ABSOLUTE
DIFFERENCE BETWEEN THE WHOLE
CHILD MODEL IN THE CLASSIC CCS
COUNTIES FOR NEW REFERRALS WAS
AROUND 1 TO 2% OF A DIFFERENCE
ONE OF THE PIECES THAT WE WERE
HELD STRONG TO IN REGARDS TO OUR
NEGOTIATIONS AND SB 5 86 IS HOW
IMPORTANT WAS TO CONTINUE TO
HAVE CHILDREN WHO ARE CCS
ELIGIBLE TO BE SCREENED IN
REFERRALS AND CONTINUE TO HAVE
THAT MANY OF THEIR PROTECTIONS
THAT WERE NEGOTIATED IN 5 86
WERE REALLY MEANT TO ENSURE THAT
THOSE PROTECTIONS ARE IN PLACE
ALSO IN MANAGED CARE, SO THE
DEPARTMENT IS VERY COMMITTED TO
CONTINUING TO WORK ON THOSE
PIECES, IMPROVEMENTS HAVING
CONVERSATIONS WITH OUR MANAGED
CARE PLANS IN REGARDS TO HOW
THAT WE CAN MAKE SURE THAT
CHILDREN WHO ARE CCS ELIGIBLE
CONTINUE TO BE REFERRED AND
ENROLLED WHEN THEY'RE ELIGIBLE.
ADDITIONALLY A CARE COORDINATION
, THIS ONE. I WOULD NOTE, THOUGH
THE OUTCOME SHOWED THAT BOTH
NEED IMPROVEMENT, BOTH THE
CLASSIC CCS AS WELL AS WHOLE
CHILD MODEL IN REGARDS TO
COORDINATING SERVICES FOR THESE
CHILDREN, SO WE'LL BE LOOKING
ACROSS BOTH THE CCS CLASSICS, UM
, BENEFICIARIES IN OUR CALLUM UM
WORKGROUP WHO'S FOCUSED ON CCS
IMPROVEMENTS FOR THAT AREA, AS
WELL AS IN WHOLE CHILD MODEL TO
MAKE SURE THAT WE'RE IMPROVING.
ONE THING I WOULD KNOW IS COME
JULY ONE OF THIS YEAR WILL BE
LAUNCHING THE ENHANCED CARE
MANAGEMENT PROPOSAL FOR CHILDREN
, WHICH WE ARE HOPING WILL HELP,
ESPECIALLY WITH THOSE MOST
COMPLEX KIDS. ONE OF THE THINGS
THE EVALUATION SHOWED IS THAT
FOR THOSE MOST COMPLEX, THEY
STILL NEED A HIGHER TOUCH OF
CARE. COORDINATION WE'RE REALLY
HOPING THAT ENHANCED CARE
MANAGEMENT WILL BE THAT OPTION
FOR THOSE FAMILIES, AND WE CAN
SEE THOSE WERE ALSO HOPING THAT
MANY OF OUR CCS PANEL PROVIDERS
WILL BE OF THOSE ENHANCED CARE
MANAGEMENT, UH, ENTITIES TO BE
ABLE TO PROVIDE THAT. COMPLEX
COORDINATION FOR THOSE CHILDREN
. UM REGARDING CSS, UH,
REIMBURSEMENT WHEN A COUNTY
TRANSITIONS FROM FIFA SERVICE TO
THE WHOLE CHILD MODEL EXISTING
LAW REQUIRES. THAT MEANT A
MANAGED CARE PLANS PAID THE
PHYSICIAN AND THE SURGEON
PROVIDED THAT EQUAL BUMPS. SO IN
CCS, WE DO HAVE WHAT'S CALLED
THE CCS BUMP FOR THOSE
PHYSICIANS THAT WAS CODIFIED
INTO STATUTE THAT THAT ALSO
APPLIES IN WHOLE CHILD MODEL AND
IS REQUIRED FOR THAT TO BE PAID.
UNLESS AGREED UPON TO A
DIFFERENT RATE WITH THE PROVIDER
DIRECTLY BETWEEN THE MANAGED
CARE PLAN AND THOSE PROVIDERS,
OF COURSE, UNDER THE HOSPITAL
QUALITY ASSURANCE, VÆ
SUPPLEMENTAL PAYMENT PROGRAMS.
THE METHODOLOGY DETERMINE THE
AMOUNT OF SUPPLEMENTAL PAYMENTS
TO HOSPITALS IN THE FEE FOR
SERVICE DELIVERY SYSTEM INCLUDE
FACTORS THAT ACCOUNT FOR THE
HIGHER ACUITY, STAYS OR SERVICES
WHILE UNDER THE MANAGED CARE
DIRECTED PAYMENTS, AS CURRENTLY
DESIGNED OR FURTHER IS THE SAME
PER DIEM. ADAM FOR EVERY PIECE.
I THINK THAT'S WHY YOU'RE HERE
THAT THERE ARE SOME CONCERNS.
EARNS FROM A HOSPITAL FINANCING
POINT OF VIEW. THE TRANSITION
FROM FIFA SERVICE TO MANAGE CARE
. THE DEPARTMENT OF HEALTH CARE
SERVICES HAS BEEN WORKING WITH C
H J FOR QUITE SOME TIME IN
REGARDS TO THE CALIFORNIA
HOSPITAL ASSOCIATION. SORRY NOT
TO USE ACRONYMS. HER QUITE SOME
TIME IN REGARDS TO HOW WE'RE
THINKING ABOUT THOSE HOLLOW
HOSPITAL QUALITY ASSURANCE, VÆ
PAYMENTS AND PIECES THAT WE CAN
DO TO ACKNOWLEDGE THAT ACUITY
THAT IS IMPACTING ESPECIALLY FOR
OUR CHILDREN'S HOSPITALS, WHICH
I KNOW YOU WILL HEAR ABOUT IN A
MOMENT, SO THE DEPARTMENT IS
COMMITTED TO WORKING WITH OUR
HOSPITAL PARTNERS TO MODIFY THE
STRUCTURE OF THE MANAGED CARE
DIRECTED PAYMENT PROGRAMS TO
ACCOUNT FOR THESE DIFFERENCES IN
REGARDS TO HOW IT'S PAID FOR ON
THE FEE FOR SERVICE. VERSUS THE
MANAGED CARE SIDE, AND THAT
WOULD INCLUDE BOTH THE INPATIENT
OUTPATIENT COMPONENTS OF THOSE
PAYMENTS. UM HOWEVER, I WOULD
KNOW UNDER THE FIFA SERVICE
PROGRAM. THESE PAYMENTS ARE
BASED ON HISTORICAL UTILIZATION,
WHICH MEANS THE IMPACTS OF THE
TRAILER BILL ON UTILIZATION WILL
NOT BE REALIZED, AT LEAST UNTIL
CALENDAR YEAR 2026 FOR OUR
HOSPITAL PARTNERS. UM IN FACT,
IN CALENDAR YEAR 24 THE COUNTIES
WHERE WHOLE CHILD MODEL IS
EXPANDED, HOSPITALS WOULD
RECEIVE SUPPLEMENTAL PAYMENTS
UNDER THE FEE FOR SERVICE
PROGRAM BASED ON CALENDAR YEAR.
21 UTILIZATION WHEN CCS REMAINED
IN FEE FOR SERVICE, UM, AND WITH
RECEIVE THE SUPPLEMENTAL
PAYMENTS UNDER THE MANAGED CARE
DIRECTED PAYMENT ON THOSE
CALENDAR YEAR, 24 UTILIZATION
WHEN MEMBERS RECEIVE CARE UNDER
WHOLE CHILD MODEL AGAIN, VERY
FOCUSED ON WORKING WITH OUR
HOSPITAL PARTNERS TO MITIGATE
THOSE TRANSITIONS. BUT GIVEN
THOSE VARIOUS PIECES, WE DO FEEL
LIKE THERE IS A TRANSITION
PERIOD AS WE CONTINUE TO MOVE
FORWARD IN REGARDS TO THOSE
VARIOUS PIECES, AND I THINK
YOU'LL HEAR FROM THE CHILDREN'S
THE CALDERON CHILDREN'S HOSPITAL
ASSOCIATION THEIR CONCERNS WITH
THOSE FINANCES. WE'VE HAD
CONVERSATIONS TO DISCUSS IN
REGARDS TO THOSE PROPOSALS. THE
TWO BIGGEST FACTORS THAT WE'VE
HEARD. IS THIS FINANCIAL IN
TRANSITION FROM PEOPLE FOR
SERVICE TO MANAGE CARE, AS WELL
AS THE REFERRALS TO CCS, WHICH
IS A DRIVER IN REGARDS TO MANY
OF THOSE COMPONENTS OF HOW THOSE
ACUITY FACTORS IN THEIR PAYMENT
WORK. HAVING THAT CCS
DESIGNATION WILL HELP IN REGARDS
TO THOSE ACUITY ASSESSMENTS AND
PAYMENT STRUCTURES THAT WE WOULD
BE WORKING TO IMPLEMENT IN THE
FUTURE. SO AGAIN, HAPPY TO
ANSWER ANY QUESTIONS THAT YOU
ALL MAY HAVE. WHEN THE TIME IS
RIGHT. NEXT WE WILL HEAR FROM
ANN LOUISE COONS, PRESIDENT AND
CEO OF CALIFORNIA CHILDREN'S
HOSPITAL ASSOCIATION. THANK YOU,
MR CHAIRMAN. UM I WANT TO START
BY JUST POINTING OUT THAT
CALIFORNIA CHILDREN'S HOSPITAL
ASSOCIATION. WE REPRESENT THE
EIGHT FREESTANDING NOT FOR
PRIVATE CHILDREN'S HOSPITALS IN
THE STATE OF CALIFORNIA. WE ALSO
OPERATE 175 CCS SPECIAL CARE
CENTERS. AND 68% OF ALL CCS.
INPATIENT CLAIMS ARE
ATTRIBUTABLE TO ONE OF OUR
MEMBERS. WE PROVIDE SOME OF THE
HIGHEST ACUITY, PEDIATRIC CARE
IN THE IN THE STATE. UH 64% OF
ALL PEDIATRIC CANCER CARE IS
PROVIDED BY OUR HOSPITAL 73% OF
ALL PEDIATRIC ORGAN TRANSPLANTS
AND 75% OF ALL PEDIATRIC CARDIAC
SURGERIES IN THE STATE, UM, ARE
PROVIDED BY OUR HOSPITALS. PRE
PANDEMIC. WE ALSO STAFFED 57% OF
ALL PEDIATRIC INTENSIVE CARE
BEDS IN THE STATE. THAT'S
PROBABLY MORE THAN THAT NOW,
BECAUSE, AS YOU KNOW, DURING THE
PANDEMIC, A LOT OF COMMUNITY
HOSPITALS SHUT DOWN THEIR THEIR
PEDIATRIC UNITS. UM TWO THIRDS
OF OUR PATIENTS ARE COVERED BY
MEDICAL, WHICH IS TWICE THE
AVERAGE FOR COMMUNITY HOSPITAL.
UM, CCS IS A IS A MAJOR CONCERN
TO US. IT'S SOMETHING THAT WE'VE
SPENT A LOT OF TIME AND WE SPEND
A LOT OF TIME WITH THESE
FAMILIES. A LOT OF THE INTENSIVE
CASE MANAGEMENT THAT IS NOW DOWN
DOWN FOR THESE FAMILIES HAS
ACTUALLY DONE AT OUR SPECIAL
CARE CENTERS. I'M SO WE'RE
EXTREMELY COMMITTED TO THIS
PROGRAM. WE'RE VERY CONCERNED
ABOUT THE FUTURE OF IT. OVERALL
WE ACTUALLY HAVE SOME
LEGISLATION THIS YEAR AS BEFORE
24, WHICH IS AUTHORED BY SENATOR
DURAZO TO TRY TO ADDRESS SOME OF
OUR OVERARCHING CONCERNS ABOUT
THE ABOUT THE CCS PROGRAM. UM
CCH, A OPPOSES THE TRAILER BILL
LANGUAGE ON PROCEDURAL POLICY
AND FISCAL GROUNDS. FROM A
PROCEDURAL STANDPOINT, THIS
ACTUALLY ISN'T A BUDGET PROPOSAL
. THERE IS NO BUDGETARY IMPACT.
UM THIS IS A POLICY PROPOSAL
THAT WE THINK SHOULD BE RUN
THROUGH THE POLICY PROCESS. THAT
WAS THE CASE WITH SB 5 86, WHICH
WAS THE LEGISLATION THAT CREATED
THE WHOLE CHILD MODEL. WE
BELIEVE THAT THE SAME THING
SHOULD BE HAPPENING HERE. UM THE
DEPARTMENT HAS ARGUED THAT THIS
IS SOMEHOW RELATED TO THE
SELECTION THAT SOME COUNTIES
MADE TO MOVE FROM MOTHER TO PLAN
OR MULTIPLE OR DIFFERENT MODELS
TO COUNTY ORGANIZED HEALTH
SYSTEM OR SINGLE PLAN. UM
COUNTIES. UM AND HAS, I THINK
IMPLIED THAT THERE WAS SOME SORT
OF A LOCAL PROCESS THAT ADDRESS
THE CCS AND THAT THERE WAS SOME
KIND OF MAYBE BUY IN ON THE PART
OF THESE PLANS TO MOVE BECAUSE
OF CCS, BUT ACTUALLY, THAT'S NOT
TRUE. NONE OF THE MATERIALS, THE
DEPARTMENT SENT OUT TWO COUNTIES
ABOUT SWITCHING MODELS INCLUDED
ANY INFORMATION ABOUT THE CCS
PROGRAM AT ALL, UM COUNTIES WERE
REQUIRED WHEN THEY WANTED TO
SWITCH MODELS TO PROVIDE
INFORMATION TO THE DEPARTMENT,
TELLING THEM WHAT THEY NEEDED TO
DO. UM AND THERE WAS NO MENTION
OF CCS MADE IN IN THAT IN THOSE
MATERIALS. SO UM, FROM A PROCESS
PERSPECTIVE, THIS REALLY TOOK US
BY SURPRISE. WE UNDERSTOOD FROM
FROM THE HISTORY ABOUT THIS
PROGRAM AND SB 5 86 WHICH, UM,
SORT OF SET UP THE WHOLE CHILD
MODEL. THAT THERE WOULD BE AN
EVALUATION THAT EVALUATION WOULD
BE PROVIDED TO THE LEGISLATURE
ON DECEMBER 31ST OF 2022. THEN
WE ASSUME THERE WILL BE ANOTHER
POLICY PROCESS WITH ANOTHER BILL
TO DISCUSS KIND OF WHAT THE
RESULTS OF THAT WERE AND MAYBE
WITH THE NEXT STEPS WOULD BE NOW
WE DON'T HAVE HOSTILITY TOWARDS
MANAGED CARE PLANS. WE HAVE A
LOT OF CONTRACTS WITH MANAGED
CARE PLANS. OBVIOUSLY. BUT WE
HAVE A LOT OF CONCERNS ABOUT THE
WHOLE CHILD MODEL AND WHAT IT
COULD MEAN FOR THE FUTURE OF THE
CCS PROGRAM. IN GENERAL, WE
RECOGNIZE THAT THERE'S BENEFITS
TO HAVING EVERYTHING
CONSOLIDATED IN IN WHAT UNDER
ONE PLAN. WE ALSO KNOW THAT THE
DEPARTMENT ITSELF HAS HAS CARVED
OUT SERVICES WHEN IT WHEN IT
SERVES A DIFFERENT PURPOSE. FOR
EXAMPLE, THE DRUG BENEFIT WAS
COMPLETELY CARVED OUT OF MANAGED
CARE. A COUPLE YEARS AGO, MENTAL
HEALTH SERVICES ARE CARVED OUT
OF MANAGED CARE PLANS. UM IT'S
NOT LIKE, UM EVERYTHING HAS TO
BE CAPITATED IN ORDER TO WORK
WELL WITH THE MANAGED CARE
PLANS, SO WE THINK THERE THERE
THERE ARE POLICY CONSIDERATIONS
THAT REALLY NEED TO BE RUN
THROUGH PROCEDURALLY AND WE
THERE'S NO RUSH TO ANY OF THIS.
THERE IS NO NEED TO DO THIS IN
THE NEXT 3 TO 6 MONTHS AND
CERTAINLY SINCE THE DEPARTMENT
FAILED TO RELEASE THE EVALUATION
TIMELY. WE DON'T THINK THAT
SHOULD CONSTITUTE AN EMERGENCY
ON ALL THE REST OF OURS PART TO
RUSH THROUGH SOME SORT OF
DECISION AGAIN. THERE IS NO
BUDGETARY IMPACT, AND THERE'S NO
NEED TO DO THIS RIGHT NOW. WE
CAN TAKE THE TIME TO DO IT
CAREFULLY, AND WE THINK THAT WE
SHOULD UM WE WOULD SAY FROM A
POLICY PERSPECTIVE, WE'VE ONLY
SEEN A SUMMARY POWER POINT OF
THE DEPARTMENT OF VALUATION THAT
IS DUE TO THE LEGISLATURE. I I'M
GONNA REFRAIN FROM MAKING ANY
SORT OF CRITICAL COMMENTS ABOUT
THE VALUE BECAUSE WE HAVEN'T
SEEN IT YET. SO I MEAN, I THINK
WE KNOW THE DEPARTMENT BELIEVES
THAT IT SHOWED THAT THERE WAS
IMPROVEMENT. I THINK IN SOME OF
THE AREAS WHERE THE DEPARTMENTS
FOCUSING WHERE THE IMPROVEMENT
IS OUR VERY PRIMARY CARE FOCUSED
, AND IT'S NOT CLEAR TO ME THAT,
SAY THE 7000 KIDS AND CCS
PUTTING THEM IN WHOLE CHILD
MODEL AFFECTED. YOU KNOW, WELL
CHILD VISIT RACE OR OR
VACCINATION RATES ARE PROBABLY
HAVE MORE TO DO WITH THE FACT
THAT YOU KNOW, OVERALL PRIMARY
CARE PERFORMANCE ON THE PART OF
MANAGED CARE PLANS HAS BEEN
PRETTY POOR OVER TIME, AND I
THINK THE DEPARTMENT AND RIGHTLY
HAS PUT A LOT OF EMPHASIS ON
THAT AND THE NEED TO DO MORE
IMPROVEMENT PLANS ON THE PART OF
THE MANAGED CARE PLANS NEED TO
IMPROVE THEIR SO IF THERE'S
IMPROVEMENT. I'M NOT SURE IT'S
REALLY SINGULARLY FOCUSED ON CCS
. IT PROBABLY HAS MORE TO DO
WITH THE OVERALL POPULATION. IN
THE IN THE EMPHASIS THAT THE
DEPARTMENT'S PUTTING ON
PREVENTION BUT AGAIN, WE KIND OF
NEED TO SEE THE EVALUATION TO
KNOW EXACTLY. I MEAN TO SEE IT
FOR OURSELVES. IT'S A VERY
COMPLICATED EVALUATION THAT
COVERS A LOT OF THINGS, AND WE
SHOULD SPEND THE TIME TO REVIEW
IT AND DO IT RIGHT. ONE THING
THAT DID COME OUT IN THE SUMMARY
OF THE EVALUATION, WHICH WE HAVE
ALSO INDEPENDENTLY CONFIRMED IS
THAT THERE IS A STATISTICALLY
SIGNIFICANT DROP IN CCS
ENROLLMENT. IN WHOLE CHILD MODEL
PLANS. TO US. THIS IS A REALLY
SIGNIFICANT SUBSTANTIAL CONCERN
, BECAUSE IF KIDS ARE NOT, IT'S
KIND OF LIKE WE WORRY ABOUT KIDS
FALLING OFF OF MEDICAL AT THE
END OF THE PUBLIC HEALTH
EMERGENCY KIDS WHO ARE WHO HAVE
CCS ELIGIBLE CONDITIONS ARE
ENTITLED TO CERTAIN SERVICES.
THEY ARE ENTITLED TO A SPECIAL
CARE CENTER VISIT ANNUALLY.
THEY'RE ENTITLED TO SPECIFIC
CASE MANAGEMENT. THEY'RE
ENTITLED TO THE SUPPORT SERVICES
PARTICULAR TRANSPORTATION
SERVICES TO HELP AMELIA, RIGHT
THERE. CONDITION UM AND MAKE
THEM. WELL UM, THE WHEN WE
ACTUALLY DID AN INDEPENDENT
EVALUATION OF THIS ENROLLMENT
PROBLEM BECAUSE WE WERE SO
CONCERNED ABOUT IT. WHEN SP 5 86
PASSED. THIS WAS ACTUALLY OUR
PRIMARY CONCERN, AND WE REQUIRE
THAT THE DEPARTMENT ADOPT A
SEPARATE CAPITATION METHODOLOGY
FOR CCS INSTEAD OF PUTTING IT
INTO THE ONE BIG CAPITATION PART
BECAUSE WE THOUGHT THAT WOULD
PROVIDE A FINANCIAL INCENTIVE TO
PLANS TO IDENTIFY THESE KIDS,
BUT IT HASN'T REALLY COMPLETELY
SOLVE THE PROBLEM. WE DID A
PUBLIC RECORDS ACT REQUEST FOR
THE DEPARTMENT IN 2020 AND GOT
COUNTY, UH, COUNTY BY COUNTY CCS
ENROLLMENT DATA. UM AND WE HIRED
AN INDEPENDENT CONSULTING FIRM
CAPITAL MATRIX CONSULTING, WHICH
IS BRAD WILLIAMS, A FORMER CHIEF
ECONOMIST AT THE L. A AND MIKE
JUST FROM DIRECTOR, FINANCE
DEPARTMENT DEPARTMENT DIRECTOR.
UM TO DO THAT EVALUATION DID A
STATISTICAL ANALYSIS AND WHAT IT
SHOWED WAS THAT, UM, IT WAS
STATISTICALLY SIGNIFICANT AND
FOUR OUT OF THE FIVE COUNTIES
FOUR OF THE FIVE HEALTH PLANS.
THERE WAS A 16% DROP IN
ENROLLMENT IN THE 1ST 12 MONTHS
AND HEALTH PLAN A CEMETERY. OH,
THE 13% DROP IN ENROLLMENT IN
THE 1ST 12. MONTHS AFTER
IMPLEMENTATION, CAL OPTIMA AND A
10% DROP IN ENROLLMENT IN THE
1ST 12 MONTHS AFTER
IMPLEMENTATION IN THE CENTRAL
CALIFORNIA ALLIANCE FOR HEALTH.
PLANS SO TO US, YOU KNOW, THIS
IS A KIND OF FUNDAMENTAL THING
THAT NEEDS TO BE SOLVED, AND
WE'RE HAPPY TO WORK WITH THE
DEPARTMENT TO TRY TO SOLVE IT.
BUT AGAIN, WE THINK IT NEEDS TO
BE SOLVED FIRST, BEFORE WE
SHOULD BE EXPANDING THE WHOLE
CHILD MODEL. FINALLY UM, AS MS
COOPER ALLUDED TO, UM WE HAVE
FINANCIAL CONCERNS ABOUT THE
IMPLEMENTATION OF THE WHOLE
CHILD MODEL AS SHE AS SHE
MENTIONED, UM THE HOSPITAL
QUALITY ASSURANCE. VÆ INCLUDES
AN ACUITY ADJUSTER WHEN
OUTPATIENT VISITS ARE PROVIDED
IN FEW FOR SERVICE. THAT ACUITY
ADJUSTER GOES AWAY, UM, WHEN THE
SERVICES ARE PROVIDED TO MANAGED
CARE, THERE IS A TIMELINE LAG
AND FOR A CERTAIN PERIOD OF
TIME, THERE'S ACTUALLY HOSPITAL
WILL RECEIVE. UM SOME PAYMENT
FOR 2019 SAY AT THE SAME TIME AS
FOR IN THE FUTURE SERVICE SIDE
AS THEY RECEIVE, UH DIRECTED
PAYMENTS ON THE MANAGED CARE
SIDE FOR A MORE RECENT YEARS, SO
THERE IS SOME OVERLAP. BUT WHEN
WE HAVE ASKED OUR HOSPITALS TO
DO AN ANALYSIS OF THE IMPACT OF
WHOLE CHILD MODEL CHALK
CHILDREN'S, WHICH HAS BEEN IN
WHOLE CHILD MILES SINCE 2019
SAYS THAT THIS IS GOING TO
RESULT IN A $20 MILLION CUT TO
THEIR HOSPITAL. UCSF FENDING OFF
OAKLAND NOW, THIS IS THEY.
THEY'RE THEY'RE SAYING THAT THIS
IS GOING TO HAPPEN THIS YEAR.
THIS IS ALREADY HAPPENING TO
THEM APART. WE HAVE A
DISAGREEMENT WITH THE DEPARTMENT
. WE MET WITH HIM EARLIER TODAY.
WE NEED TO KIND OF LOOK FURTHER
INTO THAT. UM BUT I DON'T THINK
THEY DISAGREE WITH US THAT THE
IMPACT OF THE OF THE HOSPITAL
QUALITY ASSURANCE FEED IS
BECAUSE WHEN THE HOSPITAL
QUALITY ASSURANCE PEOPLE SET UP
CCS WAS PRESUMED TO REMAIN IN
FEED FOR SERVICE, SO THERE WAS
AN ACUITY, UM, ARRANGEMENT AND
ACKNOWLEDGEMENT THERE. UM WE
RECENTLY ASKED UCSF BENIOFF
CHILDREN'S HOSPITAL GOING TO DO
AN ANALYSIS IF CONTRA COSTA IN
ALAMEDA COUNTY BECAME HOTEL
MODEL COUNTIES, AND THEY
ESTIMATE THAT THE FISCAL IMPACT
OF THEM WOULD BE $29 MILLION A
YEAR, WHICH IS AN EXISTENTIALLY
HIT TO THE HOSPITAL. THEY
OPERATE MORE CCS SPECIAL CARE
CENTERS AND ANY OTHER HOSPITAL.
MAYBE SAVE CH L A IN THE STATE.
UM THEY ALSO HAVE, UM, YOU KNOW,
THEY PROVIDE A LOT OF VERY
INTENSIVE SERVICES IN THE
COMMUNITY. UM THESE ARE SERVICES
THAT WE CAN'T WE REALLY DON'T
WANT TO HAVE TO. WE DON'T REALLY
WANT TO JEOPARDIZE THAT
HOSPITALS ABILITY TO CONTINUE TO
PROVIDE SERVICES IN THIS
COMMUNITY AND THE COMMUNITIES
THAT THEY SERVE. UM SO WE FEEL
REALLY STRONGLY THAT THOSE TWO
ISSUES BOTH THE ENROLLMENT
ISSUE, AND THE FINANCIAL ISSUE
NEED TO BE RESOLVED BEFORE THERE
SHOULD BE ANY CONSIDERATION
ABOUT THE WHOLE CHILD MODEL. AND
AGAIN, I WOULD JUST END WITH UM
, THIS ISN'T A BUDGET PROPOSAL.
IT DOESN'T BELONG HERE. UM
THERE'S NO THERE'S NO NEED TO DO
THIS RIGHT NOW, UM, THE RISK TO
CCS MEMBERS AND TO CHILDREN'S
HOSPITALS ARE SIGNIFICANT AND WE
WOULD ASK THE COMMUNITY TO
REJECT THIS PROPOSAL AND DIRECT
THE DEPARTMENT TO PURSUE THE
POLICY WAS THROUGH THE POLICY
PROCESS AS THEY DID WITH SB 5
86. THANK YOU. DEPARTMENT OF
FINANCE. UH ON THE TABLE AT THE
DEPARTMENT OF FINANCE, NO
FURTHER COMMENTS. HELLO JASON
KANSEN TAROT, CELIO. UM, I KNOW
THERE'S A LOT OF INFORMATION IN
THIS PROPOSAL JUST THOUGHT IT
WOULD BE HANDY TO POINT OUT A
FEW KEY PAGES IN THE AGENDA THAT
MIGHT BE HELPFUL. THE FIRST ON
THE BOTTOM OF PAGE 43 THAT SHOWS
THE 21 COUNTIES AND FIVE HEALTH
PLANS THAT CURRENTLY PARTICIPATE
IN WHOLE CHILD MODEL AND THESE
ARE THE COUNTIES THAT ARE
GENERALLY OPERATING COUNTY
ORGANIZED HEALTH SYSTEM MANAGED
CARE MODELS. IT'S THE ONLY ONE
EXCEPTION. THERE IS VENTURA
COUNTY, WHICH WAS EXCLUDED FROM
WHOLE CHILD MODEL. AND THEN
TURNING ACTUALLY TO PAGE 46. YOU
CAN SEE ALL OF THE COUNTIES THAT
ARE THAT ARE SWITCHING THEIR
MANAGED CARE MODELS AND JUST
GOING FROM ALAMEDA TO YUBA.
THOSE ARE THE ONES THAT ARE
SPECIFICALLY SWITCHING TO EITHER
A SINGLE PLAN OR ACOS MODEL. AND
SO THOSE ARE THE COUNTY CENTER
BEING AFFECTED BY THIS PROPOSAL
, AND THEN YOU CAN SEE THE
PHASED APPROACH THAT THE
DEPARTMENT NOTED ON PAGE 47, THE
TOP OF PAGE 48. THOSE ARE
PHASES. ONE IN PHASE TWO. A LOT
OF THE MOST OF THE COUNTIES OR
WOULD BE UNDER PHASE ONE. BUT
THE BIGGEST CASELOAD IMPACT
WOULD BE ON PHASE TWO, AND
THAT'S BECAUSE OF THE THREE
LARGEST COUNTIES ALAMEDA COUNTY
ACOSTA AND IMPERIAL WOULD BE
WOULD BE IN PHASE TWO. SO JUST
WANT TO POINT OUT RAISE A FEW
ISSUES FOR LEGISLATIVE
CONSIDERATION. FIRST WE
UNDERSTAND THE DEPARTMENT'S GOAL
AND TRYING TO ALIGN WHOLE CHILD
MODEL WITH THE RECENT MANAGED
CARE MODEL CHANGES. WE THINK
THAT THAT GOAL WARRANTS SOME
CONSIDERATION. WE ALSO THINK YOU
KNOW THE OVERARCHING OBJECTIVE
OF TRYING TO STANDARDIZE WHAT
STANDARDIZED THE WAY SERVICES
ARE DELIVERED ACROSS THE STATE
ALSO WARRANTS CONSIDERATION. ON
THE OTHER HAND, WE'VE HEARD MANY
OF THE CONCERNS THAT WERE THAT
WERE JUST RAISED IN TESTIMONY
FROM STAKEHOLDERS AND WE
UNDERSTAND THAT THE EVALUATION
WAS INTENDED TO SHED LIGHT ON A
LOT OF THESE CONCERNS DEPARTMENT
NOTED THAT THEY DID SHARE SOME
OF THE KEY CONCLUSIONS OF THAT
EVALUATION WITH STAFF. THOSE
CONCLUSIONS ARE SUMMARIZED ON
PAGES 44 THROUGH 46 OF YOUR
AGENDA, AND THE DEPARTMENT
WALKED THROUGH THEM AT A HIGH
LEVEL, SO I WON'T SPEND TIME
GOING THROUGH THEM AGAIN. BUT UM
, YOU KNOW, WE DO RECOMMEND THE
LEGISLATURE WITHHOLD ACTION
UNTIL THE FULL EVALUATION IS
RELEASED AND SOME SOME THINGS WE
THINK THAT THE LEGISLATURE WANT
TO KEEP AN EYE OUT IN THE FULL
EVALUATION. ONE OF THEM, OF
COURSE, IS LOOKING AT WHERE
THERE ARE KEY DIFFERENCES
BETWEEN WHOLE CHILD MODEL. AND
TRADITIONAL CCS, BUT THEN ALSO
THE MAGNITUDE OF THOSE
DIFFERENCES THAT THE MAGNITUDE
WASN'T ENTIRELY CLEAR FROM THE
SUMMARY INFORMATION. WE WERE
PROVIDED, SO WE UNDERSTAND THE
EVALUATION WILL HAVE MORE
SPECIFIC INFORMATION THERE. AND
THEN ALSO WHERE THE DIFFERENCES
WERE GREATEST AMONG THE
COUNTIES, YOU KNOW, UM AND WHAT
THAT SUGGESTS ABOUT THE COUNTIES
THAT ARE AFFECTED BY BY THIS
PROPOSAL. WE ARE AVAILABLE TO
FURTHER ASSIST. THE COMMITTEE
WANTS TO FULL EVALUATION IS OUT
, AND WE EMPHASIZE HERE. THE
LEGISLATURE HAS MANY OPTIONS IF
THE LEGISLATURE REVIEWS THE
EVALUATION AND FINDS THAT IT
ADDRESSES MANY OF THE CONCERNS,
IT COULD ADOPT SOME OR ALL OF
THE PROPOSAL, OR TO THE EXTENT
THAT THE LEGISLATURE NEEDS MORE
TIME TO DELIBERATE ON SOME OF
THESE ISSUES COULD ALSO DIFFER
SOME OF THIS TO A FUTURE
LEGISLATIVE CYCLE. THAT HAPPY TO
ANSWER ANY QUESTIONS. THANK YOU
. HOLD NOW. BRING IT UP TO THE
DIASPORA MEMBERS QUESTIONS. I'LL
KEEP IT HERE AT THE CHAIR. I
REALLY WANT TO GET INTO THIS
RAID, ACUITY ADJUSTMENTS AND
START TO UNDERSTAND THAT A
LITTLE BIT IF I CAN. I'M HEARING
HIGH LEVEL THAT IT'S ASSOCIATED
WITH THE HOSPITAL QUALITY
ASSURANCE. K¾T ALSO STATED THAT
THE ACUITY GOES AWAY AND HOPING
YOU CAN ELABORATE ON WHAT THAT
HIS CAUSED BY SO THAT WE CAN
THEN FIGURE OUT HOW WE CAN MAKE
SURE TO APPROPRIATELY. RESOURCE
THE ACUITY SO. THE WAY THAT
HOSPITAL QUALITY ASSURANCE FEE
WAS SET UP WHEN IT WAS
ESTABLISHED WAS THERE'S THREE
BUCKETS AND IT'S AN ENCLOSED
POOL, SO IT'S NOT THAT THE MONEY
GOES AWAY THEIR STATE SAVINGS OR
SOMETHING LIKE THAT. IT JUST
GETS DISTRIBUTED TO DIFFERENT
HOSPITALS SO CHILDREN'S
HOSPITALS BECAUSE WE SERVE THE
HIGHEST SECURITY PATIENTS, AND
WE ALSO HAVE THE HIGHEST
PERCENTAGE. MEDICAL AVANT BY
VOLUME TEND TO GET MORE OF
HOSPITAL QUALITY ASSURANCE, FEET
AND WE'VE BECOME VERY DEPENDENT
UPON IT. IN ORDER TO CONTINUE
OPERATIONS BECAUSE WE HAVEN'T
HAD A RATE INCREASE SINCE 2012.
IN FACT, THE DEPARTMENT UM AND
KEEPING, I THINK WITH THEIR
PHILOSOPHY OF WANTING TO SUPPORT
MORE PRIMARY CARE AND BASIC CARE
, THEY CUT OUR RATES BY $62
MILLION A YEAR IN 2017 IN ORDER
TO FUND AN INCREASE IN OTHER
HOSPITAL BASE RATES. SO WE'VE
BEEN ACTUALLY, UM, I KNOW THAT
THE HOSPITAL ASSOCIATION HAS
SPENT A LOT OF TIME AT BRINGING
THE LEGISLATURE UP TO SPEED ON
SOME OF THOSE, JUST THE FACT
THAT HOSPITALS HAVEN'T HAD A
RATE INCREASE IN OVER 10 YEARS.
BUT WE'VE ACTUALLY EXPERIENCED A
RATE CUT. AND SO WE'VE BEEN
USING THE HOSPITAL QUALITY
ASSURANCE FEED IS IN A WAY TO
TRY TO BALANCE THAT OVER OVER
TIME, AND SOME OF THE MORE
INCREASES IN HIGHER ACUITY THE
COST OF HIGHER ACUITY CARE. BUT
WHEN THE MODEL WAS FIRST SET UP,
THERE'S THERE WAS BROKEN INTO
THREE BUCKETS. THERE'S A FOR
SERVICE BUCKET. THERE'S WHAT'S
CALLED A PASS THROUGH BUCKET,
WHERE SERVICES, WHICH ARE STILL
CARVED OUT OF MANAGED CARE ARE
PASSED THROUGH FROM A MANAGED
CARE PLAN DOWN TO A HOSPITAL.
AND THEN THERE'S WHAT'S CALLED
THE DIRECTIVE PAYMENT BUCKET.
AND THE DIRECTIVE PAYMENT BUCKET
IS WHERE, UM, SERVICES THAT ARE
CONTRACTED THROUGH MANAGED CARE
PLANS THAT RECEIVED THEIR
SUPPLEMENTAL PAYMENTS ASSOCIATED
WITH THAT VOLUME. SO THE WAYS
CCS AND PSYCH AS THERE ARE SIX
PSYCHOLOGICAL LIKE INPATIENT
SERVICES, NOW PATIENT SERVICES
THAT ARE PROVIDED BY HOSPITALS
ARE THE TWO MAIN BUCKETS THAT
ARE REMAINING IN EITHER THE FIFA
SERVICE OR IN THE PAST THROUGH
BUCKET, SO WE'RE KIND OF MOST AT
RISK. UM, BECAUSE BECAUSE
ACTUALLY THE FEDERAL GOVERNMENT
HAS SAID THAT WE HAVE TO
ELIMINATE THE PAST THROUGH
BUCKET BY 2027. SO UM, WE'VE GOT
WE'VE GOT A PROBLEM THERE. BUT
THAT'S NOT TODAY'S PROBLEM. BUT
THE FEE FOR SERVICE BUCKET WAS
IS WHAT BASICALLY HAPPENS IS
THAT IF YOU PROVIDE A SERVICE IN
IN IN THIS CASE, AN OUTPATIENT
CCS SERVICE IN FIFA SERVICES
CARVED OUT OF MANAGED CARE.
THERE IS A MULTIPLIER THAT
HAPPENS. SO FOR EXAMPLE, AN
EMERGENCY DEPARTMENT VISIT
HAPPENS FOR ASSISI FOR ACTUALLY
ANY MEDICAL PATIENT, UM, AND IN
A CHILDREN'S HOSPITAL, AND YOU
RECEIVE $600 FOR THAT VISIT, UM
, THE SUPPLEMENT MEDICALS
HOSPITAL QUALITY ASSURANCE FEE
WOULD THEN ALSO PROVIDE ON TOP
OF THAT, UM UM, SUPPLEMENTAL
PAYMENT OF $600 TIMES THE
MULTIPLIER WHICH IN 2020. TWO
WAS 2.7 AND IN 2023 WILL
ACTUALLY BE THREE SO YOU WOULD
RECEIVE ANOTHER $1800 SAY IN
SUPPLEMENTAL PAYMENT. WHEN THAT
VISIT BECOMES A MANAGED CARE
UNDER CONTRACT WITH THE MANAGED
CARE PLAN, THE MULTIPLIER
THERE'S NO MULTIPLIER. YOU GET A
FLAT $238, SO I'LL JUST GIVE YOU
AN EXAMPLE AND OUTPATIENT
CHEMOTHERAPY VISIT WOULD BE
WOULD PAY ABOUT $22,000 TO VISIT
ITSELF WITH MEDICAL WOULD PAY
20,000. THE SUPPLEMENTAL PAYMENT
FOR THAT VISIT WOULD THEN BE
ANOTHER. 2.7 TIMES 22,000 SO
ABOUT $60,000 ON ON TOP OF THAT,
IF THAT SAME VISIT WERE PROVIDED
IN THE WHOLE CHILD MODEL COUNTY
, THE HOSPITAL RECEIVED $238.
THAT'S ESSENTIALLY WHY, WHEN THE
WAY THE MODEL WAS SET UP NOW,
ALL THAT MEANS IS THAT THAT
MONEY JUST GETS DISTRIBUTED TO
OTHER HOSPITALS. IT DOESN'T GO
AWAY OR ANYTHING LIKE THAT. IT
JUST GOES TO DIFFERENT PEOPLE.
THE PROBLEM IS THAT EVERYBODY
IT'S SORT OF A STATUS CLOSE
SITUATION. PEOPLE BECOME VERY
DEPENDENT ON WHAT THEY'RE
RECEIVING. AND THE
DISPROPORTIONATELY KIND OF HITS
US MORE THAN ANYBODY ELSE
BECAUSE WE STILL HAVE CCS VISITS
THAT ARE PROVIDED, UM, CARVED
OUT OF MANAGED CARE, AND THEY
HAVE BEEN HISTORICALLY MAY HELP
THE ADMINISTRATION RESPOND TO
THAT SPECIFIC EXAMPLE OF
POSSIBLE YEAH, I MEAN THE WAY
THAT SHE'S DESCRIBING THE
DIFFERENCES BETWEEN NETWORKS AND
FEED FOR SERVICE AND MANAGED
CARE ALIGNS FOR LACK OF BETTER
DESCRIPTION. I THINK THAT'S WHY
WE'VE BEEN ENGAGING WITH THE
CALIFORNIA HOSPITAL ASSOCIATION
IN REGARDS TO HOW DO WE CHANGE?
THE WAY THAT WE'RE DOING THE
DIRECTED PAYMENT PORTIONS, WHICH
IS THE PART THAT SHE'S
MENTIONING WHERE THERE ISN'T, UM
, LOOK AT VARIOUS SECURITY
FACTORS LIKE A CCS KIDS ARE VERY
COMPLEX HIGH Q T CASE THOSE ARE
CONVERSATIONS THAT WILL HAVE TO
CONTINUE TO HAVE THE DEPARTMENT
HAS ENGAGED FAR BEFORE THIS
CONVERSATION IN REGARDS TO HOW
DO WE MAKE THOSE TYPES OF
TRANSITION AND CHANGES AND WE'RE
VERY COMMITTED TO CONTINUING TO
FIND THOSE TYPES OF OPTIONS AS
MENTIONED, THOUGH, BECAUSE OF
THE LACK OF THE WAY IT WORKS IN
THESE PIECES. WE HAVE TIME TO DO
THAT, BECAUSE OF THE TIME THAT
THEY WILL BE PAID THE HIGHER
RATE BASED ON THE UTILIZATION.
UM BUT WE ARE VERY COMMITTED TO
CONTINUE THOSE CONVERSATIONS
WITH OUR HOSPITAL PARTNERS.
THEY'RE VERY IMPORTANT TO OUR
DELIVERY SYSTEM. THEY DO PROVIDE
A LARGE NUMBER OF MEDICAL
SERVICES, SO THEY ARE KEY
PARTNER OF OURS, AND WE WANT TO
MAKE SURE THAT WE FIND A PATHWAY
FORWARD. WITH THAT. IT SEEMS
THAT THERE'S MORE INFORMATION
THAT WILL BE OBTAINED BY THE
LEGISLATURE THROUGH THE
EVALUATION, AND I LOOK FORWARD
TO THAT INFORMATION AS IT
INFORMS OUR DECISIONS GOING
FORWARD. THANKS VERY MUCH. THIS
ENTIRE PANEL AND WE WILL NOW
MOVE ON TO ISSUE 10. ISSUE 10 AS
A PROGRAM WORKLOAD BUDGET CHANGE
PROPOSAL AND WE WILL BEGIN WITH
DIRECTOR BOSS. THE DEPARTMENT IS
REQUESTING, UH 16 PER MINUTE
POSITIONS FIVE YEAR LIMITED TERM
RESOURCES EQUIVALENT TO FIVE
POSITIONS AND THE CONVERSION OF
THREE LONG TERM RESOURCES.
LIMITED TERM EXCUSE ME RESOURCES
TO PERMANENT POSITIONS AND
EXPENDITURE AUTHORITY OF 3.8
MILLION IN THE BUDGET YEAR. HCS
IS MINDFUL OF THE PROJECTED
BUDGET CHALLENGES BUT BELIEVES
IT'S APPROPRIATE AND IMPORTANT
TO RESOURCE OUR WORKLOAD TO
FACILITATE BEING ACCOUNTABLE TO
ACHIEVE IMPORTANT POLICY AND
PROGRAM OBJECTIVES. THE
RESOURCES THAT I JUST MENTIONED
ARE REQUESTED TO ADDRESS THE
FOLLOWING ONGOING WORKLOAD.
MEDICAL HEALTH ENROLLMENT
NAVIGATORS PROJECT,
STRENGTHENING PREVENTIVE
SERVICES FOR CHILDREN AND
MEDICAL SHORT TERM RESIDENTIAL
THERAPEUTIC PROGRAM, MENTAL
HEALTH PROGRAM APPROVAL,
OVERSIGHT AND MONITORING AND
ADMINISTRATION. JUST THE
DISTRIBUTED WORKLOAD RELATED TO
THE BCPS WE'VE PER HAVE BEFORE
YOU THIS YEAR. AH THE DEPARTMENT
WILL BE ABLE TO ACCOMPLISH THE
FOLLOWING ITEMS WITH THE
ADDITIONAL RESOURCES SO WITH
REGARD TO NAVIGATORS, WE WILL
HAVE SUFFICIENT RESOURCES TO
PROVIDE OVERSIGHT OF CARE AND
SERVICES PROVIDED TO
BENEFICIARIES OF THE NAVIGATORS
PROJECT. UH, JUST LAST WEEK OR A
COUPLE WEEKS AGO, WE ANNOUNCED
THE WORD OF THE $60 MILLION TO
23 COUNTY AGENCIES AND 12 CBOS
COVERING 40 44 COUNTIES AS
NAVIGATORS. IN TERMS OF THE
STRENGTHENING PREVENTIVE
SERVICES FOR CHILDREN IN THE
MEDICAL PROGRAM. WE RECEIVE
LIMITED TERM RESOURCES A FEW
YEARS AGO RELATED TO MAINTAINING
PROVIDER DIRECTORIES AND MANAGED
CARE. COMPLIANCE WITH THOSE
PROVIDER DIRECTORIES IN THE
REQUEST IS TO MAKE THOSE
RESOURCES PERMANENT SO WE CAN
CONTINUE WITH THAT THOSE
ACTIVITIES AND THEN IN TERMS OF
THE SHORT TERM RESIDENTIAL
THERAPEUTIC PROGRAMS WITH STR
TPS MENTAL HEALTH PROGRAM
APPROVAL, OVERSIGHT AND
MONITORING. THESE ARE RESOURCES
REQUESTED. IN THE LAST TWO
YEARS, SIX COUNTIES HAVE
RELINQUISHED THEIR UM, MENTAL
HEALTH PROGRAM APPROVAL,
OVERSIGHT RESPONSIBILITIES. AND
SO THE STATE HAS HAD TO TAKE
THAT ON, INCLUDING LOS ANGELES,
WHICH HAS 65 STR TPS WELL,
FRESNO COUNTY. ONE OF THE
QUESTIONS IN THE AGENDA
CONTINUES TO RETAIN THEIR AS T
RTP. OVERSIGHT AND MONITORING,
SO THEY GAVE US NOTICE. BUT THEY
HAVE NOT. CONTINUE TO FOLLOW
THROUGH ON THAT, SO THE
REQUESTED RESOURCES ARE MEANT TO
MEET THE NEW WORKLOAD ASSOCIATED
WITH COUNTIES RELINQUISHING
THESE RESPONSIBILITIES. HAPPY TO
ANSWER ANY QUESTIONS. DEPARTMENT
OF FINANCE. KENDRA HOLLY
DEPARTMENT OF FINANCE NO FURTHER
COMMENTS TOMORROW WITH THE L A.
OH, NO, UM, CONCERNS OF THIS
PROPOSAL, SEEING THAT WILL BRING
IT UP TO THE DIOCESE. KEEP IT
HERE AT THE CHAIR. I WANT TO DIG
IN A LITTLE BIT ON THE STR TEE
PEES A LITTLE BIT. HOW MANY BEDS
ARE THERE WITHIN EACH STR TP
FACILITY IS THAT STANDARD? SO
WHEN YOU'RE SAYING THERE'S 41
ADDITIONAL. STR TPS AND
PRESIDENT COUNTY THAT THEY DID
NOT ALLOW US TO BE THE OVERSIGHT
AGENCY. HOW MANY BEDS DOES THAT?
UM, EQUATED. TO I WOULD HAVE TO
GET BACK TO YOU ON THE NUMBER OF
BEDS FOR THE FRESNO COUNTY. I
DON'T BELIEVE I HAVE THAT. IS
THERE A CAPACITY LOSS THROUGH
THE TRANSFER OF OVERSIGHT FROM
THE COUNTY TO THE STATE AS WE
EXPERIENCE WITHIN LOS ANGELES
COUNTY, OR ARE WE AS A SYSTEM
OVERALL LOSING CAPACITY OR WHAT
OCCURS WHEN THAT OVERSIGHT IS
TRANSFERRED OVER THINK THEY'RE
PROBABLY TO KIND OF
CONVERSATIONS COMING TOGETHER ON
THIS. THERE'S THE OVERSIGHT OF
THE MENTAL. WITH PROGRAM
CERTIFICATION PROGRAM. PIECE
THAT WE'RE TALKING ABOUT HERE.
AND THEN THERE'S ALSO THE WORK
THAT THE DEPARTMENT OF HEALTH
CARE SERVICES AND DEPARTMENT
SOCIAL SERVICES DID TOGETHER
WITH REGARD TO ASSESSING IF A
CERTAIN STR TPS MEET THE MD
QUALIFICATION, AND WE'VE OVER
THE COURSE OF 18 MONTHS OR SO
WENT THROUGH AND ASSESSED ALL OF
THE DIFFERENT STR TPS THROUGHOUT
THE STATE AND MANY, MOST OF THEM
ACTUALLY TRANSITION TO MEET THE
REQUIREMENTS NECESSARY TO
CONTINUING OPERATIONS. THERE
WERE THREE STR TPS WITH THE
TOTAL BED OF 237 BEDS, UM, THAT
WERE DETERMINED. MAYBE I M D S
THEY CAN CONTINUE TO OPERATE IN
THE COUNTY WOULD JUST BE
RESPONSIBLE, PROVIDING BOTH THE
STATE AND THE FEDERAL SHARE SO
ESSENTIALLY COVERING THE COST OF
THOSE OF THOSE FACILITIES SINCE
THEY ARE DEEMED I M D S UM, WHAT
OCCURRED IN FRESNO COUNTY? CAN
YOU SPEAK TO WHY THEY WERE
LOOKING TO TRANSFER OVERSIGHT. I
DON'T KNOW THAT. YEAH HAVE ONE
THAT'S APPROPRIATE. UM WITH THAT
I WILL THANK VERY MUCH PANEL 10
AND WE WILL MOVE ON TO ISSUE 11.
ISSUE 11 COVERS THE PROPOSED
TRAILER BUILT TO CONFORM
STATUTORY ESTIMATE REQUIREMENTS
TO RECENT PROGRAM CHANGES. WE
WILL BEGIN WITH DIRECTOR COOPER
THE DEPARTMENT PROPOSES TO
UPDATE AND CONFORM STATUTORY
REQUIREMENTS RELATED TO THE
MEDICAL LOCAL ASSISTANCE
ESTIMATE WITH RECENT PROGRAM
CHANGES IN MEDICAL TO REORGANIZE
THE ESTIMATE AND BUDGET ACT
INFORMATION TO CONFORM WITH HOW
THE ESTIMATE IS DEVELOPED TODAY.
OUR OBJECTIVE IS TO MAINTAIN
TRANSPARENCY AND ACCOUNTABILITY
WHILE ENHANCING USEFULNESS AND
ADMINISTRATIVE EFFICIENCY.
SPECIFICALLY THIS PROPOSAL WOULD
REMOVE THE REQUIREMENT FOR FIFA
SERVICE RATE INCREASES BE
SEPARATELY DISPLAYED. FIFA
SERVICE RATE INCREASES ARE LESS
CENTRAL, UM, GIVEN THE MEDICAL
PROGRAM WILL BE MOVING TO 99.3%
MANAGED CARE. SO REALLY, JUST
CONFORMING TO MAKE SURE WE'RE
PROVIDING THE, UM THOSE CHANGES
WITH THE ALIGNING WITH OUR
PROGRAM AS WELL AS CONSOLIDATING
ALL LOCAL ASSISTANCE. UM
ADMINISTRATION COSTS, INCLUDING
COUNTY ADMINISTRATION FOR
ELIGIBILITY DETERMINATIONS, UM,
CURRENTLY THE LARGEST COMPONENT
OF THE LOCAL ASSISTANCE IS
ADMINISTRATIVE SPENDING AS WELL
AS THE FISCAL INTERMEDIARY
MANAGEMENT. THESE ARE CONTRACTS
THAT THE STATE USES FOR OUR FEE
FOR SERVICE PAYMENTS, FOR
EXAMPLE, OR OTHER LOCAL
ASSISTANCE ADMINISTRATION SUCH
AS OTHER NON BENEFITS SPENDING
HAVE BECOME LARGER, AND SO
BREAKING THESE OUT WILL BE
IMPORTANT. FOR EXAMPLE, THE PATH
FUNDS THAT WE MENTIONED EARLIER
IS AN INITIATIVE OR A PORTION OF
THE VACCINE INCENTIVE PROGRAMS,
JUST THINGS TO HAVE MORE
VISIBILITY INTO UM, AS WELL AS
BUDGET UNDER A SINGLE BUDGET
LINE ON AND REFERRED TO AS THE
COUNTY OR OTHER LOCAL ASSISTANCE
ADMINISTRATION IN THE BUDGET,
UM, ACT BUT WOULD DETAIL WOULD
REMAIN IN THE MEDICAL ESTIMATE.
ADDITIONAL PROPOSES ARE THE
PROPOSAL REMOVES THE REQUIREMENT
FOR THE DEPARTMENT OF FINANCE TO
PRODUCE A RANGE OF ESTIMATES OF
MEDICAL SPENDING TO REFLECT
CURRENT PRACTICE. AS WELL AS
REMOVES THE REQUIREMENT FOR
COUNTY BY COUNTY ADMINISTRATIVE
COST PROJECTIONS TO REFLECT
CURRENT PRACTICE DUE TO THE
CHANGES IN THE ESTIMATE
METHODOLOGY RELATED TO THE
IMPLEMENTATION OF THE A HAS NOT
FEATURED A COUNTY BY COUNTY
PROJECTION FOR AT LEAST 10
YEARS. SO JUST KIND OF UPDATING
THE STATUTE TO CONFORM TO
CURRENT DAY HAPPY TO ANSWER ANY
QUESTIONS, FINANCE. KENDRA TULLY
DEPARTMENT OF FINANCE NOTHING
FURTHER TO ADD ELIO. WE HAVE NOT
RAISED CONCERN TO THIS PROPOSAL.
BRING IT UP TO THE DIOCESE AND
THANKS VERY MUCH PANEL 11. WE
WILL MOVE ON TO ISSUE 12. IS
SHE? 12 IS ON THE PROPOSED DELAY
OF THE TWO WEEK CHECK, RIGHT
HOLD BUYBACK. WE WILL BEGIN WITH
DIRECTOR COOPER. SO EACH JUNE
THE DEPARTMENT HOLDS THE LAST
TWO WEEKS FOR A FEE FOR SERVICE
PAYMENTS OR CHECK RIGHTS, UM AND
PAYS THEM AT THE BEGINNING OF
JULY. THE PRACTICE HAS BEEN IN
PLACE FOR A NUMBER OF YEARS
SINCE THE SHIFT WAS IMPLEMENTED
DUE TO REDUCE STATE COSTS IN A
DIFFICULT BUDGET YEAR ON A ONE
TIME BASIS IN THE 2022 BUDGET
ACT, INCLUDING INCLUDED FUNDING
TO BUY BACK THE CURRENT TWO WEEK
DELAY BY MOVING THE TWO WEEKS
BACK TO THE END OF EACH JUNE.
WHILE WE REMAIN COMMITTED TO
THIS POLICY TO PAY PROVIDERS
TIMELY DUE TO THE STATES
PROJECTED GENERAL FUND REVENUE
DECLINED. THE DEPARTMENT IS
PROPOSING TO DELAY THE BUYBACK
OF THE CHECK RIGHT HOLD UNTIL
FISCAL YEAR 24 25 THE ACTUALLY
REDUCE COSTS BY $1.1 BILLION
TOTAL FUNDS. 378 MILLION GENERAL
FUNDING CURRENT YEAR AND HAPPY
TO ANSWER ANY QUESTIONS. GOING
TO FINANCE? YEP, NOTHING FURTHER
TO ADD. THANK YOU. WITH
CONSIDERATION FOR THE STATE'S
BUDGET CONDITION. WE DO NOT HAVE
CONCERNS THAT THIS PROPOSAL
THANK YOU. WE'LL BRING IT BACK
UP TO THE DIESS. THANKS VERY
MUCH. THIS PANEL MOVE ON TO
ISSUE 13. ISSUE 13 IS ON THE
MEDICAL PROVIDER. INTERIM
PAYMENT LOAN AUTHORITY TRAILER
BILL DIRECTOR COOPER BY WAY OF
BACKGROUND. THERE ARE SITUATIONS
WHERE THE DEPARTMENT COULD RUN
OUT OF BUDGETARY AUTHORITY,
INCLUDING IN THE BUDGET ISN'T
ENACTED ON TIME OR IF THERE IS
AN UNEXPECTED MAJOR CHANGE IN
OPERATING CONDITIONS COMPARED TO
BUDGET ACT CONDITIONS, WHICH
WOULD RESULT IN PAYMENTS NOT
BEING MADE TO SOME MEDICAL
PROVIDERS OR MANAGED CARE PLANS
. STATE LAW PROVIDES, UM FOR
ACCESS TO A TEMPORARY LOAN, WITH
APPROVAL FROM THE DEPARTMENT OF
FINANCE TO END LABEL PROVIDER
PAYMENTS TO CONTINUE AND TELL
ADDITIONAL APPROPRIATIONS.
AUTHORITY IS OBTAINED. THE LIMIT
ON THE LOAN IS CURRENTLY TWO
BILLION FROM THE GENERAL FUND IN
TWO BILLION IN FEDERAL BUDGET
AUTHORITY. HOWEVER THIS AMOUNT
IS INSUFFICIENT BASED ON THE
GROWTH OF THE MEDICAL COSTS IN
PARTICULARLY MANAGED CARE OF THE
DEPARTMENT PROPOSES TO CHANGE
THE LIMIT ON THE LOAN TO A
PERCENTAGE. UM AN ESTIMATE
MEDICAL SPENDING, ALLOWING THE
LIMIT TO ADJUST THE SIZE OF THE
PROGRAM. THE TRAILER WILL
PROPOSES TO SET THE INTERIM
PAYMENT LOAN AMOUNT TO 10% OF
THE AMOUNT APPROPRIATED TO THE
GENERAL FUND 6% OF THE AMOUNT
APPROPRIATE FROM THE FEDERAL
TRUST FUNDS IN GREEN MAXIMUM
INTERIM LOAN PAYMENT AMOUNTS TO
A PERCENTAGE WILL MAXIMIZE THE
NEED TO UPDATE THE STATUTORY
LIMITS IN THE FUTURE AND HAPPY
TO ANSWER ANY QUESTIONS FROM
FINANCE. EDDIE TABLE EDDIE
DEPARTMENT OF FINANCE NOTHING
FURTHER TO ADD. WE HAVE NOT
RAISED CONCERNS TO THIS
PROPOSAL. BRING IT UP TO THE
DIOCESE WOULD THANK VERY MUCH
CHANNEL 13. WE WILL MOVE ON TO
ISSUE 14. SHE 14 IS ON THE
NEWBORN HOSPITAL. GATEWAY
TRAILER BILL DIRECTOR COOPER YES
, THE DEPARTMENT PROPOSES TO
REQUIRE ALL QUALIFIED MEDICAL
PROVIDERS PARTICIPATING IN
PRESUMPTIVE ELIGIBILITY PROGRAMS
TO REPORT THE BIRTHS OF ANY
MEDICAL ELIGIBLE INFANT BORN IN
THEIR FACILITIES, INCLUDING
HOSPITALS AND BIRTHING CENTERS
OR OTHER BIRTHING CENTERS.
WITHIN 40 BOARD. SORRY 24 HOURS
AFTER BIRTH THROUGH THE NEWBORN
HOSPITAL GATEWAY, RESULTING IN
MORE EXPEDITIOUS ELIGIBILITY
ACTIVATION FOR MEDICAL NEWBORNS
. IT ALSO MITIGATES ANY ISSUES
THAT THE PROVIDER LEVEL
REGARDING ELIGIBILITY OF NEWBORN
WHEN COVERED SERVICES ARE BEING
ACCESS. UM THE CHILD HEALTH AND
DISABILITY PROGRAM WILL SUNSET
ON JUNE 30TH 2024, THE C HDP
GATEWAY, INCLUDING THE NEWBORN
HOSPITAL GATEWAY PROCESS WILL
TRANSITION AND BE REMAIN. THE
CHILDREN'S PRESUMPTIVE
ELIGIBILITY. ONLINE PORTAL WILL
BE EFFECTIVE JULY ONE OF 2024.
WE WERE ASKED TO PROVIDE AN
UPDATE ON THE SEA HDB TRANSITION
PLAN AS WELL, UM. ACTION PROGRAM
BY JULY. 1ST OF 2024 PRESERVES
PRESUMPTIVE ELIGIBILITY
ENROLLMENT ACTIVITIES CURRENTLY
OFFERED THROUGH THE GATEWAY
PROGRAM AS WELL AS ACTIVITIES
CURRENTLY PERFORMED BY THE
COUNTIES UNDER THE CHILD LED
POISONING PREVENTION PROGRAM AS
A PART OF THE TRANSITION, THE
DEPARTMENT HAS BEEN IN MEANING
OF A LARGE NUMBER OF WORK GROUP
MEMBERS TO REALLY INFORM THE
TRANSITION PLAN AS AGREED TO
WITH THE LEGISLATURE. UM, IT HAS
INCLUDED A PUBLIC HEALTH NURSES
MANAGED CARE PLANS, COUNTY
SOCIAL SERVICE AGENCIES,
REPRESENTATIVES FROM THE HEALTH
CARE PROGRAM FOR CHILDREN IN
FOSTER CARE PROGRAM, AS WELL AS
CONSUMER ADVOCATES TO INFORM
WHAT THAT TRANSITION PLAN LOOKS
LIKE MAKING SURE THAT ANY OF THE
PROTECTIONS OR REQUIREMENTS THAT
THAT PROGRAM OR APPROPRIATELY
EMBEDDED IN ALL OF THE PIECES
MOVING FORWARD OF THE DEPARTMENT
KICKED OFF THE STAKEHOLDER
ENGAGEMENT IN LAST OCTOBER. WE
HAVE CONVENED GROUPS IN OCTOBER
, JANUARY, FEBRUARY AND AS EARLY
AS MARCH. 22ND. THERE ARE TWO
ADDITIONAL WORK. OPERATE
MEETINGS SCHEDULED IN MAY AND
JUNE, AND WE ARE VERY COMMITTED
TO CONTINUING TO WORK WITH
STAKEHOLDERS ON THAT TRANSITION
PLAN. IT INCLUDES THE
PRESUMPTIVE ELIGIBILITY
MONITORING AND OVERSIGHT
ACTIVITIES OF OUR MANAGED CARE
PLANS, TRANSITION AND
REALLOCATION OF THE VARIOUS
RESOURCES THAT WERE AGREED TO,
AS WELL AS THE CHILDHOOD LEAD
POISONING PREVENTION PROGRAM
ACTIVITIES AND THE ESTABLISHING
OF THE HEALTH CARE PROGRAM FOR
CHILDREN IN FOSTER CARE AS A
STANDALONE PROGRAM. THE
DEPARTMENT IS SOLICITING
FEEDBACK WE LOOK FORWARD TO
WORKING ON THAT WE WILL PRESENT
THAT TRANSITION PLAN TO THE
LEGISLATURE IN THE FUTURE AND
HAPPY TO ANSWER ANY QUESTIONS
YOU MAY HAVE. DEPARTMENT OF
FINANCE. NOTHING FURTHER. TAD
HELIO. WE HAVE NOT RAISED
CONCERNS WITH THIS PROPOSAL.
THANKS VERY MUCH PANEL 14. WE
WILL MOVE ON TO ISSUE 15. OUR
LAST PRESENTATION ISSUE TODAY IS
ON THE ACUTE INPATIENT INTENSIVE
REHABILITATION SERVICES TRAILER
BILL. WE WILL BEGIN WITH
DIRECTOR COOPER. THE DEPARTMENT
PROPOSES TO ELIMINATE THE
STATUTORY PROVISIONS RELATED TO
THE INITIAL EVALUATION. 7 TO 10
DAYS IN 14 DAYS TRIAL PROGRAM
FOR ACUTE INPATIENT INTENSIVE
REHABILITATION SERVICES, ACUTE
INPATIENT INTENSIVE
REHABILITATION SERVICES ARE AN
INTENSIVE SET OF SERVICES TO
REHABILITATE IT PHYSICALLY OR
COGNITIVELY IMPAIRED PATIENT TO
REGAIN THEIR MAXIMUM POTENTIAL
FOR MOBILITY, SELF CARE AND
INDEPENDENT LIVING. IN 2010. CM
S, UH, DETERMINED THAT TRIAL
PERIOD SUCH AS THESE ARE NO
LONGER CONSIDERED REASONABLE AND
NECESSARY FOR PURPOSES OF
MEDICARE COVERAGE. UM EACH
ADMISSION DECISION MUST BE
EVALUATED BASED ON THOROUGH PRE
ADMISSION SCREENING. THEREFORE
THE DEPARTMENT PROPOSES TO
UPDATE STATE LAW TO CONFORM WITH
EVIDENCE BASED PRACTICES,
FEDERAL MEDICARE POLICY AND
CURRENT DEPARTMENT POLICY ON
MEDICAL NECESSITY BY REMOVING
THE PROVISION THAT DESCRIBES THE
TRIAL PERIOD OF THIS BENEFIT,
HAPPY TO ANSWER ANY QUESTIONS.
DEPARTMENT OF FINANCE. NOTHING
PROVES THAT I THINK YOU HAVEN'T
RAISED CONCERNS WITH THIS
PROPOSAL. BRING IT UP TO THE
DIETS, SEEING NO MEMBERS.
QUESTIONS I WILL THANKS VERY
MUCH. OUR LAST PANEL OF THE DAY.
I WOULD LIKE TO THANK ALL OF OUR
PANELISTS AND WE WILL NOW BEGIN
WITH PUBLIC COMMENT. AGAIN AS A
REMINDER. WE WELCOME PUBLIC
COMMENT ON ALL 20 ISSUES THAT
ARE ON TODAY'S AGENDA. BUT ASK
THAT YOU PLEASE KEEP YOUR
COMMENTS TO ONLY THESE ISSUES.
WE WILL BEGIN PUBLIC COMMENT
WITH INDIVIDUALS WHO ARE HERE IN
THE HEARING ROOM, AND THEN WE
WILL GO TO THE PHONE LINES.
PLEASE BEGIN. THANK YOU, MR
CHAIR AND MEMBERS OF THE
COMMITTEE JED HAMPTON WITH
CALIFORNIA ASSOCIATION OF HEALTH
PLANS. CAP WE REPRESENT 43
LICENSED HEALTH PLANS COVERING
APPROXIMATELY 28 MILLION
CALIFORNIANS. THANK YOU FOR THE
OPPORTUNITY TO PROVIDE PUBLIC.
THE MANAGED CARE ORGANIZATION
TAX. UM CAPITAL MEMBERS PLAY A
VITAL ROLE IN DELIVERING HIGH
QUALITY AND COORDINATED CARE TO
MEDICARE BENEFICIARIES AN
AFFORDABLE COST TO THE STATE
CAMPUS HISTORICALLY SUPPORTED
THE ATTACKS OVER THE COURSE OF
THE LAST FEW YEARS. BETTER
REGULATIONS HAVE CHANGED AND SO
HAS THE TAX. AND AS SUCH, WE
HAVE WORKED CLOSELY WITH THE
DEPARTMENT OF HEALTH CARE
SERVICES OVER THE PAST FEW
MONTHS ON THE RENEWAL OF THE
ATTACKS. THIS THIS TASK IS A
COMPLICATED AND THE PROCESS IS
COMPLICATED, AND WE CERTAINLY
APPRECIATE THE ADMINISTRATION'S
WILLINGNESS TO CONSIDER AND
ADDRESS MANY OF OUR ISSUES
AROUND THE PROPOSAL. OUR MEMBERS
BELIEVE IT'S CRITICALLY
IMPORTANT THAT IF THE TAXES
RENEWED THAT THE FUNDING GOES TO
SUPPLEMENT THE MEDICAL PROGRAM
AND STRENGTHEN IT PROTECTS THE
AFFORDABILITY OF COVERAGE FOR
INDIVIDUALS AND EMPLOYERS AND
INCLUDES COMMON SENSE
PROTECTIONS FOR OUR MEMBER PLANS
. WE LOOK FORWARD TO CONTINUING
OUR CONVERSATIONS WITH THE
DEPARTMENT MOVING FORWARD. THANK
YOU. THANK YOU. HI THANK YOU. MR
CHAIR AND MEMBERS CADDY, SENATOR
LEE MCDONALD WAS CWD A. I WANT
TO SPEAK TO ISSUE NINE HOUR
SPECIFICALLY RELATED TO THE
FOSTER CHILD PROPOSAL ENROLLING
FOSTER CHILDREN IN THE SINGLE
PLAN MODEL COUNTIES. UM WE ONLY
RECENTLY BECAME AWARE OF THE
PROPOSAL. IT WAS NOT DISCUSSED
IN THE RECENTLY DISBANDED CAL IN
FOSTER CARE MODEL OF CARE WORK
GROUP. SO WE'RE REVIEWING THE
PROPOSAL, AND WE DO HAVE SOME
QUESTIONS THAT WILL BE PROPOSED
TO THE DEPARTMENT AS WE ENGAGE
IN REPORT BACK AS WE TAKE A
POSITION THERE ARE KNOWN ISSUES
WITH FOSTER CHILDREN ACCESSING
CARE THROUGH FEE FOR SERVICE.
BUT THEY'RE ALSO GOOD REASONS
THAT SOME FOSTER PARENTS OR
BIOLOGICAL PARENTS CHOOSE NOT TO
ENROLL THEIR CHILDREN INTO
MANAGED CARE WHEN THEY GO INTO
FOSTER CARE, SO I THINK WE HAVE
TO UNPACK HOW ACCESS TO PHYSICAL
, BEHAVIORAL AND DENTAL CARE
WILL BE IMPROVED BY THIS
PROPOSAL, AS WELL AS WE HAVE A
NUMBER OF QUESTIONS ON THE
TIMELINE THAT'S BEING PROPOSED
THE TRAILER BILL LANGUAGE WOULD
TAKE EFFECT IMMEDIATELY. SO AS
THE SINGLE PLAN MODELS CAME UP
THE CHILDREN WOULD HAVE TO, I
GUESS IMMEDIATELY BE TRANSFERRED
OR UNCLEAR ON CONTINUITY OF CARE
PROVISION THAT MIGHT NEED TO BE
PUT IN PLACE AS WELL AS THIS
HAPPENING AT THE SAME TIME, THE
PLANS ARE STANDING UP. THEY'RE
ALSO CREATING THESE WHOLE CHILD
MODELS. AND AS YOU JUST HEARD IN
THE NEXT LAST ITEM, THE C H D P
PROGRAM IS BEING ELIMINATED. AND
SO WE DON'T EVEN KNOW THE PLAN
YET FOR WHAT'S GOING TO HAPPEN
TO THE PUBLIC HEALTH NURSES THAT
WE WORK WITH THROUGH CCS. WE
DON'T KNOW THE PLAN FOR HOW OUR
CHILDREN ARE GOING TO GET
ENROLLED INTO FOSTER CARE RIGHT
NOW IN THE MEDICAL. WE DO WORK
VERY CLOSELY IN MANY COUNTIES
WITH CHD P. SO THERE'S A LOT OF
CHANGE AT ONCE, AND SO WE MAY
HAVE RECOMMENDATIONS HERE. WE'RE
ON. UM THAT THE TIMELINE SHOULD
THIS BE ADOPTED? ITS AND MORE
JUST LIKE I SAID, REPORT BACK AS
WE KIND OF FIGURE MORE OUT ABOUT
THIS AND WORK IN PARTNERSHIP
WITH THE WITH THE STATE. THANK
YOU. THANK YOU. GOOD AFTERNOON,
JENNIFER SNYDER ON BEHALF OF
CALIFORNIA ASSOCIATION OF HEALTH
FACILITIES, AND WE WANT TO
COMMENT ON THE KELLY
IMPLEMENTATION ITEM AND ALSO THE
CALEN BUDGET TRAILER BILL FIRST
, WE JUST WANTED TO EXPRESS OUR
APPRECIATION TO THE DEPARTMENT
AND OUR SUPPORT FOR THE BUDGET
TRAILER BILL LANGUAGE THAT
DELAYS THE IMPLEMENTATION OF
KILLEEN FOR THE INTERMEDIATE
CARE FACILITIES FOR THE
DEVELOPMENTALLY DISABLED. WE
BELIEVE THE DELAY PROVIDES THE
NECESSARY TIME FOR CATS I C F D.
D EIGHT D, D H AND MEMBERS
HEALTH PLANS IN THE STATE TO
WORK THROUGH HOW BEST TO
INTEGRATE THEIR PATIENT
POPULATION INTO CALENDAR. VERY
PLEASED ABOUT THAT. AND WE ALSO
SUPPORT THE IMPLEMENTATION DELAY
FOR THE PEDIATRIC SUB ACUTE
WHICH INCLUDED, BUT WE WOULD ASK
THE DEPARTMENT TO RE EVALUATE
THE DELAY FOR THE ADULT SUB
ACUTE FACILITIES, AND THERE'S
SOME CONCERNS ABOUT THE ABILITY
OF THOSE PROVIDERS TO QUALIFY
FOR ANY EQUALITY INCENTIVE
PAYMENTS THROUGH THE MEDICAL, UM
, PROGRAM. IT MIGHT BE IMPACTED
BECAUSE OF THAT, SO WE'D LIKE
FOR THEM TO RE LOOK AT THAT.
CAST NURSING FACILITY MEMBERS
ARE EXPERIENCING IN A NUMBER OF
CAL AIM IMPLEMENTATION ISSUES.
WE JUST WANTED TO NOTE TODAY. UM
THERE'S THREE FIRST IS BECAUSE
THERE IS MEDICAL MANAGED CARE
PLANS ARE SLOW TO SIGN CONTRACTS
WITH NURSING FACILITIES. UM MANY
ARE BEING FORCED TO PROVIDE
SERVICES TO MEDICAL PATIENTS
THEY ALREADY HAD IN THEIR
FACILITIES WITHOUT A CONTRACT OR
NEW PATIENTS WITHOUT A CONTRACT.
THIS AND THE SECOND ISSUE. THIS
IS HAVING AN IMPACT ON THEIR
ABILITY POSSIBLY TO RECEIVE FOR
RECOGNITION FOR QUALITY
INCENTIVE PAYMENTS BECAUSE THE
REQUIREMENT TO RECEIVE THOSE
QUALITY INCENTIVE PAYMENTS THEY
NEED TO BE NETWORK PROVIDERS, SO
WE'RE KIND OF CAUGHT IN A CATCH
22 BETWEEN NOT BEING ABLE TO
ACCOMPLISH TO GET TO THOSE
CONTRACTS AND THEN POSSIBLY NOT
BEING QUALIFIED TO RECEIVE
MEDICAL QUALITY INCENTIVE
PAYMENTS BASED ON THAT. AND THEN
THIRD. UM MANY NURSING
FACILITIES ARE ARE INFORMING US
THAT SINCE JANUARY 1ST THEY
HAVEN'T RECEIVED A PAYMENT. AND
SO THAT'S WAY BEYOND THE 45 DAYS
WHERE IT'S MANDATED FOR HEALTH
PLANS TO PAY. WE KNOW THERE'S
TWO SIDES TO THE COIN IN THAT
RESPECT, BUT WE ARE REALLY
CONCERNED ABOUT THE LENGTH AND
MEDICAL PROVIDERS. NURSING
FACILITIES ARE YOU KNOW, OVER AT
70% MEDICAL, SO FOR THEM, THAT'S
A BIG DEAL WHEN THEY WERE USED
TO RECEIVING PAYMENTS EVERY TWO
WEEKS FROM THE DEPARTMENT. SO WE
ASKED FOR A COUPLE OF THINGS
THAT THE DEPARTMENT TO CONSIDER
, UM FIRST AND FOREMOST GREATER
DHS ENFORCEMENT IN MEDICAL
MANAGED CARE PLANS SPECIFIC TO
MAKING SURE THAT THEY PAY WITHIN
THE 45 DAYS AND MAYBE SOME
AUDITS RELATIVE TO WHAT'S THEIR
PAYMENT SCHEDULE, AND ARE THEY
ADHERING TO IT AND WHAT'S
HAPPENING IN THE FIELD? AND THEN
WE ASKED THE LEGISLATURE AND
ADMINISTRATION TO SUPPORT
POSSIBLY AN ANY WILLING PROVIDER
DIRECTIVE, AT LEAST FOR THE TIME
BEING, IF THERE IS A WILLING
SKILLED NURSING FACILITY
PROVIDER OUT THERE THAN THE PLAN
SHOULD CONTRACT WE HAVE RATES
THAT ARE SET. ALREADY BY THE
MEDICAL PROGRAM, SO IT'S NOT AS
COMPLICATED TO CREATE, YOU KNOW,
A CONTRACT SITUATION. AND THEN,
UM, DURING THE TRANSITION, THIS
TRANSITION YEAR, WE FEEL THAT
THE QUALITY INCENTIVE PAYMENT
SHOULDN'T BE HINGED ON THE
CONTRACT REQUIREMENTS. UM, THAT
MAYBE WE COULD HAVE A TRANSITION
TIME WHERE QUALITY INCENTIVE
PAYMENTS COULD QUALIFY, EVEN IF
THEY'RE NOT A NETWORK PROVIDER.
AND LASTLY, WE WOULD JUST HOPE
THAT THE DHS COULD HOLD PLANS
ACCOUNTABLE FOR ESTABLISHING
THOSE CONTRACTS. SO THANK YOU
VERY MUCH. THANK YOU. MR
CHAIRMAN, MEMBERS OF THE
COMMITTEE, BRANDON MARCH YOU
WITH THE CALIFORNIA MEDICAL
ASSOCIATION WANT TO SPEAK
DIRECTLY TO ISSUE EIGHT. THE TAX
CMI APPRECIATES THE LEGISLATURE
AND THE ADMINISTRATION'S ONGOING
EFFORTS TO INCREASE COVERAGE AND
GET TO UNIVERSAL COVERAGE,
IMPROVED PATIENT AFFORDABILITY
AND PROVIDE A ROBUST BENEFIT
PACKAGE FOR THE MEDICARE
BENEFICIARIES WERE ALSO HAPPY TO
SEE THE CONVERSATION ABOUT THE
MCO TAX CONTINUE. AH AND WHAT
STRATEGIC EXCUSE ME. STRATEGIC
INVESTMENTS CAN BE MADE TO
INCREASE ACCESS TO CARE. IN THE
MEDICAL PROGRAM. HOWEVER, THE
CURRENT PLANS TO BACKFILL
GENERAL FUND OBLIGATIONS
SQUANDERED THE OPPORTUNITY. THE
STATE HAS TO BUILD ACCESS TO
CARE FOR ALL AND FUNDS GENERATED
FROM THE HEALTH CARE SYSTEM
SHOULD STAY IN THE HEALTH CARE
DELIVERY SYSTEM TO REDUCE
PATIENT APPOINTMENT TIMES, UH,
BUILD A STRONGER, MORE ROBUST
HEALTHCARE WORKFORCE AND REDUCE
OUTCOME, DISPARITIES AND
INEQUITIES. FOR THESE REASONS HE
MAY LOOKS FORWARD TO WORKING
WITH THE LEGISLATURE AND THE
ADMINISTRATION TO ADJUST THE MCO
TAX TO SUPPLEMENT CURRENT
SPENDING TO IMPROVE ACCESS TO
CARE AND RE INVEST THOSE FUNDS
TO BENEFIT PATIENTS AND PROVIDE
THEM WITH THE TIMELY CARE THEY
NEED. THANK YOU. THANK YOU. GOOD
EVENING, LINDA WAY WITH WESTERN
CENTER ON LAW AND POVERTY
REGARDING THE M C O TAX. WE
APPRECIATE THAT THIS DRAWS DOWN
SIGNIFICANT FEDERAL FUNDS TO
OFFSET GENERAL FUND WE AGREE
WITH THE CHAIR REGARDING TIMELY
PASSAGE AND IN LIGHT OF RECENT
EXPANSIONS AND FUTURE
COMMITMENTS, INCLUDING HEALTH
FOR ALL SHARE COSTS, REFORM AND
CONTINUOUS MEDICAL ELIGIBILITY.
WE RECOMMEND THIS OPPOSITE
SHOULD REMAIN WITHIN THE MEDICAL
PROGRAM, PARTICULARLY IN
COVERAGE, ELIGIBILITY AND
SERVICE BENEFITS. REGARDING UM,
WE HAVE SOME CONCERNS WITH
CHANGING THE MEDICAL ESTIMATE.
TBL TO NO LONGER REQUIRE FIFA
SERVICE RATES BECAUSE BE
SEPARATELY DISPLAYED,
CONSIDERING CERTAIN SERVICES,
NAMELY, PRESCRIPTION DRUGS IS
FIFA SERVANTS, AND THERE'S NO
OTHER PUBLIC PLACE FOR THIS
INFORMATION. AND FINALLY, WE
SUPPORT THE NEWBORN HOSPITAL
GATEWAY TBL AS IT ENSURES
EXPEDITIOUS MEDICAL ELIGIBILITY
FOR NEWBORNS TO MORE EASILY
ACCESS MEDICAL SERVICES AND
RECOMMEND THIS BE EXPANDED TO
CAPITAL LINKED UH, INFANTS TO BE
INCLUDED. THANK YOU. THANK YOU.
CHAIR AND MEMBERS MARK FRUIT
WITH THE CALIFORNIA HOSPITAL
ASSOCIATION WANTED TO SPEAK TO
THE DISCUSSION ON MEDICAL AND
KOTEX. CALIFORNIA'S HOSPITALS
PROVIDED CRITICAL SOURCE OF CARE
FOR MEDICALS 15 MILLION
BENEFICIARIES YET LONGSTANDING,
SYSTEMATIC UNDERFUNDING AND
MEDICAL PROGRAM PERSIST.
HOSPITALS HAVE NOT SEEN AN
INCREASE IN THEIR MEDICAL RATES
FOR OVER A DECADE.
REIMBURSEMENTS HAVE REMAINED
STAGNANT, HUGE PANDEMIC RELATED
LOSSES AND UNPRECEDENTED
INFLATIONARY PRESSURES,
REPLACING MANY HOSPITALS AND
PERIL. WITHOUT HELP CITIES AND
TOWNS THROUGHOUT THE STATE ARE
ON TRACK TO LOSE VITAL COMMUNITY
HEALTHCARE SERVICES AND JOBS.
CRISIS IS NOT THEORETICAL. IT IS
HAPPENING NOW. IN JANUARY, 2023
WE WITNESSED MADEIRA COMMUNITY
HOSPITAL FORCED TO CLOSE ITS
DOORS. FORCING THOSE THAT RELY
ON IN HOSPITAL FOR CARE TO
TRAVEL AS FAR AWAY. AS FRESNO
SOME 30 MILES AWAY. SIGNIFICANT
AND IMMEDIATE INVESTMENTS ARE
NEEDED TO PLACE CALIFORNIA'S
HOSPITALS ON A FINANCIALLY
SUSTAINABLE PATH. ON MARCH 15TH
350 HOSPITALS THROUGHOUT
CALIFORNIA SUBMITTED A LETTER TO
THE GOVERNMENT THE LEGISLATURE
OUTLINING THE AFOREMENTIONED
CONCERNS THAT I MENTIONED AS
WELL AS ASKING FOR $1.5 BILLION
LIFELINE TO SUPPORT THE CARE FOR
MEDICAL PATIENTS. THIS
REPRESENTS JUST 1% OF ALL
MEDICAL FUNDING AND IS ESSENTIAL
AND ESSENTIAL CASH INFUSION TO
KEEP POSSIBLE DOORS OPEN AND
SERVICES AVAILABLE IN THE SHORT
TERM. IN ADDITION TO THIS ONE
TIME REQUEST, WE NEED A LONG
TERM FIX TO THE SYSTEMATIC
UNDERFUNDING THAT I MENTIONED.
AND THIS CAN BE ACHIEVED THROUGH
THE ATTACKS. AS IT RELATES TO
THE DISCUSSION TODAY, SO
STRONGLY BELIEVES THAT THE
MANAGED CARE ORGANIZATION TAX
LIKE ALL OTHER HEALTHCARE
RELATED TAXES IN CALIFORNIA,
SHOULD BE USED TO PROTECT ACCESS
TO CARE FOR MEDICAL
BENEFICIARIES. ACCORDINGLY WE
RESPECTFULLY REQUEST THAT A
SIGNIFICANT PORTION OF THE M CEO
TAX REVENUES BE USED TO
STABILIZE CALIFORNIA'S HEALTH
CARE PROVIDERS. INCLUDING
HOSPITALS AND PROTECT ACCESS TO
CARE. THANK YOU. THANK YOU. MR
SHARON MEMBERS AMY BLOOMBERG ON
BEHALF OF THE CALIFORNIA
CHILDREN'S HOSPITAL ASSOCIATION
. THANK YOU FOR THE DISCUSSION
TODAY AND ITEM NUMBER NINE AND
ALLOWING THE CALIFORNIA
CHILDREN'S HOSPITAL ASSOCIATION
TO EXPRESS OUR STRONG CONCERNS
WITH THE PROPOSAL TO EXPAND CCS
WHOLE CHILD MODEL. ALSO I'D LIKE
TO ALIGN MYSELF WITH A
CALIFORNIA HOSPITAL ASSOCIATION
AND EXPRESS SUPPORT FOR CH. $1.5
BILLION BUDGET REQUEST TO
SUPPORT CALIFORNIA'S HOSPITALS
WHO CARE FOR BETTER CAL PATIENTS
ON AVERAGE 62% OF PATIENTS AT
CALIFORNIA CHILDREN'S HOSPITALS
ARE ON MEDICAL AND FOR SOME OF
OUR HOSPITALS AT 70, THE 75%
SIGNIFICANT AND IMMEDIATE
INVESTMENTS ARE NEEDED TO
ADDRESS SYSTEMIC UNDERFUNDING
AND PLACE CALIFORNIA'S HOSPITALS
ON A FINANCIAL SUSTAINABLE,
FINANCIALLY SUSTAINABLE PATH.
ALSO WE NEED A LONG TERM FIX OF
SYSTEMIC UNDERFUNDING IN THE
MEDICAL PROGRAM AND THE CEO TAX
CAN ASSIST WITH THIS LIKE CH A.
CCH A STRONGLY BELIEVES THAT
MAKO TAX SHOULD BE USED TO
PROTECT ACCESS TO CARE FOR
MEDICAL BENEFICIARIES, AND WE
REQUESTED A SIGNIFICANT PORTION
OF THE N C O REVENUES BE USED.
TO STABILIZE CALIFORNIA'S HEALTH
CARE PROVIDERS, INCLUDING
HOSPITALS TO PROTECT ACCESS TO
CARE. THANK YOU. THANK YOU. GOOD
EVENING, MR CHAIR AND MEMBERS
CONNIE DELGADO ON BEHALF OF THE
DISTRICT HOSPITAL LEADERSHIP
FORUM, APPRECIATE THE
CONVERSATION ABOUT HOSPITAL
REIMBURSEMENT AND WOULD LIKE TO
ALIGN MY COMMENTS IN SUPPORT OF
THE $1.5 BILLION REQUEST FOR ARE
STRUGGLING HOSPITALS DISTRICT
HOSPITALS, MORE THAN HALF OF
THEM ARE OPERATING IN THE RED
AND HAVE SERIOUSLY BEEN IMPACTED
BY THE PANDEMIC, AND WE WANT TO
ASSURE THAT ALL OF THOSE
SERVICES REMAIN OPEN FOR
CALIFORNIA'S PATIENTS. THANK
YOU. THANK YOU. GOOD EVENING
MATTLAGE ON BEHALF. SO STU,
CALIFORNIA SPECIFICALLY ON THE
AMOCO TAX ISSUE, EIGHT. WE ARE
SUPPORTIVE OF THE POTENTIAL TO
RAISE SIGNIFICANT FUNDS TO
SUPPORT THE MEDICAL PROGRAM. WE
HAVE REAL ACCESS TO CARE NEEDS,
WHICH IS CAUSED IN PART BY YOUR
HEALTHCARE WORKFORCE CRISIS, AS
MANY OF THE PANELISTS TODAY
TALKED ABOUT, UM HEALTHCARE
WORKERS, PARTICULARLY LOW WAGE
HEALTHCARE WORKERS ARE LEAVING
THE INDUSTRY AND THIS PROPOSAL
GIVES THE STATE THE OPPORTUNITY
TO LIFT UP THE WORKFORCE ACROSS
THE MEDICAL SYSTEM. WE LOOK
FORWARD TO CONTINUING TO SEE THE
PROPOSAL COME TOGETHER AND
DISCUSSING THE DETAIL HOW THE
STATE CAN MEET OUR ACCESS TO
CARE NEEDS FROM MOST VULNERABLE.
THANK YOU. THANK YOU. THANK YOU,
MR CHAIR MEGAN SUPERS ON BEHALF
OF THE CALIFORNIA PRIMARY CARE
ASSOCIATION, CALIFORNIA HEALTH
PLUS ADVOCATES THANK YOU FOR
HAVING TO HEALTH CENTER
REPRESENTATIVES ON YOUR PANEL
THIS AFTERNOON ON ISSUE NUMBER
EIGHT, AND THE EMC ATTACKS JUST
WANTED TO EXPRESS OUR SUPPORT
FOR THAT PROPOSAL AND URGED THE
LEGISLATURE TO ENSURE THAT THE
ADDITIONAL GENERATED REVENUES
FROM THE PROPOSAL GO TO SUPPORT
HEALTHCARE. UM, AND THE MEDICAL
SYSTEM. THANK YOU. THANK YOU.
CHAIR MEMBER BETH MANASQUAN. STU
CALIFORNIA WANT TO START BY
ACKNOWLEDGING THE WORK OF THIS
LEGISLATURE AND THE PUBLIC
SECTOR WORKFORCE AND SUPPORTING
THE MEANINGFUL EXPENDITURE,
HELPING AROUND HEALTHCARE
COVERAGE TO THE CRITICAL RE
DETERMINATION ACTIVITIES.
RELAUNCHING NOW LOOK FORWARD TO
CONTINUING TO WORK WITH ALL OF
YOU TO MAKE SURE WE
DETERMINATIONS, PROSTHETIC
SUCCESS FOR CONSUMERS AND FOR
THE WORKFORCE. UM WITH REGARD TO
ISSUE NUMBER NINE CCS WHOLE
CHILD MODEL EXPANSION AS YOU
MEMBERS ARE DEEPLY CONCERNED
ABOUT IT FURTHER EXPANSION OF
THIS PILOT. THE TIMING OF
PROPOSAL GOES AGAINST THE
COMMITMENT TO COMPLETE PUBLIC
EVALUATION INTERPLAY. THIS
PROPOSAL WITH OTHER MANAGED CARE
SHIPS ARE ALSO OF CONCERN TO US
AND MOST IMPORTANTLY, WANT TO
ACKNOWLEDGE THE IMPACT ON THE
GROUND, REVERSIBLE CHILDREN IN
OUR STATE THE SKILLS OF OUR
LOCAL COUNTY CCS WORKFORCE
CANNOT BE EASILY REPLICATED AND
WILL BE LOST IN A PILOT
EXPANSION THAT TAKES WORK FROM
LOCAL JURISDICTION. TIONS TO
MANAGED CARE. UM CASE MANAGERS,
NURSES, THERAPISTS WHO DEDICATES
UNIQUE NEEDS OF THE FAMILIES
THEY'RE SERVING TODAY. WE ALSO
CANNOT SEPARATE THIS FROM THE
DIFFERENT TRANSITION THAT WAS
COMMITTED TO IN THE FY 2023
BUDGET ON THE SEA HDP TRANSITION
, JUST ACKNOWLEDGING THAT THIS
TRANSITION PLUS THE EXPANSION OF
THE CCS HOTEL MODEL DOES EQUAL
SIGNIFICANT DEPLETION OF OUR
LOCAL PUBLIC HEALTH WORKFORCE.
POTENTIALLY THANK YOU. THANK
YOU. CHAIR AND MILLION MEMBERS,
MARVIN PINNELL, AND THEY HAVE A
CHILDREN'S HOSPITAL OF LOS
ANGELES ON ITEM NUMBER NINE. WE
OPPOSE THE DEPARTMENT OF HEALTH
CARE SERVICES PROPOSAL TO EXPAND
THE WHOLE CHILD, WHOLE CHILD
MODEL FOR THE RECENT STATE OF
WHETHER CALIFORNIA CHILDREN'S
HOSPITAL ASSOCIATION CHILDREN'S
HOSPITAL OF LOS ANGELES SERVES
SOME OF THE MOST NEEDED
THROUGHOUT THE STATE AND LOT OF
TIMES IN MANY OF YOUR DISTRICTS.
WE RESPECTFULLY REQUEST FOR THE
DEPARTMENT TO WOULD RATHER
BUDGET TRAILER WILL THANK YOU.
THANK YOU. MR CHAIRMAN MEMBERS
NEW ORLEANS ON BEHALF OF
CHILDREN NOW REGARDING ISSUE
THREE ON THE HEARING AID
COVERAGE FOR CHILDREN PROGRAM.
WE APPRECIATE THE SUBCOMMITTEE
OVERSIGHT OF THIS IMPORTANT
PROGRAM TO GET KIDS TIMELY
ACCESS TO HEARING AIDS. WE LOOK
FORWARD TO WORKING WITH THE HCS
TO FOLLOW THROUGH ON THE ACTIONS
THEY COMMITTED TO IN THEIR LONG
AWAITED ACTION PLAN, BUT WE
THINK MUCH MORE NEEDS TO BE DONE
IN TERMS OF MORE TARGETED
OUTREACH, ESPECIALLY TO SPANISH
SPEAKING FAMILIES TO GET
ELIGIBLE KIDS INTO THE PROGRAM,
IMPROVED PROVIDER RELATIONS TO
GET KIDS TIMELY ACCESS. AND
STREAMLINING OF ADMINISTRATIVE
PROCESSES TO KEEP ELIGIBLE KIDS
ENROLLED REGARDING ISSUES AID ON
THE WC. I'M SORRY THE EMC
ATTACKS WE SUPPORT THE STATE
SEEKING REVENUE THROUGH AN M CEO
TAX TO ENSURE MEDICAL CAN
DELIVER ACCESS TO CARE, AND
WE'RE EAGER TO SEE THE PROPOSALS
. DETAILS REGARDING ISSUE NINE
ON THE WHOLE CHILD MODEL. WE
OPPOSE THE PROPOSED EXPANSION OF
THE CCS WHOLE CHILD MODEL
BECAUSE IT IS INCONSISTENT WITH
SB 5 86 AUTHORIZING THE WHOLE
CHILD MODEL PILOTS IN 2016. AND
GIVEN THE EXPERIENCE WOULD
RESULT IN THE LOSS OF IMPORTANT
CASE MANAGEMENT EXPERTISE AND
WOULD BE DEVASTATING TO THE
PEDIATRIC SPECIALTY CARE
DELIVERY SYSTEM AND LAST
REGARDING ISSUE 14 ON THE
NEWBORN HOSPITAL GATEWAY WE
STRONGLY SUPPORT THE
ESTABLISHMENT OF THE NEWBORN
HOSPITAL GATEWAY AND SINCE WE
WOULD LIKE TO SEE IT BE USED AS
EXPANSIVELY AS POSSIBLE,
INCLUDING BABIES BORN TO MOTHERS
COVERED BY THE MEDICAL ACCESS
PROGRAM. ALSO WE APPRECIATE THE
SUBCOMMITTEE'S QUESTION ABOUT
THE HEALTH CHILD HEALTH AND
DISABILITY PREVENTION PROGRAM,
STAKEHOLDER PROCESS AND
DEVELOPMENT OF THE TRANSITION
PLAN. CHILDREN NOW HAS CONCERNS
ABOUT HOW C HDP FUNCTIONS,
INCLUDING HOW THE LOCAL
EXPERTISE AND RELATIONSHIPS MADE
WILL TRANSFER TO MANAGED CARE
PLANS AND HOW THE PLANS WILL BE
MONITORED THROUGH CONTRACTS OR
OTHER MEANS TO ENSURE CHILDREN
CONTINUE TO RECEIVE SEAMLESS
ACCESS. Tð NECESSARY SERVICES.
WE RESPECTFULLY REQUEST THAT THE
SUBCOMMITTEE CONVENE AN
OVERSIGHT HEARING THIS YEAR TO
ALLOW FOR STAKEHOLDERS ENGAGED
IN THE PROCESS AND AFFECTED BY
SEA HDP SUNSET TO SHARE THEIR
PERSPECTIVE ABOUT THE PLAN.
THANK YOU. THANK YOU. SEEING AS
THERE'S NO MORE PUBLIC COMMENT
IN THE HEARING ROOM OPERATOR
WE'RE READY TO BEGIN PUBLIC
COMMENT. FOR OUR PHONE LINES AS
A REMINDER, THE PHONE NUMBER AND
ACCESS CODE OR ON THE FIRST PAGE
OF OUR AGENDA ON THE SUBJECT, AS
WELL AS ON THE SUBCOMMITTEE'S
WEBSITE AND SHOULD ALSO BE
APPEARING ON YOUR SCREEN. IF YOU
ARE WATCHING OVER THE LIVESTREAM
THE PHONE NUMBER AGAIN, 877692.
THE PUBLIC ACCESS CODE IS 131512
7. OPERATOR. LET'S BEGIN. UNLESS
YOU'D LIKE TO MAKE A PUBLIC
COMMENT. YOU MIGHT PRESS ONE AND
ZERO AT THIS TIME. FIRST WE'RE
GOING TO GO TO LINE NUMBER 10,
PLEASE GO AHEAD. GOOD EVENING,
NICOLE COLEMAN ON BEHALF OF THE
CHILDREN'S PARTNERSHIP. SPEAKING
TO ISSUE 19 AND 14 ON ISSUE ONE
CONTINUOUS COVERAGE FOR CHILDREN
AGES 0 TO 5 WAS PASSED BY THE
LEGISLATURE LAST YEAR WHEN
COURAGE THE HCS TO MOVE TOWARDS
IMPLEMENTATION OF THE POLICY
QUICKLY TO PREVENT DEPTH AND
COVERAGE FOR CALIFORNIA. THE
CHILDREN'S PARTNERSHIP IS
OPPOSED TO THE TRAILER BILL
LANGUAGE IN A FEW NINE TO EXPAND
THE WHOLE CHILD MODEL FOR
CALIFORNIA CHILDREN'S SERVICES.
THE EXPERIENCE OF COAL CHILD
MODEL IMPLEMENTATION OVER THE
PAST FOUR YEARS INDICATES THAT
THE MODEL CAN DEPRIVE CCS
CHILDREN OF ACCESS TO THE
SPECIALIZED MEDICAL CARE AND
EXPERT CASE MANAGEMENT SERVICES.
AND THE TRANSITION WILL RESULT
IN EVEN DEEPER MEDICAL CUTS. CCS
OUTPATIENT PROVIDERS. FINALLY WE
SUPPORT ISSUES 14, THE
GOVERNOR'S NEWBORN HOSPITAL,
GATEWAY TRAILERS WILL AND
RECOMMEND THAT THE END HDB USED
TO ENROLL NEWBORNS BORN TO
MOTHERS COVERED BY THE MEDICAL
ACCESS PROGRAM, WHO ALSO QUALIFY
FOR MEDICAL AT BIRTH, OR AT
LEAST THE FIRST YEAR. WE ARE
ALSO CONCERNED THAT THE SUNSET
OF THE CHILD HEALTH AND
DISABILITY PREVENTION PROGRAM
WILL LEAVE A GAP IN PEDIATRIC
CARE, QUALITY ASSURANCE AND
TRADING FUNCTION. WE APPRECIATE
YOUR CONSIDERATION. THANK YOU.
NEXT CALLER, PLEASE. NEXT WE GO
TO LINE 28, PLEASE GO AHEAD.
GOOD EVENING TEAR ARAMBULA. MY
NAME IS KATIE LAYTON AND I'M
TESTIFYING ON BEHALF OF THE
CHILDREN'S SPECIALTY CARE
COALITION ON THREE ITEMS BURST.
WE ARE OPPOSED TO AGENDA ITEM
NINE. PHDS HAS PROPOSED TRAILER
BILL TO EXPAND THE WHOLE CHILD
MODEL. THE CALIFORNIA CHILDREN'S
SERVICES PROGRAM TREATS
CALIFORNIA'S MOST MEDICALLY
COMPLEX CHILDREN AND YOUTH,
ENSURING THAT YOU GET THE RIGHT
CARE AT THE RIGHT TIME FROM THE
RIGHT PROVIDER. WE DID HAVE
SEVERAL CONCERNS WITH THE WHOLE
CHILD MODEL HAS PERFORMED THUS
FAR, INCLUDING A STATISTICALLY
SIGNIFICANT DECREASE IN
ENROLLMENT. GUESS WHERE IT'S
GONE INTO EFFECT, MEANING THAT
YOU WERE CHILDREN ARE BENEFITING
FROM THE PROGRAM. WE ALSO KNOW
THAT MANY FAMILIES MISSED THE
DEEP EXPERTISE IN RELATIONSHIP
WITH THEIR CCS NURSE CASE
MANAGERS. AND WE ARE ALSO
CONCERNED ABOUT THE NEGATIVE
FINANCIAL IMPACT OF CHILDREN'S
HOSPITALS THAT THE PANEL SPOKE
TO EARLIER WHAT THREATENS AND
ALREADY DESTABILIZED PROVIDER
NETWORK THAT TREATS THE HIGH
VOLUME OF MEDICAL PATIENTS. SO
UNTIL WE HAVE MORE DETAILS ON
THE WAY WHOLE CHILD MODEL HAS
PERFORMED, INCLUDING THE SOLAR
VALUATION AND A BETTER
UNDERSTANDING OF THE ROOT CAUSES
OF THESE CONCERNING ISSUES. TO
CONSIDER EXPANDING AT THIS TIME
. IT'S PREMATURE AND WE FEEL
STRONGLY THAT THIS PROPOSAL
BELONGS IN A POLICY COMMITTEE
AND WOULD URGE THIS COMMITTEE TO
REJECT IT. I'D ALSO LIKE TO
VOICE OUR SUPPORT FOR ITEM
EIGHT. THE RENEWAL OF THE
ATTACKS AS WELL AS HIGHLIGHT THE
IMPORTANCE OF THESE FUNDS
DIRECTLY SUPPORTING ACCESS TO
CARE IN THE MEDICAL PROGRAM LAST
WEEK YOU THANK YOU FOR YOUR
OVERSIGHT OF THE HEARING AID
COVERAGE FOR CHILDREN PROGRAM.
THIS PROGRAM SOLD SUCH AN
IMPORTANT GAP IN COVERAGE FOR
MANY DEATH AND HARD OF HEARING
CHILDREN. BUT CONTINUED OUTREACH
EFFORTS INSUFFICIENT FUNDING OR
NECESSARY TO INCLUDE INCREASED
PUBLIC AND PROVIDER AWARENESS TO
OVERCOME ADMINISTRATIVE BURDENS
AND ULTIMATELY ENSURE THAT
CHILDREN WHO QUALIFY ARE
ACTUALLY ABLE TO FULLY BENEFIT.
THANK YOU. THANK YOU. NEXT
CALLER, PLEASE. NEXT WE GO TO
LINE 30, PLEASE GO AHEAD. HIGH
CHAIR. REMEMBER KATHY MOSSBERG,
SPEAKING ON A COUPLE OF ISSUES
TODAY FIRST. SORRY I HEARD SOME
FEEDBACK. UM.
WHEREVER HARD TIME RECEIVING
DEVELOPMENTAL. SERVICES NETWORK
, AN ASSOCIATION OF INTERMEDIATE
CARE FACILITY HOMES SERVING
INDIVIDUALS WITH DEVELOPMENTAL
DISABILITIES ACROSS THE STATE
AND ISSUES 60 SN WISHES TO
EXPRESS THEIR SUPPORT FOR DHS'S
TRAILER BILL LANGUAGE TO DELAY
THE TRANSITION OF FDD HOMES AND
SUB ACUTE SERVICES IN THE
MEDICAL MANAGED CARE UNTIL JAN 1
2024. WE VERY MUCH APPRECIATE
THIS CHANGE IN THE DEPARTMENT
HEARING OUR CONCERNS REGARDING
THE PRIOR TIMELINE, OUR HOMES
AND FACILITIES WILL CONTINUE TO
ENGAGE WITH AN APARTMENT THROUGH
THEIR STAKEHOLDER, WORKGROUP AND
WORK TOWARDS A SMOOTH POSITION
OF THE MEDICAL MANAGED CARE ALSO
WANT TO THANK THE LEGISLATURE
AND THE SUBCOMMITTEE FOR WORKING
WITH OUR HOMES SET UP THE
STAKEHOLDER PROCESS. AND ON
BEHALF OF TOTALLY KIDS. SUN
VALLEY'S WHEN THE TIME IS
APPROPRIATE, WE HOPE THIS
COMMITTEE WILL TAKE UP THE ISSUE
TO INCLUDE THE STANDALONE
PEDIATRIC SUB ACUTE FACILITIES
IN THE CURRENT HOLD. HARMLESS
MEDICAL RATES LANGUAGE. THIS
REQUEST HAS BEEN PUT FORWARD
FORWARD BY ASSEMBLYMEMBER'S
FRIEDMAN. THERE ARE ONLY THREE
FACILITIES THAT MEET THIS
CRITERIA WHO SERVED MEDICALLY
FRAGILE CHILDREN AND MEDICAL SO
IT'S IMPORTANT FACILITIES ARE
TREATED EQUALLY AND DON'T SEE
THEIR RATES FALL BELOW 22 23
LEVELS. THANKS FOR YOUR TIME
THIS EVENING AND APOLOGIZE FOR
THE FOR THE FEEDBACK. THANK YOU.
NEXT CALLER, PLEASE. NEXT WE'LL
GO TO LINE 42, PLEASE GO AHEAD.
GOOD AFTERNOON CHAIR MEMBERS,
MICHELE GIBBONS AT THE COUNTY
HEALTH EXECUTIVES ASSOCIATION OF
CALIFORNIA, AND IF YOU NINE
CHECK, WOULD RESPECTFULLY
OPPOSED THE ADMINISTRATION'S
PROPOSED EXPANSION OF THE WHOLE
CHILD MODEL. THE MANAGED CARE
PLAN MODEL CHANGES WERE
INITIATED BY COUNTIES FOR A
NUMBER OF BROADER REASONS AND
WAS NOT INTENDED TO RAISE THEIR
HANDS FOR THE WHOLE CHILD MODEL.
UM I WOULD ALSO NOTE THAT WHILE
THE SUGGEST THAT THIS IS
BRINGING COUNTIES TRANSITIONING
INTO NEW MODELS INTO ALIGNMENT
THE SINGLE MODEL PLANS OR THE
SINGLE PLAN MODEL COUNTIES. THEY
DON'T THOSE. THOSE HEALTH PLANS
DON'T HAVE CCS WHOLE CHILD MODEL
IS A PART OF THOSE PLANS TODAY.
SO THIS IS TRANSITIONING, UH,
CCS CULTURAL MODEL AND KIDS FROM
THE COUNTY OVER TO THOSE PLANS
FOR THE VERY FIRST TIME, SO
THAT'S NOT BRINGING THEM INTO.
UH YOU KNOW, CONSISTENCY WITH
THE OTHER PLANS. THIS IS A NEW
TRANSITION. I DON'T KNOW. REMIND
THE LEGISLATURE THAT THIS MEANS
THAT AS THE WHOLE CHILD MODEL
EXPANDS COUNTY STAFF THAT SERVE
THE CCS CHILDREN ARE BEING PUT
AT RISK, AND WE HAVE A LOT OF
POTENTIAL LOSS OF THEIR
EXPERTISE AS WELL. AND THIS IS
ONE OF THE MOST VULNERABLE
POPULATIONS. SO WE HEARD THE
URGED THE LEGISLATURE TO PLEASE
REJECT THE PROPOSAL. LET'S SLOW
DOWN. LET'S IMPROVE THE WHOLE
CHILD MODEL WHERE IT'S ALREADY
IMPLEMENTED BEFORE WE MOVE
FORWARD. AND THEN, LASTLY, ON
ISSUE TO HAVE CONCERNS WITH THE
CALCULATION OF THE
ADMINISTRATIVE FUNDING PROVIDED
BY TWO COUNTIES FOR ELIGIBILITY
IN CASE MANAGEMENT. WE THINK
THAT THE PROGRAM IS BEING
UNDERFUNDED AND IT'S CREATING
STRAIN AND CHALLENGES IN
CARRYING OUT OUR
RESPONSIBILITIES, AND SO WE WANT
TO JUST HAVE A CONVERSATION AND
DIALOGUE ABOUT REVISITING THE
FORECASTING METHODOLOGY TO
ENSURE THAT THE PROGRAM IS
ADEQUATELY RESOURCED. THANK YOU.
THANK YOU. NEXT CALLER, PLEASE.
NEXT WE'LL GO TO LINE 44. AND
THE CONVERSION OF THREE LONG
TERM TO PERMANENT POSITION.
REGARDING THE ONE POSITION
LENGTHEN PREVENTIVE SERVICES.
FOR MEDICAL ELIGIBLE STUDENTS. I
WOULD ASK HOW EFFECTIVE IS THE
DIRECTORY THAT'S BEING
MAINTAINED BY THAT EMPLOYEE,
REGARDLESS OF WHETHER IT'S A
SHORT TERM, LONG TERM OR
PERMANENT POSITION. AM I
CORRECT? AND THAT I SHOULD
RESERVE MY REMARKS REGARDING
ISSUE 19 UNTIL A FURTHER
HEARING. UM YOU CAN COMMENT ON
THE SCENE 19 RIGHT NOW, MA'AM,
IF YOU WOULD LIKE. VERY QUICKLY,
UM COME ON. HAS I WOULD ASK HOW
LONG HAS BEEN OUT OF COMPLIANCE
REGARDING THE $7 MILLION OWED TO
LIAISE? YOU DO EXCESSIVE
ADMINISTRATIVE WITH HOLDS AND I
WOULD ALSO ASK. HOW FREQUENTLY
DOES THIS HAPPEN? AND AGAIN? I
WANT TO ENCOURAGE THE COMMITTEE
TO CONSIDER ASSEMBLYMEMBER'S
MURATSUCHI 84 83 ADDRESSING DHC
S L E. A AUDIT. AND THE NEED TO
IMPROVE THAT PROCEDURE. THANK
YOU. THANK YOU. NEXT CALLER,
PLEASE. NEXT WE'LL GO TO LINE
51, PLEASE GO AHEAD. GOOD
EVENING, KELLY BROOKS HERE,
COMMENTING ON BEHALF OF THE
CALIFORNIA ASSOCIATION OF PUBLIC
HOSPITALS AND HEALTH SYSTEM,
PUBLIC HEALTH CARE SYSTEMS ARE
FACING A GROWING STRUCTURAL
DEFICITS, MOSTLY DUE TO THE FACT
THAT ARE 21 HOSPITALS PROVIDE
40% OF ALL HOSPITAL CARE MEDICAL
BENEFICIARIES IN THE COMMUNITIES
THEY SERVE AND RECEIVE RATES FOR
THOSE SERVICES THAT DO NOT COME
CLOSE TO COVERING THE COST OF
THAT CARE. SOMETHING IS NEEDED
NOW MORE THAN EVER TO PROTECT
OUR PATIENTS, MOST AT RISK,
ESPECIALLY AS WE FACE ECONOMIC
UNCERTAINTY. TO HELP ADDRESS
THIS. WE SUPPORT THE HOSPITAL
INDUSTRY'S REQUEST FOR 1.5
BILLION IN ONE TIME FUNDING TO
HOSPITALS LIKE THE MOST IN NEED
. WE REPLACED THE INCLUSION OF
THE NPT ATTACKS TO SUPPORT THE
MEDICAL PROGRAM AND THE
GOVERNOR. BUT BUDGET WE URGED
THE ADMINISTRATION TO DEDICATE
AND TAX REVENUES TO STRENGTHEN
MEDICAL PAYMENTS TO PROVIDERS TO
HELP ENSURE OUR ABILITY TO
MAINTAIN CRITICAL ACCESS TO CARE
FOR MILLIONS OF CALIFORNIANS. WE
ALSO SUPPORT THE GOVERNOR'S
TALLYING TRANSITIONAL REALM
WAIVER AMENDMENT, WHICH WOULD
CREATE A NEW SERVICE TO COMBAT
HOMELESSNESS IN OUR COMMUNITIES
. WE LOOK FORWARD TO WORKING
WITH THE ADMINISTRATION AND
LEGISLATURE TO IDENTIFY
STRATEGIES FOR FURTHER SUPPORT
THE HEALTHCARE SAFETY NET AND
ENSURE THAT MILLIONS OF
CALIFORNIANS WHO ARE LION
MEDICAL CONTINUE TO BE SERVED BY
PUBLIC HEALTH CARE SYSTEM. THANK
YOU. THANK YOU. NEXT CALLER,
PLEASE. NEXT WE GO TO LINE 50,
PLEASE GO AHEAD. GOOD AFTERNOON,
MR SHORT, AND I'VE COME ON
ISSUES. ON BEHALF OF LOMA LINDA
UNIVERSITY. HEALTH RADY
CHILDREN'S HOSPITAL ADVANTAGE
HELP IMPEACH THE ASSOCIATION
REPRESENTING CALIFORNIA'S
COMMUNITY SAFETY NET HOSPITALS.
PROBABLY REGARDING THE MEDICAL
PROGRAM. I'D LIKE TO URGE THE
SUBCOMMITTEE TO SUPPORT OUR
HOSPITAL SAFETY NET PROVIDERS
WHO SERVE A LARGE NUMBER OF
MEDICAL PATIENTS, WITH HOSPITAL
MEDICAL RATES BEING FROZEN FOR
YEARS IN THE COST OF STAFF.
MEDICINE SUPPLIES INCREASING IN
COST SUBSTANTIALLY. UM THE STATE
TAKING THAT IS AT RISK, AND WE
URGE YOUR SUPPORT THIS YEAR TO
FILL THAT GAP. AND WE LOOK
FORWARD TO WORKING WITH YOU ALL
ON AN ONGOING BASIS FOR REFORMS
TO THE SYSTEM. UM AND THEN,
FINALLY, REGARDING ISSUE NINE ON
BEHALF OF BRADY CHILDREN'S
HOSPITAL IN LOMA LINDA
UNIVERSITY CHILDREN'S HOSPITAL.
WE OPPOSE THE EXPANSION OF THE
WHOLE CHILD MODEL AND WOULD LIKE
TO ECHO THE CONCERNS RAISED BY
THE CALIFORNIA CHILDREN'S
HOSPITAL ASSOCIATION. THANK YOU.
THANK YOU. NEXT CALLER, PLEASE.
SO THAT'S THE LINE. 45, PLEASE
GO AHEAD. GOOD EVENING, MR CARON
MEMBERS, THE RECORD SULLIVAN
LOCAL HEALTH FAMILY, CALIFORNIA
, REPRESENTING THE 16 LOCAL
MEDICAL MANAGED CARE PLANS IN
THE STATE REGARDING ISSUE NUMBER
NINE. PC SUPPORTS THE WHOLE
CHILD MODEL AND ITS GOALS OF
IMPROVING COORDINATION.
INTEGRATION FOR THE CCS
POPULATION ACROSS ALL HEALTH AND
SOCIAL SERVICES, AND TO ENSURE
CONTINUED ACCESS TO THE HIGH
QUALITY SPECIALTY CARE. WE
BELIEVE THE COAST PLANS HAVE
DELIVERED ON THE GOALS OF FULL
CHILD MODEL BY BUILDING
EXPERTISE IN WORKING WITH CCS
POPULATION IN THEIR FAMILIES,
MAINTAINING SPECIAL CARE
NETWORKS THAT PROVIDE CRITICAL
CARE AND CLOSE PARTNERSHIP WITH
THE COUNTIES WERE SUPPORTIVE OF
THE ADMINISTRATION'S PROPOSAL TO
BUILD ON THE ON THE SUCCESS BY
EXPANDING WHOLE CHILD MODEL
THROUGH A PHASED APPROACH THAT
ACKNOWLEDGED ACKNOWLEDGES THE
EXPERIENCE IN READINESS OF
EXISTING PLANS AND THE
ADDITIONAL TIME NEEDED FOR
COUNTIES THAT ARE TRANSITIONING
TO A SINGLE PLAN. LOOK FORWARD
TO CONTINUE DISCUSSIONS WITH THE
LEGISLATURE AND ADMINISTRATION
ABOUT THIS PROPOSAL TO ENSURE
SMOOTH AND SUCCESSFUL TRANSITION
TO HOLD CHILD MICHAEL. THANK YOU
. THANK YOU. NEXT CALLER,
PLEASE. NEXT WE GO TO LINE 46,
PLEASE GO AHEAD. HI. MOLLY
ROBSON WITH PLANNED PARENTHOOD
AFFILIATES OF CALIFORNIA
REGARDING ISSUE EIGHT PACK IS
SUPPORTIVE OF THE ATTACKS BUT
WOULD LIKE TO EMPHASIZE THE
DOLLARS GENERATED BY THE ATTACKS
SHOULD FOCUS ON INCREASING
ACCESS TO PATIENT SERVICES OVER
80% OF PLANNED PARENTHOOD
PATIENTS IN CALIFORNIA ARE
MEDICAID PATIENTS, AND WE WOULD
URGE THAT DOLLARS FROM THE TAX
STAY WITHIN THE HEALTH CARE
SYSTEM TO SUPPORT PATIENTS
ACROSS THE STATE. ADDITIONALLY
ON THE PORTION OF ISSUE FIVE
RELATED TO THE PROPOSAL, AND 15
WEAVER WE ARE GRATEFUL FOR THE
ADMINISTRATION'S PROPOSAL TO
INVEST 15 MILLION IN NEW STATE
DOLLARS REFLECTIVE HEALTH AND WE
LOOK FORWARD TO CONTINUE
DISCUSSIONS WITH THE
ADMINISTRATION AND THAT
CONSIDERATION FOR HOW THOSE
FUNDS MAY BE USED. THANK YOU.
THANK YOU. NEXT CALLER, PLEASE.
NEXT WE GO TO LINE 61, PLEASE GO
AHEAD. GOOD EVENING, CAROL
BRAMBILLA AND THE WHOLE ASSEMBLY
BUDGET SUBCOMMITTEE AND HEALTH
AND HUMAN SERVICES. MY NAME IS
KATIE ADMIN, AND I'M THE FOOD
AND AGRICULTURE POLICY MANAGER
AT SPUR NONPROFIT. WE THINK IN
THE BAY AREA AND I'M SPEAKING TO
ISSUE THREE. AMONG PEOPLE WITH
MEDICAL 14% OF INDIVIDUALS ARE
LIVING WITH DIABETES IN 33%
SUFFER FROM HIGH BLOOD PRESSURE.
BLACK CALIFORNIANS ARE NEARLY
TWICE AS LIKELY TO BE DIAGNOSED
WITH DIABETES AND WEIGHT
CALIFORNIANS. THIS SHOWS THE
VAST RACIAL HEALTH INEQUITIES,
KELLAM AND SPECIFICALLY,
MEDICALLY SUPPORTIVE. FOOD
NUTRITION INTERVENTIONS CAN
ADDRESS. MEDICALLY SUPPORTED
FOOD NUTRITION REFERS TO A
SPECTRUM OF FOOD BASED
INTERVENTIONS SUCH AS PRODUCE
PRESCRIPTIONS, FOOD PHARMACIES
AND MEDICALLY TAILORED MEALS.
INACTION MEDICALLY SUPPORTED
FOOD NUTRITION CAN LOOK LIKE A
PREGNANT PERSON VISITING THEIR
DOCTOR AND BEING NOSY WITH BEING
DIAGNOSED WITH GESTATIONAL
DIABETES. INSTEAD OF JUST BEING
TOLD THE HEALTHIER THE DOCTOR
CAN PROVIDE THE PATIENT WITH THE
FRUIT AND VEGETABLE VOUCHER
KNOWN AS THE PRODUCE
PRESCRIPTION. THIS ALLOWS THE
PREGNANT PERSON TO VISIT A
GROCERY STORE FARMERS MARKET AND
REDEEM THE PRESCRIPTION FOR FREE
FRUITS AND VEGETABLES. A STUDY
COMPLETED IN SAN FRANCISCO SHOWS
THIS HAS THE POWER TO REDUCE THE
RATE OF PRETERM BIRTH BY 37.
BEYOND IMPROVED HEALTH OUTCOMES
BASED INTERVENTIONS CAN PRODUCE
COST SAVINGS. FOR EXAMPLE,
RECHERCHE RESEARCHERS HAVE
ESTIMATED THAT SUBSIDIZING
HEALTHY FOOD FOR MEDICARE AND
MEDICAID PATIENTS COULD SAVE
$40,000,000,200 BILLION IN
HEALTH CARE COSTS NATIONALLY.
MEDICALLY SUPPORTED FOOD.
NUTRITION WAS THE THIRD MOST
UTILIZED COMMUNITY SUPPORT IN
THE SECOND QUARTER OF 2022. WE
LOOK FORWARD TO SEEING THIS
CONTINUE. BUT I ALSO WANT TO BE
MEDICALLY SUPPORTIVE. STUDENT
NUTRITION EXPAND TO A QUOTE,
FULL COVERED BENEFIT IN MEDICAL
THEIR A B 16 44 AUTHORED BY
ASSEMBLYMEMBER'S BONTA. THANK
YOU FOR YOUR TIME. THANK YOU.
NEXT CALLER, PLEASE. SO GET TWO
LINES. 62, PLEASE GO AHEAD.
THANK YOU, ARAMBULA AND MEMBERS
OF THE COMMITTEE. THIS IS FELIX
WITH MANIFEST MEDICS, ONE OF
CALIFORNIA'S NONPROFIT OKAY
INVASION ORGANIZATIONS OR H I O
SHORT. SO WE ARE GRATEFUL ISSUES
FOR ALL THE PANELISTS, MANY OF
WHOM SPOKE TO THE NEED TO BUILD
INFRASTRUCTURE IN PARTICULAR
DATA SHARING TO ENABLE THE
EQUITY AND THE CARE COORDINATION
THAT COUNTY ENVISIONS PROVIDERS
AND HEALTH PLANS AND BBO
SERVICES 20 AGENCIES OR NEED TO
BE ABLE TO CONTRIBUTE TO AND
ACCESS A COMPREHENSIVE HEALTH
RECORD. FOR MEDICAL MEMBERS AND
TO RECEIVE ALERT FOR EMPLOYMENT
TRANSITIONS LIKE HOSPITAL
ADMISSIONS AND DISCHARGES SO
THAT THEY CAN RAPIDLY PROVIDE
ENHANCED HER MANAGEMENT AND
COMMUNITY SUPPORT. MANY OF THE
STATES 19 NEED TO SHARE AND USE
THE INFORMATION OR THE ONE THAT
MOST URGENTLY FACED THE GREATEST
AREAS TO RECEIVING IT TODAY. SO
THINK OF THIS AS BEING LIKE A SO
CALLED LAST MILE PROBLEM OF ANY
INFRASTRUCTURE CHALLENGE THAT
THIS SPACE THAT WE AND OTHER
CALIFORNIA H I O HAVE BOTH THE
CAPABILITIES AND THE
LONGSTANDING COMMITMENT TO OUR
COMMUNITIES TO DELIVER THIS
CRITICAL INFRASTRUCTURE FOR THE
CARE TEAMS WORKING ON CALVIN, SO
AS YOU CONTINUE YOUR BUDGET
DISCUSSIONS. URGENT REPAIR,
COUNTING WITH THE GENEROUS
FEDERAL NATIONAL OPPORTUNITIES
ARE AVAILABLE TO INVEST IN A
CHAI OS AS A DIGITAL HEALTH
STATING THAT FOR COUNTIES EXCEPT
THANK YOU THANK YOU. NEXT
CALLER, PLEASE. NEXT WE GO TO
LINE 18, PLEASE GO AHEAD. GOOD
EVENING THERE AROUND 11, MEMBERS
OF THE COMMITTEE, PREGNANCY AND
JONES FROM THE L. A COUNTY
DEPARTMENT OF PUBLIC HEALTH,
CHILDREN'S MEDICAL SERVICES,
WHICH IS WHERE C HCP IS LOCATED
IN L. A COUNTY. THANK YOU FOR
THIS OPPORTUNITY TO SPEAK TO
ITEM 14 REGARDING THE SAFETY, P
TRANSITIONS AND L. A COUNTY, THE
HDP PROGRAM, WHICH IS SUPPORTED
BY BOTH STATE AND FEDERAL
MATCHING FUNDS. EMPLOYEES
APPROXIMATELY 35 STAFF, MORE
THAN HALF OF WHOM ARE NURSES AND
OTHER CLINICAL PERSONNEL AND IS
ADDITIONALLY RESPONSIBLE FOR
MINISTRATIONS, REALLY MANAGING
HCP CSC, THE POSSIBLE CARE
PROGRAM, WHICH IN L, A COUNTY
EMPLOYEES CLOSE TO 100, PUBLIC
HEALTH, NURSES AND ADDITIONAL
SUPPORT PERSONNEL. ALL THESE
PERSONNEL HAVE EXTRAORDINARY
PEDIATRIC PRACTICE EXPERIENCE.
AND EXPERTISE. WE DO NOT WISH TO
LOSE IN OUR JURISDICTION WHEN
THE LEGISLATURE AGREED TO THE
2024 STATES IN THE LAST
LEGISLATIVE SESSION CF PLACE
THERE WITH THEIR FOSTER HERE
ADMINISTRATIVE FUNCTIONALITY
CURRENTLY IN SEE IF CP AND THAT
THERE WOULD BE NO NET LOSS BY
THEIR SAFETY, FUNDED THE HCP
POSITIONS AFTER THIS YEAR, SHE
SET WE HAVE TWO LEGISLATURA
REMAIN FULLY ENGAGED IN
OVERSIGHT OF THE HDP SUNSET
TRANSITION PROCESS TO ENSURE
THAT THESE COMMITMENTS ARE
FULFILLED, PARTICULARLY IN THE
FOUR FOLLOWING WAYS WHEN THERE'S
FULL TRANSPARENCY IN THE
DECISION MAKING PROCESS WITH
STAKEHOLDERS AND THAT FOSTER
CARE, ADMINISTRATIVE COSTS AND
FUNCTIONALITY ARE FULLY
SUPPORTIVE TO D HCS ALLOWS
MAXIMUM FLEXIBILITY AND
DETAILING POSITIONS IN
CLASSIFICATIONS THAT WILL BE
NEEDED TO CONTINUE IN THE PAST
FROM HERE ADMINISTRATIVE
FUNCTIONS THAT MAY BE DIFFERENT.
PRINT IN BOTH LARGE AND SMALL
COUNTIES. THREE FUNDS FORMALLY
DEDICATED CPR REINVESTED IN
SERVICES THAT CLOSELY
APPROXIMATE THE WORK FOR WHICH
THE HCP HAS BEEN RESPONSIBLE IN
THEIR PATH, SUCH AS IMPOSTER
CARE, OVERSIGHT OF PEDIATRIC
PRACTICE QUALITY AND FOR THE
LOSS OF MATCHING TONS RESULTING
FROM THE KGB. SUNSET IS
COMPENSATED WITH HANSEN'S
REINVESTED IN SIMILAR HEALTHCARE
EFFORTS ACCORDINGLY. THANK YOU.
THANK YOU. NEXT CALLER, PLEASE.
NEXT WE GOT TO LINE 37, PLEASE
GO AHEAD. GOOD EVENING, MRS
KELLY MCMILLAN AND I'M CALLING
ON BEHALF OF THE CALIFORNIA
DENTAL ASSOCIATION ON A COUPLE
OF ISSUES ISSUE ONE OF
CALIFORNIA ASSOCIATION SUPPORTS
CALIFORNIA'S RECOMMITMENT TO
ORAL HEALTH BY USING GENERAL
FUND SUPPORT MEDICAL
SUPPLEMENTAL PROVIDER PAYMENTS.
CONTINUED USE OF GENERAL FUND
DOLLARS, IS CRITICAL TO
MAINTAINING PROPOSITION 56
FUNDING LEVELS, WHICH PROVIDES
MUCH NEEDED STABILITY FOR THE
MEDICAL DENTAL PROGRAM. SINCE
PROPOSITION 56 TOOK EFFECT,
THERE HAS BEEN A 25% INCREASE IN
DENTAL PROVIDERS ENROLLED IN
MEDICAL, WHICH IN TURN HAS
INCREASED UTILIZATION FOR
ENROLLEES. ON ISSUE EIGHT. THE
CALIFORNIA ASSOCIATION SUPPORTS
THE USE OF THE ATTACKS TO
MAXIMIZE FUNDING FOR AND THE USE
OF FEDERAL DOLLARS AND SUPPORT
OF THE MEDICAL PROGRAM AND
ENCOURAGES DISCUSSION ABOUT
WHETHER A FUTURE ATTACKS COULD
ALSO SUPPORT IMPROVEMENTS AND
ACCESS WITH THE MEDICAL DENTAL
PROGRAM. IN ADDITION TO THE
MEDICARE SIDE REGARDING ON ISSUE
14 REGARDING THE CHILD HEALTH
AND DISABILITY PREVENTION
PROGRAMS, SUNSET UNDER ISSUE 14.
CALIFORNIA ASSOCIATION REMAINS
CONCERNED ABOUT HOW THE VITAL
DENTAL CARE COORDINATION
SERVICES FROM C HDP PROGRAMS
WILL BE PRESERVED, RESPECTFULLY
REQUEST AN OVERSIGHT PANEL HELD
THIS BUDGET CYCLE ABOUT THE HDP
TRANSITION PLAN AND FINALLY ON
ISSUES 17 WHILE THE CURRENT
DENTAL MANAGED CARE PLANS
CONTINUE TO UNDERPERFORM TO IS
SUPPORTIVE OF THE HIGH
PERFORMING AND HIGH QUALITY DEMS
PLANS AND HOPES THAT THIS
PROCUREMENT PROCESS WILL
FACILITATE THIS IMPROVED ACCESS.
CALIFORNIA DENTAL ASSOCIATION
SUPPORTS THE DEPARTMENT'S GOALS
OF INCREASING ACCESS AND QUALITY
OF CARE AND MEDICAL, AND WE WILL
CONTINUE TO BE A COLLABORATIVE
PARTNER IN ACHIEVING THE GOALS
ACROSS THE MEDICAL DENTAL
PROGRAM, REGARDLESS OF THE
DELIVERY SYSTEM. THANK YOU FOR
THIS OPPORTUNITY. THANK YOU.
NEXT CALLER, PLEASE. NEXT WE GO
TO LINE 39, PLEASE GO AHEAD.
GREAT GOOD EVENING. I'M HERE.
I'M JUST THINKING ABOUT ONE
ISSUE THREE. MY NAME IS JOHANNA
WONDERFULLY. AND I'M A RESIDENT
OF PLASTER COUNTY. I'M A MOTHER
OF FOUR CHILDREN. THREE HAVE
BEEN IDENTIFIED WITH THE HEARING
DIFFERENCE FROM MY SON WHO WAS
IN THE COMMITTEE ROOM WITH ME
EARLIER TODAY IS STILL BEING
EVALUATED TO DETERMINE HIS
HEARING STATUS. I HAVE BEEN
INVOLVED AS A PARENT MENTOR AND
ADVOCATE ACROSS THE STATE WITH A
FOCUS IN THE AREA OF RESOURCES
AVAILABLE IN THE GREATER
SACRAMENTO AREA, RECEIVED
NUMEROUS FEEDBACK ABOUT THE CCP
SINCE ITS INCEPTION, IT IS
DIFFICULT IN QUINCY FOR FAMILIES
TO NAVIGATE. AND THE LACK OF
AVAILABLE RESOURCES WITHIN
DRIVING DISTANCE. EVERY SINGLE
ACCESS TO CARE TIMELINES IN THE
BACK AND FORTH BETWEEN RECEIVING
CARE AT THEIR MEDICAL HOME. IN
THE HTTP PROVIDER MAKES FAMILIES
FEEL LIKE THEY ARE BETTER OFF
WITHOUT IT. THREE PEDIATRIC
AUDIOLOGY PROVIDERS IN OUR
REGION OUR FEDERAL PEDIATRIC, UC
DAVIS AND KAISER, ALL THREE OF
THESE PROVIDERS DO NOT PRESENTLY
EXCEPT THAT TPP PROGRAM TO GET
TO THE NEXT PROVIDER. WE HAVE TO
DRIVE, 100 PLUS MILES HSBC T
REQUIRES THAT WOULD BE COVERED
BY THE CHILD'S INSURANCE TO YOU
, SUCH AS HEARING TEST WITHOUT
THEIR HEARING AIDS ON BUT AS
YOU'RE ALL AWARE, NINE OUT OF 10
INSURANCE POLICIES DO NOT COVER
HEARING AIDS OR HEARING AIDS
SERVICES, SO IT'S BEEN A J CCP
PROVIDER IS NOT COVERED BY THEIR
INSURANCE. THEY WOULD BE
EXPECTED TO HAVE TWO SEPARATE
IDEOLOGICAL PROVIDERS, SO ONE
COVERED BY THEIR INSURANCE FOR
HEARING AIDS, OFF APPOINTMENTS
AND APPOINTMENTS WITH THE CCP
PROVIDER FOR MAINTENANCE,
STUDYING NUMERALS AND SEEING HOW
WELL THEY HEAR THEIR HEARING
AIDS ON THIS MEANS THAT IF THEIR
AUDIO GRAM SHOWS THAT CHANGE IN
HEARING AND WHAT DETERMINES THAT
A CHILD NEEDS TO HAVE THEIR
HEARING AID PROGRAMS ADJUSTED,
THEY MUST NOT CALL THEIR OTHER
PROVIDER IN WEYBURN APPOINTMENT
TO HELP THEIR PARENTS PROGRAMMED
TO BE APPROPRIATE LEVEL. THIS
LEADS TO THE ISSUE WITH TIMELY
ACCESS TO CARE. MANY PROVIDERS
IN OUR AREA ARE BOOKING THREE
MONTHS OUT. FAMILIES LIKE THE
CHANGE IN HEARING THEY HAVE TO
SCHEDULE AN APPOINTMENT. WAIT
THREE MONTHS FOR THEIR CHILD
SCENE AND BECAUSE THEY ARE
RECEIVING, WE'RE HEARING AID
FUNDING THROUGH THE HTTP, RATHER
THAN PRIVATE PAYER INSURANCE.
THERE NOW HAVE THE ADDITIONAL
WEIGHT BEHIND UNTIL THE GCC
PROVIDING OUR GEOLOGISTS CAN'T
SEE THEM AND MAKE THE ADJUSTMENT
. THEIR FAMILIES ARE ALSO UNABLE
TO COMBINE APPOINTMENT. SO IF
YOU NEED A HEARING TEST UNAIDED
AND THE YEAR HOLDS, WHICH CAN BE
ANYWHERE BETWEEN 1 TO 4 TIMES A
YEAR, PARENTS HAVE TO MAKE A
SEPARATE TRIP FOR THE AIRMALL
SITTING BECAUSE THAT IS A
SERVICE PROVIDED UNDER HS, CPT.
AND NOT UNDER THEIR INSURANCE
PROVIDER. APPOINTMENTS ARE TIME
AWAY FROM WORK TIME. OUR
STUDENTS ARE MISSING CLASS A LOT
OF TIME BETWEEN KNOWING THERE
NEEDS TO BE A CHANGE IN
PROGRAMMING AND GETTING A CHANGE
IN PROGRAMMING IF TIME WERE
ACCESS TO LANGUAGE, CLASSROOM
INSTRUCTION AND SOCIAL EMOTIONAL
HEALTH ARE DIMINISHED.
DEPARTMENT OF HEALTH CARE
SERVICES NEEDS TO INCREASE THE
SECTOR ACCESSIBILITY TO THIS
PROGRAM FOR IT TO HAVE VALUE TO
OUR SACRAMENTO AREA FAMILIES AND
TO DO THAT, THEY NEED TO KEEP
THEIR FUNDING. THANK YOU. THANK
YOU. NEXT CALLER, PLEASE. NEXT
WE GO TO LINE 54 AHEAD. THANK
YOU, MR CHAIR JONATHAN LUNA'S
PALESTINIAN STRATEGIES AND
ADVOCACY ON BEHALF OF INLAND
EMPIRE HEALTH PLANS SERVING 1.6
MORE MEDICAL BENEFICIARY SUPPORT
THE COUNTY AND INITIATIVE
ADOPTED ALL COMMUNITIES, SUPPORT
SERVICES AND ENHANCED MANAGEMENT
BENEFITS. WE LOOK FORWARD TO
HEARING MORE ON THE SIX MONTH
TRANSITIONAL RENT PROPOSAL
COMMISSION FIVE. AYE HP SAYS A
REGION OF 27,000 SQUARE MILES
AND LARGER THAN NINE STATES AND
WHAT THE DEPARTMENT OF
LEGISLATURE TO TAKE INTO
CONSIDERATION RURAL AREAS OF THE
REGION AND PROVIDING AREAS
DEVELOPING LEGISLATIVE AND
RESULTS ARE GUIDANCE,
PARTICULARLY AROUND THE M AND M
P O TECHNICAL I E. HP STANDS
READY TO INNOVATE AND SUPPORT
AND APPRECIATE LOCAL FLEXIBILITY
ALLOWANCES. TO CARRY OUT THE
DECISION. THANK YOU, MR THANK
YOU. NEXT CALLER, PLEASE. NEXT
TO THE TO LINE 49. PLEASE GO
AHEAD. GOD, THAT'S ME, GUYS.
HELLO. MY NAME IS CASEY CANE AND
I'M COMMENTING ON ISSUE NUMBER
THREE. I AM A RESIDENT PLASTER
COUNTY. I'M A MOTHER OF TWO SONS
FIRST. PAIR OF HEARING AIDS, BUT
OUR FAMILY BACK ALMOST $1500.
WE'RE FORTUNATE THAT OUR
INSURANCE COVERED A PORTION OF
THE COSTS, BUT NOT ALL OUR
FAMILY APPLIED TO THE HEARING
AID COVERAGE FOR CHILDREN
PROGRAM WHEN IT WAS FIRST BECAME
AVAILABLE FOR MONTHS, WE WENT
BACK AND FORTH WITH PAPERWORK WE
SENT IN ALL THE DOCUMENTS ASKED
ABBAS, BUT THEY NEEDED MORE
INFORMATION. A SELF ADDRESSED
ENVELOPE FROM H A CCP WAS SENT
WITH THE DOCUMENT REQUESTS ONLY
TO BE RETURNED TO ME AS UNDER
LIVABLE AS ADDRESSED. ONE WE
THEN STARTED TO RECEIVE CALLS
INFORMING US THAT OUR FILE WOULD
BE CLOSED DUE TO THEM NOT
RECEIVING THE REQUESTED DOCUMENT
. AT THIS POINT, MY SON
DESPERATELY NEEDED A NEW HEARING
AID FIRST LAST YEAR, AND WE
COULDN'T WAIT ONE NEW HEARING
AID WITH PARTIAL COVERAGE FAMILY
BACK ANOTHER $1100. IT WAS
EASIER TO SIMPLY PAY OUT OF
POCKET BUT IT HURT OUR FAMILY.
AND I KNOW THIS COST IS TURNING
SO MANY OTHER FAMILIES. THIS
PROGRAM NEEDS IMPROVEMENT AND TO
DO THAT IT NEEDS TO CONTINUE TO
BE FUNDED. WE NEED TIME FOR THIS
PROGRAM TO WORK EACH BE HCS
NEEDS TO CORRECT THE BARRIERS
THAT ARE PREVENTING ACCESS TO
CARE. THANK YOU FOR YOUR TIME.
THANK YOU. NEXT CALLER, PLEASE.
THIS TIME, THERE'S NO OTHER TO
QUÊ. THANK YOU. OPERATOR I WILL
TAKE THAT AS THE CONCLUSION OF
PUBLIC COMMENT FOR TODAY. I WILL
BEGIN BY THANKING THE
ADMINISTRATION DIRECTOR BOSS
DIRECTOR COOPER FOR STAYING ALL
PUBLIC COMMENT AS WELL AS
APPRECIATING THE DEPARTMENT OF
FINANCE THE L A ALL OF OUR
PANELISTS HERE TODAY. APPRECIATE
THE SERGEANT'S TECH MEMBERS WHO
STAYED BUT MOST IMPORTANTLY, I
WANT TO THANK THE PUBLIC FOR
PARTICIPATING AND IMPROVING OUR
PROCESS AND MAKING THIS THE
PEOPLE'S HOUSE. WE ARE ADJOURNED
FOR THE NIGHT. HAVE A GOOD
NIGHT.