BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 187 (Bonta) - Medi-Cal: managed care: California Children's
Services program
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|Version: May 28, 2015 |Policy Vote: HEALTH 8 - 0 |
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|Urgency: No |Mandate: No |
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|Hearing Date: August 17, 2015 |Consultant: Brendan McCarthy |
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This bill meets the criteria for referral to the Suspense File.
Bill
Summary: AB 187 would extend the current "carve out" of the
California Children's Services program from Medi-Cal managed
care for one year.
Fiscal
Impact: Unknown impact on overall Medi-Cal expenditures for
services provided to CCS-eligible Medi-Cal beneficiaries
(General Fund and federal funds). Historically, the state has
assumed that shifting Medi-Cal beneficiaries into managed care
will reduce costs, relative to the fee-for-service system, due
to better coordination of care and less utilization of high-cost
services. Whether the Department would actually begin shifting
CCS children to managed care after the expiration of the "carve
out" is highly uncertain, given the serious health issues
experienced by CCS-eligible children. In addition, the serious
health issues faced by CCS children make it difficult to
determine whether cost savings are likely to be achieved through
integration with managed care.
AB 187 (Bonta) Page 1 of
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Background: Under state and federal law, the Department of Health Care
Services operates the Medi-Cal program, which provides health
care coverage to low income individuals, families, and children.
Medi-Cal provides coverage to childless adults and parents with
household incomes up to 138% of the federal poverty level and to
children with household incomes up to 266% of the federal
poverty level. The federal government provides matching funds
that vary from 50% to 90% of expenditures depending on the
category of beneficiary.
In addition, the Department operates the California Children's
Services program which provides diagnosis, treatment, and case
management to children under age 21 who have complex medical
needs. (90% of CCS enrollees are Medi-Cal eligible. About 10%
are eligible only for CCS services, paid for with county funds).
Under current law, the CCS program is "carved out" of Medi-Cal
managed care, meaning that the program is operated on a
fee-for-service basis. (CCS eligible children receive services
related to their CCS eligible condition through the program, but
receive other health care services through Medi-Cal managed
care.) Under current law, the carve out expires at the end of
2015, at which time the Department could transition the CCS
population fully into managed care.
Current law allows the Department to establish pilot projects
for integrated care for CCS enrollees. Five demonstration
projects have been approved, but only one has been implemented
(operated by the San Mateo Health Plan).
The Department has been conducting a stakeholder process to seek
input on the future of the CCS program. In June 2015 the
Department released a draft proposal for the redesign of the CCC
program, which they have entitled the "Whole-Child Model". Under
this proposal, CCS services would be integrated (i.e. "carved
in") to Medi-Cal managed care plans in select counties beginning
in 2017. Under the proposal, the integration of CCS services
into Medi-Cal managed care would begin in the six counties with
a county organized health system and would expand over time to
19 additional counties.
AB 187 (Bonta) Page 2 of
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Proposed Law:
AB 187 would extend the current "carve out" of the California
Children's Services program from Medi-Cal managed care for one
year.
Related
Legislation: SB 586 (Hernandez) would eliminate the existing
sunset of the "carve out" of the California Children's Services
(CCS) program from Medi-Cal managed care. Instead, the bill
would require the Department of Health Care Services to enter
into contracts with one or more Kids Integrated Delivery Systems
(KIDS) to provide integrated care that includes both existing
CCS benefits and all other health care services provided under
the Medi-Cal program. That bill is pending in the Assembly
Health Committee.
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