There are some proposed changes to the Medi-Cal program that have some legislators asking questions. The changes would include routing seniors into managed care programs and eliminating two state agencies that are currently serving Medi-Cal patients.
California Governor Jerry Brown wants to expand what is, essentially, a pilot program. That program currently is being done in just four counties in California. At this time, the results from the pilot program have not yet been properly evaluated.
Governor Brown wants to go ahead and make that pilot program a statewide situation anyway. This is despite the remarks made by the Legislative Analyst’s Office, who cautioned against the premature rapid expansion of this program.
The pilot program puts high-needs patients who use Medi-Cal into managed care. Governor Brown wants to expand the program statewide, and have it include Medi-Cal, Medicare, and Medi-Cal that is for patients with disabilities. What does managed care mean? It is a type of health plan that is designed to reduce unnecessary health care costs.
It can achieve that goal in a number of ways. The plan could give economic incentives for doctors, (and patients) to choose less expensive forms of care. It could exert control over inpatient admissions to hospitals, and the length of time for a patient’s hospital stay. It could included a board that reviews the medical necessity of specific types of health care services, (which would impact whether or not the insurer would cover that care). Or, the plan could engage in intensive management of high-cost health care.
These changes would impact around 1.9 million people. Governor Brown believes that these changes would save the state of California $679 million this year. He also believes that the savings could total to $1 billion in the years ahead. It seems to me that the Governor’s interest in making these changes to Medi-Cal is one related to savings, and not necessarily about getting the best health care to the people of California.
At the same time this is being talked about, there are other changes being discussed. There is a plan to collapse most of the functions of state mental health services, and state drug and alcohol departments, into one entity. It would push those services into the Department of Health Care Services. That is the exact same agency that oversees Medi-Cal.
Proponents of this change feel that it would streamline the ability of health providers to help patients who have both physical and mental needs. Opponents say that this change moves things around, but doesn’t actually cut state costs. They also say it reduces the visibility and accountability of mental health and substance abuse treatment.
Image by League of Women Voters of California on Flickr