Schwarzenegger | HealthyCal - Part 2
 

Posts Tagged Schwarzenegger

  

Appeals court blocks Medi-Cal rate reduction

Published: March 4, 2010 | 1 Comment

UPDATED AT 9:06 AM ON MARCH 4

A federal appeals court has blocked the state's attempt to cut reimbursement rates for Medi-Cal to doctors and hospitals, including the UC Davis Medical Center, shown here.

A federal appeals court has once again blocked California from reducing payments to doctors and hospitals that care for the poor under the state’s Medi-Cal program, finding that the Legislature did not sufficiently study the impact of the cuts before enacting them. The Ninth Circuit Court of Appeals also rejected the state’s attempt to cut reimbursements for the wages of in-home care workers by nearly 20 percent.

The appeals court panel upheld lower court injunctions blocking the rate reductions until a full trial on the merits of the case could be held. The Medi-Cal case was brought by the California Pharmacists Association and a long list of other plaintiffs. The case challenging reductions in the wages of in-home care workers was brought by a woman who uses in-home care and the Service Employees International Union, which represents the workers.

The panel did not say that the state could never reduce reimbursement rates. But because the programs are partially funded by the federal government, the state must follow federal rules for managing the services. One of those rules states that Medi-Cal reimbursement rates must be high enough to ensure that care and services available under the plan are available to the same extent that such services are available to the general population. This is known as the “equal access to care” provision.

The state argued in its defense that some of the services at issue are not available at all to the general population because they are designed for the low-income people. But the court found that the state still had a responsibility to determine if the rate cuts would reduce access to care before implementing them.

Writing for a three-judge panel, Judge Milan D. Smith scolded the state for its repeated attempts to cut Medi-Cal rates without sufficient study.

“We have now handed down multiple decisions instructing the State on (its) procedural requirements,” Smith wrote. “We trust that the State now understands” that in order for it to comply with those requirements, it must rely on “responsible cost studies” that provide reliable data on which to base its reimbursement rates. The court in the past has also ordered the state to study the impact of the proposed rate changes before setting the rates. In this case, the court found, “the state did neither.”

California’s reimbursement rates for Medi-Cal are already below average among larger states and the state’s cost per person in the program is among the lowest in the nation.

Gov. Arnold Schwarzenegger’s office said the state will appeal the ruling.

More info:

See the court’s opinions and memoranda here.

Note: An earlier version of this item incompletely identified the plaintiffs in the case involving in-home care.

 

Care for 1 million kids at risk

Published: February 26, 2010 | No Comments

The California Budget Project has just released a county-by-county analysis showing how Gov. Arnold Schwarzenegger’s budget proposal would affect children’s health care. Statewide, the study says, 216,000 children would lose eligibility in the first round of cuts, the state would lose $265 million in federal funds, 824,000 kids would lose vision care, and 377,000 would see increased premiums. If the governor’s proposal to eliminate the Healthy Families program unless the state gets $6.9 billion in additional federal aid, more than 1 million kids would lose coverage and the state would forfeit $1 billion in federal funds. See the full report here.

 

Budget would cut support for seniors

Published: February 25, 2010 | No Comments

By Bruce Chernof, M.D.

Gov. Arnold Schwarzenegger’s proposed budget for the coming year has serious implications for California’s low-income seniors.

According to a recent analysis by the UCLA Center for Health Policy, the proposal would dismantle California’s home- and community-based long-term care system.

Full implementation of the proposed cuts would likely leave frail, low-income seniors – among the state’s most vulnerable residents – without needed support. Many could face a total loss of daily assistance, including those with serious functional limitations (e.g., inability to bathe themselves) and cognitive impairments such as Alzheimer’s disease. Left with few alternatives, many would be forced to turn to nursing homes for care. However, the state has neither enough open licensed beds nor the funds to pay for the increased demand on institutional services.

In California and throughout the country, efforts at long-term care policy reform have for years focused on helping people with disabilities remain in their homes and communities. To support the highest level of autonomy possible, the Americans with Disabilities Act of 1990, backed by findings of the U.S. Supreme Court in Olmstead v. L.C. (1999), holds the state accountable for providing care and support in the community where possible as an alternative to institutionalization. As a result, California’s community-based long-term care services have kept thousands of older adults and adults with disabilities out of institutional care. The UCLA Health Policy Center’s analysis of U.S. Census data found that nursing home rates have dropped from 5.1 percent of the population in 1980 to 2.8 percent in 2008. This time frame corresponds with increased access to publicly supported home-and community-based services.

These programs, designed to allow individuals to stay in their own homes rather than placing them in more expensive nursing homes, are subject to substantial cuts. For example, the In Home Supportive Services (IHSS) program provides personal care assistance to nearly half a million low income people who are over the age of 65, blind or disabled. Proposed cuts, according to data from the nine counties analyzed in the UCLA study, would eliminate services for 87 percent of all current recipients. More than two-thirds of elders with cognitive impairment would have their services totally cut, as well as 94 percent of those who live alone. But even the few who will retain services are at risk. If the state does not receive all $6.9 billion of federal assistance it requested, then “trigger cuts” would eliminate the entire program.

Seniors in jeopardy of losing IHSS also stand to lose Adult Day Health Care (ADHC), a community-based day care program that provides health, therapeutic and social services to 37,000 persons at-risk for nursing home placement. Cuts propose to eliminate this program all together.

Other cuts to programs that help seniors are up for discussion as well, forcing them and their families to scramble for long-term care alternatives should services disappear. Among the most unpopular of alternatives is going to a nursing home. Yet even this option presents challenges. The California Legislative Analyst’s Office estimates that up to 50 percent or 213,500 of those losing IHSS services could seek nursing home placement as a result of cuts, yet the state has only around 20,000 licensed nursing home beds available at any moment. The UCLA analysis suggests that – at most – 5 percent of those needing placement could be accommodated. Where will the rest go?

Left to fend for themselves, low income older and disabled adults with substantial impairments could likely turn to the more expensive acute care system – emergency room visits and hospital admissions – for help.

Compared to the rest of the country, California has the largest number of older adults in the nation and as baby boomers retire, that number will only grow larger. While the proposed reductions might save money in the near term, it could likely result in increased acute care costs and long-term care costs down the road.

Dismantling these programs would also have a negative effect on an already precarious California job market. If the cuts go into effect, unemployment will almost certainly rise. As many as 7,600 employees would lose their ADHC jobs and up to 370,000 paid caregivers would lose some or all of their IHSS work. Many would lose health insurance benefits provided by these jobs. Also, family caregivers who rely on these services to help care for loved ones so they can maintain employment outside of the home would be forced to find with alternative care or face jeopardizing their own jobs.

The current collection of home- and community-based services in California is not perfect. With little cohesion, this patchwork of programs often operates in silos and could benefit from a more comprehensive and effective coordination process. However, its overall contribution has been positive for seniors and family caregivers alike.

The State of California faces an overwhelming financial crisis that threatens to unravel the safety net for seniors. There are no simple answers to this painful crisis. Yet it presents an opportunity to create a more integrated, efficient and person-centered approach to care rather than leaving our poorest and most vulnerable Californians with no place to go.


Bruce Chernof, MD, is the president and CEO of The SCAN Foundation in Long Beach, California. The SCAN Foundation supported the UCLA Center for Health Policy analysis of the governor’s proposed budget.

 

Governor proposes anti-obesity agenda

Published: February 24, 2010 | No Comments

Gov. Arnold Schwarzenegger is proposing to remove sport drinks like these from California's public schools. This brand has about 150 calories and 42 grams of sugar per bottle.

Updated at 2:19 pm.

LOS ANGELES–Describing childhood obesity as a “huge problem” afflicting California, Gov. Arnold Schwarzenegger today proposed new measures to force local schools to provide fresh water, ban sugar-sweetened sports drinks and ensure that kids exercise during physical education classes and after-school programs.

Schwarzenegger also said he wants to encourage schools to keep their playing fields open after hours and on weekends and make it easier for low-income communities to receive grants to improve walking and biking routes to school.

“Obesity is a huge problem for the state of California,” Schwarzenegger said at a policy summit in Los Angeles with former President Bill Clinton.

Schwarzenegger said one-third of California teens and three out of five adults are either overweight or obese. Those numbers, he said, have been building for decades and are going to be difficult to turn around. But he said that concerted action by parents, schools, government and the private sector could have an impact.

“There is no silver bullet,” he said. “There is no magic. It cannot be done overnight.”

Gov. Arnold Schwarzenegger and former President Bill Clinton discuss obesity at a policy summit in Los Angeles. Photo from Peter Grigsby, office of the governor.

Clinton said he committed his private foundation to focus on nutrition and obesity after he had heart surgery in 2004. He said obesity-related problems, including heart disease and diabetes, account for $150 billion in spending in the Medicaid program alone, which provides health care to the poor. But he also said the problem is taking a human toll.

“We’re running the risk of having the first generation of kids live shorter lives than their parents,” Clinton said. “Until we get a hold of our lifestyles and the food chain and how we eat and exercise, we are going to have serious problems.”

Both men said parents have to do more to provide healthy foods for their children and encourage them to exercise. But they also noted that, especially in low-income neighborhoods, that can be difficult. Often, no fresh fruits or vegetables are available at nearby stores, and places for kids to play are few and far between.

Clinton offered a vague mea culpa for being part of the movement to subsidize the corn industry, a policy that has been blamed for making high-fructose corn syrup cheaper and thus more widely used in sweetened foods and beverages. Noting his own health problems, he said he has been perhaps both a “victim” and “complicit” in the problem. But he encouraged Californians to send an economic message to the food industry by refusing to buy unhealthy products.

“We need to create a movement in America to push back up the food chain so we stop subsidizing food production that is harmful to our country,” he said.

Schwarzenegger noted that he had already signed legislation to ban soda and junk food from school vending machines and require nutrition labeling on restaurant menus. But he said sweetened sport drinks were sneaking through a “loophole” in the vending machine law that needs to be closed, and he endorsed legislation requiring schools to provide fresh water with meals that they serve to students by 2012. The governor also wants physical education classes to spend at least half their time in moderate or vigorous physical activity, and after school programs to include at least 30 minutes of exercise.

The summit featured testimonials from school administrators, teachers and others who have been on the forefront of anti-obesity policies.

Jennifer LeBarre, director of nutrition for the Oakland schools, said her district has already banned sweetened sport drinks. Ken Dyar, coordinator of physical education for the Delano Unified School District, described that district’s commitment to transforming the fitness culture of its largely low-income student body. Robert Ogilvie, director of the Planning for Healthy Places program, said communities across the state are beginning to look at ways to make it easier for parents and children to eat well and exercise.

“Right now in too many neighborhoods, the healthy choice is the hard choice,” he said.

Clinton echoed that sentiment, saying that many parents feel “overwhelmed by the circumstances of their lives” and need help from government and community organizations to change their ways. But he also said the essence of the problem is not complicated.

“There is still a simple equation,” Clinton said. “In the end it’s calories in, calories out. We ingest too much and exert too little.”

–Daniel Weintraub

Note: Schwarzenegger’s event today was hosted by the California Endowment; the Endowment is also the initial funder of this web site, www.healthycal.org.

 

Schwarzenegger puts friend, confidante in education post

Published: February 23, 2010 | No Comments

Bonnie Reiss

Gov. Arnold Schwarzenegger’s appointment of Bonnie Reiss as his education secretary gives him a trusted confidante to advise him on a key issue as he winds down his seven years in office.

Reiss is a long time friend of Schwarznegger and Maria Shriver. Shriver and Reiss met while working for Ted Kennedy’s presidential campaign in 1980. Later, Reiss, a lawyer, helped create and run Schwarzenegger’s after-school foundation. When he ran for governor in 2003, Reiss was his right-hand woman, Maria’s eyes and ears on the campaign and later in the governor’s office. She was the institutional memory for the institution of Arnold, the person who knew him best and could intervene if his new staff was taking him in directions that didn’t make sense for him.

Reiss is a liberal, but in Sacramento, she was stunned at the power that labor unions had over her Democratic Party friends, especially the public employee unions. She butted heads with many of them, including the powerful California Teachers Association, which shredded her friend and boss in 2005 and set the stage for the defeat of his slate of special election ballot measures. Reiss complained that the union was more concerned about its own power and survival and protecting the rights of teachers than it was in improving education for children, including poor children.

The job of education secretary is pretty toothless. Mostly, the person in it serves as an adviser to the governor. Some past secretaries have had trouble getting governors on the phone or an appointment to see their boss. That won’t be the case with Reiss. When she wants to talk to Schwarzenegger, she will.

 

Babies, bathwater and billions

Published: February 14, 2010 | No Comments

By Wendy Lazarus

Gov. Arnold Schwarzenegger's budget could cost the state twice as much in federal funds for health care as it saves for California taxpayers. Figures from California Budget Project.

If someone handed Governor Schwarzenegger a check for a billion dollars, you probably wouldn’t expect him to tear it up or send it to Washington, D.C. to give to other states. But that’s exactly what he has proposed doing in his FY 2010/11 budget. And his budget would eliminate reliable health care for a million California children at the same time.

To be sure, the looming $25 billion-plus budget hole is a serious challenge that requires wrenching choices. But it is precisely in these tough fiscal times that it’s most vital for the state budget to reflect the priorities and wise budget choices Californians want our leaders to make.

Wendy Lazarus

Although nearly 70 percent of California voters think children not having health insurance is a serious problem, the Governor’s budget proposes to save $78 million in General Fund dollars by cutting back eligibility for kids who need California’s Healthy Families Program. This move would result in over 200,000 children losing their health coverage in one fell swoop in May. The governor also proposes a trigger that would save $126 million in General Fund spending by eliminating California’s Healthy Families program entirely—causing nearly one million children to join the ranks of the uninsured—if our state leaders can’t bring home $6.9 billion dollars in federal funds, a worthy goal but a feat virtually no one thinks is possible.

Dropping nearly a million children from health insurance, as the governor’s proposal contemplates, would result in taxpayers paying more in the long run. Uninsured children still need health care. They are just sicker and it becomes costlier to treat them when they finally get care.

The Governor is proposing to hand over to other states $800 million in federal matching funds per year for children’s health that would otherwise come to California.
But on top of that, the federal government pays California two dollars for every one dollar we put into Healthy Families from the General Fund. So the Governor, who has complained that California doesn’t get its fair share of federal funding compared to other states, is, in fact, proposing that California voluntarily hand over to other states $800 million in federal matching funds per year for children’s health that would otherwise come to California. The amount of federal funds lost to California would be well over $1 billion if we include the lost federal Medicaid matching funds from additional cuts that would be triggered.

There are multiple reasons why California doesn’t get its proportionate share of federal dollars, including funding formulas that need to be addressed. But much of the blame is our own: our leaders have chosen not to invest as aggressively as they could in drawing down available federal matches because of a preoccupation with saving state general fund dollars even when it sacrifices federal dollars equal to or greater than any state savings.

California has used this faulty fiscal logic decade after decade in both Democratic and Republican Administrations, while other states like New York and Illinois have maximized their federal “take home” by investing state dollars to bring down far more federal funds. But California’s policies have cost us much more than lost federal dollars in our budget—we’ve also undermined highly-effective programs like Healthy Families, and we’ve given up the jobs and economic stimulus that programs such as Medi-Cal have been proven to deliver to local communities.

Rather than voluntarily forfeit federal funds, California should build on last year’s success, when health plans, First 5 California, hospitals, and families using the Healthy Families Program all stepped up and found ingenious ways to lower costs and cobble together the General Fund match required to keep the program whole at this critical time. Succeeding again this year would protect our kids. It would also leverage state funds and federal funds for children to the maximum extent possible.

Wendy Lazarus is Founder & Co-President of The Children’s Partnership, a national child advocacy organization, with offices in Southern and Northern California and Washington, DC, working to ensure that all children—especially those at risk of being left behind—have the resources and the opportunities they need to grow up healthy and lead productive lives.

 

Steinberg, Arnold make joint plea in DC

Published: January 19, 2010 | No Comments

Senate Leader Darrell Steinberg. Photo from Steinberg's office.

Senate Leader Darrell Steinberg has joined Gov.  Arnold Schwarzenegger in Washington D.C. for a two-pronged bipartisan push for more aid and federal breaks for California. Steinberg message, according to his staff, is this:

Without additional federal assistance, California will be forced to make budget-balancing decisions that will further delay California’s economic recovery.  A sustained national economic recovery is not possible without California.  And the budget deficit problems facing California are neither unique nor self-inflicted.  At least 40 other states this year are confronting unprecedented budget deficits that are a product of a national recession caused by forces outside of California’s control.

Steinberg’s press secretary, Nathan Barankan, said Steinberg agrees with most of Schwarzenegger’s requests to the feds. Here, in Barankan’s words, is where they are not in sync:

–The Governor is only asking for a 9-month extenstion of the TANF Emergency Contingency Fund dollars.  Senator Steinberg has requested a 12-month extension.

–Senator Steinberg strongly supports federal healthcare reform efforts, and remains confident that congress and the President will ensure that the final version of such reform will ensure that California is able to afford it.

– The Governor seeks federal approval of various utilization controls and benefit limits in Medi-Cal.  Senator Steinberg supports the concept of greater state flexibility, but is not prepared to endorse the Governor’s requests before they can be thoroughly evaluated to ensure the changes are not harmful to Californians.

 
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