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HomeMy WebLinkAboutMINUTES - 04172007 - C.28 SE_.L TO: BOARD OF SUPERVISORS Contra -=_ _- FROM: JOHN CULLEN, COUNTY ADMINISTRATOR 4:; , A. z Costa DATE: APRIL 17, 2007 °°sr OUA--= County 9 C SUBJECT: STATE HEALTH CARE REFORM RECOMMENDATIONS SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATION: AMEND County Legislative Platform to include the California State Association of Counties (CSAC) Health Care Reform Recommendations as County policy positions. FISCAL IMPACT: Changes in state health care financing could have a significant effect on County General Fund revenue and expenditures. The net fiscal impact for Contra Costa County of the state reform proposals cannot be determined until more details about the proposals become available. BACKGROUND: CSAC Recommendations. In response to the various health care reform proposals being considered by the Governor and State Legislature, the CSAC Board of Directors CONTINUED ON ATTACHMENT: X YES SIGNATURE: �ZRECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BO D COMMITTEE APPROVE OTHER SIGNATURE(S): r ACTION OF BOA D N ���/L!,/ 7 .;?Ile Z APPROVE AS RECOMMENDED_X OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS (ABSENT /24rkLe-- ) AND CORRECT COPY OF AN ACTION TAKEN AND ENTERED ON THE MINUTES OF THE BOARD AYES: NOES: OF SUPERVISORS ON THE DATE SHOWN. ABSENT: ABSTAIN: ATTESTED JOHN WCLEN,CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR Contact Person: Anastasia Dodson,5-1022 CC: S.Hoffman,CAO D.Sansoe,CAO L.Delaney,CAO Health Services Department BY: DEPUTY SUBJECT: STATE HEALTH CARE REFORM RECOMMENDATIONS adopted the attached position and recommendation paper. These principles and recommendations are consistent with Contra Costa County's priorities and concerns, and should be included in the County's Legislative Platform. When the platform was originally adopted in January 2007 many of the proposals had not yet been released. Key CSAC findings and recommendations include: • Counties support a concept of universal health coverage for all Californians. • Moving the complex array of existing coverage and delivery systems into a universal coverage framework is a complex undertaking that requires sound analysis, thoughtful and deliberative planning, and a multi-year implementation process. • Access and Affordability. Improvements to current programs, including Medi- Cal, must be made either prior to, or in concert with, a coverage expansion in order to ensure access. o Medi-Cal reimbursement rates must be increased to incentivize providers to participate in the program. o Administrative streamlining of Medi-Cal should be adopted. o Steps must be taken to address provider shortages (including physicians and nurses). o Comprehensive systems of care should be implemented for frequent users of emergency care and those with chronic diseases and/or dual diagnoses. • Sequencing. As California moves toward a universal system of health care, the sequencing of changes must be carefully planned. o Sufficient time must be allowed for detailed data gathering of current safety net funding and the impact of any redirection of funds on remaining county responsibilities. o No safety net funding should be transferred until an analysis of who would remain uninsured is completed, to adequately fund services for these populations. o Remaining county responsibilities must be clearly defined and adequately funded. o An analysis of current health care infrastructure (facilities and providers), including current safety net facilities across the state, must be undertaken to ensure that there are adequate providers and health care facilities, and that they can remain viable after health reform. SUBJECT: STATE HEALTH CARE REFORM RECOMMENDATIONS • Financing. The system overall is currently underfunded; adequate financing must be sought for the reforms to succeed. o Federal reimbursement from Medicaid and S-CHIP should be maximized. o Actuarial studies must be completed on the costs of transferring indigent populations to a coverage model. o Safety net health care facilities must remain viable during the transition period and be supported afterwards based on analyses of the changing health market and of the remaining safety net population. Preliminary Analysis of Governor's Health Care Reform Proposal. The net fiscal impact for Contra Costa County of any of the reform proposals cannot be determined until more details become available. However, general results from the key changes proposed by the Governor are described below. 1. Medi-Cal Rate Increases (Fee for Service and/or Managed Care) would increase state/federal payments for the county hospital, clinics, and health plan, and would result in County General Fund savings. However, significant rate increases may also increase hospital/physician/managed care plan competition for Medi-Cal patients and revenue. 2. Provider Fees paid by the hospital and possibly county physicians to the state would result in County General Fund costs. 3. A significant Realignment revenue shift from counties to the state would result in County General Fund pressure to backfill the lost revenue. 4. Increased Medi-Cal, Healthy Families, subsidized pool, and guaranteed issue enrollment would increase Contra Costa Health Plan (CCHP) enrollment and revenues. The increased enrollment, particularly among currently uninsured patients who use County health facilities, would reduce County General Fund costs. 5. Proper implementation, sequencing, and enforcement of the "individual mandate" for health coverage is critical. CCHP must maintain a broad risk pool, and avoid enrollment by only those most in need of care (adverse selection). Individuals who avoid the enrollment requirements and still seek County hospital care could result in significant County costs without any offsetting revenue. To know how these proposals would affect County finances, the first key question is whether the County savings from the Medi-Cal rate increases and health insurance coverage expansion would be sufficient to offset the County costs of the provider fees and the lost Realignment revenue. The second key question is how well the changes are implemented; problems with sequencing, information, and enforcement could result in net County General Fund costs, particularly in startup years. Further information about the Governor's proposal is needed before these questions can be answered. r ---- CSAC Position and Recommendations on State-Level Universal Health Care Reform Counties support a concept of universal health coverage for all Californians. Toward that end, counties urge the state to enact a system of health coverage and care delivery that builds upon the strengths of the current systems in our state, including county- operated systems serving vulnerable populations. Currently, California has a complex array of existing coverage and delivery systems that serve many, but not all, Californians. Moving this array of systems into a universal coverage framework is a complex undertaking that requires sound analysis, thoughtful and deliberative planning, and a multi-year implementation process. As California moves forward with development of a universal coverage system, counties urge the state to prevent reform efforts from exacerbating problems with existing service and funding. The state must also consider the differences across California counties and the impacts of reform efforts on the network of safety-net providers, including county providers. The end result of health reform must provide a strengthened health care delivery system for all Californians, including those served by the safety net. Counties have a high stake in California's health reform efforts. Counties serve as employers, payers, and providers of care to vulnerable populations. Consequently, counties stand ready to actively participate in discussions of how to best structure a universal health care system for California. Counties recommend the following: 1. Access and Affordability. Access to care and affordability of care are critical components of any health reform plan. Expanding eligibility for existing programs will not provide access to care in significant areas of the state. Important improvements to our current programs, including Medi-Cal, must be made either prior to, or in concert with, a coverage expansion in order to ensure access. Coverage must be affordable for all Californians to access care. ■ Medi-Cal reimbursement rates must be increased to incentivize providers to participate in the program. ■ Administrative streamlining of Medi-Cal, including elimination of the asset test and semi-annual reporting and changes to income verification, should be adopted. California should look to other states for ideas to reduce administrative costs, such as allowing all children born into Medi-Cal to remain on the program until age 21. ■ Steps must be taken to address provider shortages (including physicians, particularly specialists, and nurses). Innovative programs, such as loan forgiveness programs, should be expanded. In an effort to recruit physicians from other states, the licensing and reciprocity requirements should be re-examined. Approved by CSAC Board of Directors March 30, 2007 Page 1 of 2 1 - Steps should be taken to reduce the amount of time it takes to obtain a Medi-Cal provider number (currently six to nine months). ■ Comprehensive systems of care, including case management, should be implemented for frequent users of emergency care and those with chronic diseases and/or dual diagnoses. Approaches could be modeled after current programs in place in safety net systems. 2. Sequencing. As California moves towards a universal system of health care, the sequencing of changes must be carefully planned. ■ Sufficient time must be allowed for detailed data gathering of current safety funding in the system and the impact of any redirection of funds on remaining county responsibilities. The interconnectedness of county indigent health funding to public health, correctional health, mental health, alcohol and drug services and social services must be fully understood and accounted for in order to protect, and enhance as appropriate, funding for these related services. ■ No safety net funding shall be transferred until an analysis of who would remain uninsured (e.g. medically indigent adults, including citizens, who cannot document citizenship under current Medicaid eligibility rules) is completed in order to adequately fund services for these populations. ■ Remaining county responsibilities must be clearly defined and adequately funded. ■ An analysis of current health care infrastructure (facilities and providers), including current safety net facilities across the state, must be undertaken to ensure that there are adequate providers and health care facilities, and that they can remain viable after health reform. 3. Financing. The system overall is currently underfunded; adequate.financing must be sought for the reforms to succeed. ■ Federal reimbursement from Medicaid and S-CHIP should be maximized. ■ Actuarial studies must be completed on the costs of transferring indigent populations, who currently receive mostly episodic care, to a coverage model to ensure that there is adequate funding in the model. ■ Counties anticipate that changes to the health care system will result in some changing marketplace dynamics. However, safety net health care facilities must remain viable during the transition period and be supported afterwards based on analyses of the changing health market and of the remaining safety net population. 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