January 4, 2013: On December 31, Federal officials from the Centers for Medicare & Medicaid Services (CMS) approved California's plan to move 860,000 Healthy Families children into Medi-Cal managed care programs.
According to David Gorn for California Healthline, these changes include "more frequent monitoring, and evaluation of the transition" to make sure kids are able to get primary care physicians. This issue was critical to many children's advocates.
"Their main concern, and ours too, is that kids are able to see a primary care physician," said Jane Ogle, at left, deputy director of the state Department of Health Care Services. "Some of the monitoring efforts we were already going to do, we were going to do quarterly. Now we're going to do those monthly. It's a workload, but we agreed to do it."
Initial monitoring will be anecdotal,In the meantime, Ogle said, DHCS has stepped up its monitoring efforts, independent of federal approval.
"In the short term, we are constantly having check-ins with health plans about plan access," Ogle said. "Getting feedback on call centers and any grievances … so we can at least get an anecdotal sense of where there might be issues."
DHCS plans to continue daily check-ins with plan contractors, Ogle said, "for the duration of the transition."
Director of healthy policy for Children Now, Kelly Hardy, told California Healthline,"We're pleased CMS is requiring the state to make contingency plans if children are having trouble accessing care … and that the state will be required to survey beneficiaries [monthly] about their experience with the transition." Although Hardy still is concerned about the transition and how quickly it is occurring (phase one began January 1, 2013). "We remain concerned that this transition is being unnecessarily rushed,said Hardy.
CMS...spokesperson Alper Ozinal said children's care will be improved ..."The modifications ...will improve the care kids in Medi-Cal receive by ...operating a single program and [coordinating] across all insurance affordability programs.
"These modifications will also deliver more robust benefits... some will also benefit from lower cost-sharing."
Written by: Taylor McCulloch