WE HAD BALLANTINE'S FOR
EVERYBODY.
IN THE BIG VALENTINE FOR THE
TEACHER ARGUMENTS THAT WOULD
GIVE.
I SHOULD THE BOTTOM YOU SHOULD
ABOUT A BIT WEIRD A MY FEELINGS
ARE HURT BUT I'LL JUST.
THROUGH THAT BY WISHING EVERYONE
A HAPPY VALENTINE'S DAY.
PLEASE CALL THE ROLL.
MITCHELL HERE NIELSEN BELL --
ALSO HERE FOR TITLE.
JONES.
LEYVA MCGUIRE MINING.
MORE LUCK.
MORALE PAN.
SKINNER STERN STONE.
AMBERG.
WHAT KASKI [inaudible]
HI.
THANK YOU VERY MUCH THE
SECRETARY NOTICES THE PRESENCE
OF THE QUORUM AGAIN WELCOME
EVERYONE TO OUR PARDON ME.
OUR FOURTH FULL BUDGET COMMITTEE
HEARING FOR THIS BUDGET YEAR AND
AGAIN HAPPY VALENTINE'S DAY.
YOU HAVE TO SAY IT LIKE THAT TO
LIKE YOU'RE REALLY HAPPY HAPPY
VALENTINE'S DAY --
MY COACH HERE USING MY BY SHEER
SEVENTEEN NIELSEN --
HAS PRESSING BUSINESS IN HIS
DISTRICT TODAY AND HE WILL NOT
BE WITH THIS THE FOCUS OF
TODAY'S HEARING IS REALLY TO
PART WE'RE LOOKING AT A
PROPOSALS IN THE GOVERNOR'S
BUDGET FOCUSING ON HEALTHCARE.
FIRST BEING OF THE EXPANSION OF
MEDICAID ELIGIBILITY TO YOUNG
ADULTS REGARDLESS OF IMMIGRATION
STATUS.
AND THE SECOND MAJOR NEW
COMPONENT THE GOVERNOR'S BUDGET
IS LEVERAGING THE STATE'S
PURCHASING POWER TO LOWER THE
COST OF PRESCRIPTION DRUGS FOR
MEDI CAL AND OTHER STATE HEALTH
PROGRAMS AS WELL AS THE PRIVATE
MARKET.
WHILE CALIFORNIA'S LED THE
NATION IN X..
THERE ARE STILL MILLIONS OF OUR
FELLOW RESIDENTS THAT REMAIN
WITHOUT ACCESS TO ADEQUATE
HEALTH COVERAGE.
THE LARGEST GROUP AMONG THE
POPULATION OF REMAINING
UNINSURED ARE UNDOCUMENTED
RESIDENTS WHO ARE IN ELIGIBLE
FOR BOTH MEDICARE AL.
AND PARTICIPATION THE COVER
CALIFORNIA HEALTH BENEFIT
PACKAGE.
IN TODAY'S HEARINGWILL HAVE A
BRIEF OVERVIEW OF THE
CHARACTERISTICS AND HEALTH CARE
NEEDS OF THE UNDOCUMENTED
POPULATION BASED ON A RECENT
REPORT.
PUBLISHED BY THE CENTER FOR
LABOR RESEARCH AND EDUCATION AT
THE UNIVERSITY OF CALIFORNIA AT
BERKELEY.
FOLLOWING THAT PRESENTATION
APARTMENT HEALTHCARE SERVICES
WILL PROVIDE US WITH AN OVERVIEW
OF THE GOVERNOR'S PROPOSAL TO
EXPAND FULL SCOPE MEDI CAL
COVERAGE TO YOUNG ADULTS UP TO
AGE.
TWENTY SIX NEXT WE'LL DISCUSS
THE GOVERNOR'S PROPOSAL TO LOWER
THE COST OF PRESCRIPTION DRUGS.
RISING PRESCRIPTION DRUG COSTS
FROM NEW HIGH COST TESTING DRUGS
SHARP PRICE INCREASES FOR
EXISTING DRUGS AND OTHER FACTORS
HAVE LED TO SUBSTANTIAL
FINANCIAL IMPACTS ON OUR PUBLIC
HEALTH CARE PROGRAMS
CALIFORNIA'S FAMILIES AS WELL AS
OUR BUDGET.
THE DEPARTMENT OF GENERAL
SERVICES WILL PRESENT THE
ACTIONS OUTLINED IN THE
GOVERNOR'S EXECUTIVE ORDER TO
IMPLEMENT A STATEWIDE BALL
PURCHASING PROGRAM FOR
PRESCRIPTION DRUGS WITH THE AIM
OF REDUCING COSTS FOR STATE
HEALTH PROGRAMS.
AND ALLOWING LOCAL GOVERNMENTS
PRIVATE PAYERS AND HELP
CONSUMERS TO BENEFIT FROM THE
STATE'S PURCHASING POWER.
THE DEPARTMENT HEALTHCARE
SERVICES WILL THEN PRESENT THE
GOVERNOR'S PROPOSAL TO
TRANSITION MEDICARE PRESCRIPTION
DRUG BENEFITS FROM MANAGED CARE
TO FEE FOR SERVICE WITH THE AIM
OF NEGOTIATING ADDITIONAL
REBATES ON DRUGS PROVIDED TO
MEDI CAL THIRTEEN POINT TWO
MILLION COVERED.
BENEFICIARIES.
PRIOR TO OUR FIRST PRESENTATION.
IS ANYONE WOULD LIKE TO MAKE ANY
COMMENTS --
SEEN NONE AND WITH THE TO
NIELSEN NOT BE IN TODAY WILL GO
AHEAD AND GET STARTED.
WITH OUR INITIAL PRESENTATION.
AGAIN THE TITLE OF THE REPORT IS
EXPAND YOU TOWARD UNIVERSAL
HEALTH COVERAGE EXPANDING
MEDICAID ALL THE LOW INCOME
UNDOCUMENTED ADULTS.
SO IF MISS LUCIA WILL COME FOR
HELLO MISS LUCIA IS THE DIRECTOR
OF THE HEALTH CARE PROGRAM AT UC
BERKELEY CENTER FOR LABOR
RESEARCH AND EDUCATION.
YOU BEING HERE AND WE'LL GO
AHEAD AND GET STARTED HAPPY
VALENTINE'S DAY HAPPY
VALENTINE'S DAY.
GOOD MORNING THANK YOU FOR THE
OPPORTUNITY TO SHARE RESEARCH
TODAY OF THE AT SENATOR MITCHELL
SAID MY NAME IS LAURA LEE C. I'M
THE DIRECTOR OF THE HEALTH CARE
PROGRAM AT THE UC BERKELEY LABOR
CENTER.
LAST WEEK WE RELEASED IN THE
RECORDS --
THAT.
BOTH THE SUMMARIZE THE EXISTING
RESEARCH SHOWING THE NEEDED FOR
THE EXPANSION OF INSURANCE TO
UNDOCUMENTED ADULTS AND ALSO
ESTIMATED HOW MANY.
CALIFORNIA ADULTS WOULD BE
ELIGIBLE AND THEN ROLL UNDER
SUCH AN EXPANSION AND I REPORT
PRIMARILY FOCUSED ON AN
EXPANSION TO ALL ITS OLD --
BUT THE THE FINDINGS ARE ALSO
APPLICABLES OF COURSE A TO THE
GOVERNOR'S PROPOSAL TO EXPAND
MEDIC HELL TO UNDOCUMENTED YOUNG
ADULTS.
SO WE STARTED BY PROVIDING SOME
CONTEXT ABOUT A IS --
AND DOCUMENT A CALIFORNIANS ARE
AND HOW INTEGRAL THEY ARE TO OUR
STATE.
THE RESEARCH CENTER ESTIMATES
THAT THEIR TWO POINT TWO MILLION
UNDOCUMENTED RESIDENTS IN THE
STATE.
AND THE UNDOCUMENTED WERE 9% OF
THE WORK FORCE AND PAID THE
THREE BILLION IN STATE AND LOCAL
TAXES EACH YEAR SO THERE REALLY
AND A GIRL TO OUR STATE'S
ECONOMY --
THERE ALSO INTEGRAL TO OUR
COMMUNITIES ABOUT TWO THIRDS
HAVE LIVED IN THIS COUNTRY FOR
AT LEAST A DECADE.
AND MORE THAN A QUARTER
HOMEOWNERS.
AND THEIR INTEGRAL TO OUR OUR
FAMILIES IN THE STATE ONE OUT OF
SIX CALIFORNIA CHILDREN HAS AND
UNDOCUMENTED PARENTS.
IN SPITE OF HOW INTEGRAL THEY
ARE TO OUR STATE THEY'RE LARGELY
LEFT OUT OF OUR HEALTH INSURANCE
SYSTEM.
WITH THEIR COLLEAGUES AT THE
UCLA CENTER FOR HEALTH POLICY
RESEARCH WE PROJECTS THAT FOUR
MILLION CALIFORNIANS WILL REMAIN
UNANSWERED IN TWENTY TWENTY AND
THAT WILL GROW TO FOUR POINT
FOUR MILLION.
AND TWENTY TWENTY THREE AND THE
LARGEST GROUP OF AN INSURED IS
UNDOCUMENTED.
ABOUT ONE POINT FIVE MILLION.
UNDOCUMENTED CALIFORNIANS ARE AN
INSERT IS OUR ESTIMATE.
AND THE REASON THAT UNDOCUMENTED
ADULTS IN THE STATE HAVE SUCH A
HIGH RATE OF AN INSURANCE IS
THAT THEY'RE XCLUDED FROM FULL
MEDICAID BENEFITS UNDER FEDERAL
POLICY.
THEY'RE ALSO NOT ELIGIBLE FOR
COVERED CALIFORNIA ENROLLMENT
EITHER WITH OR WITHOUT SUBSIDIES
ALTHOUGH THEY CAN PURCHASE
COVERAGE DIRECTLY FROM AN
INSURER ALTHOUGH WITH THEIR
INCOME PROFILE --
THAT COVERAGE IS AN AFFORDABLE
FOR MOST WITHOUT SUBSIDIES.
AND THEY'RE ALSO LESS LIKELY TO
HAVE EMPLOYER SPONSORED
INSURANCE BECAUSE THEY TEND TO
WORK IN OCCUPATIONS AND
INDUSTRIES THAT ARE LESS LIKELY
TO OFFER INSURANCE TO WORKERS.
AND SO ABOUT TWO THIRDS OF
UNDOCUMENTED ADULTS HAVE INCOME
LOW ENOUGH THAT THEY MEET THE
INCOME CRITERIA FOR MEDI CAL OR
HAVE INCOME AT OR BELOW A
HUNDRED AND 38% OF THE FEDERAL
POVERTY LEVEL.
SO A LOT OF THE THE POLICY
DISCUSSION HAS FOCUSED ON
EXPANDING MEDIC HOUSE.
AS A FIRST STEP TO CLOSING THE
COVERAGE GAPS FOR UNDOCUMENTED
CALIFORNIANS.
AMONG LOW INCOME UNDOCUMENTED
ADULTS AND PARTICULARLY THE THAT
I'M INSURANCE RATE IS ESPECIALLY
HIGH A 90% OF LOW INCOME
UNDOCUMENTED ADULTS ARE
UNANSWERED.
BASED ON ESTIMATES BY MY
COLLEAGUE PROFESSOR PERON AT
UCLA.
THAT'S COMPARED TO A 10% AN
INSURANCE RATE FOR CITIZENS AND
DOCUMENTED CALIFORNIANS OF THE
SAME INCOME RAINS.
SOME OF THESE UNINSURED ADULTS.
DO YOU HAVE RESTRICTED SCOPE
MEDI CAL --
WHICH USING FEDERAL AND STATE
FUNDS COVERS EMERGENCY AND
PREGNANCY RELATED SERVICES.
BUT UNLESS ONE IS PREGNANT
RESTRICTED SCHEMATIC HELL DOES
NOT COVER PREVENTIVE CARE
PRIMARY CARE DRUGS AND OTHER
BASIC HEALTH CARE SERVICES AND
LESS THE REQUIRED FOR THE
TREATMENT OF AN EMERGENCY
MEDICAL CONDITION.
SO WE DO HAVE A TO A TO A
PATCHWORK SYSTEM BETWEEN
RESTRICTED SCOPE MEDI CAL AND
INSERTING A COUNTY IS CERTAIN
UNDOCUMENTED DULTS ARE ELIGIBLE
FOR ACCESS TO CERTAIN HEALTH
CARE SERVICES LIKE IN HELL THE
SAN FRANCISCO AND AND MY HEALTH
LA PROGRAMS --
AND ALSO --
THE SAFETY NET HEALTHCARE SYSEM
PLAYS A VERY IMPORTANT ROLE IN
IN PROVIDING HEALTH CARE TO
UNDOCUMENTED ADULTS.
BUT IT IN SPITE OF THAT
PATCHWORK SYSTEM AND DOCUMENTED
CALIFORNIANS.
HAVE WORSE ACCESS TO CARE SO
THIS IS ALSO RESEARCH FOR MY
COLLEAGUE AT UCLA SHOWING THAT
UNDOCUMENTED LOW INCOME ADULTS --
44% OF THEM REPORTED NOT HAVING
A USUAL SOURCE OF CARE THE LOT
HIGHER THAN THE 24% OF THEIR
CITIZEN UNDOCUMENTED
COUNTERPARTS IN THE SAME INCOME
RAINS.
AND IN TH REPORT WE OFFER OTHER
EXAMPLES FROM THE THAT THE
RESEARCH THAT SHOW THE WORST
ACCESS TO CARE THAT THE THIS
POPULATION PIECES.
A BUT THE THE THE RESEARCH
EVIDENCE DOES SHOW THAT WHEN
PEOPLE HAVE INSURANCE THEIR
ACCESS TO CARE AND THEIR HEALTH --
IS BETTER A THE THERE'S A LOT OFRESEARCH ON INSURANCE EXPANSIONS
THAT HAPPENED PRIOR TO THE
AFFORDABLE CARE ACT LAKE
MASSACHUSETTS STATE HEALTH
REFORM.
AND THEN THERE'S ALSO BEEN A LOT
OF RESEARCH IN THE LAST FEW
YEARS ON THE AFFORDABLE CARE ACT
MEDICAID EXPANSION.
AND THE IMPACTS --
THEY'VE HAD AND AND SO IN TERMS
OF THE HEALTH AND ACCESS TO CARE.
HAVING INSURANCE HAS BEEN
ASSOCIATED WITH IMPROVED USE OF
PREVENTIVE HEALTH CARE SERVICES
PRIMARY CARE --
GETTING MORE REGULAR CARE IF YOU
HAVE A CHRONIC CONDITION
IMPROVED ACCESS TO TO MENTAL
HEALTH CARE SERVICES AND AND
SUBSTANCE USE DISORDER TREATMENT.
A INSURANCE HAS BEEN SHOWN TO
READ SPITTLE EMISSIONS AND EVEN
REDUCE DEATH RATES.
INSURANCE ALSO HAS BENEFITS FOR
PEOPLE'S FINANCIAL SECURITY IN
TERMS OF REDUCE DEBT REDUCED --
COLLECTIONS.
AND AND PEOPLE REPORT FEWER
PROBLEMS PAYING MEDICAL BILLS
WHEN THEY HAVE INSURANCE.
THERE HAS ALSO BEEN SOME
RESEARCH SHOWING IMPROVED
WORKFORCE PRODUCTIVITY WITH
INSURANCE --
ONE STUDY SHOWED THAT PEOPLE
WITH INSURANCE.
MISS FEWER DAYS OF WORK.
AND THERE'S RESEARCH FROM THE
INSTITUTE OF MEDICINE IN TWO
THOUSAND AND NINE THAT SHOWED.
AND COMMUNITIES THAT HAVE HIGH
AND INSURANCE RATES EVEN
INSERTED ADULTS REPORTED MORE
DIFFICULTY OBTAINING CARE AND
WERE LESS SATISFIED WITH THE
CARE THAT THEY RECEIVED.
SO CALIFORNIA HAS ALREADY TAKEN
SOME BIG AND IMPORTANT STEPS
TOWARDS MORE INCLUSIVE MEDI CAL
ELIGIBILITY POLICIES RECOGNIZING
THE VALUE THAT INSURANCE HAS.
A USING STATE FUNDS OF MEDIC HAL
OFFERS FULL BENEFITS --
TO LAWFUL PERMANENT RESIDENTS
WHO'VE BEEN IN THE COUNTRY LESS
THAN FIVE YEARS. TWO ADULTS WITH
DHAKA A DEFERRED ACTION OR
CHILDHOOD ARRIVALS AND STARTING
IN TWENTY SIXTEEN TO ALL LOW
INCOME CHILDREN REGARDLESS OF
IMMIGRATION STATUS.
SO NOW 200- AND FIFTY THOUSAND
UNDOCUMENTED KIDS IN THE STATE
HAVE FULL MEDICAL BENEFITS AND
MANY OF THOSE WERE ALREADY
ENROLLED IN RESTRICTED SCOPE
MEDI CAL PRIOR TO THE EXPANSION
AND WE'RE AUTOMATICALLY
TRANSITION TO THOSE FULL
BENEFITS.
SO I. ESTIMATE THAT
APPROXIMATELY ONE POINT ONE FIVE
MILLION UNDOCUMENTED ADULTS IN
THE STATE WOULD BE ELIGIBLE FOR
FULL MEDICAL BENEFITS IF A AND
EXPANSION OCCURRED --
OF THOSE NINE HUNDRED AND FORTY
TWO THOUSAND OR THE VAST
MAJORITY ARE ALREADY AND ROLLED
IN RESTRICTED SCOPE MEDI CAL.
AND THIS IS SIGNIFICANT FOR TWO
REASONS COULD BE AUTOMATICALLY
TRANSITION TO FULL COVERAGE ON
THE FIRST DAY THE POLICY WAS
EFFECTIVE --
BUT IT ALSO MEANS THAT THE THE
INVESTMENT OF THE STATE WOULD
MAKE AN PREVENTIVE AND PRIMARY
CARE WOULD BUILD ON THE EXISTING
FEDERAL AND STATE SPENDING
THAT'S ALREADY OCCURRING FOR
EMERGENCY IN PREGNANCY RELATED
SERVICES.
SO THERE I ESTIMATED THAT
APPROXIMATELY TWO HUNDRED AND
TEN THOUSAND WHO WOULD BE
ELIGIBLE BUT ARE NOT CURRENTLY
ENROLLED IN RESTRICTED SCOPE
MEDI CAL.
AND THERE'S THESE OF UNCERTAINTY
ABOUT HOW MANY OF THOSE WOULDN'T
ROLL BUT I HAVE ASSUME THAT 50%.
WITH WITH NEARLY AND ENROLLIN
MEDIC HOW AND THAT THAT'S
INTENDED TO TAKE INTO ACCOUNT
THAT A SMALL NUMBER OF
UNDOCUMENTED LOW INCOME ADULTS
DO YOU HAVE A PRIVATE INSURANCE
MOSTLY.
EMPLOYER SPONSORED INSURANCE
ROUGHLY A HUNDRED THOUSAND LOW
INCOME UNDOCUMENTED ADULTS HAVE
PRIVATE INSURANCE.
AND THERE IS THERE IS SOME
UNCERTAINTY ABOUT ALL OF THE
ELIGIBILITY AND ENROLLMENT
ESTIMATES ÐAUSE
ASK.
OTHER PEOPLE ABOUT THEIR
UNDOCUMENTED STATUS THE HOUSE TO
BE INFERRED AFTER THE FACT BY
RESEARCHERS SO THERE IS
UNCERTAINTY BOTH ABOUT THE
OVERALL SIZE OF THE UNDOCUMENTED
POPULATION IN THE CITY.
ENDS THEIR INCOME DISTRIBUTION.
SO WHAT I JUST DESCRIBED A IN
TERMS OF IN ROMANS IN TERMS OF
NINE HUNDRED AND FORTY TWO
THOUSAND ADULTS TRANSITIONING TO
FULL BENEFITS FROM RESTRICTED
SCOTT MEDI CAL.
AND ROUGHLY A HUNDRED THOUSAND
NEARLY AND ROLLING THAT'S WHAT I
CALLED SCENARIO ONE IN IN IN IN
MY REPORT THAT WOULD BE A TOTAL
OF ONE POINT ZERO FIVE MILLION.
UNDOCUMENTED ADULTS AND ROLLING.
I ALSO --
CONSIDERED A SECOND SCENARIO
WHICH I CALLED SCENARIO TO THAT
THAT RELATES TO FEDERAL
PROPOSALS AROUND PUBLIC CHARGE.
SO IN OCTOBER THE A PROPOSED TO
THE TO TOUGHEN AND GREATLY
EXPANDS AN EXISTING POLICY.
ALL THE PUBLIC CHARGE RULE AND
THIS WOULD MEAN THAT IF THIS
GOES INTO A FACT THAT THE
FEDERAL GOVERNMENT COULD DENY
PEOPLE GREEN CARDS ARE VISA.
VISAS BASED ON THEIR USE OF
CERTAIN PUBLIC PROGRAMS
INCLUDING THE MEDICAID.
AND THE EXPECTATION IS THAT THIS
IF THE RULE IS FINALIZED --
THAT IT WOULD HAVE A CHILLING
EFFECT ON IMMIGRANT FAMILIES IN
TERMS OF THEIR ENROLLMENT PUBLIC
PROGRAMS --
INCLUDING AMONG THOSE NOT
DIRECTLY AFFECTED BY THE RULE
THE RULE IS VERY COMPLEX THERE'S
LIKELY TO BE A LOT OF CONFUSION
AND FEAR --
AND AND BASED ON EXPERIENCE WITH
WELFARE REFORM IN THE NINETIES
THE EXPECTATION IS THAT THAT
COULD BE A BROADER A CHILLING
EFFECTS.
AND SO.
IT IN OUR RESEARCH WITH UCLA ON
ON THIS.
BECAUSE PUBLIC CHARGE RULE AND
AS A HIGH AND THIS IN A MOMENT
SCENARIO.
WE ASSUMES THAT UP.
TO THE IN ROMAN COULD DROP BY UP
235% --
AMONG CERTAIN IMMIGRANT FAMILIES --
AND OTHER RESEARCHERS NATIONALLY
MADE A SIMILAR ASSUMPTION IN
THEIR ANALYSIS.
AND SO OF A IN TERMS OF APPLYING
THAT ASSUMPTION TO AND
DOCUMENTED OLD SPECIFICALLY I
WANT TO BE CLEAR THAT THE PUBLIC
CHARGE TESTS WOULD NOT APPLY
IT'S TO EMERGENCY MEDICAL
SERVICES.
AND IT ALSO WOULD NOT APPLY TO
STATE FUNDED BENEFITS OF THE
THAT ARE NOT CASH ASSISTANCE --
HOWEVER THE THE BROADER CHILLING
EFFECTS BECAUSE THE RULE IS SO
COMPLEX --
IS LIKELY TO ALSO APPLIES TO
UNDOCUMENTED ADULTS BOTH IN
TERMS OF RESTRICTED SCOPE MEDI
CAL ENROLLMENT AND IF AN
EXPANSION OCCURS IN TERMS OF
FULL SCOPE BENEFITS.
IT'S NOT CLEAR WHEN THIS THIS
CHILLING EFFECT WOULD HAPPEN THE
RULE HAS NOT BEEN FINALIZED IT'S
NOT CLEAR WHEN IT WOULD BE
EFFECTIVE IF IT IS FINALIZED.
AND ALSO --
HOW HOW LONG IT WOULD TAKE FOR
THIS CHILLING EFFECTIVE FULLY
OCCUR -- OF
THESE THE SECOND SCENARIO IS
REALLY INTENDED TO SIGNIFY AND
SO THAT THIS PROPOSED PUBLIC
CHARGE RULE NOT ONLY THREATENS
OUR CURRENT LEVEL OF MEDIC HELLO
ENROLLMENT --
BUT COULD HINDER THE STATE'S
EFFORTS TO GET CLOSER TO
UNIVERSAL COVERAGE.
LESLIE -- IN
TERMS OF WHO IT IN THE ROLE OF
THE UNDER AN EXPANSION MOST OF
THOSE WHO WOULD IN ROLE WOULD BE
WORKING NEEDS A NON DISABLED
ADULTS.
ABOUT THE ESTIMATE THAT ABOUT 2%
OF THOSE WHO WOULD IN ROLE WOULD
BE SENIOR IS OVER THE AGE OF
SIXTY FIVE AND THAT'S CONSISTENT
WITH THE SHARE OF THE OVERALL
UNDOCUMENTED POPULATION THAT
SIXTY FIVE OR OLDER.
AND THE FEW WOULD BE DISABLED --
BECAUSE RESEARCH HAS SHOWN THAT
UNDOCUMENTED ADULTS HAVE A LOWER
RATE OF A DISABILITY THAN OTHER
WORKING AGE ADULTS.
AND FINALLY AYE ESTIMATE THAT
AROUND A HUNDRED AND FOUR
THOUSAND YOUNG ADULTS WOULD AND
ROLL UNDER AN EXPANSION.
SO JUST TO SUM UP UNDOCUMENTED
CALIFORNIANS ARE THE LARGEST
GROUP OF UNINSURED AND LOW
INCOME UNDOCUMENTED.
HAVE A PARTICULARLY HIGH AND
INSURANCE RATE OF 90%.
IN THE RESEARCH HAS SHOWN THAT
THIS IS A GROUP THAT HAS BURST
ACCESS TO CARE --
BUT THE THE THE READ SHARON'S
CAN IMPROVE THAT ACCESS AND IT
CAN ALSO IMPROVE HEALTH AND
FINANCIAL SECURITY AND WORKFORCE
PRODUCTIVITY.
OF THE ESTIMATE THAT ONE POINT
ONE FIVE MILLION ADULTS WOULD BE
ELIGIBLE THE VAST MAJORITY OF
THOSE ARE ALREADY --
IN RESTRICTED SCOTT MEDI CAL AND
COULD BE AUTOMATICALLY
TRANSITIONS AND DEPENDING ON
WHAT HAPPENS WITH FEDERAL
IMMIGRATION POLICY AND HOW AND
PEOPLE RESPOND TO THAT IN TERMS
OF THEIR ENROLLMENT DECISIONS.
BETWEEN SIX HUNDRED AND EIGHTY
THOUSAND AND ONE POINT ZERO FIVE
MILLION COULD IN RAW.
A AND THAT WOULD MEAN A
REDUCTION IN THE STATE'S
UNINSURED POPULATION BY UP TO
ONE QUARTER.
I WELCOME YOUR QUESTIONS THANK
YOU.
THANK YOU VERY MUCH CENTER MONEY.
THANK YOU MADAM CHAIR IN THANK
YOU FOR THIS EXCELLENT
[inaudible]
OVERVIEW --
YOU TALKED ABOUT THE RESPECTIVE
IMPACT TO THE PUBLIC CHARGE
REGULATIONS OF THE PROPOSED
EXPANSION OF OF THOSE.
THAT DO YOU HAVE ANY DATA
SHOWING A CURRENT.
CHILLING EFFECT IN THE
COMMUNITIES I REPRESENT PEOPLE
AREN'T WAITING STATE THEY'RE
ALREADY.
PULLING BACK FROM PROGRAMS THEY
MIGHT CURRENTLY BE ELIGIBLE.
FOR BECAUSE OF THE FEAR THAT IN
THE COMMUNITY OF ADVERSE
IMMIGRATION IMPACT.
HE I HAVE IN A I'VE I'VE ONLY
LOOKED IN MEDI CAL I HAVEN'T
LOOKED AT CONFERENCE OROTHER
PUBLIC PROGRAMS THAT COULD BE
AFFECTED --
AND IN TERMS OF MEDI CAL
ENROLLMENTS --
THERE HAS BEEN A A SLIGHT
DECLINE IN OVERALL MEDI CAL
ENROLLMENTS AND AM A SLIGHTLY
LARGER DECLINE AMONG.
THOSE IN RESTRICTED SCOPE BUT A
IS BOTH THE KINDS HAVE BEEN IN
THE RANGE OF A FEW PERCENTAGE
POINTS AND THERE ARE OTHER
FACTORS THAT COULD AFFECT
ENROLLMENT LEVELS LIKE.
THE STRONG ECONOMY WE HAVE RIGHT
NOW LIKE THE MINIMUM WAGE
INCREASE AND SO IT'S HARD TO
DISENTANGLE --
WHAT THE FACTS AND THE HI MINTA
FEAR IS HAVING ON ENROLLMENTS?
THANK YOU AND THEN WITH RESPECT
TO THE RESTRICTED SCOPE
ELIGIBILITY.
FOR PREGNANT HOMES --
YOU INCLUDE THEM ALSO IN THE IN
THE CATEGORY THE ARE CONCERNED --
COULD BE IMPACTED BY THE PUBLIC
CHARGE --
AMBER STATION IF YOU WILL
[inaudible]
YES THE THE LEGAL IMPLICATIONS
OF THE PUBLIC CHARGE REAL FOR
PREGNANT WOMEN ARE ARE MORE
COMPLICATED TO RULE THE PROPOSAL
DOES SPECIFICALLY EXCLUDE
EMERGENCY MEDICAID BENEFITS BUT
DOES NOT EXCLUDE PIC PREGNANCY
RELATED BENEFITS BUT I THINK
THERE IS SOME QUESTION ABOUT.
WOMEN WHO ARE INVOLVED IN IN
PREGNANCY RELATED SERVICES FOR A
SHORT AMOUNT OF TIME WITH THE BE
PENALIZED UNDERTHE PART PUBLIC
CHARGE TEST --
BUT I HAVE NOT DONE ANYTHING
DIFFERENTLY IN MY ANALYSIS FOR
PREGNANT WOMEN THAN. FOR OTHER
ADULTS THANK YOU KNOW I THINK
THE CONCERN IS.
EVEN IF REGULATIONS CARVE OUT --
PROTECT.
ACCESS OR ELIGIBILITY.
THE THIS DIG MONTH OF JUST FEAR
IN THE COMMUNITY --
HAS THE POTENTIAL TO OVERRIDE
[inaudible]
THAT ELIGIBILITY WITH PEOPLE.
WANTING TO ERR ON THE SIDE OF
SAFETY AND NOT ACCESSING --
PROGRAMS THEY MIGHT BE ELIGIBLE
FOR RATE THE RULE IS EXTREMELY
COMPLEX THEY CAN'T TELL ME TELL
YOU HOW MANY HOURS I SPENT ON
CALLS WITH OTHER RESEARCHERS ALL
OF US TRYING TO UNDERSTAND THE
ROLE IN AND SO THERE'S GONNA BE
A LOT OF CONFUSION AND FEAR --
ANDS -- IT
M. PEOPLE WHO ARE NOT DIRECTLY
AFFECTED BY THE RULE BECAUSE
THEY ALREADYHAVE A GREEN CARD
OR MAY NOT HAVE AN OPPORTUNITY
TO GET A GREEN CARD.
A A COULD EXPERIENCE THIS
CHILLING EFFECT AND AND AND
THERE COULD BE A CHILLING EFFECT
ON PUBLIC PROGRAMS THAT ARE NOT
NAMED IN THE RULE AS WELL.
IF I MAY JUST ASK IN ANOTHER
pPRESENTATION THE HEALTH AND LIST
THE BENEFITS OF THOSE WHO DO
HAVE INSURANCE FROM ACCESS TO
PREVENTIVE CARE.
PRIMARY CARE SERVICES --
AND A NUMBER OF BENEFITS --
MEASURED IN THESE CATEGORIES.
DO YOU HAVE. FOUR DO YOU HAVE OR
IS THERE ANY INDEX THAT ALONG
WITH THIS ACCESS SHOWS.
SAVINGS --
COST SAVINGS FOR PEOPLE TO GET
FRONT END MEDICAL SERVICES WHO
WARRANT THEN ACCESSING EMERGENCY
ROOM SERVICES OR GOING ON
TREATED IN HAVING AN AND TREATED.
EARLY CONDITION MANIFESTS IN A
FULL BLOWN --
MEDICAL CRISIS.
I I THINK THE STRONGEST
EVIDENCES THAT THAT PREVENTIVE
AND PRIMARY CARE REALLY BENEFITS
HEALTH --
THAT THE RESEARCH IS MORE MIXED
ON THE AFFECT THE INSURANCE HAS
ON THE USE OF EMERGENCY SERVICES.
ON THE ONE HAND WHEN PEOPLE GET
PREVENTIVE AND PRIMARY CARE IT
CAN PREVENT AND CERTAIN MORE
COSTLY CARE DOWN THE LINE BUT ON
THE OTHER HAND.
WHEN PEOPLE DON'T HAVE INSURANCE
A IT IS IT'S EXPENSIVE TO TO
VISIT THE EMERGENCY ROOM --
AND SO THE THE EVIDENCE ON WHAT
BUT A FACT THAT PASSED
EXPANSIONS HAVE HOME EMERGENCY
ROOM USES IS MIXED IN AND
GENERAL I WOULD SAY THAT.
THIS EXPANSION WOULD REQUIRE
SOME STATE INVESTMENT RIGHT NOW
I GUESS [inaudible]
THE CHALLENGES.
THERE'S A HUMANITARIAN SIDE OF
THIS THAT WOULD SUGGEST
HEALTHCARE FOR ALL.
BUILD HEALTHIER COMMUNITIES
REDUCES DISEASE AN ILLNESS THAT
SENTRA.
BUT FROM A BUDGET SIDE --
IT WOULD BE HELPFUL I THINK TO
UNDERSTAND THAT ANYTHING WE
MIGHT INVEST IN A FRONT END TO
BROADEN AND EXPAND ACCESS TO
CARE.
HAS A LONG TERM BUDGET BENEFIT
IS WELL AND I KNOW IT SOUNDS
LIKE FROM WHAT YOU JUST SAID.
WE DON'T HAVE THAT DISPOSITIVE
EVIDENCE AT THIS POINT THAT.
I THINK IT WOULD BE HELPFUL TO
UNDERSTAND LOOKING AT IT
STRICTLY FROM A IN BUDGET
INVESTMENT POINT OF VIEW.
IN OUT YEARS CAN WE REDUCE ON TO
THE STATE BUDGET BY GETTING
PEOPLE ENROLLED IN.
PREVENTION PROGRAMS ACCESS TO
PRIMARY CARE AT CENTER SO MORE
OF A STATEMENT THAN A QUESTION
BUT IF YOU HAVE ANY COMMENT
THANK YOU MADAM CHAIR I HOPE
THAT YOU DIRECT THAT QUESTION --
TO THE REPRESENTATIVES FROM THE
PRIVATE FINANCE WILL BE ON THE
PANEL LATER THANK YOUNG LOOK
FORWARD TO THEN I THINK YOU.
SENATOR BAIL.
THANK YOU ON OVER HERE --
WOULD THE US.
OF THAT --
THE PEOPLE IN YOUR CLASS THAT
YOU'RE TALKING ABOUT --
UNDOCUMENTED WOULD.
HEY CASH FOR THEIR HEALTHCARE
AND HAS ANYBODY MEASURED.
THAT ISSUE BECAUSE IN MY
COMMUNITY AND SALAS A IT'S
PREVALENT WAY THAT PEOPLE PAY
FOR THEIR HEALTHCARE.
AND A ITS.
COURSE DEPENDED ON WHETHER OR
NOT THEY HAVE THE CASH.
OF SO HAVE YOU MEASURE THAT HAS
THAT BEEN LOOKED AT ALL.
N. DOCUMENTED ADULTS WHO ARE
UNINSURED OFTEN STILL ARE USING
SOME CARE THEY'RE JUST NOT
GETTING ALL THE CARE THEY NEED
AND AND SOMETIMES LIKE CARE IS
THROUGH --
THE SAFETY NET SYSTEM WHETHER
THAT BE PUBLIC HOSPITALS OR ARE
A COMMUNITY CLINICS OR PUBLIC
CLINICS.
THE AND AND OFTEN IT'S PROVIDED
ON A SLIDING SCALE AND AND SO
THEY THEY ARE.
PAYING FOR SOME OF THEIR
HEALTHCARE ALREADY --
I DON'T HAVE SPECIFIC AND WAY OF
THINKING YOU THINK THE PUBLIC
CHARGE RULE WOULD.
THE MORE PEOPLE TO ABANDON.
ANY KIND OF PUBLIC HEALTH SYSTEM
AND GO TO CASH PAYING.
OF MODES TO GET THEIR HEALTH
CARE TO AVOID ANY KIND OF PUBLIC
CHARGE OF RULE THAT.
THE FEDERAL GOVERNMENT MAY
IMPOSE.
I A DO YOU THINK BECAUSE OF THE
RULE IS SO COMPLEX AND CONFUSING
THERE WILL THERE WILL BE PEOPLE
WHO ARE FEARFUL AND AND DO NOT
ENROLL IN AN PUBLIC PROGRAMS
EVEN IF THEIR PUBLIC PROGRAMS
THAT ARE NOT WOULD NOT DIRECTLY
BE AFFECTED BY THE RULE.
AND THEN THE OTHER QUESTION
MANAGERS THE LIMITED --
MEDI CAL PROGRAM.
OF AND THE FACT THAT A LOT OF
THE CARE IS PROVIDED WITH
EMERGENCY ROOMS.
HAS HAD.
LIMITED MEDI CAL --
DOES AND TO A FOCUS AT ALL ON
CHRONIC.
ONGOING ELLEN'S ILLNESSES ARE A
BRING UP MENTAL HEALTH.
OF THE MERGER ROOM IS NOT
EQUIPPED TO DEAL WITH MENTAL
HEALTH THAT'S NOT WHAT THEY DO --
CAN YOU COMMENT ON THOSE KINDS
ILLNESSES THAT ARE JUST
COMPLETELY NOT COVERED.
BY.
THIS PATCHWORK.
EMERGENCY OF KIND OF SYSTEM THAT
[inaudible]
UNDOCUMENTED.
INDIVIDUALS ARE USING.
AND AND SPECIFICALLY CAN YOU
TALK ABOUT MENTAL HEALTH RIGHT
AS A ISSUE.
YES THE RESTRICTED SCOPE.
A MEDIC HOW WOULD NOT COVERED
THE THE SERVICES SOMEONE WOULD
NEED OVER THE LONG TERM --
SOMEONE WITH A MENTAL HEALTH.
AGNES SAYS AND OCCASIONS OR
OTHER GRAY WOULD NOT COVER THE
DRUGS THE EAT.
ME IN SOME CASES COVER A LITTLE
BIT OF THE CHARACTERS YOU KNOW
GET THEM STABLE AND OUT OF THE
ER BUT BUT NOT THE LONG TERM.
THE ON GOING CARE --
THAT THEY WOULD NEEDS.
AND IF THE RESEARCH IS CLEAR
THAT THAT THIS IS ONE OF THE BIG
VALUES OF INSURANCES IS
IMPROVING ACCESS TO MENTAL
HEALTH CARE SERVICES.
IF YOU ANALYZE THE LIKE YOU HAVE
THIS PROPOSAL HERE.
FOR WE'RE LOOKING AT FOR
COMPLETE COVERAGE AGE --
TWENTY SIX HELLO THE ON COVERED
ADULTS WHEN WE STARTED THE
MEDICAL SYSTEM EXPANDING.
WERE PEOPLE HAT HAD MENTAL
HEALTH CONDITIONS --
WITH THAT POPULATION FOR
UNDOCUMENTED BE THE SAME THAT
WOULD BE A LOT OF MENTAL HEALTH
FROM.
CONDITIONS IN THAT POPULATION.
AS A THINK THE RESEARCH HAS
SHOWN THAT THERE IS CERTAINLY A
SEGMENT OF TE UNINSURED
UNDOCUMENTED ADULT POPULATION
HAS A A REAL NEED FOR MENTAL
HEALTH SERVICES.
AND IS NOT GETTING THE SERVICES.
THANK YOU --
MEN SURE THANK YOU I THINK THE
JUST.
HAVING --
EXPERIENCES CHAIR OF THE
HOSPITAL COMMITTEE IN SANTA
CLARA COUNTY --
THERE'S NO QUESTION THAT THIS
WOULD SAVE MONEY.
OF FROM THE MEDICAL SYSTEM
PROBABLY --
AND A LOT OF OTHER.
SYSTEMS TO AND I'M I'M INCLUDING --
EDUCATION CRIMINAL JUSTICE ALL
THE OTHERS SYSTEMS AS WELL AS
THE HEALTH CARE SYSTEM.
AND NAM.
HAS THERE BEEN ANY RESEARCH
QUANTIFYING OLE.
THOSE KINDS OF SAVINGS IN THIS
IN THIS AREA.
I DON'T I DON'T HAVE GOOD
NUMBERS ON THAT BUT I AGREE WITH
THE CONCEPT THAT YOU KNOW AS ONE
EXAMPLE THAT I MENTIONED IMPROVE
WORKFORCE PRODUCTIVITY WHEN
PEOPLE MISS FEWER DAYS.
WHEN PEOPLE HAVE INSURANCE THEY
MISS FEWER DAYS OF WORK AND THAT
COULD ULTIMATELY HAVE BROADER
SAVINGS TO OUR SOCIETY IN?
EDUCATION IN CRIMINAL JUSTICE OR
OTHER ARE OTHER GOOD EXAMPLES OF
THE I THINK IT'S JUST HARD TO TO
TO QUANTIFY THOSE IN AND TURN
THOSE INTO INTO BUDGET ESTIMATES.
ANOTHER ANOTHER FINANCIAL IMPACT
THOUGH THAT I DO WANT TO MENTION
IS THAT THIS PROPOSAL WOULD
CERTAINLY REDUCE UNCOMPENSATED
CARE COSTS FOR PROVIDERS --
THAT WOULD BE IT ANOTHER
RELEVANT.
THANK YOU SENATOR OFF.
THANK YOU MADAM CHAIR YOU KNOW I
DON'T THINK THERE'S ANY QUESTION
THAT WE NEED TO TRY.
TO COVER MORE FOLKS WITH
INSURANCE OF SOME SORT --
ONE OF THE WAYS WE'RE PROBABLY
GOING TO BE ABLE TO DEAL WTH
THIS ESCALATING COSTS OF HEALTH
CARE.
MORE COVERAGE COMMUNITY CLINICS
AS OPPOSED TO EMERGENCY ROOMS.
BUT IF WE HAVE TO MAKE CHOICES
AND OBVIOUSLY CHOICES HAVE BEEN
MADE IN THE BUDGET PROPOSAL.
TO EXPAND COVERAGE FOR THOSE
BETWEEN NINETEEN AND TWENTY SIX
YEARS OF AGE --
HAVE YOU ANALYZE THE PUBLIC
POLICY ISSUES ASSOCIATED WITH
COVERING THE NINETEEN TO TWENTY
SIX YEAR OLDS.
AS OPPOSED TO COVERING THOSE WHO
WERE SIXTY FIVE OR OLDER OR
THOSE WHO WERE SIXTY OR OLDER.
SENIORS WHO ARE MORE LIKELY TO
HAVE SERIOUS MEDICAL CONDITIONS
TO TODAY IF UNDOCUMENTED ARE NOT
COVERED.
BY ANYTHING ANYWHERE.
WELL I THINK LIKE YOU SAID IT
REALLY IT COMES DOWN TO A PUBLIC
POLICY DECISION I MEAN BASED ON
OUR RESEARCH THERE'S A NEED FOR
FOR ALL. FOR INSURANCE ACROSS
ALL OF THESE AGE GROUPS --
BUT LIKE YOU SAID AS AS SOME
PEOPLE HAVE PROPOSED FOCUSING ON
SENIORS BECAUSE THEY DO HAVE THE
THE HIGHEST NEED FOR HEALTH CARE
SERVICES AND AND OTHERS HAVE A
PROPOSED FOCUSING ON YOUNG
ADULTS.
BECAUSE TODAY THERE ARE TO OUR
CHILDREN WHO ARE AGING OUT OF OF
MEDI CAL --
AND AN EXPANDING TO YOUNG ADULTS
WOULD.
PREVENT THAT AT LEAST FROM A FEW
YEARS FOR A FEW YEAR THE
AFFORDABLE.
CARE ACT EXPANSION REQUIRING A
PRIVATE INSURERS TO ALLOW YOUNG
A YOUNG ADULT DEPENDENCE TO BE
ON THEIR PARENTS PLAN TO THEIR
TWENTY SIXTH BIRTHDAY.
BUT I REALLY I REALLY THINK IT
DOES.
COME DOWN TO IT A PUBLIC POLICY
DECISION IF THE EXPANSION CAN'T
OCCUR TO ALL AGE GROUPS THAT
ONES IN TERMS OF DECIDING HOW TO
PRIORITIZE OTHER BEEN ANY
STUDIES DONE ON ON UTILIZATION
PROJECTED UTILIZATION RATES. FOR
THE NINETEEN TO TWENTY SIX YEARS
OF AGE GROUP AS OPPOSED TO THOSE
WHO ARE SIXTY FIVE AND OLDER OF
THOSE WHO ARE SIXTY AND AND OVER.
I HAVEN'T SEEN ANYTHING
SPECIFICALLY FOR UNDOCUMENTED
ADULTS IN THOSE AGE GROUPS --
I AM SURE THERE CERTAINLY IS A%
RESEARCH ON ON DIFFERENCES AND
UTILIZATION BY AIDS ACROSS THE
BROADER POPULATION BY AGE GROUP.
THANK YOU VERY MUCH FOR YOUR
SPOTS AND YOU PRESENTATION THANK
YOU VENTURE THANK YOU DR GRANT.
THANK YOU IT'S GOOD TO SEE YOU
YET.
AGAIN.
HE HAD TO JUST COUPLE DAYS AGO
I'M TALKING ABOUT FOR ABILITY --
SO FREE SHE YOUR PRESENTATION --
AYE AYE A THE FIRST OF ALL JUST.
TO SUCH A LITTLE BIT ON WHAT --
CENTER ROCK JUST ASKS ND TO TO
I GUESS ONE OF THE THINGS WHEN
WE TALK ABOUT.
SORT OF DOING EIGHTEEN TWENTY
SIX VERSES IN OLDER AGE GROUP --
WE TOUCH ON PREVENTION --
AGAIN I RECOGNIZE THAT THE OLDER
AGE GROUP HAS.
PERHAPS GREATER IMMEDIATE HEALTH
NEEDS ARE NEEDS --
THERE'S AN OPPORTUNITY --
FOR PERHAPS MORE PREVENTION WITH
SOME THAT YOU'LL RECOGNIZE ALSO
THE IDEA IS THE ONE THAT OTHER
THINGS WHEN WE ENROLL MORE
PEOPLE INTO HEALTH COVERAGE FOR
THINGS TO RECOGNIZE IS THAT WHEN
SOMEONE HASN'T HAD CONSISTENT
HEALTH COVERAGE AND YOU CAN
CORRECT ME IF I'M WRONG.
THEY'RE NOT THAT FAMILIAR THE
HEALTH CARE SYSTEM THAT HEALTH
COVERAGE RIGHT.
SO THE ACTAL TO LEARN HOW TO
USE IT SO WHAT YOU SEE IS WHEN
YOU FIRST DO AN EXPANSION YOU'LL
SEE SPIKE IN EMERGENCY ROOM USE
EVER GOES ALL WAIT A MINUTE I
THOUGHT COVERAGE SUPPOSED TO
LOWER EMERGENCY ROOM USE WELL IF
THAT'S WHAT YOUR NORMAL HABIT IS.
YOU DON'T GO THERE WHEN YOU'RE
ON INSURED BECAUSE IT'S
EXPENSIVE UNLESS YOU REALLY HAVE
TO BUT STILL THAT'S THE PLACE TO
GO -- AND
AND BECAUSE THAT'S MAY BE YOUR
ONLY OPTION ARE ONE OF THE FEW
OPTIONS --
MAYBE IF YOU'RE FORTUNATE TO
HAVE A COMMUNITY CLINIC YOU
MIGHT HAVE THOUGHT BUT SO YOU
HAVE TO HAVE TO TEACH PEOPLE TO
SAY WELL ACTUALLY THAT'S NOT
WHERE YOU GO FIRST YOU ACTUALLY
HEAR YOU ACTUALLY HAVE OTHER
OPTIONS NOW.
AND SO --
THAT BIT OF TRANSITION I THINK
IT'S SOMETHING SOMETIMES PEOPLE
DON'T RECOGNIZE YOUR ROLLING
PEOPLE INTO COVERAGE THAT IS NOT
JUST ABOUT --
HERE'S INSURANCE CARD YEARS
MEDIC HOW YOU'RE GOOD IT'S LIKE
WELL HOW DO YOU USE IT.
WHAT DOES THIS MEAN WHAT CAN YOU
ACTUALLY ACT YEAH GO OFF AND?
THEY'LL GO OFF AND BE HEALTHY SO --
WE DO I THINK THERE'S AN
EDUCATION COMPONENT THERE AND I
SO WHEN WE SAW THAT HEALTHY
FAMILIES AND SO THE HELP EXACTLY
WHEN WE GAVE THE CHILDREN
COVERAGE BUT NOT THE PARENT
RIGHT SO SO I I GO THROUGH THIS
I APPRECIATE THAT IT IS JUST.
TO IN TERMS OF SETTING
EXPECTATIONS ABOUT WHAT WE
EXPECT TO HAPPEN.
AND SO I THINK THAT SO THERE'S
SOME ARGUMENT TO SAY WE HAVE.
HOPEFULLY WE HAVE --
KIDS WHO AS THEY GET OLDER YOU
CANDEVELOP MORE OF A HABITS A
SOCIAL NORM ABOUT COVERAGE THAT
WE CAN SUPPORT.
MIGHT BE SOMETHING TO THAT WE
MIGHT WANT TO THINK ABOUT ON THE
BENEFIT SIDE OF WHY WE POLICY
WHY SHE'S ONE OR THE OTHER --
CERTAINLY THE UTILIZED LESS SO
WE CAN PROBABLY COVER MORE FOR
THE SAME AMOUNT OF DOLLARS AGAIN
THERE'S A PUBLIC POLICY CHOICE
ABOUT WHERE THE NEED IS AND SO
FORTH -- I I
DO A TOUCH ABOUT SO AND YOU KNOW
WE MENTION THIS IN THE PREVIOUS
HEARING A LITTLE BIT BUT IN
TERMS OF EXPANDING.
YOU KNOW --
THERE PEOPLE ARE ELIGIBLE FOR
MEDICARE I'LL. TO LEARN AND
ROLLING AND THEN WE HAVE BEEN
DOCUMENTED WHO ARE ELIGIBLE BUT
WE ALSO KNOW WE A LOT BLENDED
FAMILIES RIGHT YEAH.
AND SO AND WHAT WE ALSO KNOW
FROM PREVIOUS EXPERIENCE WITH
HEALTH CARE EXPENSES THAT.
OFTENTIMES OF ONE FAMILY MEMBER
CAN'T GET AT THERE'S LESS
INCLINATION FOR THE WHOLE FAMILY
TO ENROLL.
AND THEN WELL LATER ON TOP OF
THAT PUBLIC CHARGE RIGHT SO.
SO PUBLIC CHARGES IN JUST ABOUT --
WITH THE UNDOCUMENTED MEMBERS OF
THE HOUSEHOLD WANT TO AFRAID TO
TAKE PUBLIC SERVICES AT THE
WHOLE HOUSEHOLD.
THEY'RE AFRAID THAT THEY'LL BE
LINKED TOGETHER SO REJECTION ON
SITE -- PAGE
FOR THE SLIDE --
IS.
DID YOU BUILD THEN FOR PUBLIC
CHARGE IN THIS AT ALL OR NOT SO
THIS IS JUST THE BETTER CASE
SCENARIO WITHOUT PUBLIC CHART
RIGHT THIS IS THE THE BETTER
CASE SCENARIO WE DON'T HAVE ANY
ANY CHILLING EFFECT FROM PUBLIC
CHARTER FROM THE BROADER.
IS FEAR THAT'S BEEN YOU KNOW
CREATED UNDER THE FEDERAL
ADMINISTRATION --
AND AND SO THIS PICTURE COULD BE
WORSE AT THE PUBLIC CHARGE RULES
FINALIZED SEPARATELY WE HAVE
DONE RESEARCH WITH THE UCLA
CENTER FOR HEALTH POLICY
RESEARCH.
ON HOW MANY CALIFORNIANS MIGHT
DESCEND ROLE FOR MEDI CAL AND
USING IT IN THAT RESEARCH.
WE ESTIMATED THAT I THINK IS
AROUND SEVEN HUNDRED AND SIXTY
THOUSAND FEWER PEOPLE MY AND
ROLE IN MEDIC HOW UNDER.
THE THE THE WORST CASE THE
FEDERAL MEANT SCENARIO THE 35%
ISN'T ROMANCE IN THE AREA AND
70% OF THOSE WHO WOULD DESCEND
ROLE FOR MEDI CAL WOULD BE.
ED CHILDREN MOSTLY CITIZENS
CHILDREN IN THESE THAT MAKE
STATUS FAMILIES.
OKAY.
I'D APPRECIATE YOU --
CLARIFYING THAT AND THE OTHER
QUESTION I JUST HAD WAS IS THAT --
SO YOU MENTIONED THAT A LOT OF
MANY OF THE END DOCUMENT OUT --
ARE ABOUT ALMOST A MILLION ARE
RESTRICTED SKILL MEDI CAL BUT I
JUST WANT CLEAR FIGHT FOR
PEOPLE'S ACCESO PERSONAL --
PEOPLE ON RESTRICTED SKILL MEDI
CAL YOU CONSIDERED --
UNINSURED ARE DO YOU COUNT THEM
AND THEN SHARED --
IN IN THE IN ALL OF OUR
ESTIMATES INCLUDING INCLUDING
THE FIGHTING RAGES REFERENCING
AS THERE ARE PEOPLE UNDOCUMENTED
ADULTS WHO REPORT TO SURVEYS
LIKE THE CALIFORNIA HEALTH
INTERVIEW SURVEY AND TO THE
CENSUS THAT THEY MEDI CAL.
AND IN OUR ESTIMATES WE TREAT
THEM AS UNANSWERED BECAUSE WE
KNOW THAT THEIR THEIR ONLY
ELIGIBLE FOR THOSE LIMITED
SERVICES OKAY IT'S LIKE CLARIFY
THAT AND THE OTHER THING IS IS
THAT.
WHO?
SO SO WE'VE TALKED A LOT ABOUT
WHAT.
A RESTRICTED MEDI CAL IS BECAUSE
OF BUT WHO CAN ACTUALLY ACT EVEN
ACCESS RESTRICTED MEDI CAL.
WHICH WHICH PEOPLE ARE WE
TALKING ABOUT THOSE --
RESTRICTED SCOPE MEDI CAL AS IS
AVAILABLE TO LOW INCOME PEOPLE
EARNING LESS THAN A HUNDRED AND
38% OF THE FEDERAL POVERTY LEVEL
WHICH IS ABOUT SIXTEEN THOUSAND
DOLLARS FOR A SINGLE PERSON. TO
IT REGARDLESS OF IMMIGRATION
STATUS MOST OTHER.
THE MOST CITIZENS UNDOCUMENTED
PEOPLE IN THAT INCOME RANGE ARE
ALREADY ELIGIBLE FOR FROM WITH
GOT MEDI CAL WE'RE TALKING ABOUT
RESTRICT IT'S GOT MEDI CAL BEING
FOR UNDOCUMENTED ADULTS.
OKAY BUT ANYONE OF THAT BELOW
THAT AIRING HAZARD AND THE
RESTRICTIONS IN TERMS OF SIGNING
UP BECAUSE IT IS A AND IS THAT
YOU HAVE --
YEAH [inaudible]
THE NO DID DID YOU HAVE ONE IN
THE OTHER SIDE TO SIDE SO
THROUGH JUST TO CLARIFY DOES AND
SO THAT AND THAT'S ONLY COURSE
ONLY FOR EMERGENCIES.
EMERGENCY IN PREGNANCY RELATED
SERVICES ALSO USING STATE FUNDS
AND RESPECT IT'S GOT MEDI CAL
DOES PROVIDE SOME A NURSING HOME
SERVICES TO PEOPLE WHO NEED IT
AND THERE ARE FEW OTHER AND
SMALL EXCEPTIONS LIKE THAT.
SO I GUESS I WOULD JUST POINT
OUT THAT --
EVEN THOSE PEOPLE ARE TALKING
ABOUT WHETHER THE FIGHT COVERAGE
OR NOT CONFERENCE OF COVERAGE OR
NOT.
I WOULD KEEP IN MIND THAT --
PEOPLE WHO DON'T HAVE COVERAGE
NOT ONLY OF COURSE THEY SUFFERED
THE CHALLENGES THAT YOU OUTLINED
PRESENTATION WE'RE STILL PAYING
FOR THEM [inaudible]
HER.
OR SO PAINFUL IN SOME WAY
WHETHER THROUGH --
YOU KNOW THROUGH RESTRICTED
SKILLED MEDI CAL ACTUALLY OR THE
OTHER WAY WE ACTUALLY PAID FOR
THEM IS IS THAT --
WHEN THEY CAN'T AFFORD TO PAY
FOR THE CARE THEY GET THOSE
CLASS GETS SPREAD OUT TO
EVERYONE ELSE WHO HAS INSURANCE
PRIVATE INSURANCE OTHER PEOPLE
SO FORTH THOSE COSTS GET SPREAD
OUT?
SO I THINK THAT IN SOME
SURVEYING* WELLS SO WHY
SHOULD WE SPEND MONEY ON IS THAT
WE KIND OF ALREADY ARE.
IT JUST DEPENDS ON WHERE THE
MONEY FLOWS BECAUSE I THINK
THAT'S SOMETHING ELSE WE
HOPEFULLY NEED TO ACKNOWLEDGE
THAT.
THOSE COSTS DON'T JUST GO AWAY
IF WE DON'T PROVIDE COVERAGE
THEY FIND A WAY IT GETS UP TO
THE GETS COVERED SOME OF THE WAY
AND MAYBE LESS AND AND A LESS
FUNCTIONAL WHERE IN A WAY THAT
MAY NOT NECESSARY TREATMENT
CENTER SO THE RIGHT KIND OF CARE.
BUT THOSE COST TO MAKE THE WAY
AROUND AND THEIR OPINION ON THAT.
RATE RATE A AGREE THAT --
WE ARE ALREADY SPENDING ON CARE
FOR THIS --
GROUP -- IN
AND HOW WORSE WHERE THOSE
DOLLARS ARE COMING FOR IT FROM
IS QUITE COMPLICATED.
AND ALSO THERE'S A LOT OF CARE
THAT'S NEEDED THAT THAT'S NOT
BEING OBTAINED THEM.
BECAUSE OF THE THE ACCESS TO
CARE THERE'S A LOT OF UNMET AND
RAIL CARE KNEES BUT IN THE END.
WHEN THEY FINALLY DO? SIX CHAIR
OFTENTIMES LATER AND MORRIS THIS
AND MORE EXPENSIVE SETTINGS
OTHER TYPES OF THINGS WE ALL DO
BEAR THE WE VENTURE.
WE'VE ACTUALLY DO THAT THOSE
COSTS ARE THERE AND HOPEFULLY WE
CAN FIND MORE EFFECTIVE WAYS OF
DELIVERING THAT CARE TO PRODUCE
BETTER HEALTH OUTCOMES.
OKAY THANK YOU AGAIN THANK YOU
BEGIN MEASURE THANK YOU ONE
THING THAT OCCURRED TO ME
SENATOR PANEL LISTEN TO YOUR
QUESTIONS AS WE TALK AS WE TALK
ABOUT A CHILL AFFECT WE WILL
HAVE CREATED OUR OWN CHILL
AFFECT IF WE'VE COVERED.
ON CHILDREN LAST YEAR AND IF
THIS ACTION ISN'T TAKEN WILL
HAVE A WHOLE GROUP OF PEOPLE WHO
WILL AGE OUT.
OF AT NINETEEN OF COVERAGE BE
PROVIDED GO BACK INTO A
SITUATION WHERE THEY'RE NOT
COVERED SO THAT CREATES A
DIFFERENT KIND OF CHILL EFFECT
IN TERMS OF A LACK A LACK OF
STATE IS DONE IN TERMS OF
PROVIDING COVERAGE [inaudible]
SENATOR STONE.
HAPPY VALENTINE'S DAY MADAME
CHIANGTO USE THEIR MEMBERS
LADIES AND GENTLEMEN THANK YOU
FOR YOUR PRESENTATION I I
APPRECIATE I HAVE A FEW
QUESTIONS --
I I DO APPRECIATE YOUR
PRESENTATION IT WAS VERY --
IN LIGHTNING --
FIRST A ABOUT THE PUBLIC CHARGE.
THAT'S KIND OF A NEW CONCEPT TO
ME -- YOU
SAID IT'S A POLICY AND IN THE
MAKING POTENTIALLY IS THAT
SOMETHING THAT --
I ASSUME IT'S HEALTH AND HUMAN
SERVICES --
ADOPTS THEMSELVES OR DOES THIS
REQUIRE CODIFICATION BY.
CONGRESS AND WE TALK ABOUT THE
CHILLING EFFECTS BUT CAN YOU
TELL US WHAT THE DIRECT EFFECTS
ARE NOT ONLY.
TO THE BENEFICIARIES NOT WHAT
THEY THINK COULD HAPPEN TO THEM
BUT WHAT CAN HAPPEN TO THEM AND
DOES THIS PUBLIC.
CHARGE HAVE ANY AFFECT ON OUR
MEDI CAL WAIVER WHICH IS UP IN
TWENTY TWENTY AND WILL IT HURT
OUR ABILITY.
TO GET TRADITIONAL FUNDS THAT WE
NEED TO FIND OUR MEDICAID
PROGRAM IN CALIFORNIA.
THE A THERE IS A LONG STANDING A
PUBLIC CHARGE POLICY ALREADY IN
PLACE IT WAS ACTUALLY
IMPLEMENTED IN THE EIGHTEEN
EIGHTIES RIGHT AROUND THE SAME
TIME AS THE CHINESE EXCLUSION
ACT IF THAT GIVES YOU A SENSE O
WHERE IT CAME FROM. TO THE BUT
IT ITS RELATIVELY NARROW RIGHT
NOW -- IT
APPLIES TO PEOPLE WHO ARE
APPLYING FOR A GREEN CARD OR
VISA AND THE THE PUBLIC PROGRAMS
ED THAT COUNTS AGAINST YOU IF
YOUR PURSE YOU PARTICIPATE OUR
INSTITUTIONAL LONG TERM CARE.
AND CERTAIN CASH BENEFITS EARLY
PEOPLE WHO ARE APPLYING FOR A
GREEN CARD OR VISA ARE NOT
ELIGIBLE FOR THOSE SERVICES AND
SO THE NUMBER OF PEOPLE OF
DIRECTLY AFFECTED UNDER CURRENT
POLICY IS IS RELATIVELY LIMITED --
THE IT'S THE DEPARTMENT OF
HOMELAND SECURITY THAT'S
PROPOSING THIS CHANGE.
THE PROPOSAL CAME OUT IN OCTOBER
THE COMMENT PERIOD.
CLOSED IN DECEMBER WAITING TO
SEE IF THEY ISSUE A FINAL RULE --
IT WOULD NOT REQUIRE A CONGRESS
OF THE A AND THE PROPOSED RULE I
FOCUSED ON THE PUBLIC PROGRAM
ASPECT OF IT FOR THIS
PRESENTATION BUT IT WOULD
GREATLY EXPANDS THE NUMBER OF
THE CRITERIA.
THAT THE FEDERAL GOVERNMENT
COULD LOOK AT AND DETERMINING
WHETHER SOMEONE GETS A GREEN
CARD OR VISA AND IT WOULD COUNT
AGAINST SOMEBODY.
IF THEY HAVE LOW INCOME IF THEY
HAD LINKED LIMITED ENGLISH
PROFICIENCY A NUMBER OF OTHER
FACTORS.
IN TERMS OF DETERMINING WHETHER
THEY GET THE GREEN CARD SO
THERE'S A DIRECT A FACT IN TERMS
OF LIMITING IMMIGRATION.
BUT THE FACT WE'VE BEEN MOST
FOCUS ON IN OUR RESEARCH
SOMETIME FOCUS ON HEALTH CARE IS.
THE THE BROADER CHILLING EFFECT
IT COULD HAVE ON PUBLIC PROGRAMS
NOT TESTS MEDI CAL BUT ALSO CAL
FRESH FOOD STAMPS AND OTHER
PROGRAMS --
AS YOU KNOW --
WE WE DID SESSION WHICH WAS A
NECESSITY WE JUST DIDN'T HAVE
THE MONEY.
AND AS A RESULT MEDI CAL FEES
DOCTORS ALBEIT SOME OF BEEN
INCREASED --
THE DAILY PART OF YOUR STUDY --
LOOK AT AT THE PRESENT DAY --
ACCESSIBILITY TO OUR EXISTING
NETWORK OF PROVIDERS THAT TAKE
MEDICARE WHICH IS LIMITED
BECAUSE OF THE LOWER FEES.
AND WHAT THE POTENTIAL IMPACT
WOULD BE --
ADDING THIS POPULATION TO THOSE
THOSE ROLES ARE ALREADY STRESSED.
THERE'S BEEN A LOT OF GOOD
RESEARCH ON MEDI CAL AT ACCESS
IS NOT MY SPECIFIC AREA OF
EXPERTISE IN TERMS OF THE
INTERACTIONS WITH THIS POLICY --
AS AS DOCTOR PAN WAS DESCRIBING
UNDOCUMENTED ADULTS ARE ALREADY
GETTING SOME OF THE CARE THEY
NEED IN OUR HEALTHCARE SYSTEM
AND I THINK BRINGING THEM INTO.
THE HEALTH INSURANCE SYSTEM IN A
MORE FORMAL THE PLANNED OUT WAY
WOULD HELP.
THE STATE PLAN. FOR ITS ITS THE
PROVIDER CAPACITY NEEDS AND HELP
TO IT THE BETTER ADDRESSED SOME
OF THOSE ACCESS ISSUES.
AND SO AS A PART OF THE YOU OF
QUANTIFIED DO IT WITH THE COSTS
ARE GOING TO BE TWO OF IN ROLL
pPROGRAM.
I BELIEVE THAT YOU'RE GOING TO
YOU'RE GOING TO HEAR FROM THE
ADMINISTRATION ON THE COST NEXT
OKAY SO -- I
DO HAVE SOME QUESTIONS ON THAT
AND AND THE FEDERAL FUNDING THAT
COULD BE LOST.
AS A RESULT OF OF THAT SO --
THANK YOU FOR A STATION.
THANK YOU ROSWELL.
YES THANK YOU VERY MUCH FOR YOUR
PRESENTATION --
NINE AND ALSO APPRECIATE THE
CONTEXT THAT YOU GAVE THE
STABILITY.
OF THE UNDOCUMENTED DOG
COMMUNITY THE THEY'RE ALREADY
INTEGRATED INTO OUR COMMUNITIES
OUR SOCIETY
NO MATTER WHERE WERE ALL.
WELL IN THE SAME COMMUNITIES --
START A REPRIEVE SHAPE THAT
CONTEXT THAT YOU GAVE --
TWO QUESTIONS ONE IS --
I KNOW YOU KIND OF REFERRED TO
THIS BUT REALLY WHO ASSUMES.
WHERE IS THE RESPONSIBILITY AND
THAT BEING? TO GIVE MEDICAL
ATTENTION. TO THE SOME. TO THE
UNDOCUMENTED --
I MEAN IT'S NOT LIKE.
THEY DON'T DO ANYTHING ABOUT
THEIR ILLNESS WHAT WHAT REALLY
ENDS UP HAPPENING WHERE WHERE DO
THEY END UP GOING WHO ASSUMES
THE THE RESPONSIBILITY.
OF TAKING CARE OF THEM WORK SOME
WEIGHT RESPONDING TO THEIR
MEDICAL NEEDS.
WELL TODAY A LOT OF THE CARE
THAT UNDOCUMENTED RESIDENTS GET
IS THROUGH PUBLIC HOSPITALS
THROUGH A PUBLIC CLINICS THROUGH.
A COMMUNITY HEALTH CENTERS
FEDERALLY QUALIFIED HEALTH
CENTERS.
WHO OFFER CARE TO EVERYONE
REGARDLESS OF IMMIGRATION STATUS
AND OFTEN DO SO ON A SLIDING
SCALE BASIS --
THE SAN CALIFORNIANS
DO YOU HAVE ACCESS TO NON
EMERGENCY SERVICES --
THROUGH COUNTY PROGRAMS LAKE
HEALTHY SAN FRANCISCO AND MY
HEALTH LA --
BUT IT'S A DON'T PROVIDE
INSURANCE BUT OFFER AND CARE AT
GREATLY REDUCE COSTS OF THEM.
ED BUT THOSE.
NOT EVERY COUNTY HAS A PROGRAM
LIKE THAT THOSE ARE ARE SOME OF
THE MORE COMPREHENSIVE PROGRAMS
AND A LOT OF THE COUNTIES THAT
DO OFFER ANY EMERGENT NON
EMERGENCY SERVICES.
TO UNDOCUMENTED RESIDENTS OFFER
LIMITED BENEFITS AND THEN THERE
ARE OTHER COUNTIES THAT HAVE
ENROLLMENT CAPS FOR THEIR
PROGRAMS SO.
THERE'S STILL A LOT OF GAPS IN
THE SYSTEM AND IT'S AND IT'S NOT
CONSISTENT ACROSS THE BOARD SO.
RAY IT'S VERY THINKING FRAWLEY'S
DIFFERENT FROM THIS COUNTING YOU
DON'T KNOW WHAT TO EXPECT OKAY --
AND THEN YOU MENTIONED --
ONE OF THE REASONS --
FOR HIGH PERCENTAGE OF THE
UNDOCUMENTED NOT HAVING A
COVERAGE IS BECAUSE OF NOT
HAVING EMPLOYER COVERAGE
COMPARED TO THE REST OF ALL OUR
COMMUNITIES.
IF YOU HAVE MORE INFORMATION
ABOUT THAT --
COULD YOU EXPAND --
I'M.
FLIPPING TO THE RELEVANT PAGE
INNER FOR IT --
SO.
FROM THE CALIFORNIA HEALTH
INTERVIEW SURVEY --
WE CAN LOOK AT IT NON CITIZENS
WITHOUT A GREEN CARD WHICH
INCLUDES SOME PEOPLE WITH A VISA --
WHO ARE NOT UNDOCUMENTED BUT IS
MOSTLY A GROUP THAT'S
UNDOCUMENTED?
AND AMONG WORKING AGE ADULTS THE
1% OF NON CITIZENS WITHOUT A
GREEN CARD HAD EMPLOYER
SPONSORED INSURANCE IN.
TWENTY FOURTEEN AND THAT'S
COMPARED 268% OF CITIZENS AND
38% OF CALIFORNIANS WITH A GREEN
CARD SO SIGNIFICANT LAKE ABOUT A
THIRD OF THE RATE OF HAVING
EMPLOYER SPONSORED INSURANCE AS
CITIZENS.
EXPLANATION FOR THAT.
THEY WORK IN THE TO OFF IN THE
LOW WAGE JOBS INDUSTRIES --
THAT DON'T NECESSARILY PROVIDE
HEALTH BENEFITS TO THEIR WORKERS
AND THE AS OF THE EMPLOYERS HAVE
A ROLE IN A YOU KNOW A REALLY
BIG ROLE IN THIS STATE AND
OFFERING HEALTH INSURANCE AND
STILL HALF OF CALIFORNIANS.
GET COVERAGE THROUGH THEIR JOB
OR FAMILY MEMBERS JOB --
BUT THE EMPLOYERS THAT'S NOT
TRUE FOR THE EMPLOYERS THAT OF A
UNDOCUMENTED WORKERS TO THE SAME
EXTENT.
IF YOU HAVE OTHER CITIES OR IF
YOU CAN GET.
MORE INFORMATION ABOUT THAT I
WOULD APPRECIATE IT THANK YOU
VERY MUCH.
THERE ARE MORE LOT.
THANK YOU MADAM CHAIR HAPPY
VALENTINE'S DAY THING TO YOU SIR.
I'M.
IN LOOKING AT TODAY'S AGENDA WE
DON'T HAVE MANAGED CARE
ORGANIZATIONS OR POSITION GROUPS
OR HOSPITALS ON THE AGENDA AND I
I I I AM WONDERING IF I SHOULD
ASSUME THAT BECAUSE THEY'RE NOT.
THAT THEY MIGHT BENEFIT FROM.
THIS SOURCE OF REVENUE AND
THEY'RE JUST GONNA BE REAL HAPPY.
BASED ON SOME OF YOUR PRIOR
REMARKS AT EIGHTY HERE AT LEAST
THERE'S A FUNDING SOURCE NOW.
WE HAVE A DOCUMENTED INDIVIDUAL
SHOW UP IN OUR EMERGENCY ROOMS
IT SAID IT WAS IT WOULD THAT BE
A CORRECT ASSUMPTION I CAN'T
SPEAK FOR ANY SPECIFIC GROUPS
BUT IN GENERAL THE REMAINDER
STANDING IS THE HEALTHCARE
PROVIDERS AND INSURERS ARE ARE
SUPPORTIVE BRING EVERYONE INTO
THE SYSTEM.
THEN -- I
HAD THE PRIVILEGE OF SITTING ON
IT COUNTY OPERATED HEALTH SYSTEM.
BOARD FOR FOUR YEARS AND I I SEE
THAT IT'S AN AMAZING MODEL I I'M
WONDERING IN YOUR RESEARCH DID
YOU REVIEW THE COUNTY OPERATE
HEALTH SYSTEMS IN CALIFORNIA.
A IT HASN'T IT HASN'T BEEN A
FOCUS OF MY RESEARCH I THINK I
THINK IT IS A REALLY.
GOOD QUESTION TO LOOK AT THE
DIFFERENT MEDI CAL MANAGED CARE
MODELS AND AND WHAT.
IMPACT THEY'RE HAVING BUT IT
HASN'T BEEN A FOCUS FOR ME.
I SAT ON THE CAL OPTIMA BOARD SO.
IF YOU WANT TO DO A LITTLE SIDE
JOURNEY ON EXPERIENCE --
THE MEMBERSHIP IS IS RATHER
DRAMATIC COMPARED YOU KNOW FOR A
POPULATION OF THREE MILLION IN
OUR COUNTY.
THINK WE'RE UP TO ABOUT SIX
HUNDRED THOUSAND MEMBERS IT'S
REALLY [inaudible]
OF THEN CáC QUITE PHENOMENAL
BUT BUT THE ISSUE IS BANNED AS
CENTER STONE RAISED IS IS BEEN
BINDING.
POSITIONS AND HOSPITALS TO TO
COOPERATE --
EVEN THE UNIVERSITY OF
CALIFORNIA IRVINE THEIR HOSPITAL
WAS NOT BIKE VERY HELPFUL TO CAL
OPTIMA.
IN SEEING PATIENTS SO I'M JUST
WONDERING IF YOU'VE DONE ANY
REVIEW RESEARCH AND IN THAT AREA
JUST.
OKAY WITH HOW DO WE HOW DO WE
ACTUALLY.
YOU KNOW WHAT ARE.
FILL THE VACANCIES YOU KNOW HOW
DO WE GET THE DOCTORS BECAUSE AS
AS DOCTORS DON'T MENTION THAT
THE MEDICAL RATES.
WHEN WE HAD THE RECESSION WE HAD
TO KEEP CUTTING 10% 10% AND THE
AND AND THE DOCTORS ARE JUST
SINGLE TIME OUT IF OR NOT GONNA
BE COMPENSATED FAIRLY?
IN THE YOU'RE LOOKING AT A GROUP
THAT I WOULD THINK WOULD NEED.
BILINGUAL SKILLS AS WELL.
IT OUT AN OLD MULTITUDE OF
LANGUAGES AS I'M JUST JUST
CURIOUS HOW DO WE MANPOWER
[inaudible]
THIS WHOLE.
PROJECT YEAH WE DEFINITELY HAVE
GOT CENTER CAPACITY IMMINENT IF
THIS WILL COME UP AND OTHER
OTHER.
OTHER HEARINGS BUT THERE IS A
GREAT REPORT LAST WEEK ON THE
FUTURE OF THE HEALTH CARE
WORKFORCE THAN WHAT THE STATE
NEEDS TO DO --
TO TO BUILD UP THAT CAPACITY --
AND I WOULD AGREE WITH YOU OF IN
TERMS OF THE NEED FOR CULTURAL
CARE.
AT THE THERE'S ALREADY A GREAT
NEED FOR THAT AND BASED ON WHO
WHO'S ALREADY ELIGIBLE AND THAT
WILL GROW EVEN FURTHER --
WITH THIS EXPANSION.
THANK YOU VERY MUCH.
C. APPRECIATED THANK YOU MANAGER.
THANK YOU AND WE HAVE.
RECENT BUDGET HISTORY --
SPENT QUITE A BIT OF TIME
TALKING ABOUT PROP FIFTY SIX AND
ACKNOWLEDGING THAT REALITY IN
TERMS TO PROVIDE A SHORTAGE AND
HAVE.
HAVE DONE OUR DUE DILIGENCE --
IN IN IN THE IN THE GOOD TIMES
OF OF BUDGET RECENT HISTORY IN
TERMS OF ACKNOWLEDGING THAT AND
DO WHAT WE CAN TO INCREMENTALLY
IMPROVE --
REIMBURSEMENT RATES AND YOU KNOW
PERHAPS EXPANDING THE MEDI CAL
POOL WOULD ATTRACT MORE
PROVIDERS BACK INTO THE SYSTEM --
I THINK THAT'S ONE WAY OF
LOOKING AT IT AS WELL.
ANY OTHER QUESTIONS --
BEFORE WE MOVE ON OUR AGENDA. TO
THE NEXT PANEL.
SEEN ON THANK YOU VERY MUCH
THANK YOU.
FOR JUMP STARTING THIS --
VERY IMPORTANT CONVERSATION.
I'M SORRY I HAD ONE QUESTION I
MISS MY OWN NOTE.
EVERYONE ELSE COME ON THE NEXT
PANEL COME JOIN.
AND I HAD IT IN MY HAND LOOKING
AT IT GEE WHIZ PAGE NINE OF YOUR
SLIDE AND YOU MAY HAVE SAID YOU
PRESENTATION I MISSED IT.
WHERE YOU SHOW CURRENT ENROLLED
IN RESTRICTED MEDI CAL?
AN ELIGIBLE BUT NOT ROLL THE
STONE ONLY 80% BUT TO IT BOUT
TWENTY TEN THOUSAND PEOPLE.
ANY SENSEOF WHY THEY AREN'T
ENROLLED.
WELL AS THAT ENROLLMENT RAY IS
NOT TOO DIFFERENT FROM WHAT WE
SEE FROM THE OVER ALL OF THE
BUTTON MEDI CAL POPULATION GOT
IT.
TO OVERALL WE ESTIMATE THAT MORE
THAN 90% OF THOSE CITIZENS
UNLAWFULLY PRESENT IMMIGRANTS
WERE ELIGIBLE TO ENROLL BENEFITS --
ARE ENROLLED IN.
THE AND PEOPLE CAN ENROLL IN
RESTRICTED SCOTT MEDI CAL NOT
ONLY.
IS SOME PEOPLE ENROLL WHEN THEY
ACTUALLY NEED CARE LIKE IN THE A
ARSENIC BUT OTHER PEOPLE.
MAY ENROLL FOR EXAMPLE WHEN
THERE'S THE ENROLLING THEIR
WHOLE FAMILY AND MEDICAL BECAUSE
THEY HAVE CITIZEN CHILDREN WHO
ARE ELIGIBLE AND THEY GET
ENROLLED AT THE THING I DIDN'T
KNOW IF WE HAD THE ANSWERS TO
THAT QUESTION AS WE AS WE DEAL
WITH THE PUBLIC CHARGE.
YOU KNOW FLOW RAMP UP MIX
HOUSEHOLD STATUS ALL THESE
ISSUES THAT WILL COMPLICATE OUR
ABILITY TO ENROLL PEOPLE ARE
MOSTLY PROVIDE FULL COVERAGE SO
I THAT WE MIGHT HAVE SOME
INSIGHT THERE THANK YOU VERY
MUCH.
COLLEAGUES WERE GOING TO MOVE
NOW INTO OUR SECOND PANEL THE
GOVERNOR'S PROPOSED EXPANSION OF
FULL SCOPE MEDI CAL COVERAGE I
THINK THIS IS THE GROUP THAT
WILL ANSWER SOME OF YOUR
QUESTIONS THAT YOU WERE --
POLICY --
SPECIFICALLY WITH REGARD TO WHY
THE THIS WAY.
FIRST WE'LL HEAR FROM MISS CAN'T
WELL HELLO HIEF DEPUTY DIRECTOR
DEPARTMENT OF HEALTH CARE
SERVICES SHOULD BE FOLLOWED BY
AN TO CHING'S SECTION CHIEF
ADULT PROGRAMS ESTIMATE AND
AUTOMATION FROM DEPARTMENT OF
SOCIAL SERVICES.
LARA YELLOW STAFF FINANCE BUDGET
ANALYST FROM THE PART IN FINANCE
AND SYDNEY.
TANIMOTO STAFF FINANCE A BUDGET
ANALYST IN THE DEPARTMENT
FINANCE.
HELLO EVERYBODY HAPPY
VALENTINE'S DAY.
I'M NOT WEARING RED BUT JENNIFER
IS SOCIAL SHE'LL BE THE
REPRESENTATIVE IN DCS THAT'S
ACTUALLY.
MORE OF A FESTIVE.
ANYWAY -- SO
THINGS ARE HAVING US TODAY SO
JUST BRIEFLY I'LL GO OVER WHAT
THE PROPOSAL IS AN ARE FISCAL
ESTIMATE AND I KNOW AS YOU
MENTIONED YOU HAVE OTHERS HERE
WHO WILL SPEAK TO THEIR PIECES.
SO THE GOVERNOR IS PROPOSING
THAT WE EXPAND --
FULL SCOPE MEDI CAL TO THOSE WHO
ARE AGE ãETEEN UP
OF TWENTY SIX WE ARE
ANTICIPATING ABOUT A HUNDRED AND
THIRTY EIGHT THOUSAND
INDIVIDUALS WILL NOW IT WOULD BE
GETTING FULL SCOPE COVERAGE AT
THE END OF THE FIRST YEAR OF
THIS EXPANSION --
ABOUT EIGHTY SIX THOUSAND OF
THOSE ARE INDIVIDUALS ARE
CURRENTLY ENROLLED IN THE
LIMITED SCOPE COVERAGE --
OUR NUMBERS ARE SLIGHTLY
DIFFERENT FROM THE PREVIOUS
PANELIST IN TERMS OF SORT OF THE
TOTAL POPULATION NUMBERS BUT
PRETTY CLOSE PROBABLY JUST
DIFFERENT POINT IN TIME
ESTIMATES --
IN TERMS OF THE FISCAL ESTIMATE
WE EIGHT MILLION TOTAL FINES --
FOR A FULL FIRST YEAR OF OF THE
END OF THE PROGRAM A HUNDRED
NINETY FOUR MILLION OF THAT IS
GENERAL FUND --
KEEPING IN MIND AGAIN THAT WE
CURRENTLY SPEND MONEY ON THE
RESTRICTED SCOPE SO WE'VE OFFSET
THAT -- TO
TO GET TO SERVE THAT NET
INCREASE GENERAL FUND A HUNDRED
NINETY FOUR MILLION.
I'M OBVIOUSLY THE GOVERNOR HAS
PROPOSED THAT THIS BE AFFECTED
NO SOONER THAN JULY FIRST I
THINK ALL OF YOU ARE AWARE THAT --
OUR SYSTEMS DON'T TURN ON A DIME.
WHO -- WE
ARE CURRENTLY WORKING ON WHAT
THE YOU KNOW UP.
ACTUAL TIMELINE WILL LOOK LIKE
WE'RE CERTAINLY MOVING FORWARD
NOW WITH THOSE NECESSARY CHANGES --
UNDER THE ASSUMPTION THAT
SOMETHING OF THIS NATURE WILL
HAPPEN SO THAT WE CAN DO IT AS
QUICKLY AS POSSIBLE.
BUT IT'S DEFINITELY NOT GOING TO
BE JULY FIRST SO JUST.
TO PUT OF A YOU KNOW I THINK YOU
ALL KNEW THAT BUT LET'S JUST BE
BE.
STRAIGHTFORWARD --
BUT WHILE WERE WORKING ON THE
SYSTEM PIECE AND AGAIN THAT'S
YOU KNOW EFFORT FAIRLY
SIGNIFICANT PIECE --
IN TERMS OF CHANGING ELIGIBILITY
DEVELOPMENT OF THE ELIGIBILITY
ENROLLMENT PLAN WE DID THIS FOR
SB SEVENTY FIVE AND TO THIS WILL
INFORM FOLKS OF THE STEPS THAT
WERE TAKING AND REALLY BE ABLE
TO GET.
INPUT ON WHAT'S THE BEST WAY TO
OUT REACH TO FOLKS SO THAT
THEY'RE AWARE OF OF THIS
POSSIBILITY WILL ALSO BE --
DEVELOPING BENEFICIARY NOTICES
AGAIN THIS IS VERY TYPICAL FOR
US AND WHAT WE DID IN SB.
SEVENTY FIVE REALLY TO HELP THEM
UNDERSTAND WHAT ARE THEY
ELIGIBLE FOR IF THEY'RE
SWITCHING FROM RESTRICTED SCOPE
TO FULL SCOPE --
THEIR HEALTH PLAN ENROLLMENT
INFORMATION AND HOW TO ACCESS
THAT AND SO WILL BE WORKING
OBVIOUSLY WITH OUR CONSUMER
FOCUSED STAKEHOLDER GROUP THAT
WE HAVE EVERY MONTH.
AS WELL AS OUR COUNTY PARTNERS
IN THE ELIGIBILITY OFFICES AND
SEE W. D. A TO MAKE SURE THAT
THOSE NOTICES ARE CLEAR AND THAT
PEOPLE ARE ABLE TO UNDERSTAND
THE INFORMATION THAT'S BEING
PRESENTED TO THEM.
SO THAT'S REALLY THE HIGH LEVEL
OF THE PROPOSAL ALL CERTAINLY --
TURN IT OVER TO MY COLLEAGUE
FROM SOCIAL SERVICES --
THANK YOU SIR.
RIGHT FOR SOCIAL. FOR FOR SOCIAL
SERVICES THREE ASSUMING ABOUT
TWO POINT TWO MILLION.
DOLLARS IMPLEMENTATION OF OFF
THE UNDOCUMENTED.
ARE WE DO HAVE A THREE MONTH LAG
AFTER THE USE YES IMPLEMENTATION
FOR RESTRICTED SCOPE AND SIX
POINT PLAN. FOR THE AND ELIGIBLE
BUT NOT RULES KEYSTONE.
SO WE'RE ASSUMING THAT --
IN NINETEEN TWENTY ONLY ROUGHLY
AROUND FIFTY SIX CASELOAD THAT
WERE.
GOING TO HAVE A JUSTICE US RISK
I JUST AS RECIPIENT.
THANK YOU NGUYEN WHOLE QUESTION
TO THE IN COLLEAGUES.
NEXT WITNESS.
LARA YEAH LE DEPARTMENT OF
FINANCE --
WAS FOR THE GOVERNOR'S PROPOSAL
AND ARE HERE TO ANSWER ANY
QUESTIONS YOU MAY HAVE.
HEARD.
AND FOR A AND WHENEVER YOU'RE
FROM SYDNEY.
SORRY JAKE A POOR WITH THE
DEPARTMENT OF INANCE SYDNEY
ACTUALLY COULDN'T MAKE IT TODAY
GOT IT OR REPLACE ALL RIGHT
GREAT.
WE WELCOME YOU JACOB
[inaudible]
DANCE MEGLIO.
A HIGH BEN JOHNSON LA --
HAPPY VALENTINE'S DAY AND THE
VALENTINE'S DAY --
SO YESTERDAY WE RELEASE
GOVERNOR'S MEDI CAL BUDGET AND
THIS DOES INCLUDE AN ANALYSIS OF
THE PROPOSED INCREASE IN --
MEDI CAL EXPAND --
ELIGIBILITY FOR THIS POPULATION --
I I WOULD NOTE THAT ULTIMATELY --
UNDER THE GOVERNOR'S PROPOSAL
THE NET COST OF THE EXPANSION IS
A IS CURRENTLY PROJECTED TO BE A
LITTLE LOWER GIVEN SOME SAVINGS
ON THE WAS ESSENTIALLY A
REDIRECTION OF FUNDING THAT
CURRENTLY GOES TO COUNTY HEALTH
ACTIVITIES --
TO ULTIMATELY OFFSET GENERAL
FUND COSTING QUE IN CALORIES AND
SO THAT WOULD LOWER THE NET
GENERAL FUND --
ESTIMATE FOR THIS PROPOSAL TO A
HUNDRED AND THIRTY FOUR MILLION
DOLLARS --
WE WE WE CREATED OUR SORT OF OWN
SORT OF PROJECTIONS AND TRIED TO
TIE THEM AS CLOSELY AS POSSIBLE --
TO THE ADMINISTRATION'S
ASSUMPTIONS AND WHILE THE THE
COST IN THE IN TWENTY NINETEEN
TWENTY WOULD BE ABOUT ONE
HUNDRED AND THIRTY FOUR MILLION
WHICH WE DO AND OUR PROJECTIONS
WHICH SHOW THAT IT WOULD GROW.
TO HOLD POTENTIALLY ABOUT A
LITTLE LESS THAN THREE HUNDRED
MILLION DOLLARS NET GENERAL FUND
IN THE OUT YEARS AS NEW ELIGIBLE
BUT NOT ROLLED INDIVIDUALS COME
ON TO THE PROGRAM AND AS I JUST
AS COSTS.
POTENTIALLY RAMP UP INTO THE OUT
YEARS YOUR FINDINGS --
FIRST -- WE
GRAPPLE WITH SOME OF THE SAME
ISSUES AS SENATOR ROTH IN OUR
ANALYSIS OF THIS PRESENTS AN
OPPORTUNITY FOR THE LEGISLATURE
TO DECIDE AMONG ITS PRIORITIES
IN TERMS OF DO WE DO WE EXPAND
COVERAGE TO THE NINETEEN TO
TWENTY FIVE YEAR OLD POPULATION
THERE BY.
YOU KNOW EXTENDING CONTINUOUS
COVERAGE ALL THE WAY FROM --
ZERO TO TWENTY FIVE AND MAKE IT
CONSISTENT WITH THE ACA.
VERSES YOU KNOW OTHER
CONSIDERATIONS SUCH AS ELDERLY
POPULATION HAVING HIGHER HEALTH
NEEDS AND HAVING HEALTH NEEDS
THAT MIGHT NOT.
AS OFTEN BE COVERED BY EMERGENCY
IN RESTRICTED SAID PREGNANCY
RELATED SERVICES SUCH AS FOR THE
YOUNG ADULT POPULATION.
WE DON'T HAVE A RECOMMENDATION
THERE BUT JUST A A BRACE SOME OF
THOSE ISSUES FOR CONSIDERATION --
SECOND WE DO FIND THAT THE
INCREMENTAL COST OF INCREASING
THE SIX PAGER COULD BE SOMEWHAT
OVERSTATED ONE FOR THE SAME
REASON --
THAT -- MISS
CAN'T WELL TO THE IMPLEMENTATION
DATE PROBABLY NOT OCCURRING
RIGHT ON JULY FIRST --
AND THEN THE SECOND IS WHAT WE
FIND TO BE IN A RONI IS
ASSUMPTION RELATED TO CASELOAD
WHICH MAY MAKE THAT MAY MAKE THE
CASE LOW'S SOMEWHAT OVERSTATED --
NOT JUST IN TWENTY NINETEEN
TWENTY BUT GOING FORWARD --
IN OUR VIEW CORRECTING THIS
ASSUMPTION --
THIS ARONIE IS AS I'M SURE WE
THINK WOULD WOULD LOWER COSTS BY
ABOUT TWENTY MILLION DOLLARS
ANNUALLY --
WE ALSO DO RAISE SOME ISSUES ON
THE ON THE PROPOSED RE DIRECTION
ON OF REALIGNMENT WE'RE
CONTINUING TO ASSESS THAT AN
ALTERNATE WE WILL RELEASE A
FUTURE --
ANALYSIS OF THAT --
BUT WE DO RECOGNIZE THAT SOME
INCREASE IN THE REDIRECTION OF
REALIGNMENT FUNDING IS LIKELY
APPROPRIATE GIVEN THAT COUNTY
COSTS HAVE GONE DOWN BOTH AS
RESULT OF THE ACA.
AS A RESULT OF WHAT HAPPENED IN
THE INTERVENING YEARS WITH THE
EXPANSION OF CHILDREN'S COVERAGE
SO UNDER ANY UNDER --
AN EXTRA A FURTHER EXPANSION --
AND WE'D ALSO NOTE THERE AND
JUSTIFICATION THAT --
CERTAIN COUNTIES THAT --
WORK TOGETHER TO PROVIDE
COVERAGE UNDER THAT COUNTY
SERVICES --
MEDICAL PROGRAM.
THAT THEY HAD THEY'VE BUILT UP A
LARGE RESERVE AND I THINK THE
THE PROPOSED REDIRECTION IS
ATTEMPTING TO SORT OF MAKE
FUNDING A LITTLE BIT MORE IN
LINE.
WITH THAT WITH WHAT THEIR
EXISTING BUDGET IS --
BUT WE DO RIGHT WE WE WOULD
RAISE.
QUESTIONS ABOUT THE SCOPE AND
MAGNITUDE OF THAT --
PROPOSED INCREASE IN THE
REALIGNMENT RE DIRECTION --
FINDING THAT IT COULD HAVE
IMPACTS ON LOCAL PUBLIC HEALTH
ACTIVITIES --
AND IT THAT IT IT COULD CALL
FEATURE VIABILITY --
THE SERVICES FOR GIVEN THAT IT
IT PROBABLY WOULD NOT RECEIVE
ANY FUNDING WHATSOEVER AND
REALIGNMENT --
FOR THE FORESEEABLE FUTURE SO
HAPPY TO TAKE ANY QUESTIONS
THANK YOU.
UP I'M GONNA START IF YOU DON'T
MIND CALLING THE DISK A HAVE A
THE TEN THOUSAND FOOT LEVEL
QUESTION YOU KNOW WE WE DID
CHILDREN LAST YEAR NO WARNING.
EITHER FROM THE DEPARTMENT OR
FINANCES THERE'S ANY THOUGHT
GIVEN IS THIS KIND OF AN
INCREMENTAL APPROACH SO WE DID
KIDS ARE WE LOOKING AT YOU KNOW
THIS.
THE NEXT SEVEN YEAR GAP.
BECAUSE I'M RECOGNIZING HOW
COMPLEX THIS IS.
IT WE'RE GOING TO REALIGN
REALIGNMENT.
RECOGNIZING THE TIME AND AND
EFFORT AND COST IT TAKES TO
UPDATE SYSTEMS TO GET READY --
YOU KNOW.
DOES IT MAKE SENSE TO PERHAPS
DUE A YEAR PLANNING WHATEVER AND
TALK ABOUT BRINGING THE ENTIRE
UNDOCUMENTED POPULATION THAT
WE'VE TALKED ABOUT.
INTO THE MEDI CAL SYSTEM.
AS OPPOSED TO THE IF.
EVERY YEAR SEVEN YEAR GROUP.
THIS PIECEMEAL APPROACH THANK
YOU SENATOR SONG [inaudible]
IT.
LAURIE LA THE BERMAN FINANCE SO.
TO ANSWER HE FIRST PART OF THE
QUESTION REGARDING --
IF THIS IS JUST AN INCREMENTAL
APPROACH GOVERNOR HAS STATED%
THAT THE GOAL IS FOR EVERYBODY
TO HAVE COVERAGE IN THE STATE OF
CALIFORNIA AND HE DID STATE --
DAD THIS IS A FIRST STEP OF THIS
IS A DOWN PAYMENT --
WITH.
BRAD BUT CURRENTLY IN THE
GOVERNOR'S BUDGET THE PROPOSAL
IS TO BUILD ON SB THIRTY FIVE
EXPANSION AND CONTINUE COVERAGE
THROUGH THE AGE OF TWENTY FIVE
TO YOUR SECOND POINT I THINK
THAT IS.
DISCUSS THROUGH THE BUDGET
PROCESS ON EXPAND YOU KNOW
LEGISLATORS PRIORITIES AND
POTENTIAL EXPANSION TO THE FULL
POPULATION AND WHAT THE COSTS OF
THAT WOULD BE.
BECAUSE I MEAN JUST PRACTICALLY
THINKING IN TERMS OF COSTS
ASSOCIATED WITH IT INCREMENTAL
APPROACH TO UPDATING SYSTEMS BUT
COSTS ASSOCIATED WITH AN
INCREMENTAL APPROACH TO
EDUCATING THE GENERAL PUBLIC
ABOUT WHO'S COVERED THIS YEAR
WHO'S GONNA BE COVERED NEXT YEAR
WHO'S GONNA BE COVERED IN YOUR
FIVE OR SIX WE HEAR.
THE ISSUES AROUND THE CHILLING
EFFECT OF PUBLIC CHARGES SO MANY --
CHALLENGES TO ROLLING OUT
EXPANSION OF SERVICES WITH
EXPERIENCE AT HISTORICALLY
HEALTHY FAMILIES IT TOOK US.
YOU KNOW FIVE TIMES AS LONG AS
WE THOUGHT IT WOULD IN TERMS OF
INTRODUCING TO A NEW POPULATION
A NEW HEALTH PRODUCTS.
AND SO I HOPE THAT WE WILL LEARN
FROM OUR PAST EXPERIENCES AND
BENEFIT FROM THEM THEY REALLY
THINK ABOUT DOESN'T MAKE SENSE --
TO DO IT AT LEAST IN A BIGGER
SWAPPED IN SEVEN YEAR INCREMENTS
SINCE THE NINETEEN TO TWENTY
FIVE YEAR OLD WHO'LL COME NEXT --
AND I DON'T MEAN TO SOUND FLIP
IT IT REALLY IS A A QUESTION
ABOUT [inaudible]
STRATEGICALLY APPROACHING THIS
EXPANSION.
SURE SO JUST TO ADD ON TO WHAT
MY COLLEAGUE FROM DEPARTMENT OFFINANCE SAID I MEAN CERTAINLY
THERE ARE.
YOU KNOW WOULD BE ADMINISTRATIVE
EFFICIENCIES DOING IF WE WERE
GOING TO CONTINUE TO DO THIS TO
DO THIS AT THE SAME TIME I WOULD
JUST POINT OUT AND I THINK WE
SHARE THESE COSTS WITH YOUR
STAFF AND CERTAINLY WITH THE LA
SO.
WHEN WE TALK ABOUT THOSE
ADDITIONAL POPULATIONS THE
DOLLARS WERE TALKING ABOUT GET
PRETTY SIGNIFICANT ABOUT TEN
TIMES LARGER THAN THE NUMBER
WE'RE TALKING ABOUT HERE?
THAT WOULD BE TALKING ABOUT LIKE
ONE POINT. SIX ONE POINT EIGHT
BILLION DOLLARS GIVE OR TAKE
JUST IN THE MEDI CAL PROGRAM
THAT DOES NOT REFLECT THE COSTS --
OF ADDITIONAL HSS ON THE CELLS
ARE SIR THAT SORT OF IN THE
OFFICE THE ARE.
WE ARE NOT ALWAYS SUPER
EFFICIENT AND THE COST OF
ADMINISTRATION BUT WE'RE NOT WE
DON'T COST ONE POINT EIGHT
BILLION TO CHANGE THE HEALTHCARE
SYSTEM.
I GET THAT BUT BUT BUT BUT WE
BUT WE ALSO TALKED ABOUT THIS
MORNING IS RECOGNIZING WHAT
PERCENTAGE OF THE POPULATION IS
CURRENTLY RECEIVE A RESTRICTED
MEDI CAL.
THE I JUST THIS PIECE WOULD BE
BIGGER BECAUSE THE OLDER
POPULATION THEIR NEEDS ARE.
BROADER AND IT'S BEYOND THE
SCOPE OF RESTRICTED MEDI CAL SO
I GET THAT.
THE ONLY --
HAVE ANY COMMENT ON MY RANT --
WELL I MERRY REALLY COVER MISS
CAN'T WILL REALLY COVER DOWN --
MOST WAS GONNA SAY THE
ADMINISTRATION DID RELEASE
ESTIMATES WHEN WE PUT IT
TOGETHER SO --
ULTIMATELY THIS PROPOSAL WOULD
TOUCH MAYBE TWO HUNDRED AND
FIFTY THOUSAND OF UNDER THE
ADMINISTRATION'S ESTIMATES. ONE
POINT TWO BILLION --
ART MILLION EXCUSE ME PEOPLE WHO
COULD GAIN --
COVERAGE UNDER AN EXPANSION --
TO AND WE FIND THAT THIS WOULD
AND OR AT LEAST THE
ADMINISTRATION FINDS AND IN US
AND TRYING TO ADD ASSOCIATE
COSTS WITH AYE TO ASSESS AND SO
FORTH.
THIS WOULD RAISE STATE COSTUME
FOR A BY OVER TWO BILLION
DOLLARS AND THIS INCLUDES
EXISTING SPENDING AND THAT
THAT'S THE INCREMENTAL COST
ABOVE WHAT WE SPEND ON
RESTRICTED SCOPE SERVICES --
FOR FOR MUCH OF THIS ONE POINT
TWO POPULAR --
ONE POINT TWO MILLION POPULATION --
A HIGH PERCENTAGE OF WHOM ARE
ENROLLED IN CURRENTLY IN
RESTRICTED SCOPE.
AND I'LL MAKE ONE LAST --
POINT THEN I'LL MOVE ON TO
SENATOR ROD --
FIVE CERTAINLY --
I'D FIVE VOTED IN SUPPORT OF THE
EXPANSION LAST YEAR AND WILL WE
SUPPORT EXPANSION.
TO UP TO TWENTY FIVE YEAR OLDS I
JUST KNOW WE'RE GONNA SPEND A%
LOT OF TIME AND ENERGY RESOURCES --
TALK ABOUT A HUNDRED AND THIRTY
THOUSAND PEOPLE WHEN THERE IS A
BROADER POPULATION --
THAT IF PHILOSOPHICALLY WE ARE
GONNA MAKE A POLICY DECISION TO
PROVIDE ACCESS TO CARE TO THOSE
WHO ARE ELIGIBLE.
BUT FOR THEIR IMMIGRATION STATUS
THIS INCREMENTAL APPROACH IT'S
GONNA TAKE A LOT OF TIME ENERGY.
FORCE TO DO THAT WE SHOULD HAVE
THE BROADER CONVERSATION SENATOR
ROBB.
THANK YOU MADAM CHAIR --
I HAVE TWO AREAS AND LIKE TO ASK
ABOUT ONE HAS TO DO WITH THE THE
PUBLIC POLICY ISSUE
UNFORTUNATELY OF RACES EVEN
THOUGH.
MOST OF US I THINK CERTAINLY I'M
ONE OF THOSE WOULD LIKE TO COVER
EVERYONE.
AS A AS A MECHANISM OF TRYING TO
DRIVE DOWN THE OVERALL COST OF
HEALTH CARE IN THE END CERTAINLY
IN CALIFORNIA IF NOT THE UNITED
STATES.
BUT WE CAN'T DO THAT.
SO THE PUBLIC POLICY DECISION TO
COVER THOSE NINETEEN TO TWENTY
SIX AS OPPOSED.
TO COVERING THOSE. SIXTY FIVE
AND OVER ARE THOSE SIXTY YEAR
OVERI'M LOOKING IN OUR ANALYSIS
AND IT LOOKS TO ME THAT THE
OVERALL COST OF THE NINETEEN TO
TWENTY SIX IS ABOUT TWO HUNDRED
AND FIFTY SEVEN MILLION.
LESS THE BEFORE YOU TAKE OFF THE
FEDERAL [inaudible]
SHARE VIA.
AND THE COST OF COVERING THE
SENIORS IS ABOUT A HUNDRED AND
FIFTEEN MILLION.
BEFORE YOU TAKE OFF THE A
FEDERAL SURE FOR THE EMERGENCY
CARE.
IT WOULD SEEM TO ME THAT IN
LOOKING AT FURTHER EIGHTEEN
ALICE'S IF WE IN FACT HAVE FORTY
SEVEN COUNTIES THAT ARE
PROVIDING SOME.
ELEMENT.
OF SAFETY NET SERVICES NOT
EMERGENCY CARE TO THE
UNDOCUMENTED POPULATION --
AND GIVENWHAT I ANTICIPATE THE
UTILIZATION RATE OF THE NINETEEN
TO TWENTY SECURE ROLES TO BE.
THAT WOULD MITIGATE TOWARD
COVERING.
THE SENIOR POPULATION IF WE HAVE
TO MAKE A CHOICE.
COULD SOMEBODY AND I UNDERSTAND
CONTINUITY OF CARE AND AND DUCT
PAN A PREVENTIVE MEDICINE AND
ALL THAT BUT COULD SOMEONE.
TALK TO ME ABOUT THE POLICY
DECISION.
THAT WAS MADE.
SO I JUST WANT AT ONE ONE NOTES
THOSE COSTS ARE OUR DH CS COSTS
IN THE IN THE MEDI CAL ESTIMATE
WHAT'S NOT REFLECTED THERE ARE
THE COSTS OF AYE AGES STATUS.
SO I DON'T I I WOULD DEFER TO MY
SOCIAL ERVICES COLLEAGUES TO
MAKE SURE THAT WE HAVE THE
CORRECT TOTAL FAR TOTAL NUMBERS
BECAUSE THE TWO FIFTY SEVEN AND
AND ONE FIFTEEN ARE ACCURATE-FROM.
THE DTS SIDE BUT I JUST AS COST
OBVIOUSLY WOULD BEVERY
DIFFERENT SO I JUST I DIDN'T
WANNA HAVE A MISUNDERSTANDING OF
WHICH POPULATION MIGHT BE
CHEAPER I THINK WHEN YOU ADD IN
I JUST AS IT.
CHECK IT CHANGES THE TOTALS
LET'S ASSUME IT'S EQUAL.
THAT'S A SUMA LET'S ASSUME A
DOUBLING OF THE COST FOR THE
SENIOR POPULATION. TO GET IT TO
TWO HUNDRED AND THIRTY OR TWO
HUNDRED AND FIFTY SEVEN ONE
ADDRESS THE POLICY ISSUE AND THE
DECISION THAT WAS MADE TO COVER
THE NINETEEN TO TWENTY SIX YEAR
OLDS AS OPPOSED TO THE SENIOR
POPULATION ANDPROBABLY HAS A
HIGHER UTILIZATION RATE WITH
MEDICAL CONDITIONS THAT.
ARE MUCH.
A MORE SERIOUS THAN THE
INVINCIBLE POPULATION.
THANKS.
DIFFERENT FINANCE THAT I THINK
THAT'S A REASONABLE --
NOTE I THINK THAT A WELL TAKEN.
I WOULD SAY THAT THE THAT THE
POLICY DECISION WAS TO BUILD ON
THE PREVIOUS EXPANSION LIKE HAS
PREVIOUSLY BEEN STATED. TO BUILD
ON THE EXPANSION OF THE SB
SEVENTY FIVE SO CURRENTLY --
INDIVIDUALS ARE COVERED THROUGH
THE AGE OF EIGHTEEN SO THAN THIS
WHAT A CONTINUE THROUGH THE AGE
OF TWENTY FIVE THAT'S THE THE
GOVERNOR'S --
BUDGET THAT'S WHAT INCLUDES
THROUGH TWENTY FIVE WE'RE HAPPY
TO DISCUSS ANY --
THE LEGISLATURE'S PRIORITIES
WELL AND BELIEVE ME I'M NOT
BEING CRITICAL OF THE
ADMINISTRATION I APPLAUD ANY
EFFORT TO INCREASE THE NUMBER OF
COVERED --
INSURED INDIVIDUALS IN THE STATE
OFCALIFORNIA AMONG THE
UNDOCUMENTED POPULATION SO KUDOS.
TO TO YOU AND TO THE
ADMINISTRATION FOR THAT WILL LET
ME MOVE ON TO MY SECOND AREA.
AND THAT'S THIS NINETEEN NINETY
ONE REALIGNMENT IN THE CALL BACK.
COULD SOMEONE GOING TO OF THIS
IS A AN ISSUE THAT I'M
INTERESTED IN AND I KNOW MY
COLLEAGUE TO MY RIGHT FROM
RIVERSIDE COUNTY IS ALSO
INTERESTED AND SO COULD SOMEONE
PLEASE EXPLAIN TO ME THE CLUB
THAT PROCESS AND HOW THE AMOUNTS
WILL BE.
COMPUTED FOR THE CALL BACK.
AND LET'S ASSUME WE'RE NOT ONE
OF THE C..
WHAT WE CALL?
THE SIXTY FORTY SEVENTY FIVE
TWENTY FIVE COUNTIES.
PLUS PLUS WHATEVER SO ALL --
WALK THROUGH JUST THE DIFFERENT
CALCULATIONS THAT HAPPEN AND
THEN CERTAINLY MY DEPARTMENT
FINANCE COLLEAGUES CAN TALK
ABOUT THE PROPOSAL THAT'S
CHANGING WHAT WE PUT IN PLACE
WITH THE EXPANSION IN.
TWENTY FOURTEEN SO WHAT WE REFER
TO AS AB --
EIGHTY FIVE WAS THE INITIAL --
DETERMINATION OF HOW MUCH MONEY
WE WERE EXCHANGE WITH YOU KNOW
WITH THE COUNTIES TO PAY FOR CAL
WORKS BECAUSE OF THAT BROUGHT
EXPANSION THAT HAPPENED IN IN
TWENTY FOURTEEN WITH THE ACA --
THE WAY WE ENDED UP DOING THAT
IN THE LEGISLATION THAT WAS
PASSED IS THAT COUNTIES WERE
BROKEN INTO THREE GROUPS.
WE HAD THE CMS P. COUNTIES WHICH
WERE JUST THE STREET SIXTY FORTY
IN THE INITIAL AB EIGHTY FIVE WE
HAD OUR PUBLIC HOSPITAL COUNTIES --
WHICH WE CALL DOES NEED A PUBLIC
HOSPITAL SYSTEMS THE PEACHES.
LOTS OF DIFFERENT THINGS --
AND THEN WE HAD THE REST OF THE
COUNTIES THAT ARE THAT DON'T
HAVE YOU MAJOR PUBLIC HOSPITAL
SYSTEMS WE CALL THEM ARTICLE
THIRTEEN IS JUST BECAUSE THAT'S
WHAT IT IS IN THE STATUTE.
WE WE DON'T HAVE FANCY NAMES FOR
ANYTHING.
SO -- SO FOR
THE FOR THE NON CMS P.TOWNIES
BOTH THE PUBLIC HOSPITAL SYSTEMS
AND THE NON PUBLIC HOSPITAL
SYSTEM COUNTIES THEY HAD A
CHOICE.
AS TO WHETHER THEY JUST WERE
DOING THE SIXTY FORTY SO
REDIRECTING 60% OF THE
REALIGNMENT TO FIND CAL WORKS OR
IF THEY WANTED.
TO PARTICIPATE IN THE FORMULA
METHOD WHICH IT'S COMPLICATED
BUT THE IDEA THEY'RE BEING THAT
WE WOULD CALCULATE WHAT WE WOULD
EXPECT COUNTIES HAVE OTHERWISE
SPENDS.
IN REALIGNMENTS AND ALL THE
FUNDING THAT WE THEY GETFROM
MEDI CAL IN OUR IN OUR WEAVERS.
AND COMPARE THAT TO THEIR COSTS
THEY WERE SAVING MONEY WE WOULD
RE DIRECT 80% OF THAT SAVING SO
IT'S A VERY COMPLICATED FORMULA
THAT WE DO.
EVERY YEAR --
AND ALL OF OUR PUBLIC HOSPITAL
COUNTIES HAVE CHOSEN THAT
METHODOLOGY AND THEN I BELIEVE
FIVE OF OUR I THINK FIVE OTHER
COUNTIES CHOSE THE FORMULA SO --
THE VAST MAJORITY OF THE RE
DIRECTION COMES FROM THE FORMULA
BASED COUNTIES --
WITH THE SMALLER DOLLARS COMING
FROM CMS P. AND THE OTHER SIXTY
FORTY COUNTIES AND THE CHANGES
THAT THAT.
MISSILE WILL GO OVER --
ARE REALLY TODAY.
THAT NON FORMULA THE FORMULA
ISN'T CHANGING IT'S REALLY THE
ONES WHERE IT'S NOT A IT'S NOT
BASED ON COST AND REVENUE IT'S
JUST BASED ON A SPLIT PERCENTAGE
OF THE REALIGNMENT.
RYAN MILLER DEPARTMENT OF
FINANCE AND SO --
I GUESS TO GET AT THE THE CHOICE
THAT WE MADE ABOUT ABOUT WHAT
LEVEL TO REDIRECT --
AS AS MS CAM WELL AT NOTED
EARLIER THE GENERAL FUND COSTS
OF THIS EXPANSION ARE ESTIMATED
AT ONE HUNDRED NINETY FOUR
MILLION DOLLARS --
COUNTIES ARE CURRENTLY
RESPONSIBLE FOR PROVIDING HEALTH
CARE TO ENGINE --
POPULATIONS AND SO --
WE LOOK TO ADD WHAT SORT OF
ESTIMATE --
WE WOULD HAVE ON ON WHAT SORT OF
SAVINGS THAT THEY WOULD
EXPERIENCE --
THE SIXTY THREE MILLION
REPRESENTS LESS THAN A THIRD OF
THAT TOTAL.
IT SEEM REASONABLE TO US WE'RE
TALKING WITH COUNTY IS TO LEARN
MORE ABOUT THIS BUT WHEN I THINK
YOU THINK ABOUT IT IN TERMS OF
IT BEING LESS THAN A THIRD OF
THE TOTAL GENERAL FUND COST.
WE A WE THOUGHT THAT WAS A
REASONABLE ASSUMPTION IN
NINETEEN NINETY ONE REALIGNMENT
AND BELIEVE ME I AM.
NOT AN EXPERT ON THIS SO I AND I
HAVE THICK SKIN SO I WOULD
EXPECT YOU TO CORRECT ME IF MY
UNDERSTANDING IS INCORRECT.
BUT THE FUNDING FORMULA THAT WAS
ARRIVED AT AN NEGOTIATED FRANKLY
BY THE COUNTIES IN THE
ADMINISTRATION AT THE TIME IN.
NINETEEN NINETY ONE WAS BASED ON
KELLY POPULATIONS AT THE TIME
CASELOADS AND THERE WAS SOME
OTHER FACTOR THAT I'M CONFESS I
DON'T REMEMBER.
IN NINETEEN NINETY ONE RIVERSIDE
COUNTY'S POPULATION WAS A
MILLION OR LESS.
TODAY IT'S ABOUT TO ALMOST TWO
POINT FIVE MILLION IN THE CASE
LOADS OF INCREASED.
TO IN A IN A COMMENSURATE WAY.
THE FUNDING FORMULA THE BASIC
FORMULA MY UNDERSTANDING FURTHER
UNDERSTANDING IS HAS NOT BEEN
ADJUSTED SINCE.
NINETEEN NINETY ONE THAT THERE
WAS SOME GROWTH FACTOR IN THE
NINETY ONE REALIGNMENT FLOW TO
THE COUNTIES.
AND THERE WAS OF OF THE WAY TOO
FOR DIRECT.
A LITTLE BIT MORE OF THE GROWTH
FACTOR.
TO THE UNDER FUNDED COUNTIES AND
THAT'S BEEN GOING ON BUT THAT'S
BEEN A RATHER SMALL.
INCREMENTAL INCREASE IN THE FLOW
OF MONEY THROUGH THE PIPELINE
AND OF COURSE WHEN WE HAD THE
HSS SITUATION A FEW YEARS AGO
WAS CHEWED UP --
AND USED.
APPROPRIATELY FOR NECESSARY
SERVICES FOR THE H. ASSIST
SERVICES.
SO BOTTOM LINE IS WE HAVE
UNDERFUNDED COUNTIES WHO AND
WHAT I'M HUGE FUNDING DISPARITY
IN THE STATE.
THE URBAN COASTAL AREAS VERSUS
THE INLAND AREAS NORTH CENTRAL
AND IN ONE SOUTH.
SO IF YOU'RE CALLING BACK MONEY
YOU'RE CLAWING BACK MONEY IN
SOME CASES AT THE UNDER FUNDED
COUNTY LEVEL.
FROM COUNTIES WHO DON'T HAVE
VERY MUCH MONEY TO BEGIN WITH TO
PROVIDE HEALTH CARE AND MENTAL
HEALTH SERVICES.
SO MY REQUEST IS THIS MILLION
CONTEMPLATING THIS POLICY --
THAT YOU THINK ABOUT WHETHER YOU
CAN ADJUST THE CALLBACK. TO IN
EFFECT -- DO
WHAT.
POLITICALLY MIGHT BE IMPOSSIBLE
TO DO IN TERMS OF THE OVERALL
FORMULA BUT IT JUST.
OF THE MONEY THAT COUNTIES
PARTICULAR THESE UNDERFUNDED
COUNTIES HAVE. TO PROVIDE BADLY
NEEDED HEALTH AND MENTAL HEALTH
SERVICES INSTEAD OF APPLYING A
ONE SIZE FITS ALL CALL BACK. TO
THE APPROPRIATELY FUNDED
COUNTIES IN THOSE THAT SOME OF
US WOULD ARGUE.
ARE SERIOUSLY UNDERFUNDED DOES
THAT MAKE SENSE.
SO I JUST WANTED TO SO I WOULD I
WOULD JUST POINT OUT IN TERMS OF
THE WAY IT WORKS TODAY --
SINCE RIVERSIDE COUNTY IS THE
ONE THAT'S BEING MENTIONED THEY
ARE ONE OF THE FORMULA COUNTIES.
SO IT'S ESSENTIALLY IT'S BY
WHILE THEY PROBABLY DIDN'T A
100% CORRECT FOR THAT IT REALLY
WAS A LOOK A LOOK AT THE
REVENUES THEY WERE GETTING
INCLUDING REALIGNMENT WHICH FOR
THEM YOU KNOW MAY HAVE BEEN
LOWER THAN IT SHOULD HAVE BEEN.
AND THEIR ACTUAL COSTS IN
PROVIDING CARE TO ONLY TAKE BACK
FUNDING. TO THE EXTENT THAT THEY
HAVE MORE REVENUE THAN THEY HAVE
COST.
WE CAN MAKE IT TO THAT WE CAN
MAKE A DECISION.
AS TO HOW MUCH TO CLUB BACK.
FROM COUNTIES CAN'T ME RIGHT SO
IT IS IN STATUTE THE A. B.
EIGHTY FIVE FORMULA THE CHANGES
THAT ARE BEING PROPOSED WITH
RESPECT TO THIS AREN'T CHANGING
WHAT RIVERSIDE FORMULA IS.
IT'S IT'S BECAUSE THEY ALREADY
PICKED THE FORMULA AND AREN'TA
SIXTY FORTY COUNTY PRESUMABLY
THIS WILL BE A TRAILER BILL
OFFICE IN THE BUDGET AND RIGHT
SO WE CAN ADJUST YOU COULD YOU
COULD ADJUST THE FORMULA THAT'S
WHAT I'M ASKING THAT SOMEBODY
TAKE A LOOK AT BECAUSE OF THE
FULL.
OF YOU KNOW I DON'T KNOW I JUST
THE FORMULA BUT ME A NIGHTMARE.
I'VE SEEN SOME STATISTICS THAT
INDICATE FOR EXAMPLE THE BAY
AREA THE PER CAPITA.
FUNDING FLOW IS ABOUT TWELVE
HUNDRED DOLLARS PER CAPITA AND
IN RIVERSIDE AND SAN BERNARDINO
COUNTIES IT'S ABOUT THREE
HUNDRED AND FIFTY DOLLARS.
PER CAPITA.
NOW THAT'S A DIFFERENCE.
AND IT'S A DIFFERENCE IT IS VERY
DIFFICULT FOR A COUNTY TO MAKE
UP.
BECAUSE WE'RE TALKING ABOUT
HEALTH CARE SERVICES WERE
TALKING ABOUT MENTAL HEALTH
SERVICES.
AND THAT IMPACTS HOW WE DEAL
WITH HOMELESS HOMELESSNESS AND
ALL THE REST OF THE STUFF SO IF
THERE'S A WAY. TO HELP COUNTIES
THAT ARE UNDER FUNDED I AM
ASKING THAT YOU TAKE A LOOK AT
IT BECAUSE I KNOW POLITICALLY WE
WILL NEVER [inaudible]
PROBABLY.
READJUST THE FUNDING FORMULA THE
NINETEEN NINETY ONE FUNDING
FORMULA BECAUSE TO DO SO WITH
THAT AN INFLUX OF NEW MONEY.
MEANS IT'S SOMEBODY'S LOSING A
PROGRAM IN ORDER FOR SOMEBODY
ELSE TO GAIN ONE SO BUT HERE YOU
HAVE AN OPPORTUNITY BECAUSE
YOU'RE PULLING BACK MONEY FROM
THE COUNTY.
BECAUSE OF THIS NEW PROGRAM. TO
TO ADJUST THE AMOUNT OF MONEY
THAT YOU PULL ASKING.
THANK YOU SPEAK MEASURE THANK
YOU.
THANK YOU VERY MUCH SHOT I
SHOULD MENTION THIS CAN'T WELL
ACTUALLY YOUR HAIR'S RETESTED.
FOR VALENTINE'S DAY.
THERE YOU GO.
THAT'S REAL COMMITMENTS.
FOR SO I DID WANT TO BECAUSE OF
MADE REFERENCE TO IT I KNOW
THAT'S FALLS MORE SOCIAL SERVICE
SIDE SO PERHAPS MORE QUESTION
FOR FINANCE --
SO IN TERMS OF THE HSS PORTION --
HOW MUCH ARE WE LOOKING AT --
FOR FOR THIS POPULATION AND THEN
IF WE WERE LOOKING BEYOND HOW
FAST WITH THAT GO SO WE'RE
LOOKING AT A HUNDRED NINETY FOUR
MILLION GENERAL FUND --
THE FOR FOR THIS --
PROPOSED EXPANSION WHAT
PROPORTION OF THAT'S AYE HSS.
SUPPORT FOR THE ARM FOR THE FOR
THE OVER --
TWENTY SIX POPULATION WE'RE
STILL WORKING ON THAT WITH THE
DEPARTMENT OF SOCIAL SERVICES TO
COME UP WITH AN ESTIMATE.
REGARDING THE THE PROPOSAL --
THAT'S BEFORE YOU SO THE FIRST
YEAR THE COSTS ARE --
IT'S GOOD THERE'S A BOOK YOU
KNOW A A DELAY A LAG AND THEN
THERE'S A RAMP UP --
THOSE COSTS WILL GROW OVER TIME
SO I THINK WE'RE ESTIMATING TWO
POINT TWO MILLION FOR THE FIRST
YEAR -- THEY
WILL GROW --
I THINK WE'RE ESTIMATING LIKE
TWENTY SIX MILLION OKAY --
AND THEN KEEPS GOING UP AFTER
THAT WELL I MEAN SOME POINT THAT
YOU SEE WITH THIS COMES THE
POPULATION AGED SOURCE DID THE
WHEN YOU STOP THE RAMP UP PARTS
OF FEW YEARS SO I THINK I'M
LOOKING AT AND WE'RE STILL
LOOKING AT THAT.
SORT OF LONG TERM WHAT IS OUT
RANGE OF LIKE.
IS IT FORTY MILLION
APPROXIMATELY FORTY TO FORTY
FIVE MILLION OKAY ITSELF
ACTUALLY --
SMALL BUT IT'S CHUNK BUT STILL.
YES SIGNIFICANT CHOCOLATE MODEL
SIGNIFICAN RIGHT RIGHT AS LARA
IS THE OTHER SIDE NUMBER THIS IS
THE THE NINETEEN TO TWENTY SIX
RIGHT EXACTLY SO SO I THINK.
SO I THINK THAT ONE OF THINGS
CERTAINLY WE DEFINITELY WHILE
LOOK AS WE'RE LOOKING FARTHER
OUT IS.
WHAT HAPPENS TO THE AYE HSS?
PORTION NOW I WOULD ALSO MAKE
NOTE THAT --
LOVED SO USUALLY THINK OF THE
EIGHTEEN TO TWENTY FIVE OR
TWENTY SIX THAT'S A AS IT'S ONLY
THREE HEALTHY AND THAT'S TRUE
BUT YOU KNOW THERE ARE A LOT OF
CHILDREN WHO HAVE --
CONDITIONS AND DISABILITIES THAT --
STILL NEED HELP EVEN AFTER EIGHT
SO I WOULD BE SURE THAT WE'RE
LOOKING AT THAT.
AS WELL --
NOW IN TERMS OF CCS ANY I GUESS
EASIEST CUTS OFF AT EIGHTEEN
ANYWAY BUT I MEAN I'M DISRUPTING
ABOUT WHAT KIND OF SUPPORT FOR
THAT I CARE WE'RE GONNA BE ABLE
PROVIDE BY NOW INCLUDING THIS
POPULATION --
FOR PEOPLE WITH --
WELL NOW YOUNG YOUNG ADULTS WITH
A SIGNIFICANT --
CONDITIONS.
EASIER TO GO TO TWENTY ONE SO
THERE WILL BE SOME ADDITIONAL
EXPANSION --
AND THAT'S ACCOUNTED FOR IN OUR
COSTS RIGHT THOUGH I THINK THESE
TO BE ON THAT IT'S YOU KNOW THE
SAME SERVICES THAT WE PROVIDE TO
ANY OTHER FULL SCOPE MEDICAL
BENEFITS YOUR AFTER THEY AGE OUT
AND THE OPPORTUNITIES TO BE IN
SOME OF OUR WAIVER PROGRAMS OR
OTHER THINGS.
IN ORDER TO PROVIDE THOSE
SUPPORTIVE AND MORE INTENSIVE
SERVICES THAT THEY CURRENTLY GET
OFTEN THREE CCS.
OKAY WELL I THINK THIS IS A AND
I REALIZE THAT MOST OF THIS
FOCUSED ON COVERAGE --
AND WE'LL EXPLORE SOME OF THIS
MORE IN OUR BUDGET SUBCOMMITTEE --
AT A IS WERE LOOKING AT THIS SO
IF I FOR THE CONVERSATIONS ABOUT --
COORDINATION OF CARE HOW DO WE
TRY TO REDUCE THE COST CURVE NOT
ONLY OF COURSE FOR THIS
POPULATION BUT MORE BROADLY.
AT BECAUSE I THINK IT'S PEOPLE
SAID IT WILL BE ONE TO GET MORE
LOWER HEALTHCARE COSTS NOT JUST
FOR THE STATE BUT ACTUALLY
OVERALL.
AND THEN --
WHAT ARE THINGS THAT WE CAN DO
WITH MEDI CAL BEING A LARGE
PURCHASER --
NO THIRD OF ALL CALIFORNIANS
HALF OF ALL CHILDREN --
TO TRY TO CHANGE THE SYSTEM OF
CARE AS WELL SO OKAY THANK YOU
[inaudible]
WELL.
I AGREE WITH THE CHAIRS
DISCUSSION ON THE HI IN.
OF ABOUT ELIGIBILITY --
WHO GETS SERVED TO DOESN'T GET
SERVED IS ALMOST LIKE A MORAL
DECISION?
WHICH IS.
CREATE A LOT OF COMPLICATIONS IN
MY MIND TO CHOOSE ONE GROUP THE
NEEDS HEALTHCARE OVER ANOTHER
GROUP I THINK [inaudible]
THERE [inaudible]
THERE'S SOME.
THOUGHT THAT HAS TO BE PUT INTO
THE A IN A REAL WAY.
BEFORE WE JUST CHARGE IN DO THIS
IN MY OPINION I MEAN.
IT'S A IT'S A IT'S A JAR IS SO
AND SO IS LIKE A MORAL DECISION
YOU'RE MAKING.
AND AND IS SOMEBODY'S COMMITTED --
TO UNIVERSAL HEALTH CARE AS I
HAVE BEEN --
I FIND IT TROUBLING I HAVE A
QUESTION THOUGH--
FOR THE ELIGIBILITY --
PROCESS OF OUR ARE YOU SERVING
THERE'S NO CHANGES IN THE
ELIGIBILITY PROCESS AS IT STANDS
NOW.
WITH THE COUNTIES --
AMASSING THE SOCIAL SERVICE --
OF DEPARTMENT.
YOU'RE ASSUMING THAT THE L. L.
G. BILL THE PROCESS IS THE SAME.
OUR AS WE HAVE NOW FOR THE
COUNTY SCRIPT.
YES --
ENSURING THAT THE CASE TOLD --
THE PRODIGIOUS PROVIDED WE HAVE
ONE POINT 3% INTAKE.
WITH WHAT THE CURRENT OF CASE WE
ARE.
FROM MEDI CAL TO I JUST SORT OF
THERE'S NO CHANGE TO YOUR SYSTEM
OKAY SO --
HAS THERE BEEN --
AS A SOCIAL SERVICE AGENCY --
DISCUSS THE OR EXPLORED --
MEDICO --
ELIGIBILITY SIMPLIFICATION --
HOW DOES THIS PROPOSAL OR MAYBE
GOING TO A?
BROADER --
UNIVERSAL.
OF HEALTHCARE SYSTEM --
OF PRETTY OPPORTUNITY MAYBE.
FOR RE EXAMINING THE ELIGIBILITY
SYSTEM.
AS WE KNOW IT --
IN TERMS OF PROCESSING PEOPLE
TIMING.
AND SO FORTH COULD DOES A SOCIAL
SERVICES.
ANY KIND OF ANSWER ON THAT ISSUE.
SO JUST A STEP IN FOR MY
COLLEAGUE HAS MEDI CAL ABILITIES
ACTUALLY DONE THROUGH DTS AND
NOT THROUGH SOCAL SERVICES
OTHER COUNTIES TO THE COUNTY DO
IT BUT IT THROUGH US --
YEAH SO --
CERTAINLY YOU KNOW WE HAVE WE
CONTINUE TO LOOK AT HOW DO WE
MAKE CHANGES AND IMPROVEMENTS --
PART OF THAT PART OF THE
DECISION MAKING AND HOW WE'RE
EXPANDING THE COVERAGE HERE WAS
PART OF THAT SIMPLIFICATION WE
DID NOT JUST LIKE FOR THE KIDS
WE DID NOT INCLUDE WE DO NOT
CREATE NEW AID CODES WHICH IS
ITS OWN.
CHALLENGING PROCESS WE ARE
TRYING TO CONSOLIDATE INTO THE
EXISTING AID CODES --
IN ADDITION CERTAIN AGE BECAUSE
YOU HAVE NOW [inaudible] 200-
THAT'S THAT'S WHY I'M TALKING
ABOUT YES I IT SO.
IT'S AN I WE THIS IS DEFINITELY
AGREE DEFINITELY AGREE SENATOR
BELL AND YOU CAN IF YOU TALK TO
MY ELIGIBILITY PEOPLE YOU'LL
TELL THEM.
THEY WILL TELL YOU THAT I KEEP
SAYING CAN GET TO LIKE TEN THEY
TELL ME THAT'S IMPOSSIBLE BUT
WE'RE GONNA TRY TO GET LOWER
THAT'S MY GOAL.
I PROMISE YOU IS MICHAEL.
BUT SORT OF MONEY FOR THE
COUNTIES TO IMPLEMENT A BILLS BE
SYSTEM WITH HUNDREDS OF A CODE
ABSOLUTELY --
SO I I KNOW THAT FOR A FACT.
HIRE ALL THE ELIGIBILITY WORKERS
WHEN I WAS A SUPERVISOR SO SO --
I LIKE I LIKE TO SEE --
IF WE'RE GOING IN A DIRECTION
[inaudible]
OF FULL.
CARE FOR EVERYBODY.
PART OF THE IMPORTANT JOB WE
HAVE IS TO SIMPLIFY THE
ELIGIBILITY PROCESS.
AND CREATED A ELIGIBILITY
PROCESS IS MUCH SIMPLER LESS
EIGHT CODES.
A SIMPLIFIED PROCESS BECAUSE
WE'RE CHALLENGED WITH IN THIS
CASE.
OF THE PUBLIC CHARGE --
ISSUE WHERE PEOPLE ARE GOING TO
BE DISINCLINED TO WANT.
TO UP PARTICIPATE IN THIS IN THE
FIRST PLACE SO.
WE HAVE TO WE HAVE TO CHALLENGE
OURSELVES. TO TO REINVENT THE
ELIGIBILITY PROCESS.
AND I I DON'T KNOW IF THAT'S A
MAJOR PART OF THIS DECISION.
THAT'S BEEN MADE BECAUSE I THINK
IT HAS TO BE IF WE'RE MAKING
CHANGES IN THE MEDICAL SYSTEM.
ELIGIBILITY PROCESS IS IS
CUMBERSOME COMPLICATED.
IS IT --
CREATES --
MANY MISTAKES --
THE MORE THE MORE.
CODE IT CODES WHERE PEOPLE WERE
GOING FROM ONE A CODE TO ANOTHER
FOR EXAMPLE.
IT SEEMS LIKE IF THERE TWENTY
SIX AND THEN THERE.
TWENTY SEVEN THAT'S JUMPING FROM
SOMETHING TO SOMETHING --
IF THEIR INCOME GOES UP AND DOWN
I MEAN ALL THOSE KINDS OF
FACTORS --
IT'S IT'S IT'S TIME THAT WE LOOK
AT THE CHANGING OF THE
ELIGIBILITY PROCESS SIMPLIFYING
IT MAKE IT SIMPLE FOR THE
CONSUMER CONSUMER FRIENDLY --
THAT'S GOT TO BE PART OF THIS
I'M JUST I'M JUST SAYING RIGHT I
THINK IT'S IMPORTANT.
THANK YOU VERY MUCH SENATE BILL
THAT'S A GOOD POINT TO RAISE AS
I THINK WE HAVE THERE HAVE BEEN
MEDI CAL ELIGIBILITY
SIMPLIFICATION BILL PACKAGES.
FOR DECADES BUT WHAT I HEAR YOU
SAYING WHICH I UNDERSTOOD YOUR
TALK ABOUT A SIMPLIFICATION THE
FRONT IN AND BACKING AND
SIMPLIFICATION.
OF FOR BENEFICIARY TO APPLY BUT
ALSO IN TERMS OF THE BACK IN
TERMS OF HOW IT'S ADMINISTERED --
AT THE STATE LEVEL AND THE
COUNTY EXPERIENCE AS WELL I GOT
IT SIMPLIFICATION ALL THE WAY
AROUND THE FRONT LINE PEOPLE
HAVE A LOT IDEAS ON THIS YES AND
I THINK IF WE'RE ALSO OF
STRATEGICALLY WE'RE GOING.
TO UNIVERSAL.
HEALTH CARE WE SHOULD START
DOING THIS NOW BUILDING THE
INFRASTRUCTURE TO SIMPLIFY IT
GOT IT THANK YOU SIR.
CENTER WIECKOWSKI.
GOING BACK TO I GUESS LISTENING
TO MY COLLEAGUES AND SENATOR
ROSS ISSUE ON THE CLOCK BACK YOU
WERE TALKING SIXTY MILLION
DOLLARS OUR HAND OUT ON PAGE SIX
SHOWS THAT SOME ELEVEN COUNTIES
ARE NOT.
PROVIDING ANY NON EMERGENCY CARE
RIGHT NOW FOR A FRIEND DOCUMENTS
WHAT IS WRONG WHICH IS LETTING
THEM HALF THE MONEY.
IN SAYING YOU PROVIDING THE CARE
NOW.
WHY WOULD WHAT WHAT WHAT
POSSIBLY COULD THE COUNTY
HOSPITALS?
TO THAT WOULD BE INAPPROPRIATE
IT WOULDN'T BE PROVIDING
SERVICES TO THE POPULATION AT
THE SERVER IF WE JUST LET THEM
KEEP MONEY.
BUT BUT THERE'S A THERE'S ELEVEN
THAT DON'T AND SOME OF THEM ARE
BY PROVIDING SOME SAFETY NET
WOODEN THE ON THE NATURAL WOULD
NEED JUST PROVIDE MORE SERVICES.
THEY HAD MORE MONEY.
AND TRY TO WANT TO BE SO NAIVE.
NO -- THANK
YOU SENATOR --
WELL I I I I AGAIN THE PROPOSAL.
FROM THE ADMINISTRATION REFLECTS
THAT WE WOULD BE TAKING ON THAT
RESPONSIBILITY AND I I
UNDERSTAND YOUR POINT --
BUT FOR ON THE RESPONSIBILITY WE
THINK IT'S APPROPRIATE TO MAKE
THE ADJUSTMENT.
AND I CAN JUST JUMP IN I MEAN I
THINK THAT --
CERTAINLY WE KNOW OUR COUNTY
PUBLIC HOSPITAL SYSTEMS DO
PROVIDE A SIGNIFICANT AMOUNT OF
CARE AND WILL CONTINUE TO THAT
TO WHOEVER REMAINS UNINSURED.
I THINK --
THE REALITY IS THAT THERE IS
MORE FUNDING IN TOTAL THAT THEY
WOULD BE GETTING THROUGH AN
EXPANSION TO BE ABLE TO PROVIDE
THOSE SERVICES AND PROVIDE THEM
ANYMORE MANAGED WAY.
AND HAVING INDIVIDUALS HAVE
ACCESS TO OTHER SERVICES THAT
PERHAPS THEY DON'T HAVE IN THE
COUNTIES TODAY BECAUSE YOU KNOW
AS YOU KNOW COUNTY SYSTEMS ARE
VERY VARIED ACROSS THE STATE
WITH SOME HAVING.
SIGNIFICANT OUTPATIENT PRIMARY
CARE AND OTHERS BEING MORE --
CONSTRAINT ON THAT SIDE SO WE
VIEW IT AS A BENEFIT TO THE
PUBLIC HOSPITAL SYSTEMS TO DO
THIS EXPANSION --
YES THERE IS MONEY COMING OUT IN
THE IN THE REALIGNMENT
REDIRECTION BUT THE OVERALL A
EXPENDITURES FOR THESE
INDIVIDUALS WE THINK WILL RESULT
IN ON ON YOU KNOW REDUCING
UNCOMPENSATED COSTS THAT THOSE
COUNTIES ARE CURRENTLY --
PROVIDING AND THAT THE CARE WILL
BE MORE COORDINATED.
EVE EVEN THE CAVEAT THAT THE THE
AYE HSS.
PORTION OF IT IS GOING TO BE
ANOTHER A BIGGER.
AMOUNT OF LARGE AMOUNT OF MONEY
FOR THE SENIOR POPULATION EVEN
THOUGH IT'S ONLY TWENTY FIVE
THOUSAND PEOPLE IT JUST SEEMS
THAT THERE'S THERE'S A LOT OF
WORK TO BE DONE IN THIS AREA
EVEN THOUGH WE'RE ACCEPTING.
MORE RESPONSIBILITY.
FOR PERHAPS THE SIMPLEST OF A
COHORT THE NINETEEN TWENTY FIVE
YEAR OLD SAID IN THE IN THE
PEOPLE THAT AREN'T AREN'T
COVERED I JUST.
I JUST THROW IT OUT TO THAT IF
WE DIDN'T CLUB BACK ANYTHING
WAGES SUCKED UP TO SIXTY MILLION
THAT THERE'S A POTENTIAL FOR FOR
OTHER GOOD THINGS TO BE OCCURRED
IN THIS POPULATION THAT WE'RE
TRYING.
TO IT'S NOT EXACTLY EXPANDING IT
TO EVERYBODY BUT IT SAYS HERE WE
COME [inaudible]
THIS [inaudible]
THROUGHOUT THE I'M.
I'M STILL REALLY UNCLEAR IN
TERMS OF WHY --
BE SELECTED THE NINETEEN TO
TWENTY SIX AGE BRACKET --
SOME REFERENCE WAS MADE TO THE
ACA BUT THE ACA DIDN'T USE THAT
AGE TO EXCLUDE [inaudible]
ANYBODY --
YOU NOT EXCLUDED FROM ANY
BENEFITS FROM --
NINETEEN TO TWENTY SIX YOU HAD
TO DO WITH WHETHER YOU GET
COVERAGE UNDER YOUR YOUR YOUR
ALL EXISTING HEALTH PLAN. TO
EXTEND IT BUT IT WASN'T USED TO
EXCLUDE ANYBODY --
IN FACT THE ONLY EXCLUSION UNDER
THE ACA IS A FAIR AND DOCUMENT
YOU CAN EVEN PURCHASE.
INSURANCE IF YOU'RE A
UNDOCUMENTED SO I DON'T
UNDERSTAND THE THE RATIONALE OR
THE OF WHY THIS PARTICULAR AGE
WAS SELECTED --
AND AS SENATOR MITCHELL SAID
WE'RE MOVING TOWARDS WHAT MY
UNDERSTANDING IS WE'RE SUPPOSED
TO BE MOVING TOWARDS ELIMINATING
THE UNINSURED AND THE WHOLE
STATE THAT EVERYBODY HAVE HEALTH
INSURANCE --
AND WE'RE GONNA DO THIS BY THESE
LITTLE AGE BRACKETS WHAT'S THE
WHAT'S THE POLICY RATIONALE.
UP IF WE'RE MOVING TOWARDS FULL
CUP FULL ON MAKING SURE
EVERYBODY HAS HEALTH INSURANCE
ARE HEALTH THE HEALTH COVERAGE.
AND WE GO FROM ZERO TO EIGHTEEN
AND THEN WE GO FROM NINETEEN TO
TWENTY SIX ARE WE GONNA DO THIS
AND SEVEN YEAR INCREMENTS --
MEAN WHAT I DON'T UNDERSTAND THE
RATIONALE --
SOMEONE MENTIONED WE'RE BUILDING
ON WHAT'S BEEN DONE BUT WE WENT
FROM ZERO TO EIGHTEEN TO NOW.
1-922-6 HOW DO YOU BUILD IT WERE
YOU KNOW THE THE NUMBER IS SO
MUCH SMALLER THAT WE'RE GOING TO
COVER SO --
I WOULD RATHER THAT ARE
RATIONALE BE BASED ON WE'RE
MOVING.
IN THIS IS HOW WE'RE GOING TO
GET.
TO QUICKLY WE'RE GOING TO GET TO
EVERYBODY.
I'D BEEN NO HAVE NO UNINSURED IN
THE STATE OF CALIFORNIA I MEAN
THERE'S BEEN.
REALLY.
BIG DEBATES AS I UNDERSTAND IT I
WAS IN HERE.
BUT WE ALL SAID OR ALL OF
EVERYBODY UP HERE SAID WE WANT
COVERAGE FOR EVERYBODY.
THE I DON'T I DON'T GET HOW OLD
THIS LITTLE [inaudible]
PLEASE.
OUGHT WAS ARRIVED AT AS A WAY TO
GET TO WHERE WE REALLY WANT TO
BE WHICH IS EVERYBODY COVERED.
LARA ALLIED DEPARTMENT OF
FINANCE -- I
THINK YOUR POINTS ARE WELL TAKEN
AND I THINK THAT ULTIMATELY.
LIKE THE GOVERNOR HAS SEATED
AIDS IT IS THE FIRST PREVIOUSLY
NOTED THAT COST TO BUILD ON SB
THIRTY FIVE IS POPULATION --
IS ABOUT ONE HUNDRED NINETY FOUR
MILLION FOR MEDI CAL BENEFIT
COSTS WHEREAS EXPANDING THROUGH
THE AGE OF SIXTY FOUR AND ABOVE
IS A ONE POINT SEVEN BILLION
GENERAL FUND COSTS FOR MEANT FOR
JUST FOR MEDI CAL NINE NOT
INCLUDING I JUST AS COSTS SO.
I THINK IT'S A BOTH --
BUILDING ON SB SEVENTY FIVE IT'S
CONSISTENT WITH THE COVERAGE
THAT INDIVIDUALS MAY GET YOU
KNOW THE AND AS REQUIRED THROUGH
THE ACA THROUGH THE AGE OF
TWENTY FIVE BUT ALSO THERE'S A
SIGNIFICANT --
FISCAL DECISION THAT THAT WAS
MADE.
DO YOU HAVE A NUMBER AS TO WHAT
IT WOULD COST TO COVER EVERYONE.
IN THE STATE TO ELIMINATE THE
UNINSURED THAT.
EVERYBODY OR JUST AND DOCUMENTAL
HAVE FOR EVERYBODY TO REDUCE THE
ANYBODY NOW NOT FOR EVERYBODY --
I DON'T KNOW IF WE HAVE THAT.
I HAVE WE WERE MORE IN THE WORKS
OF PUTTING TOGETHER AN ESTIMATE
LOOKING AT THE MEDI CAL AND I
HSS COSTS FROM THE UNDOCUMENTED --
BUT YOU KNOW COVERING EVERYBODY
WOULD BE KIND OF OUTSIDE THE
SCOPE OF DH CS AT THIS HEARING
TODAY.
FROM I ADD ON TO WHAT MY
COLLEAGUE SAID A MOMENT AGO --
YEAH I THINK THE GOVERNOR'S MADE
IT CLEAR THAT HE HAS A GOAL TO
COVER ALL OF THESE FOLKS AND SO.
YOU KNOW.
I WOULD OFFER THAT --
GIVEN THE THE THE CAR --
AND AGAIN WE'LL HAVE TO GET BACK
WITH YOU ON THE AYE HSS
COMPONENT OF THAT BUT AS AS
MERRY DESCRIBED EARLIER --
SOMETHING LIKE ONE POINT SEVEN
ONE POINT.
EIGHT BILLION FOR JUST THE MEDI
CAL PART OF THAT --
THAT WOULD BE A VERY DIFFICULT
COSTS TO ACCOMMODATE IN ONE YEAR
AND UNDER THE BUDGET PROPOSAL IT
WOULD PROBABLY MEAN HAVING TO DO
PULL BACK ON SOMETHING.
ELSE.
THIS WAS THE RIGHT MIX FOR THE
FROM THE ADMINISTRATION'S
STANDPOINT I WOULD ALSO ADD --
THIS BUDGET DOES QUITE A BIT --
REGARDING --
YOU KNOW BILLIONS OF DOLLARS OF
PENSION PAYMENTS AND CLEANING UP
BUDGETARY DEBT THAT'S GOING TO
READ THAT'S GOING TO BE REVEALED.
REAL SAVINGS IN THE FUTURE
HUNDREDS OF MILLIONS OF DOLLARS
THAT WILL ALLOW THE STATE TO
CONTINUE MAKING PROGRESS LIKE
THIS -- SO.
YEAH BUT WE'RE HAPPY TO CONTINUE
THAT CONVERSATION WE'RE
CERTAINLY YOU KNOW HEARING THESE
THESE PERSPECTIVES RALLY THINGS.
SENATOR STONE.
THANK YOU THANK YOU FOR THE
PRESENTATION AND YOU KNOW WE SAW
A LOT OF CUTS WITH THE RETURN
RECESSION I I TALKED ABOUT
BEFORE AND IF.
IS THE IS THE GOVERNOR
CONSIDERING AS WE MOVE FORWARD
WITH --
POTENTIALLY THIS --
THIS PLAN.
AND AND MAYBE THE F. R. FURTHER
EXPANSION. TO RESTORING SOME OF
THE BENEFITS AND THE MEDICAL-PROGRAM PODIATRY AUDIOLOGY AND
CON AND SCREAMS.
PROVIDER RATES IS IS IS THAT
EMANATING IN THE IN THE IN THE
OFFICE OF THE GOVERNOR --
TO PROVIDE A HOLISTIC.
HEALTH CARE PLAN FOR PEOPLE TO
TO EMBRACE NUMBER.
ONE NUMBER.
TWO ASSUMING A TWO HUNDRED FIFTY
EIGHT MILLION DOLLAR COST ONE
NINETY FOUR MILLION TO THE
GENERAL FUND --
WE'RE NOT GONNA GET ANY --
FEDERAL ASSISTANCE THAT'S GONNA
BE 1100% --
STATE -- BUT
HAD WE USE THAT MONEY FOR
ENHANCEMENT OF THESE OTHER
SERVICES OF WHAT KIND OF FEDERAL
FUNDS ARE WE LEAVING OFF THE
TABLE.
SO OBVIOUSLY I WOULD NEVER DARE
TO SPEAK FOR THE GOVERNOR BUT
I'LL TRY TO ANSWER SOME OF THE
PIECES I MEAN I THINK YOU KNOW
IT AS AS OUR DEPARTMENT FINANCE
COLLEAGUES SAID THERE HAD TO BE
CHOICES MADE IN SORT OF WHAT WAS
BEING DONE --
SO WHILE WE WHILE THE GOVERNOR
DID NOT SPECIFICALLY PROPOSED TO
RESTORE BENEFITS OR TO UNDO THE
CUTS THAT STILL REMAIN ALTHOUGH
NOT ALL OF THEM DO YOU.
THERE IS BILLIONS OF DOLLARS IN
THE PROP FIFTY SIX MONEY THAT'S
GOING TO INCREASED PROVIDER
RATES SO IT'S NOT A DIRECT
UNDOING OF THE CUTS BUT IT'S A A
SEPARATE WAY OF PROVIDING
FUNDING AND INCREASE THAT AMOUNT --
BY A FEW HUNDRED MILLION IN PROP
FIFTY SIX MONEY FOR THIS
UPCOMING YEAR --
AS YOUR SECOND QUESTION THAT
WE'VE DONE THAT ANALYSIS I DON'T
KNOW THAT HOW.
EASY THAT ANNOUNCES WOULD BE --
I WOULD SAY THAT WE DO GET
FEDERAL FUNDS FOR THIS
POPULATION BECAUSE WE STILL
CONTINUE TO CLAIM. FOR THE
LIMITED SCOPE SERVICES SO THAT'S
WHY OUR TOTAL FUND IS TWO FIFTY
SEVEN BUT OUR GENERAL FUND IS
ONE NINETY FOUR SO WE ARE
GETTING ABOUT SIXTY FOUR MILLION
IN FEDERAL FUNDS --
SO YES IF THIS WAS FOR FULL YOU
KNOW FULLY FEDERALLY ELIGIBLE
FOLKS IT WOULD --
DRAWDOWN ADDITIONAL FEDERAL
MONEY BUT IT WOULD BE GOING FROM
ZERO TO SOMETHING IT WOULD BE
GOING FROM SIXTY FOUR TO
PROBABLY LIKE A HUNDRED AND
TWENTY OR SOMETHING LIKE THAT.
OFF THE TOP OF MY HEAD OAK DON'T
LIKE QUOTE ME ON THE HUNDRED AND
THEN FINALLY --
WE HAVE A A WAIVER WITH THE
FEDERAL GOVERNMENT THAT IS
EXPIRING IN TWENTY TWENTY AND
WE'RE GONNA HAVE TO GO TO THE
FEDERAL GOVERNMENT AND AND
NEGOTIATE --
HOW WE'RE GOING?
TO PAY FOR THE SERVICES WITH
FEDERAL FUNDS IN THE FUTURE.
ASSUMING THAT THIS --
THIS.
IDEA OF SERVICES BETWEEN
NINETEEN AND TWENTY SIX AND I
SHARE THE CONCERNS.
OF THE SENATOR FROM LOS ANGELES
AND MY MY COLLEAGUE FROM
RIVERSIDE --
THAT.
THE NEED IS PROBABLY MUCH
GREATER THE SIXTY FIVE YEAR OLDS
TO OVER --
AM AM PROBABLY --
ACCESS OUR EMERGENCY ROOMS AND I
HAVE A HAVE A COSTS IT IS SAID
THAT THAT IS RATHER SIGNIFICANT
BUT EMBRACING WHATEVER PROGRAM
WE ULTIMATELY EMBRACE IS
PROBABLY GOING TO CONTINUE TO
DRAW MORE.
UNDOCUMENTED AGREEMENT
IMMIGRANTS TO THE PROGRAM DO YOU
SEE THIS IN ANYWAY JEOPARDIZING
OUR ABILITY TO GO --
EIGHT UP IN A POSITIVE WAY --
FOR THE STATE --
WITH THE FEDERAL GOVERNMENT.
AND THAT'S A HARD QUESTION TO TO
ANSWER I MEAN CERTAINLY
CALIFORNIA HAS ALWAYS BEEN MUCH
MORE EXPANSIVE --
IN OUR COVERAGE WE'VE WE'VE
CURRENTLY PROVIDE FULL COVERAGE
TO THOSE WHO ARE OTHERWISE NOT
ELIGIBLE FOR A FEDERALLY COVERED
WHO ARE DOCUMENTED CITIZENS --
OBVIOUSLY THAT SHOT THE CHILDREN
EXPANSION THAT WE DID LAST YEAR
WE HAVEN'T HEARD ANY SPECIFIC.
CONCERNS OR ISSUES --
AS LONG AS WORK YOU KNOW
APPROPRIATELY A HUGE STATEMENT
ON WHAT --
WE DO WITH OUR STATE FUNDS
CERTAINLY THE ISSUE OF THE WE
WERE EXPIRING NEXT YEAR IS ONE
THAT WE WILL BE TALKING ABOUT --
I HAVE BEEN TALKING ABOUT IT IN
IN SOME STAKEHOLDER MEETINGS IN
TERMS OF THE SIZE AND SCOPE OF A
WILL PROBABLY NEED TO ASK FOR
THE FEDERAL GOVERNMENT ON THE
ACTUAL WEAVER SIDE WILL PROBABLY
BE DECREASED.
AND WILL BE LOOKING AT HOW DO WE
USE SORT OF LESS SUBJECTIVE
AUTHORITIES FROM THE FEDERAL
SIDE TO IT.
TO MAKE SURE THAT WE'RE
MAINTAINING ALL THE MONEY SO WE
ARE THINKING THROUGH FOR ALL OF
THOSE.
IMPACTS --
BUT YEAH THAT THERE HAS NOT CMS
IS NOT RAISE ANY PARTICULAR
ISSUES TO US ABOUT --
OUR PRIOR EXPANSIONS OR THEY ARE
ALSO AWARE OF THIS PROPOSED
EXPANSION AS LONG AS WERE.
DOCUMENTING APPROPRIATELY THE
JUST THE FEDERAL FUNDS PIECE
THAT THEY'RE RESPONSIBLE FOR YOU
CAN YOU EDUCATE ME EVEN FORGIVE
MY IGNORANCE WITH RESPECT TO THE
NEXUS BETWEEN.
EXPANDING --
MEDICAL COVERAGE TO A DOCUMENT
AS AND THE THE NEXUS TO AYE HSS
COVERAGE UNDERSTANDING THAT.
MY UNDERSTANDING IS THAT AYE HSS
IS A IS A FEDERALLY FUNDED
PROGRAM --
BUT IT BUT IS THERE IF WE IF WE
OFFER -- ON
DOCKS --
FIVE YEAR OLDS ARE ORDER WITH
MEDI CAL COVERAGE DOESN'T HAVE
TO COME ALL OR NOTHING WITH HSS
EVEN THE STATE'S BACK FILLING IT.
BECAUSE I THINK THAT'S WHERE
WE'RE SEEING A LOT OF THE RED
FLAGS HERE TODAY SUCH AS A VERY
EXPENSIVE PROGRAM --
CAN CAN WE OFFER ONE WITHOUT THE
OTHER -- IS
A WAY TO I'M SORRY INCREMENTALLY
GET TO WHERE --
THIS THE LEGISLATURE ONCE AGO
SURE CERTAINLY SO THERE WOULD
NOT BE A FEDERAL REQUIREMENT TO
EXTEND NAY TO ASSESS --
TO THIS POPULATION SINCE IT'S
NOT A FEDERALLY REQUIRED
POPULATION SO THAT WOULD BE A
DECISION THAT THE LEGISLATURE
AND THE GOVERNOR WOULD BE MAKING
ABOUT DOING SOMETHING DIFFERENT
THAN WHAT WE'VE DONE BEFORE
WHICH IS WHEN WE HAVE EXPANDED
FULL SCOPE COVERAGE WE GIVE
THOSE INDIVIDUALS THE FULL SCOPE.
OF ALL OF THE BENEFITS WHICH IS
INCLUSIVE OF AYE TO ASSESS AND
MANY OTHER THINGS BUT CERTAINLY
THAT'S NOT REQUIRED FOR MANY
FEDERAL PERSPECTIVE IT IS A
STATE DECISION.
AND YOU HAVE --
IF YOU DON'T HAVE IT TODAY I
WOULD LIKE TO GET THE COST OF
WITH THE I. JUSTICE COSTS WOULD
BE.
FOR THE THE ELDERLY POPULATION
THAT SEEMS TO BE --
COST PROHIBITIVE IN IN THE EYES
OF WHAT I'M HEARING HERE TODAY
IN OUR DEPARTMENT OF SOCIAL
SERVICES AND DEPARTMENT FINDS
ARE WORKING ON THAT AND SO
CERTAINLY WILL GET BACK TO YOU
RETREAT THAT THANK YOU SO MUCH.
THANK YOU VERY MUCH TO THE FINAL
QUESTIONS DR GRANT A JUST
BRIEFLY --
SO AS YOU'RE LOOKING AT THAT
HOUSES A BE HELPFUL TO HAVE A
BREAKDOWN OF THE DIFFERENT
COMPONENTS FOR A SPECIAL.
THAT.
I THINK WITH THIS AGE GROUP.
FOR WE'LL DO OUR OUR SIDE I
THINK AS YOU KNOW WE DO SORT OF
PM OVERALL PM PM'S AND SO WE'LL
PROBABLY HAVETO MAKE SOME
ASSUMPTIONS ABOUT PERCENTAGES
BUT WE'RE HAPPY TO DO THE BEST
THAT WE CAN THEN OBVIOUSLY I TO
SAYS IS BEING CALCULATED
SEPARATELY [inaudible]
THE WRONG.
ME JUST ASK ONE QUICK QUESTION
ABOUT MY UNDERSTANDING THE
PREMISE BEHIND THE AGES SAYS
PROGRAM IS.
YOU KEEP PEOPLE HOME FOR EXAMPLE
WHEN YOU KEEP THEM OUT OF HIGH
COST INSTITUTIONS.
YOU YOU I ASSUME YOU HAVE TO
BUILD IN SOME COST SAVINGS
ASSOCIATED WITH THE ISS HSS
PROGRAM.
AN ADDITION TO JUST WHAT THE
BILL IS RIGHT DOESN'T IT IMPACT
YOUR OVERALL.
MEDI CAL.
COST IF YOU DON'T HAVE A AGES
SAYS AND YOU HAVE PEOPLE IN
INSTITUTIONS.
SO I JUST I JUST WANNA MAKE SURE
I'M UNDERSTANDING SO IF IF WE
WERE YOU KNOW TAKING THE PATH
THAT THAT SENATOR STONE WAS.
DISCUSSING WHETHER THE COST ON
THE MEDICARE ON THE NON ART IS
ASIDE WE NEED TO INCREASE TO
ACCOUNT FOR THE FACT THAT I JUST
AS WASN'T KEEPING PEOPLE OUT OF
NURSING SOI THAT IS A FAIR
QUESTION I DON'T THINK WE'VE
EVER WE'VE NEVER LOOKED AT IT BY
ABOUT.
SORT OF DIVIDING UP THE BENEFITS
THAT WE WE WOULD HAVE TO COME UP
WITH A METHODOLOGY BUT I THINK
IT'S A FAIR QUESTION THAT WE
WOULD NEED TO TAKE A LOOK AT AND
I THINK THAT'S TRUE OF ANY
BENEFIT RIGHT I MEAN I THINK. TO
THE DEGREE WE MAKE.
DECISIONS ON CERTAIN BENEFITS IT
COULD AFFECT THE OVERALL COST
BECAUSE UNFORTUNATELY EVEN
THOUGH WE DO.
HELP FUND THE AGES HAS SAID OF
THE CAL THE FEDERAL SIDE
NOBODY'S RECOGNIZE THE SAVINGS
AND WE DON'T GET CREDIT FOR THE
SAVINGS THAT WE HAVE TO CORRECT.
CREW TO THE FEDERAL.
MEDICARE MEDICAID PROGRAM YEAH I
MEAN I THINK ONE OF THE THE
CHALLENGES IN THE WAY THAT SOME
OF OUR RELATIONSHIP WORKS ON
EXPANDING FULL SCOPE TO THOSE
WHO HAVE.
WE GET SOME PORTION OF FEDERAL
FUNDS IS ON THE ON THAT
DEPARTMENT SIDE WE DO THAT BASED
ON A PERCENTAGE BASIS SO WE WENT
WE'VE HAD.
YOU KNOW REACH AN AGREEMENT WITH
THE FEDERAL GOVERNMENT THAT I'M
JUST I DON'T REMEMBER THE NUMBER
SO DON'T QUOTE ME ON THIS BUT
LIKE 45% OF THE COST WOULD
OTHERWISE BE EMERGENCY COSTS
THAT'S HOW WE GET TO THAT SORT
OF SPLIT THAT YOU SEE.
HERE WHERE WE'RE GETTING FEDERAL
FUNDS SINCE NO PART OF AYE TO
SAYS IS CONSIDERED EMERGENCY
SERVICE A. AS IT IS A 100% STATE
FUNDED AND SO THAT S ONE OF THE
THE CHALLENGES AND CERTAINLY --
TO YOUR POINT IF IT WOULD HAVE
RESULTED IN HIGHER OTHER COSTS
THE PERCENTAGE THE FEDERAL
GOVERNMENT WOULD GO UP IF WE-DIDN'T COVER I JUST US --
BUT THEY YES THAT WOULD BE
SOMETHING THEY WOULD PROBABLY
RECOGNIZE OUR ADDRESS.
THANK YOU THANK YOU MANAGER.
THE OUR FIRST --
PRESENTER YOU KNOW THAT.
I KNOW WE TEND TO ASSOCIATE AYE
TSS SERVICES WITH THE ELDERLY
BUT I'D JUST SAYS SERVICES CAN
BE APPLIED TO ANYONE OF ANY AGE
IF THEY HAVE A DISABILITY.
AND SORRY.
SEEING A SLIDE THAT TALKED ABOUT
INDIVIDUALS WITH DISABILITIES --
HERE IT IS PAGE.
ELEVEN BOMB AND IT TALKS ABOUT A
HUNDRED FOUR THOUSAND YOUNG
ADULTS.
I TWO PUT AT SO THIS.
AND SO YOU'RE FACTORING IN
CURRENTLY IN TERMS OF YOUR
ESTIMATES POTENTIAL I TO ASSESS
COSTS. FOR EVEN YOUNGER
UNDOCUMENTED RESIDENTS CORRECT
THEY'RE NOT IN OUR ESTIMATE BUT
YES THIS IN THE SOCIAL SERVICES
ESTIMATE THEY ARE --
S. AS ASSUMING THOSE COSTS.
I JUST WANT TO BE CLEAR. FOR THE
BILL ADDED ANOTHER QUESTION --
ONE MORE QUESTION LIKE COLUMBO.
IRAQ ALONE THAT'S I I WANTED TO
KNOW -- THE
RELATIONSHIP WITH THE FEDERAL
GOVERNMENT --
WITH THE WAIVER IS VERY
IMPORTANT FOR US HE'S COMING
YEAR AND THE LEGISLATURE IN THIS
COMMITTEE AND THE WHOLE
LEGISLATION BE.
FULLY ENGAGED IN.
WHEN YOU KNOW THAT THE ISSUE AND
I CERTAINLY AGREE WITH MY
COLLEAGUE FROM RIVERSIDE THAT?
WE NEED TO KIND OF FULLY ENGAGE
OURSELVES AND UNDERSTANDING THAT
I HAD I HAD ONE PARTICULAR
SERVED US A MENTAL HEALTH
QUESTION --
ONE OF THE BIG --
PROBLEMS WITH --
ESSENTIALLY GETTING PEOPLE OUT
OF INSTITUTIONAL FACILITIES LIKE.
STATE HOSPITALS OR LA COUNTY
JAIL FOR EXAMPLE THE BOARD OF
SUPERVISORS IN LA MADE SOME
DECISIONS. TO START TALKING
ABOUT A MENTAL HEALTH FOR A
FACILITY BUT THEY HAVE THIS
PROBLEM.
IN IMPLEMENTING THAT WITH THE
THE WAIVER THE I AM THE ISSUE.
TO REQUEST THE FEDERAL
GOVERNMENT ARE IS THE DEPARTMENT
TO MAKE SOME EFFORT TO ALLOW
CALIFORNIA [inaudible] TO BE
EXCLUDED FROM THAT LAW AND AND
PROCEED WITH --
THAT ISSUE SO WE CAN HAVE THESE --
PSYCHIATRIC HOSPITALS.
OF IN CALIFORNIA.
YES SO --
STATUS OF THE ON SHORE SO WE
OBVIOUSLY DO YOU ALREADY HAVE
THAT WITH RESPECT TO THE SUBURBS
USES SIDE WE'VE BEEN HAD WE'VE
HAD THAT FOR SEVERAL YEARS OF
THE WAIVER.
THINK THIS IS A NEW OPPORTUNITY
FROM THE FEDERAL GOVERNMENT ON
THE MENTAL HEALTH SIDE --
IS A PART OF OUR OVERALL
PLANNING AS WE LOOK AT OUR
WEAVERVILLE NOT ONLY ARE ELEVEN
FIFTEEN WAIVER --
BUT ALSO OUR MENTAL HEALTH
WAIVERS IS ALSO EXPIRING NEXT
YEAR AND SO IT THAT'S A PART OF
THAT THAT WHOLE PROCESS THAT
WILL BE STARTING --
SOME STAKEHOLDER WORK IN THE
FALL IN TERMS OF WHAT THINGS
NEED TO BE INCLUDED HOW WOULD-THEY BE FUNDED.
OBVIOUSLY JUST LIKE WITH THE
SEVENS USE DISORDER --
WAIVER YOU KNOW IT IS SOMETHING
THAT THEN COUNTIES OFTEN TO YOU
SINCE COUNTIES ARE RESPONSIBLE
FOR THE FUNDING SO WE DON'T HAVE
ALL FIFTY EIGHT COUNTIES RIGHT
EVEN ON THE SENTENCE YOU SIDE.
SO THAT'S JUST ANOTHER THING TO
ADD TO KEEP IN WE PAY FOR MENTAL
HEALTH SERVICES IT WOULD REALLY
NEED TO BE ALSO BE A COUNTY
DECISION TO WANT TO PROVIDE THAT --
I AM CERTAIN THERE PROBABLY SOME
THAT WOULD --
THE CITY --
YEAH WELL JETER THE PRISONS YOUR
ARM ON THE BUDGET SUBCOMMITTEE
MANAGER AND SKINNER --
WE WERE LIKE.
KIND OF TAKEN ABACK WITH THE
MULTI BILLION DOLLAR INCREASE.
AND WE AND AND NO INCREASE IN
THE POPULATION.
SO I THINK SOME OF US OUT SO WHY
IS THAT HAPPENING.
WELLS BECAUSE OF FORTY FIVE
HUNDRED ADDITIONAL PEOPLE.
IN THE STATE PRISON WERE
REQUIRED TO HAVE EXTRA MENTAL
HEALTH SERVICES.
IN THE STATE PRISON.
IN THE COSTS OF HEALTHCARE IN
THE STATE PRISON IS GONE UP WE
NOW SPEND NINETY THOUSAND
DOLLARS PER INMATE.
NOW [inaudible]
I I THINK THE WHEN WE TALK ABOUT
SAVING MONEY.
IF YOU ADD IN THE COUNTY'S JAIL.
LIKE WHAT LOS ANGELES DOING IS
IS FISCALLY CORRECT TO DO.
THIS TO GET THESE PEOPLE OUT OF
SERVICE IN HUMANE.
SITUATION AND PUT INTO A
THERAPEUTIC HEALTH CARE FACILITY.
AND I THINK A. WE AT THE STATE
NEED TO THINK THE SAME WAY.
AS THEY WERE DOING WITH OUR
STATE FACILITIES WE NEED TO KIND
OF HAVE A A PLANT.
SO THAT'S WHERE WE NEED THIS
WAIVER.
NOT WE'RE SPENDING BILLIONS
EVERY YEAR.
THAT WE COULD BE SPENDING WITH
MEDI CAL MATCH.
CORRECT.
UNION AMERICA BECAUSE THE STATE
PRISON WE HAVE TO PAY FOR IT OF
THE GENERAL FROWNED.
ACOSTA 100% STATE GENERAL FUND.
IF WE HAD THESE FACILITIES INTO
COMMUNITIES PSYCHIATRIC
[inaudible]
SECURE PSYCHIATRIC HOSPITALS WE
COULD WE COULD THEN.
CARE FOR PEOPLE REDUCE
RECIDIVISM AND LOWER COST.
AN I TAKE THIS AS THIS OUT SO
THAT'S WHY I KEEP INSISTING.
THAT THE CRIMINAL JUSTICE SYSTEM
THE HEALTHCARE SYSTEM HAS TO HAS
TO BE LOOKED AT TOGETHER.
IN CALIFORNIA IN OUR BUDGET IF
WE DON'T IF WE KEEP LOOKING AT
IT LIKE WE HAVE IN THE FILES IN
SILOS.
WE'RE NOT WE'RE NOT WE'RE NOT
GOING TO SAVE ANY MONEY IN THE
SO I I I INSISTED THAT WAIVER.
BE A PRIORITY THIS YEAR BECAUSE
OTHERWISE WE'RE GONNA HAVE
ANOTHER BILLION DOLLAR INCREASE
IN THE BUDGET OF THE CRIMINAL
JUSTICE SYSTEM RIGHT MISSY ON MY
CONSERVATIVE FISCAL.
AND THEN HEAD SINCE THEY KNOW
THE F. THE MEN CORNER OF THEIR
SENATOR BILL THAT'S THE AMEN
CORNER.
THANK YOU VERY MUCH --
TO THE PANEL WE APPRECIATE YOU
COLLEAGUES WE'RE GOING TO MOVE
ON WITH OUR OF ELEVEN FORTY
HAVING ARRIVE --
TO OUR US STAKEHOLDER PANEL --
AGAIN UNDER THE EXPANSION.
SECTION OF OUR AGENDA WE'RE
GONNA HAVE REPRESENTATIVES COME
FORTH FROM THE CALIFORNIA
IMMIGRATION POLICY CENTER.
HEALTH ACCESS CALIFORNIA.
AND COUNTY HEALTH EXECUTIVES
ASSOCIATION OF CALIFORNIA.
WE'RE GOING TO HEAR FIRST FROM
MISTER.
YEAH SO GAG MOESHA GAG NEEDS TO
PRONOUNCE YOUR FIRST NAME FOR ME.
DEEP AND I HAVE THAT RIGHT.
DEEP INDIGNATION WHO'S THE
SENIOR LET'S SAY THE ADVOCATE
FROM THE CALIFORNIA IMMIGRANT
POLICY CENTER HE'LL BE FOLLOWED
BY EVERYBODY'S FAVORITE BETH
DETAIL.
POLICY ADVOCATE WITH HEALTH
ACCESS CAL SAY THAT BECAUSE BETH
AND I WORKED TOGETHER.
FOR LONGER THAN WE EITHER OF US
WOULD CARE TO ACKNOWLEDGE.
FOLLOWED BY MISS MICHELLE GIVENS
IS EXECUTIVE DIRECTOR OF THE
COUNTY HEALTH EXECUTIVES
ASSOCIATION OF CALIFORNIA MYSTIC
EGNATIA THANK YOU FOR BEING HERE
THANK YOU AND AGAIN MY NAME IS
STEVEN TCHNICIAN WITH THE
CALIFORNIA IMMIGRANT POLICY
CENTER.
WHERE THE PROD CO SPONSORS OF
THE PROPOSAL TO EXTEND MEDI CAL
ELIGIBILITY TO ALL INCOME
ELIGIBLE RESIDENTS REGARDLESS OF
THEIR IMMIGRATION STATUS AND WE
DO WANT TO THANK THE GOVERNOR
FOR INCLUDING HIS INITIAL
PROPOSAL I'M TO AGES?
TWENTY FIVE OMINOUS JANUARY
TENTH BUDGET.
CALIFORNIA LEAD THE COUNTRY IN
EXPANDING OB PULLED PRO
IMMIGRANT POLICIES SUCH AS
HEALTH FOR ALL KIDS --
WHICH TO DATE HAS AND ROLLED
OVER TWO HUNDRED SIXTY EIGHT
THOUSAND UNDOCUMENTED LOW INCOME
CHILDREN WHICH WOULD OTHERWISE
NOT HAVE ANY ACCESS TO HEALTH
CARE SERVICES --
THESE CHILDREN LIKE WAS
MENTIONED BEFORE WILL AGE OUT --
OF MEDI CAL AT THE AGE OF
NINETEEN AND WE DO AGREE THAT
WOULD CREATE ITS OWN CHILLING
EFFECT. ONE OUT OF TWO CHILDREN --
IN CALIFORNIA HAS AN IMMIGRANT
PARENT BUT IMPORTANTLY ONE OUT
OF SIX HAS A PARENT WHO IS
UNDOCUMENTED.
SADLY THESE PARENTS ALONG WITH
OLDER SIBLINGS AND GRANDPARENTS --
CONTINUE TO BE SYSTEMATICALLY
EXCLUDED FROM ACCESSING
COMPREHENSIVE IN PRINT
PREVENTATIVE HEALTHCARE.
AMONG THE MANY STORIES HAVE
FAMILIES DEVASTATED BY THEIR%
LACK OF HEALTH INSURANCES THAT
OF MARIA AND HOBBY ERR.
THEIR PARENTS TO THREE CHILDREN --
WHO RESIDE JUST OUT OF SAN
FRANCISCO?
WHEN HAVE YEAR WAS DIAGNOSED
WITH DIABETES?
HE AND HIS WIFE TRAVEL TO MEXICO
FOR INSULIN.
LAST YEAR THEY CROSS THE BORDER
JUST TO GET INSULIN.
AND THEY DIDN'T RETURN TO THEIR
CHILDREN OUR COMMUNITY.
THIS STORY AS WELL AS COUNTLESS
OTHERS SHOW THE PAINFUL REALITY
THAT FAMILY SEPARATION IS NOT
JUST A RESULT OF WALLS AND BANDS
FAMILY SEPARATION CAN ALSO
RESULT FROM DEEP IN EQUITIES AND
OUR HEALTHCARE SYSTEM.
HEALTHCARE IS ALSO INTEGRAL TO
THE CURRENT CONVERSATION AROUND
ECONOMIC DISPARITIES IN OUR
STATE AS WAS ALSO MENTIONED
UNDOCUMENTED CALIFORNIANS PAY AN
ESTIMATED THREE POINT TWO
BILLION DOLLARS EVERY YEAR AND
STATE AND LOCAL TAXES AND MAKE
UP ALMOST ONE TENTH OF OUR
STATE'S WORK FORCE.
AND DESPITE CONTRIBUTING SO
SIGNIFICANTLY TO CALIFORNIA'S
ECONOMIC VITALITY TO THEIR LABOR
AND TAXES THEY'RE EGREGIOUSLY
EXCLUDED FROM THE PROSPERITY
WHICH THEY HAVE HELPED TO
GENERATE.
WHEN AND UNDOCUMENTED ADULT GETS
INJURED ON THE JOB THEY HAVE FEW
OPTIONS TO ACCESS CARE?
IF AN ILLNESS DOESN'T GO AWAY BY
ITSELF THE CONSEQUENCE IS
PERMANENT DISABILITY OR DEATH.
UNDOCUMENTED ADULTS CUT
CONSTITUTE THE SINGLE LARGEST
GROUP IN CALIFORNIA'S REMAINING
UNINSURED POPULATION --
AND WE CERTAINLY AGREE THAT
BROADER CONVERSATION DOES NEED
TO HAPPEN --
BECAUSE IT'S MORE URGENT NOW
THAN EVER THAT --
OUR LEADERSHIP AND CARING FOR AN
UPHOLDING THE DIGNITY OF OUR
IMMIGRANT COMMUNITIES --
IS -- AT THE
FOREFRONT OF THE CONVERSATION WE
HAVE THE WILL AND RESOURCES TO
DO THIS --
TOGETHER AND REACH OUR GOAL
THANK YOU FOR YOUR TIME.
THANK YOU VERY MUCH WE'RE GONNA
HOLD ALL THE QUESTIONS TO THE IN
THE FULL PANEL THANK YOU MISTER
BELL.
A BILL HEALTH FOR HEALTH TAXES
CALIFORNIA WE'RE PROUD TO
SPONSOR WITH CALIFORNIA
IMMIGRANT POLICY CENTER.
THE EFFORT TO GET TO HELP FOR
ALL TO COVER ALL UNDOCUMENTED
ADULT IN CALIFORNIA AND TO DO SO
WITH THE SAME BENEFIT PACKAGE
THAT EVERY OTHER CALIFORNIAN IS
ENTITLED.
TO WE'VE LISTENED TO THE
DISCUSSION HERE TODAY AND I WANT
TO NOTE THAT IF YOU'RE OVER
SIXTY FIVE OR IF YOU'RE UNDER
EIGHTEEN AND YOU NEED HOME CARE
YOU SHOULD BE ABLE TO HAVE HOME
CARE RATHER THAN SAYING THAT A
FAMILY MEMBER HAS TO BE OUT.
OF THE WAGE PAYING ECONOMY IN
ORDER TO CARE FOR YOU THAT.
WE HAVE HOME CARE.
MOST PEOPLE WHO PROVIDE HOME
CARE NOW OUR FAMILY MEMBERS AND
THAT'S A GOOD THING IT'S SO HOW
IT SHOULD BE.
AND A HIGH PERSONALLY AM PROUD
OF THE STATE OF CALIFORNIA
RECOGNIZES THEIR LABOR BECAUSE
MOST OF THEM ARE WOMEN.
I ALSO WANT TO PUT A FINER POINT
ON OF THE DISCUSSION ABOUT
RESTRICTED SCOPE WE TALK ABOUT
SORT OF BLISSFULLY THAT YOU GET
A BURKE CHEN C. OLY CARE BUT
YOU DON'T CARE PRIMARY
PREVENTIVE CARE LET ME.
IN SPLITS THOSE AMONG YOU WHO
HAVE WORKED WITH PEOPLE WHO ARE
UNDOCUMENTED NO OR UNINSURED FOR
ANY REASON.
KNOW THE REALITY OF LIVING
SICKER DYING YOUNGER AND BEING
ONE EMERGENCY ROOM VISIT AWAY
FROM BANKRUPTCY.
IF YOU HAVE ASTHMA YOU DON'T GET
THE MEDICATION TO CONTROL YOUR
ASTHMA WHEN YOUR ASTHMA IS SO
BAD YOU'RE ENDANGERING YOUR LIFE
YOU WILL GET A TREATMENT IN THE
EMERGENCY ROOM BUT SHE WON'T GET
ONGOING MEDICATIONS.
THE FAMILY WHO WERE THE ONGOING
DOCTOR VISITS THE TESTS.
AT ONE POINT TO ONE OF OUR
COUNTIES IN IN CALIFORNIA THE
DIABETES MANAGEMENT PROGRAM WAS
THAT THE HEALTH DIRECTOR.
VISITED THE PEOPLE WHO HAD
AMPUTATIONS.
K. THAT'S WHAT HAPPENS IF YOUR
DIABETES ISN'T ISN'T MANAGE TO
HAVE AMPUTATIONS THERE ARE ANY
NUMBER OF ACADEMIC STUDIES ABOUT.
DIABETES AND THE UNINSURED
HEARING CALIFORNIA THAT SHOW THE
RATE OF AMPUTATIONS ARE HIGHER
FOR PEOPLE WHO DON'T HAVE
COVERAGE.
IT'S ALSO THE RATE OF BLINDNESS
SO WHEN WE TALK ABOUT PEOPLE
NEEDING CARE.
IT'S NOT JUST ABOUT KEEPING
PEOPLE OF THE EMERGENCY ROOM
IT'S ABOUT KEEPING THEM.
IN THE COMMUNITY WORKING
CONTRIBUTING PAYING THEIR TAXES
BEING PART OF THEIR FAMILIES.
THE SAME THING IS TRUE FOR
CANCER.
AN AUNT WHO HAD BREAST CANCERS
CHILD STOLE TO THE SOLUTION THE
CARE SHE RECEIVED WAS WHEN SHE
SCREAMED LOUDLY ENOUGH THAT THE
NEIGHBORS CALLED THE COPS.
THEY TOOK HER TO COTTAGE
HOSPITAL IN SANTA BARBARA WITH
THE FOR PAIN MEDS SHE WASN'T
SCREENED SHE WASN'T TREATED SHE
WASN'T PROVIDED ANY OTHER CARE
MY GRANDFATHER SPEND HIT.
HER LAST YEAR'S CARING FOR HOME
THOSE ARE THE REALITIES OF BEING
UNINSURED SO WE SORT OF PASS
OVERWRITTEN TALK ABOUT PRIDE
PEOPLE DON'T GET PRIMARY
PREVENTIVE CARE.
I WANTED TO PUT A SHARPER POINT
FOR ON IT FOR YOU ISSUE MAKES
THIS THESE DECISIONS ABOUT WHO'S
GOING TO GET HERE.
HOW MANY PEOPLE ARE GOING TO GET
COVERAGE WHEN IT'S GOING TO
HAPPEN WE'VE BEEN WORKING FOR
HEALTH FOR ALL FOR MORE THAN
FIVE YEARS NOW?
WE'RE HAPPY THAT WE'VE MADE SOME
PROGRESS WE'RE DELIGHTED THAT
THE GOVERNOR SAYS HE'S COMMITTED
TO ALL.
BUT SOMETIMES WE GET A LITTLE
IMPATIENT WHEN WE THINK ABOUT
REAL PEOPLE --
FINALLY WITH RESPECT TO
REALIGNMENT.
THE ADMINISTRATION PROPOSES TO
TAKE A THIRD OF THE MONEY BUT
THE ONLY PROPOSED COVER 10% OF
THE PEOPLE YOU MIGHT WANT TO
THINK ABOUT THAT --
YOU ALSO MIGHT WANT TO THINK
ABOUT THE FACT THAT SOME
COUNTIES TO A FAIR AMOUNT SOME
COUNTIES DON'T DO VERY MUCH.
AND SOME COUNTIES HAVE RECENTLY
STARTED DOING MORE WEATHERED
SACRAMENTO OR THE CMS PEAK
COUNTIES THAT HAVE RECENTLY
EMBARKED ON DOING MORE SHE'D
WANT TO KEEP THAT IN MIND AS
YOU'RE THINKING.
IF YOU'RE NOT GOING TO DO
EVERYBODY THIS YEAR.
WE SURE HOPE.
AS YOU THINK ABOUT THIS --
WE'D ASK YOU TO KEEP THOSE SORTS
OF FACTORS IN MIND IN ALSO TO
REMEMBER.
IT'S NOT JUST DOLLARS IT'S REAL
PEOPLE IN REAL CARE.
THANK YOU.
THANK YOU MS GIVENS.
GOOD MORNING MICHELLE GIVEN THAT
THE COUNTY HEALTH EXECUTIVES
ASSOCIATION OF CALIFORNIA WE
REPRESENT LOCAL HEALTH
DEPARTMENTS THROUGHOUT THE STATE
WE'RE MANDATED TO PROVIDE
INDIGENT HEALTH SERVICES AND
PUBLIC HEALTH SERVICES TO OUR
COMMUNITIES.
AT CHECK HAS BEEN SUPPORTIVE AND
CONTINUES TO BE SUPPORTIVE OF
EXPANDING MEDIC HELD HER ALL
INDIVIDUALS REGARDLESS OF
IMMIGRATION WE SUPPORTED LAST
YEAR'S BILLS IN BUDGET PROPOSALS.
AND TO EXPAND COVERAGE TO
UNDOCUMENTED YOUNG ADULTS AND
SENIORS AND WE'RE REALLY PLEASED
TO SEE THE GOVERNOR NEWSOME'S
PRIORITIZED EXPENDING MEDIC CAL.
HOWEVER OUR CONCERN IS THAT --
IT IN GENERAL FINANCING
ADDITIONAL EXPANSIONS OF MEDIC
HAL USING ADDITIONAL COUNTY
REALIGNMENT DOLLARS IT JUST
GIVES US GREAT PIES AND I'M HERE
TODAY TO TO JUST HIGHLIGHT A FEW
OF THE ADVERSE IMPACTS TO
COUNTIES THAT --
WEREN'T YOUR CONSIDERATION ONE
CRITICAL USE OF HEALTH
REALIGNMENT DOLLARS THAT THE
GOVERNOR'S PROPOSAL DOES NOT
ADDRESS IS THE PROVISION OF
PUBLIC HEALTH SERVICES --
UNDER AB EIGHTY FIVE THE FORMULA
INCLUDES A MECHANISM TO ALLOW
COUNTIES TO RETAIN A PERCENTAGE
OF FUNDING THAT WAS HISTORICALLY
USED FOR PUBLIC HEALTH SERVICES.
HOWEVER FOR AND THE KILLINGS
WERE 60% OF THOSE REALIGNMENT
DOLLARS ARE BEING REDIRECTED THE
UNDERSTANDING WAS THAT THAT 40%
WOULD REMAIN UNCHANGED WITH THE
JURISDICTIONS AND BUY IT AND AND
WOULD BE A STABLE SOURCE OF
FUNDING FOR A RESIDUAL AN
INSURED RESPONSIBILITIES AND FOR
OUR PUBLIC HEALTH SERVICES.
AND LET ME JUST PAINT A PICTURE
OF SOME OF THE ISSUES THAT WERE
EXPERIENCING ON THE PUBLIC
HEALTH SIDE.
AND CALIFORNIA HAS SEEN A
HISTORIC INCREASE IN THE RATE OF
STDS OVER THE LAST THREE YEARS --
WE'RE EXPERIENCING MORE
DEVASTATING FIRES AND AN UPTICK
IN HOMELESSNESS WHICH BOTH
CONTRIBUTE TO AN INCREASED RISK
OF INFECTIOUS DISEASE --
AND WE'RE ALSO SEEING DISEASES
THAT WE THOUGHT WERE FOR
CALIFORNIANS ARE OBESE AND 46%
OF CALIFORNIANS ARE PRE DIABETIC
THIS LOSS OF ADDITIONAL HEALTH
REALIGNMENT DOLLARS IS REALLY
GOING TO CRIPPLE OUR ABILITY AS
LOCAL HEALTH DEPARTMENTS TO
CONTINUE TO ADDRESS THESE ISSUES.
THE GOVERNOR'S PROPOSAL ALSO
ASSUMES THAT ALL COUNTIES WILL
CONTINUE OUR WILL EXPERIENCE
EVENINGS AND WHEN THIS
POPULATION HAS MOVED INTO BEING
ELIGIBLE FOR MEDI CAL BUT IT
DOESN'T ACKNOWLEDGE THE VARIOUS
WAYS IN WHICH COUNTIES HAVE
FILLED THEIR INDIGENT CARE
RESPONSIBILITIES.
AND IT DOES NOT ADDRESS THE
UNCERTAINTY AROUND PUBLIC CHARGE
THE FEDERAL THREATS THAT REMAIN
TO THE AFFORDABLE CARE ACT IN
THE CONTINUE NEED TO ENSURE A
VIABLE SAFETY NET.
WE LOOK FOR TING GAUGING WHAT
THE LEGISLATURE IN THE
ADMINISTRATION I'M AROUND THESE
ISSUES AND WE JUST ASK THAT YOU
AND CONTINUE JUST TO THINK ABOUT
HOW FUNDAMENTAL NINETEEN NINETY
ONE REALIGNMENT IS TO LOCAL
HEALTH DEPARTMENTS.
BOTH TO OUR OBLIGATION TO
PROVIDE INDIGENT CARE SERVICES
BUT ALSO TO OUR OBLIGATION TO
PROVIDE PUBLIC HEALTH SERVICES
AND AND WE THINK THAT THIS IS A
TIME WHERE GREATER INVESTMENTS
INTO PUBLIC HEALTH IS NEEDED.
AND SO THIS PROPOSAL JUST GIVES
US PAUSE BECAUSE OF THOSE.
THANK YOU VERY MUCH QUESTIONS
COLLEAGUES [inaudible]
DOCTOR PAN --
I'VE APPRECIATED THE THE
PRESENTATION REGARDING PUBLIC
HEALTH --
ARE HEALTH CAMILLE BE LOOKING AT
PUBLIC HEALTH INFRASTRUCTURE AND
THE LACK THERE OF AND I KNOW
THAT -- WELL
THAT BASICALLY IN RECESSION MANY
COUNTIES CUT BACK THEIR PUBLIC
HEALTH DEPARTMENTS --
WE'VE MADE SOME I GUESS IT JUST
MEANS TO REALIGNMENT THAT --
PRIME MEANS FEWER DOLLARS ARE.
TRICKLING DOWN TO PUBLIC HEALTH
SAME TIME --
WELL I CAN'T TELL YOU WHAT'S
GOING TO HAPPEN EACH YEAR I IT
SEEMS LIKE WE ALWAYS KIND OF
WONDER TO OUTBREAKS OF SOMETHING.
AND THEN WE HAVE THE ON GOING --
ISSUE FOR EXAMPLE I GUESS DUTIES
THE FACT THAT WE HAVE BABIES
BORN WITH SYPHILIS.
IN TODAY'S SOCIETY IN CALIFORNIA
I MEAN.
SOMETHING'S GONE VERY WRONG.
SO -- SO WE
SINCE WE SHOULD CERTAINLY LOOK
AT THAT AND SEE WHAT WE'RE DOING
TO STRENGTHEN THE PUBLIC HEALTH
AND STRUCTURE --
NOT THAT I WANT TO OPEN UP
NINETY ONE REALIGNMENT --
BUT WE SHOULD LOOK AT HOW THOSE
DOLLARS SLOW INTERPLAY HAPPENS
BETWEEN --
BETWEEN COUNTY AND AND AND AND
AND MEDI CAL.
THANK YOU ANYONE ELSE. FOR MORE
LOT FALL BY THIRTY BELL.
THANK YOU MADAM CHAIR IBM.
COMING FROM COUNTY LAND --
APPRECIATE --
MISGIVINGS YOU'RE.
AT LEAST GIVING --
YOUR YOUR POSITIONS --
REALIGNMENT IT'S BEEN A KIND OF
AN AWKWARD.
STRATEGY FOR COUNTIES AB ONE AND
I BEING THE MOST RECENT WHICH
YOU KNOW YOU GIVE US ALL THE
WORK AT THE COUNTY LEVEL AND
THEN YOU SAY YOU'LL FIND IT BUT
THE FUNDING HAS ALWAYS BEEN --
BELOW WHAT THE ACTUAL COSTS HAVE
BEEN SO IT'S BEEN ROLLED REAL
DIFFICULT ESPECIALLY WITH AB ONE
I WITH THE HEALTH CARE OF THE OF
THE INMATES ARE COMING TO OUR
COUNTY SO WE'RE PAYING SOME
PRETTY SERIOUS.
HEALTH CARE COST SO I'M JUST THE
CURIOUS ABOUT --
THIS REVERSE REALIGNMENT IDEA IT
WAS SORT OF IT WHEN I WHEN I WAS
REVIEWING THE MATERIAL I WAS I
THOUGHT THIS IS THIS IS UNIQUE
OUT ARE WE HOW DO WE DO THAT SO.
THANK YOU FOR DRAW --
YOU MADE A COMMENT ABOUT
DISEASES THOUGHT OR EDUCATED OR
SHOWING INCREASES COULD YOU.
EXPAND ON THAT.
SURE I THINK AND WE'RE SEEING
THINGS LIKE TYPHUS WERE SEEING
YOU KNOW.
OTHER THIRD OF MEASLES I THINK
EVERY DAY THERE'S A NEW THREAT
TO PUBLIC HEALTH IT'S THAT'S
COMING OUT IN THE THIS IS NOT --
THEY'RE NOT UNCOMMON AS THE
DEPARTMENT OF PUBLIC HEALTH
ISSUE TO REPORT IN TWENTY
SIXTEEN AND I BELIEVE THEY'LL
PUBLISH THE TWENTY SEVENTEEN
REPORT.
THERE ARE THERE ARE A TONS OF
DISEASES THAT ARE AROUND THAT
pGRAPPLING WITH AND WE DO A LEVEL
OF INVESTIGATION I'M IN CONTACT
TRACING AND SO FORTH.
AND THEN WE ALSO TAKE
PRECAUTIONS TO MAKE SURE THAT
WE'RE TRYING TO PREVENT THE
SPREAD --
AND THEN I I ALSO WOULD WANT TO
HIGHLIGHT NOT THAT IT'S DISEASES
THAT WE THOUGHT WERE ONCE A
RADIC HEATED BUT EVEN THINGS
LIKE A NARROW OUTBREAK.
I THINK WE FAIL TO THINK ABOUT
HOW OLD THESE THINGS CAN IMPACT
AT PARTICULARLY VULNERABLE
COMMUNITIES THE ELDERLY AND
CHILDREN AND SO FORTH.
AND I AM I PAINTED THE PICTURE
OF HOW WILD FIRES IN THE
INCREASE OF THAT REALLY CRIPPLES
OR PUTS ADDITIONAL PRESSURES ON
A PUBLIC HEALTH SYSTEM.
AND I THINK THERE'S SOMETHING TO
BE LEARNED ABOUT THE WILDFIRE
EXPERIENCE IN BICU COUNTY
WHERE THERE WERE THREE OUTBREAKS
OF NARAL BUYERS HAPPENING AND
HOW OUR PUBLIC HEALTH DEPARTMENT%
BOTH AT THE LOCAL LEVEL AND AT
THE STATE LEVEL HAD TO BRING IN
ADDITIONAL RESOURCES TO TRY TO
ADDRESS. TO ISOLATE AND
PARTICULARLY IN A SETTING WHERE
IT YOU KNOW IT'S A CONGREGATE
CARE SETTING AND YOU'RE NOT AND
YOU KNOW INDIVIDUAL HOMES AND
AND THINGS OF THAT MATTER SO WE
WILL CONSTANTLY CONTINUOUSLY
HAVE PRESSURES FOR PUBLIC HEALTH
I THINK OUR FLU SEASON HAS.
VARIOUS RAMP UPS AND IT'S MY
UNDERSTANDING THAT IT'S STARTING
TO GET A LOT WORSE RIGHT NOW --
AND SO THERE WILL ALWAYS BE IN A
NEW THREAT TO PUBLIC HEALTH.
THANK YOU THANK YOU MANAGER
THANK YOU THIRTY BILL.
I'M INTERESTED IN THE REACTION
FROM OUR OUR REPRESENTATIVES --
READ COMMENTS ON HOW THAT WOULD --
AFFECT.
IN THE ATTEMPTS THAT WE HAVE IN
CALIFORNIA TO ADD.
OF INSURANCE PROGRAMS MEDICARE
ALL. TO UNDOCUMENTED AND ALSO.
OF THE WHOLE [inaudible]
CASH.
PAYMENT SYSTEM FOR IMMIGRANTS.
IN TERMS OF PAYING CASH HOW THAT
BECOMES A EXPLOITIVE
[inaudible]
MEDICAL SYSTEM.
IF YOU COULD COMMENT ON THAT
PLEASE I'D APPRECIATE OR AND
THANK YOU FOR BRING UP THE
COMMON A PUBLIC CHARGE --
I THINK THAT WHAT WE HAVE SEEN
ANECDOTALLY AND A LOT OF OUR
COMMUNITIES IS THAT.
THE CONSTANT --
A STRESS THAT THEY'RE NOW FACING
AND TRAUMA NOT ONLY FROM PUBLIC
CHARGER PROPOSALS THAT --
GENERALLY PEOPLE DON'T
UNDERSTAND AT THIS TIME --
IN IMMIGRANT COMMUNITIES BUT
ALSO FROM THINGS LIKE ICE RAIDS
AND FAMILY --
DETENTIONS AND DEPORTATIONS AND
SEPARATIONS --
THERE'S A GENERAL SENTIMENT
AROUND FEAR AND SO WITH THAT I
RELATION OF PUBLIC CHARGE ON
BECAUSE THERE IS NO FINAL
PROPOSED RULE WE CAN'T
NECESSARILY SAY WHAT WILL BE
AFFECTED WHAT WILL NOT BE
AFFECTED --
AND AS WAS PREVIOUSLY MENTIONED --
MANY UNDOCUMENTED RESIDENTS MAY
NOT EVEN BE AFFECTED BUT JUST
BECAUSE THAT THERE IS THE FEAR
AND CONFUSION --
ANECDOTALLY RIGHT NOW WE ARE
ALREADY SEEING AN UPTICK IN
DESCEND ROLE MEANT --
BUT WE DO EXPECT THAT THEY WOULD
HAVE.
QUITE A SIGNIFICANT EFFECT IS
BECAUSE A LOT OF FAMILIES ARE
MAKE STATUS FAMILIES AND ALSO --
SOMEBODY AT ASTUTELY MENTIONED
THAT IF ONE PERSON --
DOESN'T GET HEALTH INSURANCE OR
CAN'T GET IT. FOR ONE PERSON
FEELS AFRAID BECAUSE THE PUBLIC
CHARGE THE ENTIRE FAMILY IS
LIKELY TO STAY AWAY FROM THAT
BENEFIT --
TO THE CASH IS THAT THE CASH --
I'M ISSUE --
WE'RE HAPPY TO GET MORE
INFORMATION TO THE MEMBERS OF
THIS COMMITTEE --
I DON'T HAVE ANY SPECIFICS --
BUT YEAH BY I CAN I STE
INCENTIVIZING --
THESE SYSTEMS THAT ARE OFFICIAL --
BECAUSE THERE IS NO COVERAGE FOR
MEDI CAL FOR UNDOCUMENTED
RESIDENTS OF THE DO YOU HAVE TO
FIND PIECEMEAL WAYS TO FIND CARE.
OR AGAIN LIKE I SAID A JUST
RESULT IN PERMANENT DISABILITY
OR DEATH IF THAT PROBLEM CAN BE
SOLVED DO THINK DO YOU THINK
THAT -- THE
THE WHOLE PUBLIC CHARGE AND IF
WE GO IN AND WE SAY WELL WE'RE
GOING TO COVER ALL THESE ADDED.
PEOPLE YOU THINK WE HAVE TO HAVE
A COMMUNITY OUT REACH --
TO SIGN PEOPLE UP.
DO YOU HAVE ANY ADVICE ON THAT
FOR US ABSENT IF WE'RE GONNA
HAVE TO DO THAT IN.
A WAY WHERE WE HAVE PEOPLE WITH
FEARS AND AB HOW DO WE GO ABOUT
DOING THAT WHAT WOULD YOUR
ADVICE BE I THINK THAT WE ARE
THE OTHERS.
TO YEAH ABSOLUTELY I THINK WE
GOT WE LEARNED A LESSON FROM THE
ACA THAT IT DID REQUIRE A LOT OF
OUR REGION EDUCATION TO REACH
PEOPLE I MEAN ESPECIALLY IN
IMMIGRANT COMMUNITIES WHERE --
SOME POPULATIONS MAY ALREADY BE
I'M DISTRUSTFUL OF INSTITUTIONS
IT DOES REQUIRE --
A LOT OF OUR REGION EDUCATION
AND SO WHEN IT COMES TO AND
ROMAN PEAS --
I THINK WHAT WITH OUR DECADES OF
EXPERIENCE OF WORKING WITH AN
IMMIGRANT COMMUNITIES --
WE SEE THAT WE NEED TIME AND
PARTNERSHIP WITH THE STATE AND
COMMUNITY ORGANIZATIONS I'M TO
REACH PEOPLE WHERE THEY'RE OUT
TO AND WHERE THEY FEEL
COMFORTABLE WITH PEOPLE WHO
SPEAK THEIR OWN LANGUAGE.
IF I MY MENTOR BETH BELL
HEALTHAXIS AGAIN WE AND
OFFICIALS IN THIS INCOME LEVEL
OR ALREADY AND ROLLED IN
RESTRICTED SCOPE COVERAGE.
AND SO WE ALREADY HAVE A
CONNECTION WITH SOME THE
EXPERIENCE WITH CHILDREN WHICH
WAS IN A HAPPIER TIME WHEN THE
WASN'T PUBLIC CHARGE ON THE
HORIZON.
WAS THAT WE SAID.
HELLO YOU KNOW ON THE SOME SUCH
DAY YOU'RE GOING TO GO FROM
EMERGENCY ONLY COVERAGE
COMPREHENSIVE COVERAGE.
AND PEOPLE WERE MOSTLY HAPPY
ABOUT THAT --
WE WOULD IT THIS IS SOMETHING
WHETHER IT'S THE LOW INCOME
HEALTH PROGRAM THE YOU'LL RECALL
FROM THE PRE ACA WE'VE ACTUALLY
GOTTEN PRETTY GOOD AT MOVING
POPULATIONS FROM LIMITED.
COVERAGE. TO FULL CUP
COMPREHENSIVE COVERAGE AND SO WE
WOULD HOPE BUT IT HAS TO GO HAND
IN HAND WITH EXPLAINING.
WHAT IT IS THAT'S GOING ON SO
THAT FOLKS NOW AND THAT THE
DEPARTMENT SPOKE TO THAT AND WE
WOULD HOPE THAT ARE --
FOUNDATION PARTNERS WHO HAVE
BEEN SO COMMITTED TO SUFFER
WOULD ALSO COULD CONTINUE TO BE
COMMENDED AS WELL.
THANK YOU TO THE PANEL FOR
BRINGING INTO THE CONVERSATION
REAL LIFE EXAMPLES IN REAL LIFE
HEALTH CRISISTO REALLY HELP
FRAME THE CONVERSATION WE'RE
HAVING WE APPRECIATE THAT THANK
YOU.
WE'RE GOING TO HOLD PUBLIC
COMMENT TO THE END OF THE-HEARING.
WE'RE GONNA TRANSITION NOW TO
PART BE OF THE HEARING THE
GOVERNOR'S PRESCRIPTION DRUG
PROPOSALS.
THE FIRST PANEL --
WILL FOCUS ON THE EXECUTIVE
ORDER ON BULK PURCHASING.
AND WE'RE GOING TO HEAR FROM
[inaudible]
MATT BENDER OUR LEGISLATIVE
AFFAIRS MANAGER DEPARTMENT OF
GENERAL SERVICES CLINT CALLUM
ASSISTANCE PROGRAM BUDGET
MANAGER DEPARTMENT FINANCE.
AND OF COURSE MISTER JOHNSON
FROM THE LA JOH.
COLLEAGUES FOLLOW THIS PANEL
WE'RE GONNA HAVE THE SECOND
PANEL ON THE TRANSITION FROM --
MEDI CAL PHARMACY THE FEE FOR
SERVICE AND THEY WILL GOING TO
HAVE A STAKEHOLDERS PANEL --
WITH REPRESENTATIVES FROM.
S. CI YOU [inaudible]
HEALTH ACCESS.
OF THE INLAND EMPIRE HEALTH
PLANS CALIFORNIA HOSPITAL
ASSOCIATION PHARMA.
THE CALIFORNIA PHARMACISTS
ASSOCIATION JUST TO GIVE YOU A
HEADLINE ON WHAT'S COMING NEXT.
MR BENDER WELCOME AND THANK YOU --
THANK YOU MADAM CHAIR AND
MEMBERS AND A ON BEHALF OF THE
DEPARTMENT OF GENERAL SERVICES
HAPPY VALENTINE'S DAY TO ALL OF
YOU FROM DG US.
THANK YOU SO MUCH.
ALL RIGHT --
IT THE MAP UNDER FROM THE
DEPARTMENT OF GENERAL SERVICES --
HERE TALK ABOUT OUR PIECE OF THE
GOVERNOR'S EXECUTIVE ORDER --
WE START OUT THE COMMITTEE
ANALYSIS POSE AN INTERESTING
QUESTION --
AND THE QUESTION IS IS THERE ANY
ABILITY. TO NEGOTIATE FOR LOWER
PRICES ON SOLE SOURCE DRUGS THAT
DON'T HAVE A GENERIC EQUIVALENT
WITHOUT TURNING INTO A BINARY
CHOICE WHERE OF NEGOTIATIONS
BREAK DOWN THE DRUG JUST ISN'T
COVERED AT ALL --
AND THE ANSWER IS YES THERE ARE
WAYS TO LEVERAGE THE STATE SPEND
WITHOUT TURNING IT INTO THAT
KIND OF A BINARY CHOICE IN TGS --
DOES THAT CURRENTLY FOR A STATE
AGENCY CUSTOMERS --
GOT NEGOTIATED PRICING
AGREEMENTS FOR NINETEEN PRIORITY
MEDICATIONS WITHOUT NEEDING.
TO ELIMINATE ACCESS TO OTHER
MEDICATIONS AND WE'VE DONE THIS
BY OFFERING PREFERENTIAL
PLACEMENT ON A FORMULARY.
THAT DOESN'T PROHIBIT THE USE OF
JERRY -- BUT
BEFORE I GET INTO EXACTLY HOW WE
DO IT I I NEED TO CLARIFY WHAT
EXACTLY WE DO A TGS WITH RESPECT
TO PRESCRIPTION DRUGS --
DDS HAS TWO DISTINCT ROLES IN
ITS SUPPORT TO DRAW A
DISTINCTION BETWEEN THEM --
THE FIRST ROLE WHICH IS THE GS
AS TRADITIONAL ROLE IS TO BUY
PHARMACEUTICALS. FOR STATE
AGENCIES THAT DON'T HAVE THEIR
OWN INDEPENDENT DRUG PURCHASING
PROGRAMS --
THAT'S WHAT WE CALL THE STATE
WIDE PHARMACEUTICAL PROGRAM --
THE CORE CUSTOMERS HERE OR CDC
ARE OF THE DEPARTMENT STATE
HOSPITALS AND THE DEPARTMENT OF
DEVELOPMENTAL SERVICES.
THOSE ARE --
THOSE ARE CALLED OUT IN STATUTE
AS OUR CORE CUSTOMERS IN
ADDITION --
WE ALSO BY FOR THE CHP THE CSU
SYSTEM AND SOME CD PH PROGRAMS --
LOCAL AGENCIES CAN ALSO USE OUR
CONTRACTS AND ACTUALLY WE HAVE
THREE OF THEM CURRENTLY OF THE
LOS ANGELES COUNTY JAIL WHICH
WAS ALREADY MENTIONED --
SACRAMENTO COUNTY JAIL IN SAN
DIEGO COUNTY HEALTH AND HUMAN
SERVICES AGENCY --
AND WERE ACTIVELY WERE WORKING
TO RECRUIT MORE --
INCLUDING THROUGH MS GIVENS
ORGANIZATION PRESENTING TO THEM
AND PRESENTED TO OTHER AGENTS
OTHER GROUPS THAT REPRESENT --
COUNTIES ANOTHER LOCAL.
ALL OF OUR MAJOR CUSTOMERS ARE
PURCHASERS TO TAKE PHYSICAL
POSSESSION OF THE DRUGS AND
DISPENSED THEM TO THEIR
POPULATIONS.
THAT'S DISTINCT FROM A PAY YEAR
RULE WHERE --
WHERE IS THE PAYER IS
ESSENTIALLY REIMBURSING FOR THE
DISPENSATION OF A DRUG AT A
RETAIL PHARMACY WE DO A VERY
SMALL AMOUNT OF THAT BUT
OVERWHELMINGLY OUR CUSTOMERS ARE
PURCHASERS --
THERE WERE THERE ALSO SOME MAJOR
AGENCIES THAT DON'T PURCHASE
THEIR DRUGS RUDY DJIA'S OF MEDI
CAL PERS AND THE UNIVERSITY
CALIFORNIA ARE THE BIGGEST ONES.
IN THAT KIND OF LEADS TO TGS IS
SECOND ROLE --
WHICH IS AS THE FACILITATOR FOR
THE CALIFORNIA OF PHARMACEUTICAL
COLLABORATIVE --
THIS IS AN INTERAGENCY WORKING
GROUP THAT BRINGS TOGETHER THE
MAJOR STATE TRUCK PURCHASING
PROGRAMS US LOCAL AGENCY
REPRESENTATIVES --
SOME REGULATORY AGENCIES AD
OTHER POLICY MAKERS --
ALL OF WHOM HAVE AN INTEREST IN
A PRESCRIPTION DRUG PRICES --
THE GOAL IS TO CONTROL
PHARMACEUTICAL RELATED SPEND FOR
A CD CPC MEMBERS.
WE HAVE THREE BASIC FOCUSES --
THE FIRST A PROCUREMENT WHICH IS
TO DEVELOP STRATEGIES AND
PARTNERSHIPS. FOR JOINT
SOLICITATIONS AND PRICING
AGREEMENTS THAT --
AS WELL AS CONTRACT PULLMAN
EXECUTION --
SECONDS POLICY --
DEVELOPING POLICY PROPOSALS
RECOMMENDATIONS FOR LEGISLATIVE
CHANGE --
AND THE THIRD IS PARTICIPATION
OTHER GOVERNMENT AGENCIES --
THE BILL TO SHARE INFORMATION
AND IDEALLY TO SURE PURCHASING
POWER -- THE
CURRENT FORM OF THE CPC DATES TO
TWO THOUSAND SIXTEEN IT'S THE
SUCCESSOR TO PREVIOUS GROUPS
DATING BACK TO TWO THOUSAND
SEVEN THAT WERE ORIGINALLY SET
UP. TO FACILITATE INFORMATION
SHARING BETWEEN TGS PURRS AND
THE UNIVERSITY OF CALIFORNIA IN
RESPONSE. TO TWO THOUSAND FIVE
LEGISLATION --
SUGGESTING THAT --
OVER THE YEARS THE ROLE IN
MEMBERSHIP HAS EXPANDED --
REFLECTING THE ADMINISTRATION'S
INTEREST IN --
PRESCRIPTION DRUG COSTS --
TGS HAS ALSO RECENTLY BEEN
STEPPING UP TO SUPPORT THE
COLLABORATIVE ON MORE OF IT WITH
YOU KNOW DEDICATED STAFF RATHER
THAN AS A COLLATERAL DUTY FOR
OUR DRUG PURCHASING STAFF --
THE BASICS DESK CALIFORNIA
PHARMACEUTICAL COLLABORATIVE --
THE BROADER WORK GROUP --
LET ME BRING IT BACK TO THE
STATEWIDE PHARMACEUTICAL PROGRAM
WHICH IS OUR CORE PURCHASING
OPERATION AT TGS OFFERED CCR DS
HDS IN THE OTHER AGENCIES --
THE BASIC STRATEGIES WE USED TO
GET LOWER PRICES FOR CUSTOMERS
IS A MIX OF VOLUME PURCHASING
AND PREFERENTIAL PHARMACY PLAY
OUR PREFERENTIAL FORMULAR
REPLACEMENT --
WE HAVE A FEW DIFFERENT
CONTRACTING APPROACHES --
WE USE DIRECT NEGOTIATIONS WITH
MANUFACTURERS WE USE --
WHOLE PHARMACEUTICAL WHOLESALER.
THAT CAN PROVIDE AS VOLUME
PRICING --
WE ALSO USE A GROUP PURCHASING
ORGANIZATION --
TO SECURE DISCOUNTS ON OTHER
DRUGS PART --
THREE BIGGEST CUSTOMERS CBC RDS
AGENT EDS HISTORICALLY OUR
BIGGEST CUSTOMERS --
HAVE USED A COMMON DRUG
FORMULARY CREATIVELY CALL THE
COMMON DRUG FORMULARY --
THAT WAS STARTED IN --
TWO THOUSAND ONE IT'S BEEN KEPT
UP TO DATE SINCE THEN WITH A A
MINOR WRINKLE TO THE CDC ARE
RECEIVERSHIP.
IT'S TECHNICALLY A SEPARATE
FORMULAR BUT WE TRY TO KEEP THEM
AS CLOSELY ALIGNED AS POSSIBLE --
ON THE COMMITTEES QUESTION ABOUT --
HOW WE APPROACH --
SOLE SOURCE DRUGS WITH NO
GENERIC ALTERNATIVE --
GENERALLY WE'VE ACHIEVED GOOD
RESULTS BY WORKING WITH OUR
COMMON DRUG FORMULARY COMMITTEE
ON ISSUES RELATED FORMULA
REPLACEMENT --
OUR NEGOTIATING POWER DEPENDS IN
SIGNIFICANT PART OF OUR ABILITY
TO CHANNEL THE STATE SPEND --
TOWARD PARTICULAR MEDICATIONS --
WHEN WE OF MULTIPLE DRUGS IN THE
SAME THERAPEUTIC CLASS --
US SIM SAME INDICATIONS SIMILAR
EFFECTIVENESS WE'VE HAD SUCCESS
IN OBTAINING DISCOUNTS --
IN EXCHANGE FOR MORE FAVORABLE
FORMULAR REPLACEMENT.
BECAUSE IF YOU SAY HAVE FIVE ON
PATENT DRUGS THAT TREAT THE SAME
CONDITIONS SIMILAR EFFECTIVENESS
INDICATIONS --
WE CAN PICK.
ONE UP PARDON ME.
WE CAN PICK ONE IS THE SORT OF
THE DEFAULT FIRST LINE THERAPY --
AND COST CAN BE A FACTOR IN THAT --
WE CAN ALSO STILL BY THE OTHER
MORE EXPENSIVE DRUGS --
AS SECOND LINE THERAPIES WERE
FOR PARTICULAR SITUATIONS WHERE
OUR FIRST LINE DRUG ISN'T A DICK
INDICATED FOR WHATEVER REASON --
BUT OUR ABILITY TO CHANNEL SPEND
TOWARD A PARTICULAR DRUG DOES
GIVE US --
SOMETHING MEANINGFUL TO OFFER
MANUFACTURERS IN EXCHANGE FOR
DISCOUNTS --
OBVIOUSLY THIS APPROACH REQUIRES
A LOT OF CLOSE COLLABORATION
WITH CLINICIANS TO REVIEW THE
DRUGS ARE THERAPEUTIC CLASS.
EVALUATE ROLE TO THE FACT IN
THIS DETERMINE WHAT KIND OF
FORMULA REPLACEMENT AND
UTILIZATION TROLLS ARE GOOD WITH.
ARE CONSISTENT WITH GOOD --
MEDICAL PRACTICE --
WE WORK CLOSELY WITH COMMON DRUG
FORMULARY COMMITTEE WHICH
REPRESENTS OUR CORE AGENCIES.
A BROADER PURCHASING PROGRAM
WOULD LIKELY BRING IN --
BROADER CONSULTATION WITH
PARTICIPATING AGENCIES --
BUT AS THE ON THE SPECIFIC
QUESTIONS THAT THE COMMITTEE
POST WE DO HAVE OPTIONS --
IN MANY CASES WHERE THERE'S A
SOLE SOURCE BROKEN NO GENERIC
ALTERNATIVE --
I AT THIS POINT IN.
EARLY EXECUTION OF THE EXECUTIVE
ORDER I DON'T THINK WE WANT TO
RULE ANYTHING OUT BUT THERE ARE
DEFINITELY.
OPTIONS THAT WE CAN PURSUE --
WITH THAT --
LIKE TO TURN IT OVER TO CLINT
FOR ANYTHING YOU'D LIKE TO ADD.
CLINT COUNT APARTMENT FINANCE --
NOTHING FURTHER TO ADD HERE TO
ANSWERING QUESTIONS.
NOT HAVE BEEN JOHNSON WITH THE
LA -- WE'RE
CONTINUING TO ANALYZE THIS
PROPOSAL AS THE ADMINISTRATION
IS AND WE THINK ULTIMATELY A LOT
IS GOING TO DEPEND ON ONE THE
FUTURE FINDINGS --
OF FROM THE ADMINISTRATION ON IN
OF THEIR EXISTING PRACTICES AND
THE AND POTENTIAL STRATEGIES FOR
GOING FORWARD.
WE WOULD NOTE THAT THE POTENTIAL
FOR SCALING --
EXISTING PRACTICES IS LIKELY
GOING TO HAVE A MAJOR EFFECT ON
ITS POTENTIAL TO ALTERNATELY
PRODUCE FUTURE FUTURE SAVINGS --
AT FOR OUR UNDERSTANDING IS THAT
CURRENTLY SAY --
DG HASSLE NEGOTIATE ON BEHALF OF
A FEW HUNDRED THOUSAND LIVES MAY
BE --
WHEREAS OTHER NEGOTIATORS
MILLIONS OF LIVES UPON WHICH
THEY ARE NEGOTIATING PRICES OVER
SO THE THE POTENTIAL IN THE GOV
UNDER THE GOVERNOR'S EXECUTIVE
ORDER TO BRING IN PRIVATE IF
THEY ULTIMATELY CHOOSE.
TO COULD REALLY BE A A BOOST FOR
THE STATE BUT ULTIMATELY WILL
DEPEND ON THEIR FUTURE DESIRE TO
DO SO SO BUT THIS IS SOMETHING
WE CONTINUE TO TRY TO UNDERSTAND
BETTER.
MUCH QUESTIONS SENATOR MONEY.
THANK YOU MADAM CHAIR --
THANK YOU FOR THIS THE OVERVIEW.
IN.
MAYBE A SHOW MY IGNORANCE BUT I
GET THE IDEA OF USING.
OUR BUYING POWER TO COVER.
THOUSANDS TENS OF THOUSANDS OF
PATIENTS.
BUT FROM A PHYSICIAN PERSPECTIVE
OFTEN. ONE DRUG THAT MIGHT WORK
FOR PATIENT AMY DOES NOT WORK
FOR PATIENT BE.
SO HOW WHAT'S THE FLEXIBILITY
THE PRESCRIBING PHYSICIAN WHEN
THE STATE.
IS USING ITS LEVERAGE TO
PURCHASE MASSIVE QUANTITIES OF
DRUG AIMED AT THAT THE PHYSICIAN
CONSIDERS FOR THIS PATIENT WE
NEED TO TRY DRUGS BEING MAYBE
DRUG SCENE.
HOW DOES THAT?
FLEXIBILITY IN PRESCRIBING.
PLAY INTO THE MASS PURCHASING.
THAT'S A GOOD QUESTION --
AS I INDICATED ARE ARE EXISTING
COMMON DRUG FOR MILLER THAT WE
USE FOR THE STATE INSTITUTIONS.
DOESN'T YOU KNOW DOESN'T RULE
OUT THE USE OF ANY DRUG --
PER SE -- WE
THE UNITED SOME THERAPEUTIC
CLASSES WE A ONE DRUG THAT WE'VE
IDENTIFIED AS YOU KNOW HAVING
PREFERENTIAL PLATE PLACEMENT.
AND SO THEIR UTILIZATION
CONTROLS AND OTHER DRUGS THAT
DOESN'T MEAN YOU CAN'T USE IT --
BUT TYPICALLY THERE'S AN
AUTHORIZATION PROCESS IS
REQUIRED TO USE IT --
THIS IS YOU KNOW NOT RADICALLY
DIFFERENT FROM THE PRIOR
AUTHORIZATION PROCESS THAT WE
EXPERIENCE WITH OUR OWN HEALTH
CARE -- SO
THERE IS THERE IS OPPORTUNITY TO
ALLOW FOR PARTICULAR SITUATIONS
WHERE -- YOU
KNOW. 80% OF THE TIME THE DRUGS
ARE THE SAME BUT FOR THIS 20% OF
THE POPULATION DRUG AXES REALLY
YOU'RE BETTER PAT --
EVEN IF IF OVER TIME YOU LEARN
THAT.
AS MANY AS 20%.
WON'T BENEFIT FROM DRUG A CAN
CAN DRUG BE BE PART OF THAT
PURCHASING.
STRATEGY WHEN YOU KNOW.
NON IN SOME OF THESE
INSTITUTIONS THEY'RE GONNA NEED
TO ACCESS THAT VERSES THE DELAY
OF OF HAVING.
TO GO THROUGH WHATEVER THE
BUREAUCRATIC PROCESSES OF
GETTING THAT AUTHORIZATION --
WE DEFINITELY CAN WE DEFINITELY
CAN PURSUE MORE THAN ONE DRUG IN
A THERAPEUTIC CLASS --
AND TRY AND TRY OUR BEST. TO TO
OFFER THE OPPORTUNITY TO CHANNEL
SPEND TOWARD THE MANUFACTURERS
AND US SEE WHAT THEY'RE WILLING
TO GIVE US.
BEGIN IN JUST LOOKING IN
ECONOMIES OF SCALE.
SO CANADA HAS AMONG --
THE LEAST EXPENSIVE.
DRUG PRICES IN THEY HAVE ABOUT A
SIMILAR POPULATION TO THE ENTIRE
POPULATION OF THE STATE OF
CALIFORNIA --
YOU'RE BUYING ON BEHALF OF STATE
ENTITIES COVERING STATE COVERED
PATIENTS --
HEY IS THERE ANY PROHIBITION TO
CALIFORNIA.
COMBINING WITH OTHER STATES TO
FURTHER MAXIMIZE OUR LEVERAGE IN
THAT MARKET TO SET REYES ANTI
TRUST ISSUES OR COULD WE PARTNER
WITH OREGON AND WASHINGTON FOR
EXAMPLE. TO HAVE EVEN A STRONGER --
LEVERAGE IN THAT MARKET THAT THE
PHARMACEUTICAL PRODUCER ANY.
THEY WANT THE CANADA ACCOUNT NOW
THEY WANT THE NOT JUST
CALIFORNIA BUT A COMBINED --
STATE THE GROUP OF EMPIRES OF
THAT SO THAT'S A GREAT QUESTION
IT'S AND IT'S DEFINITELY
SOMETHING THAT WE'VE TALKED
ABOUT AND INNER CONSIDERING --
ACTUALLY.
PRICE YOU MENTIONED OREGON
WASHINGTON WHICH WERE THE ONE
THE THE THE THOSE STATES HAVE
EXPRESSED YOU KNOW GENERAL
INTEREST.
IN --
PRESCRIPTION DRUG PURCHASING AS
WELL OBVIOUSLY CALIFORNIA'S MUCH
BIGGER STATE THAN THOSE TWO
STATES -- SO
THAT THERE MAY BE YOU KNOW
FRANKLY THE OTHER STATES MAY
BENEFIT MORE THAN CALIFORNIA.
BUT YES THERE ARE POTENTIAL
BENEFITS TO JOINING WITH OTHER
STATES -- IF
WE CAN IF WE CAN MAKE IT ALL
WORK.
WHEN I HESITATE TO SAY ME WE
SHOULD EXPLORE WORKING WITH
TEXAS TOO BUT THAT MAY BE A NON
STARTER CAM?
THANK YOU MADAM CHAIR THINKING.
THANK VENTURE FOR THOSE OF US
WHO HAVE --
SAFETY NET CLINICS IN SAFETY NET
HOSPITALS COUNTY HOSPITALS WHO --
HAVE COME TO RELY ON THREE FORTY
B. WAIVER --
AND THE DISCOUNTS --
TO STRETCH RESOURCES AND KEEP
THE DOORS OPEN --
DO YOU ANTICIPATE THAT THIS
PRESCRIPTION DRUG PROPOSAL WILL
HAVE AN IMPACT ON THOSE ENTITIES
AND HOW DO YOU PROPOSE TO
MITIGATE THAT. TO A TWO PARTER.
OKAY --
THANK YOU THANK YOU FOR THE TWO
PART QUESTION --
I THINK.
I DON'T HAVE --
COMPLETE ANSWER FOR THAT --
OBVIOUSLY.
THE EXTENT THE EXACTLY WHO IS
GOING TO BE PURCHASING THROUGH
THE BULK PURCHASING PROGRAM.
OBVIOUSLY WE WOULD LIKE IT TO BE
EVERYONE BUT THERE ARE
PARTICULAR IS WITH.
DIFFERENT AGENCIES AND PRIVATE
PURCHASERS --
EACH ONE HAS ITS OWN SORT OF
LEGAL FRAMEWORK --
LEGAL ISSUES --
OTHER PRESS OTHER PROGRAM
PRICING THAT MAY BE AVAILABLE TO
THEM SO.
I THINK THE SHORT ANSWER IS THAT
IF WE'RE WORKING WITH SAFETY NET
CLINICS.
WE'RE GOING TO WORK TO TRY AND
UNDERSTAND WHAT THEY GET UNDER
THREE FORTY BE --
WHETHER WE CAN WHETHER WE CAN DO
SOMETHING FOR THEM THAT IS
BENEFICIAL TO THEM RELATIVE TO
THREE FORTY BE.
AND WHAT KIND OF LEGAL OBSTACLES
THERE ARE IF ANY TO THEIR
PARTICIPATION WILL IT SEEMS TO
ME IT'S JUST MOVING MONEY AROUND
ISN'T IT SO.
YOU NEED TO FIGURE OUT WHAT THE
DELTA IS AND THEY'RE EITHER
GOING TO MAKE UP THE DELTA
THROUGH THE THREE FORTY B.
PROGRAM OR THE STATE'S GOING TO
HAVE TO COME BACK IN.
IF YOU VALUE THE CONCEPT OF SO
AND AND AND MAKE IT UP I'M JUST
ASKING THAT YOU TAKE THAT INTO
CONSIDERATION.
CAN WE WE NOT HAVE A DELTA.
THAT STATES NOT IT'S ON
ADDRESSED AT THE END OF THIS
PROCESS WE WE DEFINITELY CAN
TAKE THAT INTO CONSIDERATION
WHATEVER WERE.
TALKING WITH SOMEONE ABOUT
BRINGING THEM INTO THE PROGRAM
THANK YOU THANK YOU MADAM CHAIR.
FORGIVE ME IF I MISSED IT --
WHEN I HAD TO STEP AWAY FROM THE
DANCE FOR A QUICK SECOND --
BUT THE EXECUTIVE ORDER COULD
INCLUDE A PRETTY AGGRESSIVE
TIMELINE FOR KIND OF ROLLING OUT
THE BULK PURCHASING PROGRAM --
WHAT'S THE STATUS ON
IMPLEMENTATION ARE YOU CAN IN
YOUR MILESTONES --
ELSE PLANNED.
IT ALSO TALKS ABOUT PROVIDING
REPORT TO MORE CURIOUS AS TO
WHETHER ANY THOSE REPORTS ON
YOUR STATUS WILL BE MADE PUBLIC.
ALL RIGHT --
LET ME --
LET ME FIRST ADDRESS STATUS --
WE HAVE --
COLLECTED DATA FROM ALL OF THE
STATE MEMBERS.
OF THE OF THE CPC THEY WERE
ASKED TO IDENTIFY THEIR TOP
FIFTY OVERALL SPEND DRUGS TO US --
WE RECEIVE THAT DATA WERE STILL
US OF COLLECTING DATA FROM THE
LOCAL SOME OF THAT IS STILL
TRICKLING IN.
BUT WE'RE ALREADY LOOKING AT THE
DATA -- Là
LOOKING AT PRIORITIZATION
CRITERIA --
FRANKLY THERE'S A FAIR AMOUNT OF
WORK GOING ON IN PARALLEL
BECAUSE OF THE AGGRESSIVE TIME
ONCE YOU'VE TALKED ABOUT.
BUT THE REPORT TO THE GOVERNOR --
THE FIRST FOUR TO THE GOVERNOR'S --
TO MARCH FIFTEENTH AND SO FAR SO
GOOD IN TERMS OF STAYING ON
SCHEDULE FOR THE OUT AND WE'LL
THE BILL'S REPORT BE MADE PUBLIC.
I THINK --
INITIALLY THEIR INTENDED TO BE
FOR THE GOVERNOR'S DELIBERATION --
AND I DON'T KNOW THE LONG TERM
PROSPECTS OF RELEASING THE PORTS
REPORTS HOWEVER I WOULD SAY THAT
NATURALLY WHATEVER DECISIONS
COME OUT OF THE REPORTS.
AND THOSE DISCUSSIONS WILL
PROBABLY INCLUDE WHAT DATA WAS
USE WHAT OPTIONS WERE CONSIDERED
I MEAN I THINK THAT WOULD BE A
LOT OF WHAT'S IN THE REPORT NOW
WHETHER IN FACT THAT EXACT
REPORT IS RELEASED I DON'T KNOW
[inaudible]
TURNER.
I THINK WHAT MOST OF US ARE
CONCERNED ABOUT AS ELECTED
OFFICIALS WHAT I ASSUME IS
REALLY DRIVING --
THE GOVERNOR AND FOR THAT MATTER
THE THE PRESIDENT'S INTEREST IN
A TO BE TO CONTROL THE COST OF
PHARMACEUTICALS IS REALLY MAKING
SURE THE CONSUMERS --
EXPERIENCE A SAVINGS THE BOOKS
AND SO THAT THAT THEY BENEFIT
FROM THE LOWER CLASS.
SO.
I'M CURIOUS AS TO TO WHETHER OR
NOT -- YOU
CAN GUARANTEE THAT THAT WILL BE
THE EXPERIENCE PARTICULARLY IF
YOU'RE GOING TO ALLOW PRIVATE
PAYERS TO BENEFIT.
FROM THE STATE'S PURCHASING
POWER.
THAT'S A THAT'S A GREAT QUESTION --
OBVIOUSLY THERE ARE A LOT OF
COMPLICATED ISSUES THAT NEED TO
BE WORKED OUT --
WITH THE PRIVATE PAYER
PARTICIPATION I THINK ARE PER
YOU KNOW.
THE THE WHOLE IDEA OF HAVING
POTENTIAL PRIVATE PURCHASER
PARTICIPATION IS TO GIVE THEM TO
THE OPPORTUNITY TO PURCHASE TO
PARTICIPATE IN A BIGGER POOL.
THEN WOULD OTHERWISE BE THE CASE --
WERE YOU KNOW THE THE POINT IS
TO GET LOWER A PRESCRIPTION DRUG
PRICES. FOR ALL THE PARTICIPANTS --
THAT'S WHAT WE'RE SHOOTING FOR
AND WE AND THAT'S WHAT WE EXPECT
WOULD HAPPEN.
IT'S OUR EXPECTATION BUT WE
THERE'S NO.
AS THE COMMERCIAL SAYS GARY
AUNTIE.
IF AYE AYE THERE ARE WERE ALL
WERE WERE WERE A MONTH IF IT
WERE A MONTH AND TO IMPLEMENT
MANNING THE EXECUTIVE ORDER AND
I YOU KNOW.
I THINK THE WHOLE POINT.
IS TO OBTAIN LOWER PRICES GET TO
A SITUATION WHERE WE'RE MAKING A
DECISION WHERE WHERE.
ESSENTIALLY IT'S THE DECISION IS
TO DO SOMETHING THAT MOVES
FORWARD BUT GOES IN THE WRONG
DIRECTION IN TERMS OF GETTING
LOWER PRICES.
I THINK WE'RE PROBABLY GOING TO
TAKE THE OTHER APPROACH --
WITH YOU KNOW OUR FOCUS
OBVIOUSLY WE'RE LOOKING AT THE
AT THE AT THE AGGRESSIVE
TIMELINE TO DELIVERABLES IN THE
EXECUTIVE ORDER.
BOTH ULTIMATELY WERE TRYING TO
MAKE THIS A BENEFIT FOR THE
PEOPLE CALIFORNIA AND THINGS
THAT ARE TO BENEFIT FRUIT PEOPLE
CALIFORNIA --
NOT THINGS THAT WE WANT TO DO.
GOOD TO HEAR THANK YOU FOR THAT
ANY -- FINAL
QUESTIONS OH MY GOODNESS.
SENATOR SHOULD OWN FOLLOWED BY
SENATOR MORE LOT.
ANSWERED OPINION AMOUNT OF CHAIR --
I WONDER FIRST OF ALL SAY I LINE
MY CONCERNS WITH US SENATE ROTH
OF THREE FORTY B. PROGRAM
ESPECIALLY IN SOME OF THE MORE
RURAL AREAS WITH HOSPIALS THAT.
HAVE --
THESE DRUG DISCOUNT PRO CLOSE
THE DOORS AND WILL HAVE OTHER
PROBLEMS ON OUR WATCH --
YOU MENTIONED --
AND NEGOTIATING WITH --
SIMILAR PHARMACOLOGICAL CLASSES
OF DRUGS TO PUT ONE ON A
FORMULARY AND AND ANSWER --
CENTER MONIES QUESTION OF
PHYSICIANS CAN MAKE THE CASE FOR
PRIOR AUTHORIZATIONS THIS
ATIENT IS ALLERGIC TO THIS
BRAND NAME DRUG IN THE START
WORK THE SAME WAY.
AND THEREFORE THAT'S THE ONLY
DRUG THAT THEY CAN BE PUT ON AN
ULTIMATELY THEY THEY DO ONE THE
QUESTION IS WHETHER YOU CAN
NEGOTIATE WITH THEM IF THEY'RE
NOT THE DRUG OF CHOICE ON ON A
FORMULARY.
BUT ONE AREA THAT HAS SEEN
SIGNIFICANT INCREASES IN A YOU
YOU DIDN'T ADDRESS AT AND THAT
IS THE ISING COST OF GENERIC
DRUGS --
THERE WE DON'T SEE THE THE
DELIVERY OF NEWER DRUGS COMING
ON THE MARKET LIKE WE DID IN THE
EIGHTIES NINETIES --
GETTING THROUGH THE FTA AS A
VERY ARDUOUS LONG COMPREHENSIVE
PROCESS IT SHOULD BE BECAUSE WE
WANT TO MAKE SURE THE DRUGS ARE
SAFE AND EFFECTIVE BUT A WAY
THAT.
DRUG COMPANIES ARE BOOSTING
THEIR PROFITS IS TAKING DRUGS AT
YOU KNOW ORIGINALLY AS AN
EXAMPLE FOR HE'S NOW --
THEY'VE GONE UP TO IN SOME CASES --
FIVE HUNDRED TO A THOUSAND
DOLLARS A THOUSAND SO YOU IT'S
NOT THE INGREDIENTS HAVE GONE UP
IT'S JUST THAT.
THEY'VE DECIDED THAT THEY'RE
GOING TO RAISE THE PRICE.
SO WHAT I WOULD ENCOURAGE IS
THAT WHEN YOU ARE LOOKING --
FOR PREFERRED --
DRUGS ON A FORMULARY LIST THAT
YOU NEED TO LOOK AT MANUFACTURES
AND GET THESE MANUFACTURERS TO
COMPETE WITH ONE ANOTHER --
ALSO I THINK --
PURCHASING IN VOLUME IS IS VERY
VERY IMPORTANT ESPECIALLY IF
YOU'RE GIVING EXCLUSIVITY TO
CERTAIN FORMULARIES AND IT
SOUNDS LIKE --
YOU DO SOME OF THE BIDDING FOR
THE STATE OF CALIFORNIA YOU
DON'T DO MUCH FOR UNIVERSITY
CALIFORNIA OR MEDI CAL.
SO -- WHILE
I HAVE NEVER BEEN AN ADVOCATE OF
THE EXPANSION OF GOVERNMENT --
I'M GONNA FLOOR ON AN IDEA THAT
I MENTIONED BEFORE I THINK WE
SHOULD FOR THE CALIFORNIA
DEPARTMENT PRESCRIPTION
PURCHASING AN ADJUDICATION.
AND WHAT I THINK THE STATE OF
CALIFORNIA SHOULD DO.
IS GET INTO THE PBM BUSINESS AND
WE SHOULD HAVE A STATE PBM.
THE MAYBE CUT CONTRACT WITH
WASHINGTON CONTRACT WITH OREGON
DO THEIR EACH INDICATIONS AND
INSTEAD OF ALLOWING THESE
PRIVATE COMPANIES TO OPERATE IN
A BLACK BOX.
AN EXTRACT BILLIONS OF DOLLARS
AWAY FROM LORING PREMIUMS AND
BENEFITS FOR OUR BENEFICIARIES
THAT WE SHOULD BE AT THAT TABLE
IT SOUNDS LIKE TO ME WHAT THE
STATE IS TRYING TO DO IS
RECREATE THE WHEEL THAT THE P.
B. M.'S OF ALREADY.
DONE -- BUT
WHY SHOULD WE YOU KNOW ALLOW
THEM.
TO SIPHON OFF BILLIONS OF
DOLLARS FROM THE STATE OF
CALIFORNIA WHEN WE HAVE SO MANY
IS WE HAVE A DISCUSSION TODAY
ABOUT PROVIDING.
CARE FOR UNDOCUMENTED PEOPLE OF
ALL AGES YOU KNOW TO TRY TO SAVE
THE STATE MONEY BECAUSE WE WANT
TO GOING TO EMERGENCY ROOMS.
WE'RE TALKING ABOUT --
IMPLEMENTING A EIGHT A PENALTY --
TO BACK FILL THE FEDERAL LACK OF
A PENALTY.
HAVING OUR OWN PVM ABOUT WHERE
THE COST OF THE PENALTIES A HALF
A BILLION DOLLARS HAVING OUR OWN
PBM LADIES AND GENTLEMAN CAN
RAISE NOT A BILLION BUT BILLIONS
OF DOLLARS A YEAR. FOR THE STATE
OF CALIFORNIA TO EMBARK ON A
SOME OF THE GOALS AND
ASPIRATIONS --
THAT WE ALL --
EITHER EMBRACE PHILOSOPHICALLY
OR PARTIALLY --
SO -- I
THROW THIS OUT THERE THIS IS A
BIG IDEA BUT CALIFORNIA.
SHOULD LOOK AT BIG IDEAS.
AND AND AND NOT RECREATE THE
WHEEL MY CONCERN ABOUT WHAT THE
GOVERNOR'S PLAN IS IS THAT WE'RE
NOT GOING TO SEE ANY OF THE
FRUITS OF OUR LABORS TILL.
TWENTY TWENTY ONE TWENTY TWENTY
TWO YOU COULD FORMA PBM IN SIX
MONTHS AND YOU CAN HAVE AN
OPERATING.
VERY AGGRESSIVELY --
BY NEXT YEAR.
AND YOU IF YOU FORM YOUR PBM
YOU'RE NOT GOING AFTER REACH OUT
TO THE DRUG COMPANIES THEY'RE
GOING TO REACH OUT TO YOU THEN
YOU'RE GOING TO HAVE THEM LINED
UP AT A TABLE.
AND BELIEVE ME YOU CAN GET SOME
SIGNIFICANT --
BREAKS THAT ARE ON UP WE DON'T
KNOW ABOUT.
HOW PBM IS TRULY OPERATE BUT WE
DO UNDERSTAND THAT WHAT USED TO
BE A SWITCH OF FIFTEEN CENTS AS
A TRANSACTION MEDIATOR BETWEEN A
PATIENT AND A?
IN A AN INSURANCE COMPANY.
COMPANIES LIKE EXPRESS SCRIPTS
THAT HAVE A VALUE OF FIFTY
BILLION DOLLARS BELIEVE ME IT'S
NOT FROM GETTING FIFTEEN CENTS A
TRANSACTION --
TRANSMITTING PRESCRIPTION CLAIMS
SO I SAY WE OUGHT TO TAKE THAT
OPPORTUNITY INVESTIGATED HAVE
OUR OWN CALIFORNIA PBM HAVE OUR
OWN --
DEPARTMENT THAT OVERSEES AT
WHICH WILL I GUARANTEE YOU BRING
AND THOUSANDS MORE THAT'S GOING
TO COST US TO CREATE THIS
DEPARTMENT WE GET ONLINE FASTER
AND WE GIVE THE HEALTH CARE THAT
OUR CITIZENS DESERVE AND NEED AT
THE LOWEST COST POSSIBLE SO.
I'D LIKE TO GET YOUR YOUR YOUR
YOUR YOUR THOUGHTS ON THIS --
THIS VOLLEY --
WHAT THAT WILL THANK THANK YOU
FOR THE SUGGESTION I MEAN?
WE'RE IN THE EARLY STAGES OF
IMPLEMENTATION IN THERE A LOT OF
DIRECTIONS THAT WE CAN GO IN --
I'M I'M GLAD THE WORK HEARING
IDEAS THAT ABOUT.
A POTENTIAL ULTIMATE SOLUTIONS --
I WOULD SAY.
WE'RE ACUTELY AWARE THAT.
IN MANY YOU KNOW IT THAT IN MANY
CASES THERE'S A SIGNIFICANT
AMOUNT OF VALUE THAT'S BEING
CAPTURED BY THE PBM --
THAT WE DON'T REALLY WE DON'T
NECESSARILY KNOW ABOUT BECAUSE
THE THE PAYMENTS ARE GOING TO
WERE FROM.
THE STATE THIS IS MORE OF AN
ISSUE.
DTS.
DOES VERY LITTLE PEAK WORK WITH
PVM AS WE USE THEM ON A LIMITED
BASIS FOR SERVICE DELIVERY TO
CERTAIN.
POPULATIONS THAT NEED TO USE A
RETAIL PHARMACY --
FOR THE MOST PART WE DO NOT --
FOR OUR OWN --
ACTIVITIES AS A PURCHASE --
BUT THE THE THE CONCEPT OF
FINDING WAYS TO CAPTURE THE
VALUE THAT THE P. B. M.'S ARE
CURRENTLY CAPTURING IS AN
INTERESTING IDEA AND IT'S
SOMETHING THAT WE'VE TALKED
ABOUT.
INTERNALLY I DON'T I HAVE NOT
HEARD THE THE IDEA OF CREATING
OUR OWN BEFORE BUT I THINK.
A LOT OF POSSIBILITIES ARE ON
THE TABLE RIVERSIDE COUNTY WHEN
I WAS ON THE BOARD OF
SUPERVISORS WE HAD A VERY BOLD
IDEA.
WE WE WANTED TO EMBRACE THE THE
PACE PROGRAMS THE WESTERN
COUNCIL OF GOVERNMENTS AND CAME
UP WITH A PROGRAM WHERE YOU
COULD --
EFFECTIVELY AND EFFICIENTLY
FINANCE SOLAR PANELS SO YOUR
PROPERTY TAXES IT WAS SUCH A
GREAT PROGRAM WE SEVERAL WHEN WE
EXPAND IT STATEWIDE.
AND AS A RESULT WE CREATED
SAVINGS FOR BENEFICIARIES
THROUGHOUT THE STATE OF
CALIFORNIA DOUBLE YOUR CARD OF
COURSE GOT SOME ADDITIONAL
REVENUE THAT THEY CAN PROVIDE
FOR EVEN MORE SERVICES.
TO RESIDENTS OF RIVERSIDE COUNTY
IF WE WE SET UP THE TEMPLATE OF
A STATE PBM AND WE COULD
CONTRACT TO STATES LIKE.
OREGON AND WASHINGTON --
THERE COULD BE SOME REVENUE
STREAMS EVEN FOR THE STATE OF
CALIFORNIA BECAUSE WHY SHOULD
THE OF THE STATE'S RECREATE THE
WHEEL WE'VE GOT THE THE
HORSEPOWER TO DO WITH OUR
POPULATION --
I THINK IT COULD BE BENEFICIAL
TO TO MANY OF THE WESTERN STATES
THAT I THINK WOULD BE STANDING
IN LINE TO JOIN OUR EFFORTS.
OKAY.
THANK YOU VERY MUCH.
THANK YOU MANAGER I DON'T KNOW
HOW I TOP THAT.
SENATOR PLEASE DON'T FEEL LIKE
YOU HAVE.
TO THANK YOU MISTER BENDER
BECAUSE BECAUSE WE ARE YOU KNOW
YOU'RE ALREADY DOING VOLUME
PRICING.
YOU'VE GOT CLOUT.
IN IN YOUR READY A SIGNIFICANT
PLAYER AND I'M JUST WONDERING
YOU KNOW MAYBE A SHORT ANSWER
JUSTICE YOU KNOW JUST TO THE RAP
IT INTO A SMALL BALL BUT BUT BUT
HOW DO YOU.
HOW DO YOU BUILD ESSES CLOUD
EVEN MORE?
TO YOU KNOW SQUEEZE OUT.
A LITTLE MORE RAIN BUT HOW DO
YOU ADD VALUE --
WELL HOW WE ADD VALUE --
RELATIVE TO WHAT WE'RE DOING NOW.
IS -- I
THINK THAT THE APPROACH IS
TRYING TO SEE WHAT OTHER --
AGENCIES WE CAN WORK WITH --
IT ALL ENDS IT IN.
IN IN THE NEAR TERM ND THEN
WE'RE ALSO LOOKING AT PRIVATE
PURCHASERS AS WELL --
TO SEE YOU KNOW HOW CAN WE PUT
THE PURCHASING POWER TOGETHER
WHAT ARE THE DIFFERENT --
WHAT ARE THE MEDICATIONS THAT
OTHER AGENCIES ARE OURS AND I'M
JUST WNDERING HOW DO YOU
QUANTIFY IT MEAN?
CAN YOU SAY I'M GONNA GET.
THE DOLLAR OFF OF X.IN MIDDLE
TRANSIT INTO WHY A WHAT.
WHAT WE WHAT ARE YOU LOOKING AS
A AS A GOAL AS A?
AS A RESULT WELL --
OUR EXISTING SORT OF BENCHMARK
WERE OR OR GOAL THAT WE USE ON A
SCORE CARD THE FOR THE STATEWIDE
PHARMACEUTICAL PROGRAM IS 60%.
OFF OF SUGGESTED WHOLESALE PRICE
AND I BELIEVE THE LATEST NUMBER
I'VE SEEN IS THAT WERE AT SIXTY
NINE AND A HALF SO.
YOU'RE GONNA GO FOR SEVENTY
YEARS --
SEVENTY ONE I YOU KNOW WHAT
OTHER PEOPLE ARE GOING TO MAKE
THE DECISION ON WHETHER WE
WHETHER WE SET A HIGHER GOAL BUT
YEAH WE WE DEFINITELY ARE
LOOKING.
TO WE'RE LOOKING TO SAVE THE
STATE MONEY AND I THINK IN
ADDITION.
TO THE SORT OF BENCHMARK THAT WE
USE FIRST FIRST AND SO FORTH --
WERE ALSO MINDFUL OF THE FACT IS
THE AS PURCHASERS GENERALLY THAT
A THAT A DISCOUNT OFF LIST PRICE.
IS A DISCOUNT OFF LIST PRICE BUT
THE LIST PRICE CAN CHANGE.
SO WE ALSO WANT TO LOOK AT THE
DELTA WATER WE GETTING THAT WE
DIDN'T GET BEFORE AND WE'RE
ALWAYS TRIED TO WE'RE ALWAYS
TRYING TO GET A LOWER PRICE.
THANK YOU THANK YOU MEASURE.
EVERYTHING.
THANK YOU SO VERY MUCH --
I KNOW WE'RE GOING.
TO THE SPELL BE FOLLOWED BY A
DTS ON ONE THING AND TRY TO
FIGURE OUT WHAT THE INTERFACES
BETWEEN THE TWO BECAUSE I GUESS
IN THE GOVERNOR'S EXECUTIVE
ORDER BASICALLY WITH ATTRACT
FREE.
ONE LARGE POOL.
RIGHT SO FOR EXAMPLE RIGHT NOW --
DO YOU DO ANY NEGOTIATION FOR
MEDI CAL PATIENTS SO WE HAVE THE
WE HAVE A BUDGET.
WE HAVE A GOOD CHUNK THAT --
OUR FEE FOR SERVICE ACTUALLY --
AFFECT ME THE MOST EXPENSIVE
MEDIC THE THE PHILLY --
MEDICATIONS ARE CARVED OUT SO
THERE.
SO THAT IF YOU --
SO THAT BEING HANDLED BY MEDI
CAL DIRECTLY RIGHT NOW OR DO YOU
ARE YOU INVOLVED IN THAT AT ALL --
I THINK I I'M NOT AWARE OF ANY
SPECIFIC TGS ROLE THAT'S THAT'S
BEEN IDENTIFIED FOR THE
TRANSITION. TO FEE FOR SERVICE --
OVER IT MEDI CAL --
CURRENTLY THE TO CURRENTLY MEDIC
HELP --
CHOIRS DRUGS YOU KNOW COMPLETELY
INDEPENDENTLY FROM DJ US AND
WE'RE NOT TRYING TO REPLICATE
WHAT THEY DO --
BUT OBVIOUSLY WE'RE TALKING
TOGETHER RIGHT WE'RE TALKING
WITH THE AC US ABOUT WHAT WE CAN
DO TOGETHER --
AND WHAT WE CAN TO THE ISLANDS
THERE'S A LOT OF THEIR A LOT OF
WRINKLES TO FIGURE OUT --
THERE ARE A LOT OF THEIR A LOT
OF SPECIFIC PROGRAMMATIC ISSUES
THAT THEY HAVE IT THE ACS THE WE
DON'T HAVE AS A AS A TRUE
PURCHASER --
THE I MEAN THEY'RE OPERATING ON
A DIFFERENT JUSTICE THE JUST TO
CLARIFY MY UNDERSTANDING IS THE
EXECUTIVE ORDER WAS TO CREATE
THIS LARGER PULL SO ARE YOU
TELLING ME THAT YOU'RE STILL
FIGURING ARE YOU.
SO IS THE INTENTION.
TO BRING ALL THE PURCHASING
UNDER.
TGS UNDER YOUR PROGRAM THAT'S
WHY I THOUGHT THESE A WATER SAID.
ED TO GET THAT WRONG.
I DON'T THINK.
I DON'T THINK THAT IS DEFINITELY
WHAT WE'RE GOING TO END UP WITH
CERTAINLY WE'RE TRYING CERTAINLY
WERE TRYING TO CONSOLIDATE.
OKAY BUT THE BUT THEY'RE ALSO
GOING TO BE SOME REPORTS THERE'S
WERE OTHERS --
MAY REPORT FROM US AND THEN I
BELIEVE A JULY REPORT FROM DEC
US -- THAT
ARE GONNA HAVE SOME IDEAS OKAY.
FOR STATUTORY FOR POSSIBLY
STATUTORY CHANGE --
THEIR VARIETY OF WAYS THAT YOU
COULD PUT THE TWO THINGS
TOGETHER THAT MIGHT NOT BE TGS
ASSUMES TOTAL RESPONSIBILITY FOR
EVERYTHING ALL RIGHT WELL OKAY
SO I WOULD APPRECIATE.
BEING KEPT APPRISED OF THAT ALL
IS.
NOW IN THE BUDGET SO COMMUTER
BUT THE HEALTH COMMITTEE CHAIR
BECAUSE NOW BECAUSE THE NEXT
QUESTION IS IS THAT.
I WAS ASSUMING UNDER EXECUTIVE
TO WE'RE GOING TO COME TOGETHER
AYE EXPRESSION TO YOU WOULD THAT
IS WHO HAS RESPONSIBILITY OVER.
FOR EXAMPLE THE FORMULARY.
AND IS UP TO YOU HAVE YOUR OWN
PROCESS FOR DEVELOPING FORMULA
AIRY.
DTS L. HAS ITSELF HOW WE'RE
GOING TO DEVELOP FORMERLY HOOPS
WHO'S PROVIDING INPUT INTO THAT
FORMULARY.
SO WE TALKED ABOUT YOU KNOW THE
ROLE OF PROVIDERS ACTUALLY
TAKING CARE PATIENTS BE SURE
THAT THE FORMALLY ANY PART OF IT
OBVIOUSLY ONE THE BIG GOALS IS.
TO LOWER THE PRICE BUT YOU ALSO
BE SURE YOU HAVE ACCESS TO THE
RIGHT KIND OF DRUGS HOW DO YOU
DECIDE THAT HADES FIVE DRUGS ARE
ALL SENSEI DENTICLE ARE NOT OKAY.
YOU KNOW WHAT CLASS LIKE I DID I
SAID ANTI HYPERTENSIVE AS WELL
AND SAY A PRETENCE OF YOU COULD
HAVE BETA BLOCKERS YOU CAN HAVE
DIURETICS YOU CAN HAVE SO YOU
KNOW IS THAT WHAT I DID HOW
BROADLY YOU CLASSIFY THEM AS
BEING IN QUOTE THE SAME CLASS
RIGHT.
DEPENDS ON HOW YOU.
CLASSIFY CLASS BETTER THAN
OTHERS AND SO FORTH SO.
SO WHO'S MAKING THOSE KIND OF
DECISIONS BECAUSE EVENTUALLY A
AND THEN ALSO WHO'S GOING TO
MAKE THE DECISIONS ABOUT WHAT
ARE THOSE THE ONLY SAID
PREFERRED.
MEDICATION FINE SO WHAT.
ARE THE BARRIERS TO GETTING THE
QUOTE NON PREFERRED MEDICATION
SO -- YELLED
AT NO PRIOR YOU TALK ABOUT PRIOR
AUTHORIZATIONS BY THE WAY
THERE'S A WHOLE PROBLEM WITH
BIRD PHYSICIAN BURN OUT PRIOR
AUTHORIZATIONS IN THAT DENIAL OF
ACCESS TO CARE NOT SAYING THAT
WE DON'T HAVE ANY IS MECHANISMS.
AND ANY QUESTIONS HOW OFTEN THE
APPLIED TO FOR EXAMPLE --
IF YOU NEED A PRIOR
AUTHORIZATION FOR A QUOTE NON
FORMULARY DRIVE.
IS THAT SOMETHING YOU JUST DO
ONCE AND YOU'RE DONE IS THAT
SOMETHING EVERY REFILL I GOT A
RECENT RESUBMIT PAPERWORK ON THE
OTHER EXTREME IS IT BY THE WAY
BECAUSE WE DO MEDI CAL COUNTY BY
COUNTY AND ALSO WE HAVE COUNTIES
MULTIPLE PLANS MY COUNTY
SACRAMENTO HAS SIX PLANS.
I BELIEVE --
SO IF THEY CHANGE FROM ONE PLAN
TO ANOTHER DO YOU START ALL OVER
AGAIN.
ARE YOU MOVE FROM ONE COUNTY TO
ANOTHER DO YOU START ALL OVER
AGAIN OR DO WE SAY YOU KNOW WHAT
WE KNOW THAT THIS WAS THE
MEDICATION REALLY WORKS FOR YOU
WE DON'T HAVE TO GO THROUGH THIS
AGAIN RIGHT.
IF YOU CHANGE --
MEDICAL GROUPS SO THOSE ARE AS I
AND SO HAVING SOME CLARITY ABOUT
WHO'S OVERSEEING WHAT.
AND THEN YOUR PROCESS OF
NEGOTIATING BECAUSE RIGHT NOW
YOU'RE NEGOTIATING ESSENTIALLY
FOR ENTITIES THAT.
TAKE THE MEDICATION AND AND
STUFF LIKE THAT CDC ARE RIGHT I
MEAN IT'S NOT THAT THE YELLED A
LOT LIKE THE INMATES ARE GOING
AROUND BASICALLY WHAT HAPPENS IS
THAT.
SO IT'S NOW IT'S GONNA BE A BIT
DIFFERENT YOU OF ALL THESE
DIFFERENT PROVIDERS AND SO FOR
THE A DIFFERENT PHARMACISTS YOU
HAVE MEDICATIONS ARE
ADMINISTERED BY A YOUNG
CLINICIANS ITS ADDRESS.
SO HOW IS SO --
SO ANYTIME YOU'RE GONNA
INTERFACE OR SOMEONE'S GONNA BE
INTERFACING WITH THE
PHARMACEUTICAL COMPANIES SAYING
WE'RE NEGOTIATING RIGHT.
AND SO THEY'RE GOING TO WANT TO
KNOW.
OKAY WELL WHAT DOES IT MEAN TO
BE THE PREFERRED MEDICATION
RIGHT AND HOW MUCH IS THAT DRIVE
BUSINESS TOWARD MY MEDICATION
VERSUS SOMEONE ELSE'S LIKE HOW
MUCH MORE MARKET SHARE BECAUSE
THAT'S GOING TO AFFECT YOUR
NEGOTIATING POSITION.
RIGHT SO AND TRY TO GET SOME
CLARITY AS TO THE RELATIONSHIP
BETWEEN WHO'S DOING ANY COACHING
WHICH AGENCY IS A D. G. S. R..
AND BECAUSE I UNDERSTAND IS A
BIG PULL AND THEN WHO'S GOING TO
BE SETTING THE RULES FOR ALL
THESE OTHER THINGS BECAUSE
FRANKLY --
NOW I AM A MEDIC CAL PROVIDER
I'M GOING TO HEAR FROM PATIENTS
BUT YOU KNOW WHAT I ALSO TELL
THIS PATIENTS TO GO TALK TO
THEIR LEGISLATOR ABOUT WHY THEY
CAN GET THE MEDICATION ON
FORCING IN THIS DISTRICT THAT
STILL BE. FOR MY COLLEAGUES --
THAT WILL BE --
YOU KNOW THAT THEY'LL BE SO SO
SO SO WE NEED TO PROVIDE SOME
CLARITY THERE AND MAYBE YOU
DON'T HAVE THE ANSWERS NOW BUT I
DO EXPECT TO HEAR IT TO WHEN WE
DO OUR BUDGET SUBCOMMITTEE
HEARINGS.
BUT WE DEFINITELY WANT TO KNOW
THOSE ANSWERS AND IF WE COULD
HEAR THAT IS --
THAT WE WOULD GET THOSE IN THAT
INFORMATION AND STATE HAVING TO
ASK FOR IT ALL THE TIME.
AND AND BY THE WAY I KNOW THE
JUST GONNA COME UP TO ME ASKING
SIMILAR QUESTIONS BUT YES.
AND DOCTOR BROWN I UNDERSTAND --
IT WAS NOT BUDGET COMMITTEES
STAFF ASSUMPTION THAT IT WAS ALL
CAN BE ROLLED INTO ONE BECAUSE
THERE ARE SOME FEDERAL
RESTRICTIONS --
SO WE MIGHT OFFLINE HAVE TO
PROVIDE YOU WITH A BACKGROUND IN
TERMS OF WHITE CAN'T BE FRAME
THAT WAY.
CRACKING GOING RESPOND THAT BE
GREAT.
THANK YOU OF AND THIS IS THE
CENTER PAN HAS HAS --
UP A NUMBER OF THOSE ISSUES I'VE
I'VE I'VE HEARD A COUPLE OF
THOSE I'M HEARING FOR THE FIRST
TIME SO I'M GLAD WE'RE HAVING
THIS HEARING --
SO -- BUT
THE THERE ARE AS SENATOR PANNED
THE SO ELOQUENTLY DESCRIBED
THERE ARE NUMEROUS COMPLICATIONS
IS AND HOW YOU SET UP A PHARMACY.
THEIR NUMEROUS COMPLICATIONS IN
GOVERNANCE OVER THE PHARMACY OUR
ASSUMPTION IS THAT THE AGENCIES
THAT ARE PARTICIPATING.
IN THE IN THE PURCHASING PROGRAM
WOODS --
IDEALLY COLLECTIVELY DECIDE ON
THE PHARMACY --
WE D. G. S..
YOU KNOW DON'T ARE DICTATORS IN
THAT REGARD WE WERE --
BECAUSE THEY HAVE THE DEPTH OF
CLINICAL EXPERTISE IN HOW THESE
MEDICATIONS ARE USED IN THERE
YET IN THEIR SETTINGS --
SO WE WOULD EXPECT THAT.
WE WOULD EXPECT THAT IT WOULD BE
A COLLECTIVE EFFORT TO SET FOR
FORMULAR RULES --
AS FOR THE EXACT SHOWN TO YOU
KNOW HOW YOU SET UP A PRIOR
AUTHORIZATION SYSTEM.
IN ORDER TO SUPPORT GOOD PATIENT
CARE.
AND AVOID DRIVING THE PHYSICIANS
CRAZY --
THOSE ARE BOTH IMPORTANT GOALS A
WITH THE THAT WE WOULD
DEFINITELY TAKE INTO ACCOUNT --
OBVIOUSLY YOU KNOW WE ARE TRYING
TO REDUCE THE COST OF
PRESCRIPTION DRUGS.
THE COST OF PRESCRIPTION DRUGS
IN A WAY THAT'S CONSISTENT WITH
GOOD PATIENT CARE --
KEEP IN MIND IT'S AT BOSTON I
CARE ABOUT PHYSICIANS I GOING
CRAZY MORE IMPORTANT LIKE THE
PATIENTS THE BECAUSE OF THE
PATIENTS GET FRUSTRATED THEY
CAN'T A EDUCATIONS INDEED.
SO -- AND I
ATE FROM WHAT I'M HEARING
PERHAPS AT ANY AND I WANT SELL
MAYBE DH CS WHO SETS THOSE RULES.
BUT YOU'RE THE NEGOTIATOR TO
CERTAINLY OF DEPENDING ON AND
WE'LL GO OF COURSE FEATURE WE
FOLLOW CERTAIN FEDERAL RULES FOR
EXAMPLE MEDI CAL YOU HAVE TO
PROVIDE ALL MEDICALLY NECESSARY.
MEDICATION SO I GOT THAT.
I WOULD SAY IN TERMS OF A NEAR
TERM --
OBJECTIVE --
WE MAY IDENTIFY IT OF A FEW
DRUGS -- OR
A FEW THERAPEUTIC CLASSES TO
TARGET FIRST AND SO IT MAY BE AN
INTERIM SITUATION WHERE WE START
OUT OKAY WE'RE TALKING ABOUT
THIS.
A CLASS CAN WE ALL AGREE THAT
YOU KNOW CAN WE ALL AGREE THAT
IF THE DISCOUNT ON THIS IS GOOD
ENOUGH IT'S A FIRST.
THEN WE CAN AGREE TO THE SIDE OF
FORMULARY RULES THIS PRIOR
AUTHORIZATION --
APPROACH FOR THE JUST FOR THIS
CLASS WE ALSO HAVE OUR OWN
FORMULAR IS BUT WERE AGREEING ON
HOW WE HANDLE THIS PARTICULAR
CLASS.
THAT CAN BE AN INITIAL STAGE
TOWARD EVENTUALLY GETTING TO A
MORE MERCH SYSTEM.
WELL A LOOK FOR TEN CAN I GUESS
TO POINT OUT AND THAT THERE ARE
MANY OPTIONS I THINK PEOPLE ARE
POINTING OUT YOU KNOW POTENTIAL
CHALLENGES TO AN IMPLEMENTATION
OF A BOOK PURCHASING PROGRAM
ACROSS BUYERS IN PAIRS IN THOSE
COMPLICATIONS.
AND THAT'S REALLY WHAT THE THE
THE EXECUTIVE ORDERS LAYING OUT
IS LET'S GATHER THE DATA PRESENT
OPTIONS FOR CONSIDERATION FOR
THE GOVERNOR TO COME FORWARD IN
THE FUTURE.
BUDGET OR ARE AT SOMETIME I WE
DON'T ACTUALLY KNOW THE VEHICLE
IN WHICH THAT WOULD SHOW --
COME TO ALL --
FOR CONSIDERATION ABOUT HOW TO
CHANGE EXCELLENT POINTS AS DID
OTHER SENATORS --
BUT AND WILL TAKE THAT IS FOOD
FOR CONSIDERATION OF FOOD FOR
THOUGHT SO.
THANK YOU ANYTHING YOU WANNA.
SEE NO FURTHER QUESTIONS THANK
YOU VERY MUCH JOHN WE APPRECIATE
YOU.
GOING TO TRANSITION COLLEAGUES --
TO THE TRANSITION INTO FEE FOR
SERVICE FOR ALL IN THE MEDI CAL
PHARMACY PROGRAM DIRECTOR CAN'T
THANK YOU FOR JOINING US.
HAPPY NEW YEAR AND HAPPY
VALENTINE'S DAY.
WE HAVEN'T SEEN YOU BEFORE
COMMITTEE.
MISTER MILLER --
ASSISTANT PROGRAM BUDGET MANAGER
DEPARTMENT OF FINANCE AND MISTER
JOHNSON WILL BE JOINING US AS
WELL.
DIRECTOR CAN'T MAKE HAPPY
VALENTINE'S DAY LITTLE HEART
HERE JUSTINO FOR EXTRA FOR THE
LOWER.
BACK READ LOW --
SO I THINK YOU I WANT --
TO FIRST START OFF BY --
SCENE THAT YOU KNOW THE
GOVERNOR'S X. SENATE VERY --
DIFFERENT TRACKS OF WORK THAT WE
INDEED YES ARE COLLABORATING ON
JUST -- TO
PUT A FINE POINT ON IT IS THAT
D. G. S. AS THEY BALK PURCHASER
OF PHARMACEUTICAL SERVICES AND
MEDI CAL AND OTHER TYPES OF
EMPLOYERS LIKE CALPERS ARE --
PAYERS SO WHEN A INSTITUTION OR
AN ORGANIZATION GHOSTED YES AND
SAYS WE WOULD LIKE A THOUSAND
DOSES OF FILL IN THE BLANK DDS
GOES THEY NEGOTIATE WITH THE
MANUFACTURER.
AND THEN THOSE THOUSAND DOSES
ARE DISTRIBUTED TO THAT
POPULATION FOR WHICH THE
ORGANIZATION IS BUYING ON BEHALF
OF SO BE AT CDC OUR STATE
HOSPITALS DEVELOPMENTAL CENTER --
OBVIOUSLY AS A PAIR AS MEDICARE
ALL WE HAVE PATIENTS THAT
RECEIVED PRESCRIPTIONS FROM
THEIR PHYSICIAN THEY GO INTO A
PHARMACY THE PHARMACY DISPENSES
THE PRESCRIPTION AND WE
REIMBURSE.
US SO IT IS A VERY DIFFERENT --
PURCHASING MECHANISM AND SO I
JUST WANTED TO MAKE SURE THAT --
WHEN WE TALK ABOUT THE TASKS
RELATED TO DO AS TO A BOOK
PURCHASE SCENE --
COOPERATIVE WITH LARGER
PARTICIPATION BY BOTH OTHER
STATE ENTITIES AS WELL AS
PRIVATE ENTITIES.
AND THEN WE AT THE DEPARTMENT OF
HEALTH CARE SERVICES --
NOT ONLY ARE LOOKING TO MAKE
CHANGES WITHIN THE MEDICAL
PROGRAM MORE BARK BROADLY TO
LEVERAGE OUR PURCHASING POWER
BUT ALSO LOOKING AT OTHER TYPES
OF SOLUTIONS IN WHICH WE CAN TRY
TO LEVERAGE MEDI CAL AS A
PLATFORM PROGRAM IF YOU WILL. TO
DRIVE DOWN PRICES FOR OTHER
TYPES OF PAYERS.
I THINK --
YOU KNOW THERE WAS A HEARING
PROBABLY A COUPLE OF YEARS AGO
AND SO I SAVED --
SOME OF MY FAX JUST BECAUSE I
LIKE SAID THIS IS NOT THE FIRST
TIME THAT WE'VE HAD THIS
DISCUSSION IN THE LEGISLATURE --
I THINK I STARTED THESE
DISCUSSIONS BACK IN TWO THOUSAND
AND FOUR WHEN I WAS WITH THE
DEPARTMENT THE FIRST TIME --
SO WHEN WE LOOK AT CATALOG
PRICING FOR CERTAIN CLASSES OF
DRUGS IN MEDIC HOW --
AND WE HAVE THIS BUT IT WAS THE
PRICING OVER FOR YOUR FOR DRUGS
THAT WE EITHER COVER OR HAVE TO
MAKE AVAILABLE TO BENEFICIARIES
BASED ON MEDICAL NECESSITY.
MOST OF YOU ARE FAMILIAR WITH SB
PEN CRACKS --
THAT AVERAGE WHOLESALE PRICE
OVER A FOUR YEAR PERIOD WENT UP
BY TWO HUNDRED AND 69% SET ONE
UP FROM EIGHTY TWO DOLLARS TO
TWO HUNDRED AND TWENTY AND
THAT'S THE CHEAPEST INCREASE ON
THIS CHART.
WE HAVE DRUGS --
THAT ARE FOR ANTI CONVULSANT --
WENT UP FROM FIVE CENTS A TABLET
TO A DOLLAR TWENTY TWO WHICH YOU
SAY THAT'S NOT BAD BUT THAT WAS
A TWO THOUSAND THREE HUNDRED AND
36% INCREASE IN PRICE.
WE HAVE A DIABETES DRUG THAT
WENT FROM TO CENTS A TABLET TO A
DOLLAR SEVENTEEN THAT'S A FOUR
THOUSAND SEVEN HUNDRED AND 32%
PRICE INCREASE --
WE HAVE AN ANTI DEPRESSANT THAT
WENT FROM EIGHT CENTS A CAPSULE
TO FIVE DOLLARS AND SEVENTEEN
CENTS. 6290% INCREASE --
HYPERTENSIVE --
WAS -- TWO
CENTS A TABLET IT WENT TO A
DOLLAR 854-700-0100 AND 46%
PRICE INCREASE.
MY FAVORITE --
IS A CAPSULE FOR EARTH THYROID
THOUGH SENATOR STONE JUST LAUGHS
I'M GONNA WITH HIM FOR MY
PHARMACY --
IT WAS FOR SENSE --
A CAPSULE IT WENT TO TWENTY TWO
DOLLARS AND NINETY SIX CENTS IT
WAS A 4900071% IN CRISIS
INCREASE IN PRICE.
I THINK WHEN THE GOVERNOR TALKED
ABOUT -- THE
PRICE SCENE --
AND THE FACT THAT IS
UNSUSTAINABLE --
MEDI CAL BENEFICIARIES DON'T
HAVE --
THEY'RE PROTECTED FROM THESE
COST INCREASES WE OBVIOUSLY AS A
STATE WHERE THE IMPACT OF THOSE
PRICE INCREASES WE OBVIOUSLY TRY
TO DO OUR BEST THROUGH --
SUPPLEMENTAL REBATE NEGOTIATIONS
AND MAKING SURE THAT WE'RE
ENCOURAGING PLANS TO USE THE
MOST EFFICACIOUS AND EFFICIENT --
DRUGS AS POSSIBLE BUT I THINK
WHEN YOU THINK ABOUT THE LARGER
ISSUES AROUND THE POPULATIONS
THAT DON'T HAVE THE LUXURY OF
EITHER MEDICAL COVERAGE OR THEY
ARE IN THE DOUGHNUT HOLE IF
THEIR MEDICARE PART D. RECIPIENT
OR IF THEY ARE ON THE PRIVATE
MARKET ND DON'T HAVE.
ON ARE THEY HAVE A HIGH
DEDUCTIBLE AND THEY'RE AT RISK
FOR DRUGS UP TO A CERTAIN DOLLAR
AMOUNT.
THESE PRICE INCREASES FOR THEM
ARE EXTRAORDINARILY BOTH --
IMPORTANT AND IN SOME CASES
SIGNIFICANT SUCH THAT THEY CAN'T
ACTUALLY ACCESS THE DRUG AND SO
I JUST WANTED TO KIND OF LAY
THAT OUT THERE FOR PURPOSES OF
THIS EXECUTIVE ORDER.
IS REALLY ASKING US AS A STATE
DEPARTMENT TO LOOK AT SOLUTIONS
MORE BROADLY NOT JUST SO THAT WE
SOLVE OUR OWN PUBLIC PURCHASING
ISSUES AROUND THE PRICE OF DRUGS
BUT ALSO LOOK TO SOLUTIONS THAT
CAN HELP.
NOT ONLY OTHER STATE PURCHASERS
BUT OTHER PURCHASE YOU KNOW DOWN
TO THE CONSUMER INDIVIDUAL LEVEL
IN CALIFORNIA SO THOSE ARE THE
KIND OF IDEAS AND
RECOMMENDATIONS AND SOLUTIONS
THAT WE ARE LOOKING TO PROVIDE
TO THE GOVERNOR BY THE JULY
TWELFTH ST.
I'M SPECIFIED IN THE EXECUTIVE
ORDER -- IN
THAT EXECUTIVE ORDER IT WAS ALSO --
DIRECTED THAT WE WOULD BE
CARVING OUT.
ALL PHARMACY BENEFITS --
IN THE MEDICAL MANAGED CARE
PROGRAM AND RETURNING THEM TO
THE FEE FOR SERVICE PROGRAM --
THEIR WORST MULTIPLE REASONS FOR
THE INCLUSION OF THAT PROPOSAL
IN THE EXECUTIVE ORDER --
OBVIOUSLY ONE OF THE FIRST AND
MOST OBVIOUS IS THAT --
BY ACCUMULATING ALL OF THE
MILLIONS OF LIVES WE CURRENTLY
pOFFER COVERAGE --
FOR WE HAVE TWO MILLION
APPROXIMATELY IN FEE FOR SERVICE
WE HAVE APPROXIMATELY ELEVEN
MILLION IN MANAGED CARE.
BY PUTTING THOSE ALL INTO --
ONE PURCHASING POOL WE ALL HAVE
OBVIOUSLY INCREASE OUR
NEGOTIATING LEVERAGE TO DRIVE
BETTER DEALS WITH MANUFACTURERS
AS WELL AS MORE SIGNIFICANT
REBATES.
BUT I THINK ANOTHER --
REASON THAT WE AS OF STEP IN AND
MULTIPLE STEP SOLUTION IS --
FROM AN ACCESS POINT IN YOU KNOW
SENATOR PAN WAS CERTAINLY
APPRECIATE THIS AS WELL IS --
ACCESS -- IN
MEDI CAL PHARMACY AND A FEE FOR
SERVICE ENVIRONMENT WE HAVE --
PROVIDER AGREEMENTS WITH 97% OF
THE PHARMACIES IN THE FEE FOR
SERVICE SIDE.
SO ACCESS FROM A STANDPOINT IN
THE FEE FOR SERVICE SIDE IS
ACTUALLY BETTER THAN IT IS AND
THE MEDI CAL MANAGED CARE MARKET
TODAY -- I
THINKS THE OTHER THING THAT
PEOPLE HAVE BEEN CONCERNED
AROUND IS THE IDEA OF A FORMULA.
IN MEDI CAL SO WE DON'T HAVE A
FORMULAR YOU WE HAVE A
CONTRACTOR GLASS WHICH IS A
SERIES OF DRUGS THAT WE HAVE
SUPPLEMENTAL REBATES IN PLACE
WITH ON THE MANUFACTURER'S.
AND SO --
ONE OF THE THINGS THAT WE DO
BEFORE WE PUT ADDRESS ON THE
CONTRACT DRUG LIST AS WE LOOK AT
IT FOR EFFICACIOUS NOUS FOR
SAFETY FOR POTENTIAL FOR MISUSE --
FOR OTHER ALTERNATIVES --
AND OBVIOUSLY COST IS ALWAYS --
AN IMPORTANT FACTOR FOR US IN
THE CONSIDERATION OF THAT.
PATIENTS ARE ABLE TO GET DRUGS
THAT ARE NOT ON THE CONTRACTOR
GLASSED AND THEY WILL CONTINUE
TO GET DRUGS --
AS THEY ARE APPROPRIATELY
PRESCRIBED BY THEIR PHYSICIAN
REGARDLESS OF WHETHER THEY ARE
ON THE CONTRACT RECKLESS OR NOT
THE CONTRACT RECKLESS IS REALLY.
IN OUR WAY --
OF SETTING UP A NEGOTIATING
MECHANISM WITH MANUFACTURERS
WHICH IS IF YOU WANT TO BE ON
THE CONTRACTOR OF LIST --
WE TYPICALLY PUT DRUGS ON THERE
WITHOUT A PRIOR AUTHORIZATION
REQUIREMENT BUT IN EXCHANGE
THERE ARE SUPPLEMENTAL REBATES
THAT ARE PAID BY THAT
MANUFACTURE IN ORDER TO HAVE
PLACEMENT ON THAT LIST BUT IT IS
NOT.
A FORMULARY --
SOME OF THE REASONS --
ALSO THAT WE ARE OUT WORKING TO
CARVE THE DRUGS OUT OF THE
MEDICAID MANAGED CARE --
WORLD IS AND WE ARE LOOKING TO
STANDARDIZE BENEFITS ACROSS OUR
DIFFERENT MODELS AND ACROSS THE
DIFFERENT COUNTIES.
OVER THE COURSE OF TIME AS A
PROGRAM --
WE HAVE CARVE DRUGS IN AND OUT
BASED ON COST BASED ON NEED --
SO FOR EXAMPLE BLOOD FACTOR IS A
GOOD EXAMPLE WE HAVE HAD THAT
INTO THE MANAGED CARE CONTRACTS
WE'VE HAD IT OUT IT'S NOW CARVED
OUT WE HAVE HIV DRUGS THAT ARE
CARVED OUT THE PLANS ARE NOT.
RESPONSIBLE FOR THEM --
WE TREAT HEPATITIS C. DRUGS AS A
CATEGORY--
SOMEWHAT DIFFERENTLY THAN THE
REST THEY GET A SUPPLEMENTAL
CAPITATION PAYMENT --
BASED ON THE PATIENT BEING
PRESCRIBE SOMETHING IN THE
HEPATITIS C. CATEGORY AND SO WE
ARE COMMITTED TO PROVIDING THE
BENEFIT --
AND CONTINUING TO MAKE SURE THAT
BEEN A FISHERIES HAVE ACCESS TO
ALL OF THE DRUGS THAT THEY ARE
PRESCRIBED BY THEIR PROVIDER WE
HAVE CHOSEN --
IN THIS EXECUTIVE ORDER AND IN
THE GOVERNOR'S BUDGET TO SAY
THAT WE THINK THAT IT IS BOTH --
BETTER ACCESS FOR THE PATIENT AS
WELL AS THERE ARE SEVERAL
PURCHASE SCENE --
OPPORTUNITIES THAT WE CAN USE IN
THE SHORT TERM --
AS A STATE BY DOING THAT AND
PUTTING IT THROUGH THE FEE FOR
SERVICE SYSTEM --
THE LAST THING I WOULD SAY AND
I'M HAPPY TO TAKE QUESTIONS IS --
OTHER STATES ARE LOOKING AND
GRAPPLING WITH THIS ISSUE AS
WELL --
THERE ARE A VARIETY OF
ALTERNATIVES THAT HAVE BEEN
PROPOSED TO SEE A MASS --
I THINK THAT --
THE FEDERAL GOVERNMENT JUST
RELEASED A PROPOSED DRAFT RULE A
COUPLE IT MAY HAVE ONLY BEEN A
WEEK AGO BUT IT FEELS LIKE
LONGER IT MAY HAVE JUST BEEN A
WEEK AGO --
TO CHANGE THE NATURE OF THE
RELATIONSHIP BETWEEN P. B. M.'S
AND MEDICAID MANAGED CARE PLANS
AND MEDICARE PART D. PLANS --
AND THEY'RE TRYING TO BASICALLY
REMOVES THE ABILITY FOR PM'S TO
HAVE PREFERENTIAL --
STEERING OF DRUGS BASED ON THE
AGREEMENTS THAT THEY HAVE WITH
THE MANUFACTURERS AND INSTEAD
TURNING THAT INTO A FLAT FEE
TYPE OF SERVICE ARRANGEMENT.
THE THING THAT WE WOULD SAY IT'S
INCLUDED IN THE FEDERAL THE
DRAFT FEDERAL RULE IS IT WILL
INCREASE PRICES IRONICALLY TO
STATE PURCHASERS AND TO THE
FEDERAL GOVERNMENT BECAUSE NO
LONGER OUR PLANS GOING TO BE
RECEIVING EITHER DISCOUNTS ARE
REBATES.
DUE TO THOSE PBM ARRANGEMENTS
AND THERE'S A FLAT FEE AND SO
ACTUALLY IT RAISES THE COST OF
DRUGS WHICH IN.
SOME CASES JUST CONFIRMS THAT WE
ARE ON THE RIGHT PATH IN TERMS
OF REMOVING THE DRUGS OUT OF THE
MANAGED CARE CONTRACTS ALL
TOGETHER AND PUTTING THEM INTO
THE FEE FOR SERVICE --
SYSTEM SO WITH THAT I'M HAPPY TO
ANSWER QUESTIONS.
BEFORE WE DO THAT --
LET'S HEAR FROM MR MILLER DO YOU
HAVE ANYTHING TO ADD.
OKAY GREAT MISTER JOHNSON I
WOULD MEAN GREAT BUT YOU NONE OF
THE MR JOHNSON --
SO WE HAVE NOT COMPLETED OUR
ANALYSIS OF THE GOVERNOR'S
PROPOSAL BUT SO WHAT I'LL SHARE
IS REALLY JUST SOME OF THE
THINGS THAT WE'RE LOOKING AT AND
THE QUESTIONS THAT WE'RE ASKING.
TIME FIRST IS WHAT WITH THE
PROPOSAL ULTIMATELY RESULT INSTATE SAVINGS --
WE THINK IT COULD --
IT WOULD ALLOW THE STATE TO
COLLECT --
OR AT LEAST --
FACILITATE THE STATE COLLECTING --
SUPPLEMENTAL REBATES ON BEHALF
OF ALL THE PHARMACEUTICALS THAT
ARE PAID --
FOR AS OPPOSED TO JUST THE SO
THIS COULD ROW --
INCREASED DAY SAVINGS FOR TO THE
TUNE OF HUNDREDS OF MILLIONS OF
DOLLARS.
REFERENCE YOU WE DON'T HAVE A
SOLID UNDERSTANDING OF THAT FOR
CONTEXT THOUGH -
THE STAE A WE GOT ESTIMATES
FROM THE ADMINISTRATION THAT THE
STATE DOES SPEND --
NINE BILLION DOLLARS ANNUALLY ON
DRUGS WITHIN MANAGED CARE AS
OPPOSED TO FOUR BILLION DOLLARS
IN FEE FOR SERVICE SO THERE IS
THOSE ARE QUITE A THAT'S QUITE A
BIT OF NEW --
SPENDING THAT COULD BE ELIGIBLE
FOR SUPPLEMENTAL REBATES ON
CELLS CONTINUE TO ANALYZE THAT
OUR UNDERSTANDING IS THAT THE
ADMINISTRATION --
SOMETIME WILL RELEASE A FISCAL
ESTIMATE OF THIS AND WILL
DEFINITELY LOOK VERY CLOSELY AT
THAT -- I
CYCLE A SECOND SORT OF POTENTIAL
IMPACT -- IS
THAT -- AS
CENTER OFFICE BROUGHT UP --
IT THIS THIS --
PROPOSAL COULD RESULT IN SAVINGS
THAT ARE RETAINED BY THREE FORTY
BE ENTITIES --
THAT INSTEAD WOULD --
ULTIMATELY BENEFIT THE STATE SO
THAT'S ANOTHER AVENUE FOR
SAVINGS BUT AN IMPACT ON ON
SAFETY NET PROVIDERS THROUGHOUT
THE STATE.
AND THEN THIRD THERE COULD BE
SOME REDUCE COSTS IN MANAGED
CARE -- AS A
RESULT OF ADMINISTRATIVE
UNDERWRITING --
COSTS GOING DOWN --
WITHIN THE MEDICARE PROGRAM --
THERE ARE STILL REASONS WE THINK
TO BE CAUTIOUS --
ON THE POTENTIAL FOR SAVINGS --
MEDICARE PLANS CAN LEVERAGE
THEIR THEIR BUYING POWER TO
DETAIN YOU KNOW GOOD RATES WITH
PHARMACIES AT THE TIME OF
DISPENSING AND SO FORTH SO WE
WILL LOOK FORWARD TO SEEING WHAT
THAT WHAT GETS INCLUDED IN THE
COST ESTIMATES THERE --
BUT THEN OUTSIDE OF THE COST
ESTIMATE WERE OF COURSE TRYING --
TO IMPACTS ON PERRANCE WE
UNDERSTAND THAT IT WILL IT COULD
STANDARDIZATION OF THE DRUG
BENEFIT --
BUT ALSO WANT UNDERSTAND HOW IT
IMPACTS CARE COORDINATION --
THAT TIMELY SUBMISSION --
PHARMACEUTICAL UTILIZATION DATA
TO MANAGED CARE PLANS AND TO THE
PRIMARY CARE PHYSICIANS THAT ARE
THAT ARE ULTIMATELY COORDINATING
THEIR CARE SO --
THERE'S NOT A LOT WE STILL A LOT
OF QUESTIONS AND A LOT TO
CONSIDER IN ANALYZING THIS
PROPOSAL.
THANK YOU ARE I I TOO AM SORRY A
DOCTOR PAN IS IN HERE WE HAD A
DISCUSSION AT OUR BUDGET.
HEARING BRIEFING YESTERDAY --
A ABOUT THE TRANSITION FROM TO
FEE FOR SERVICE ON HE EXPRESS OF
THE THE CHALLENGES AS A PROVIDER
HIMSELF IN TERMS OF YOU KNOW
BEING ABLE TO PRESCRIBE AND
GUARANTEE YOUR PATIENT HAS A
MEDICATION THAT AS THE POSITION
HE THINKS IS IN THEIR BEST
INTEREST.
YOU MADE REFERENCE TO A CONTRACT
DRUG LIST AND THAT I I
UNDERSTAND YOU CORRECTLY WHEN
YOU DIFFERENTIATED.
THAT FROM AN ACTUAL FORMULARY AS
WE UNDERSTAND FORMULA IN HOW ARE
THEY DIFFERENT --
I THINK THAT WHEN YOU HAVE --
FORMULAR USE AND THE RATE OF IN
THE NON MEDICARE ALL PURCHASED
SEEN IF IT'S NOT ON THE
FORMULARY THAT YOU REALLY DO
HAVE TO GO THROUGH PROBABLY A
PRETTY EXTRAORDINARY AND IN SOME
CASES I'LL JUST SAY IT'S NOT A
COVERED DRUG RIGHT SO THEY'LL
SAY THAT.
YOU KNOW THAT IS A DRUG YOUR
PHYSICIAN MAY BE PRESCRIBING IT
TO YOU BUT WE DON'T COVER AND SO
THEREFORE THE BENEFICIARY OR THE
COVERED IN ROWLEY HAS TO GO AND
JUST.
PAY CASH FOR IT AND MEDI CAL
SESSION WRITES A SCRIPT FOR
SOMEONE AND IT'S NOT ON THE CD
L. THEY HAVE TO DO TREATMENT
AUTHORIZATION REQUIRED OKAY AND
THEN WE WOULD COVER IT AND ALSO
THE BUT THEN HE THAT HE DID AND
HE DID ACKNOWLEDGE IN OUR
CONVERSATION.
THE CHALLENGES FROM HIM BECAUSE
IT FROM HIS PERSPECTIVE OF EVEN
GOING TO THE TAR PROCESS BUT IT
IS DIFFERENT IN THAT THROUGH THE
TAR PROCESS.
BE IT ONEROUS AND TIME CONSUMING
BUT YOU CAN GET ACCESS TO THE
MEDICATION.
AS OPPOSED TO A FORMER PROCESS
WHERE YOU CANNOT.
OKAY AND THEN THE LAST THING I
WOULD SAY AND I FORGOT TO
MENTION THIS IS AND I KNOW THAT --
DOCTOR PAN AND OTHERS HAVE
CERTAINLY EXPRESSED CONCERN
AROUND THE CARE COORDINATION SO
FOR BENEFICIARIES THAT ARE
ENROLLED IN MANAGED CARE TODAY
AND THEY DO RECEIVE A CARVED OUT
DRUGS SO SAY YOU HAVE SOMEONE.
WITH -- CAM
APHELIA AND THEY ARE ARE
RECEIVING BLOOD FACTOR AND THAT
IS BEING --
BOTH --
HANDLED AND DISPENSED AND
WRITTEN IN THE FEE FOR SERVICE
AND REIMBURSED IN THE FEE FOR
SERVICE WE PROVIDE THAT DATA AND
FLOW THAT DATA THE PLANS WE
FLOAT ON A MONTHLY BASIS I THINK
THAT WE RECOGNIZE --
WITH THE SHIFT INTO FEE FOR
SERVICE THAT WE WOULD HAVE TO
MAKE SOME CHANGES WITHIN OUR OWN
SYSTEMS WHICH IS WHY IN SOME
CASES THE EXECUTIVE ORDER.
SAYS JANUARY OF TWENTY TWENTY
ONE ISIN WHICH WE WOULD BE
FLOWING THAT INFORMATION --
IN A MUCH MORE RAPID WAY SUCH
THAT PLANS WOULD BE AWARE OF
WHAT BENEFICIARIES ARE GETTING
IN TERMS OF PHARMACY CLAIMS.
IN THE FEE FOR SERVICE WORLD
TODAY -- WE
GET PRETTY TIMELY CLAIMS JUST
BECAUSE PHARMACIES DISPENSING
DRUGS AND PRETTY MUCH SUBMIT A
CLAIM ON THE SAME DAY IT'S A
IT'S A PRETTY INSTANTANEOUS.
OUR SYSTEM SO I THINK THAT THOSE
ARE SOME OF THE SYSTEMS ISSUES
THAT WE'RE AWARE OF AND WE
CERTAINLY ARE COGNIZANT OF AND
NOT WANTING TO DISRUPT.
THE PLANS ABILITY TO SEETHE
FULL ARRAY OF SERVICES THAT A
BENEFICIARY MAY BE RECEIVING AND
IN SOME CASES THERE ARE OTHER
CARVE OUT SERVICES THAT PLANS ON
ACTUALLY GET ACCESS TO THAT DATA
AND SO.
YOU KNOW WE'RE TRYING --
TO IN MULTIPLE WAYS TO IMPROVE
THAT DATA FLOW SUCH THAT PLANTS
CAN SEE --
LOTS OF OTHER SERVICES THAT
DON'T EXIST IN THEIR
RESPONSIBILITY.
THANK YOU ANY QUESTIONS FROM.
COMMITTEE MEMBERS.
SCENE NINE THANK YOU VERY MUCH
APPRECIATE YOU [inaudible] FOR
WAITING.
BECAUSE WE'RE GONNA TRANSITION
INTO OUR STAKEHOLDER PANEL --
FOR THIS SECTION OF OUR AGENDA.
AND WE'RE GOING TO HEAR FROM YOU
CHAU CABRERA.
S. CI YOU BEST THE PALE BRAD
GILBERT.
INLAND EMPIRE HEALTH PLAN
BARBARA GLACIER FROM THE
HOSPITAL ASSOCIATION.
ACTUALLY LESS SIX WITH THE I
WITH FARMER SAY POLICY DIRECTOR
FOR PHARMA.
AND JOHN ROCK WITH THE
CALIFORNIA PHARMACISTS
ASSOCIATION.
I'M SORRY THAT OUR BIGGEST PANEL
HAPPENS TO BE OUR LAST PANEL THE
AFTERNOON BUT BE THAT AS IT MAY
I'D ASK ALL OF YOU TO BE AS
BRIEF AND YET COMPREHENSIVE AS
POSSIBLE.
WE'LL START WITH MISS CABRERA.
GOOD AFTERNOON THINK YOU SO MUCH --
WE ARE HERE I'M HERE ON THE HAVE
SCA YOU CALIFORNIA TO EXPRESS
STRONG SUPPORT FOR THE
GOVERNOR'S VISION ON REFORMING
HOW THE STATE PURCHASES
PRESCRIPTION DRUGS. FOR OVER A
THIRD OF CALIFORNIANS THROUGH
BOTH ARE MEDI CAL AND OTHER
STATE PURCHASERS OF PRESCRIPTION
DRUGS.
THE HEALTH CARE INDUSTRY IS
COMPLEX AND OPAQUE BY DESIGN SO
THAT THE VARIOUS ACTORS CAN
LEVERAGE THE MAXIMUM POP PROFITS
POSSIBLE AND WE'VE HEARD A BIT
ABOUT THAT IN THE DISCUSSION ON
P. B. M.'S.
WE'RE INTERESTED IN THE
POSSIBILITIES OF SIR WHICH
MAXIMIZES THE PUBLIC SECTOR
SPEND FOR PHARMACY BENEFITS AND
WHICH INVITES OTHER PUBLIC AS
WELL AS PRIVATE PURCHASERS TO
BUY INTO.
AND WHILE WE REALIZE THAT MEDIC
THE MEDIC HOW PIECES COMPLICATED
BY BOTH MEDICAID BEST PRICE AND
PROGRAMS SUCH AS THREE FORTY
BEING IN THIS PHASE WE SHOULD BE
ASKING QUESTIONS ABOUT WHERE THE
STATE IS NOT ADEQUATELY USING
ITS SIZE AND SKILL. TO SAVE
TAXPAYERS MONEY AND INNOVATE ON
OUR DRUG PURCHASING WHILE AT THE
SAME TIME PROTECTING MEDICARE
BENEFICIARIES GUARANTEED ACCESS
TO MEDICALLY NECESSARY DRUGS.
AND FOR OUR SAFETY NET PROVIDERS
TO REMAIN WHOLE.
AS ONE EXAMPLE EVEN WITHIN
MEDICAID OTHER STATES HAVE DONE
AUDITS AND REPORTS WHICH YOU
FOUND THAT PVM STILL HAVE A
SPREAD AND THEY POCKET REBATES
WITHOUT THE STATE PURCHASER
KNOWING.
DO OUR MEDI CAL MANAGED CARE
PLANS WHO CONTRACTED P. P. B.
M.'S TODAY KNOW THAT THEIR
REBATES ARE BEING PASSED ON AND
IS THERE TRANSPARENCY AROUND THE
SPREAD IS ONE OF THE QUESTIONS
THAT WE THINK IS IMPORTANT.
TO UNDERSTAND IF THERE IS
SIGNIFICANT PUSHED BACK TO A
CARVING THIS OUT INTO FEE FOR
SERVICE --
WE NEED TO KNOW HOW MUCH MONEY
WE'RE LEAVING ON THE TABLE AND I
THINK EVEN THAT SORT OF PICTURE
OF WHAT WE'RE CURRENTLY SPENDING
IS NOT ENTIRELY CLEAR.
IN ADDITION ARE WE DOING ENOUGH
TO ASSASSINATE INCENTIVIZE THE
APPROPRIATE EFFECTIVE USE OF
DRUGS.
ARC RELEASED A REPORT THIS YEAR
THAT FOUND THAT ONE IN FOUR
ANTIBIOTICS --
IN COMMERCIAL COVERAGE WORK
COMPLETELY UNNECESSARY AND A
LARGE NUMBER OF THOSE WERE FOR
CONDITIONS.
THAT THEY DESCRIBED AS A NATION
WHERE ANTIBIOTIC SHOULD NEVER BE
USED AND SO THERE IS A TON OF
EDUCATION THAT NEEDS TO BE DONE
AND WE NEED TO LOOK AT THOSE
ARRANGEMENTS BETWEEN ON THE BACK
AND BETWEEN PERCH MANUFACTURERS
PM'S AS WELL AS PHYSICIANS --
MEDI CAL THE TIME BEFORE THE
NEXT BLOCKBUSTER DRUG HITS THE
MARKET IN OVERWHELMS OUR STATE
GENERAL FUND.
THIS TYPE OF RISK REQUIRES
CREATIVE POLICY SOLUTIONS
INCLUDING CONSIDERATION OF
AGGRESSIVE APPROACHES SUCH AS
THE IDEA PUT FORTH BY A SENATOR
STONE TODAY FOR A STATE RUN PBM --
AS WELL AS THE IDEA OF POT
POSSIBLY LOOKING INTO THE STATE
MANUFACTURING GENERICS ON ITS
OWN -- WHICH
IS SOMETHING THAT WE'VE DONE TO
A LIMITED DEGREE BUT COULD DO A
LOT MORE OF WE LOOK FORWARD TO
WORKING WITH THE GOVERNOR AND ON
HIS PRESCRIPTION DRUG PROPOSAL
AND APPRECIATE THE ATTENTION.
TO THIS ABOUT FASTEST GROWING
COST DRIVER AND HEALTHCARE THANK
YOU THANK YOU MISS CAPELL BETH
BILL ON BEHALF OF HEALTH ACCESS
CALIFORNIA I'D LIKE TO BEGIN
WITH A CLARIFICATION MADAM CHAIR.
UNDER CALIFORNIA LAW OF HEALTH
PLANS IN MOST HEALTH INSURERS
ARE REQUIRED TO COVER ALL
MEDICALLY NECESSARY DRUGS
WHETHER THEY'RE ON THE FORMULARY
OR NOT.
THE EXCEPTION IS LARGE GROUP
COVERAGE UNDER THE DEPARTMENT OF
INSURANCE WHICH WE HOPE TO
RECTIFY THIS YEAR BUT OTHERWISE
WHETHER TO ON THE FORMULARY OR
NOT IT IS WRITTEN.
IT IS REQUIRED THAT HEALTH PLANS
AND INSURERS COVER MEDICALLY
NECESSARY DRUGS.
AND THERE IS A PROCESS THE
INDEPENDENT MEDICAL REVIEW
PROCESS FOR DETERMINING WHETHER
IT'S MEDICALLY NECESSARY OR NOT.
IF THE PLAN IN THE PRESCRIBER
CANNOT AGREE WE DO SUPPORT THE
GOVERNOR'S PROPOSAL WE PROVIDE A
LETTER TO THE GOVERNOR AND TO
YOUR COMMITTEE AND OTHERS.
WE THINK WITH SUPPLEMENTAL
REBATES AND REBATES ON THE MEDI
CAL PROGRAM CAN SAVE AS MUCH AS
5260% OF THE DRUG PRICE.
WE ARE GETTING THE MANDATORY
REBATE WHICH IS ABOUT 23% --
BUT WE WOULD LIKE TO SEE THE
STATE OF CALIFORNIA TAKING
ADVANTAGE OF THOSE SUPPLEMENTAL
REBATES WHICH SHE HAD PIONEERED
IN THE EARLY NINETIES.
WE WOULD ALSO RECOMMEND THAT WE
HAVE A SINGLE STATEWIDE
FORMULARY AND THAT IT IS
NEGOTIATED --
BY DRUG CLASS TAKING INTO
ACCOUNT CLINICAL EFFECTIVENESS
RATHER THAN BEING NEGOTIATED
MANUFACTURE BY MANUFACTURERS SO
CENTER PAN IN YOUR EXAMPLE OF
HYPERTENSIVE IS THAT WOULD THAT
WOULD BE ENOUGH IN.
EACH OF THE CATEGORIES IN THAT
IF NONE OF THOSE FOR APPROPRIATE
FOR AN INDIVIDUAL THAT SOMEONE
SHOULD BE ABLE TO OBTAIN THROUGH
AN APPEAL PROCESS THE
APPROPRIATE --
ANTI HAVE PRETENCE OF OFF
FORMULAR.
WE WOULD ALSO SUGGEST.
THAT WE LOOK AT INFLATION
ADJUSTED REBATES --
OR FLAT AMOUNT SO THAT WE DON'T
TO AS THE PRICES INCREASING YOU
HEARD FROM.
MISS CAN'T THE DIRECTOR ABOUT
SOME PRETTY DRAMATIC PRICE
INCREASES THAT THOSE OF THAT WE
CONTINUE TO KEEP THE AMOUNT TO
THE STATE FLAT RATHER THAN.
HAVING IT BE ON A PERCENTAGE
BASIS.
LIKE OTHERS WE SUGGEST LOOKING
MULTI STATE EFFORTS WHETHER IT'S
EFFECTIVENESS REVIEW OR
PURCHASING.
AND WE'RE VERY INTRIGUED BY THE
IDEA THE STATE PBM AND WOULD BE
INTERESTED IN.
AND DISCUSSIONS ON THAT ONE
FINAL POINT IS AS WERE THINKING
ABOUT THIS --
IT.
THE MEDI CAL PROGRAM INCLUDING
THE MANAGED CARE TRANSFORMATIONS
OF THE LAST.
DECADE HAVING WE THINK ABOUT THE
AC EXPANSION AND BRINGING IN
TROUBLES ADULT BUT THE OTHER
THINGS WITH OTHER THING WE HAVE
DONE.
ISSUE OF FROM FEE FOR SERVICE
DEMAND THE DRAMATIC CHANGE IN
AND OF ITSELF --
AS WE THINK ABOUT THOSE WE'RE
NOT ENTIRELY CLEAR THAT THE
MANAGED CARE PLANS ARE --
BARGAINING IN THE BEST INTEREST
THE STATE OF CALIFORNIA AND SO
WE WELCOME THE PROPOSAL AND FEE
FOR SERVICE SO LONG AS IT'S DONE
IN A WAY THAT.
CONSUMERS HAVE MEDICALLY
NECESSARY DRUGS AND THERE IS
SOMETHING LIKE INDEPENDENT
MEDICAL REVIEW TO ASSURE PEOPLE
THAT THEY CAN GET WHATEVER THE
NEW A STRONG GIVES WHETHER.
IT'S IN THE MANAGED CARE CONTEXT
OR NOT THANK YOU THANK YOU
MISTER GILBERT --
GOOD MORNING --
ACTUALLY NOW GOOD AFTERNOON --
I'M DOCTOR BRAD GILBERT ON THE
CEO BY EACH P. WE'RE RESPONSIBLE
FOR ORGANIZING THE CARE FOR ONE
POINT TWO FOUR MILLION HUMAN
BEINGS IN THE INLAND EMPIRE --
WHAT I WANT TO REALLY TALK ABOUT
HIS CLINICAL ISSUES IS WHERE I
WANT TO FOCUS I APPRECIATE THAT
THERE'S BEEN A LOT OF DISCUSSION
ACOSTA NAY TOTALLY UNDERSTAND?
THE IMPORTANCE OF COST IN THE
MEDICAL PROGRAM FOR SURE --
I DO WANT.
TO GET A CO BEST --
COMMON ABOUT FORMULAR IS WE WERE
ROUTINELY APPROVED DRUGS THAT
ARE NOT ON THE FORMALLY THROUGH
A PRIOR OFF PROCESS AND WE DO IT
IN TWENTY FOUR HOURS AS REQUIRED
BY LAW. TO WERE VERY QUICK AND
LOOKING AT THE NEED FOR THE DRUG
AND APPROVING AT SO I'M GONNA
TRY TO TALK ABOUT THREE KEY
AREAS JUST AS EXAMPLES NUMBER
ONE IS OPIOIDS.
SO WE ALL KNOW THAT THERE'S THIS
HORRIBLE WITH MANY PEOPLE
ADDICTED AND HAVING ISSUES.
WE NEED TO DEAL WITH THAT AT THE
TIME OF THE PRESCRIPTION NOT
AFTER THE FACT IF IT INDIVIDUALS
PRESCRIBED AN EXCESSIVE AMOUNT
OF AN OPIATE OR THE PRESCRIBED A
BENZODIAZEPINE ON TOP OF AN
OPIATE.
WE NEED TO DEAL WITH THAT RIGHT
AT THE TIME OF THE PRESCRIPTION
AND SO WE DO CLINICAL WORK. FOR
THOSE MEMBERS GET THEM INTO PAIN
MANAGEMENT YOU KNOW FIND
ALTERNATIVES FOR THEM AND DEAL
DIRECTLY WITH THEIR PRESCRIBER
IF THEY HAVE MULTIPLE
PRESCRIBERS OF THE GOING TO
MULTIPLE PHARMACIES WE GOT A
DEAL WITH THAT IN THE MOMENT SO
GETTING THE INFORMATION
AFTERWARDS.
DOESN'T REALLY HELP.
SECOND AREA ARE REALLY HIGH IN
COMPLICATED DRUGS I'M SURE MANY
OF YOU HAVE SEEN THE ADS FOR K.
TRUDA WHICH IS A VERY COMPLEX.
IMMUNOMODULATOR DRUG THAT IS
USED AS A PRIMARY TREATMENT FOR
SOME CANCERS BUT OVERALL VERY
GENERALLY AS A FINAL TREATMENT
FOR CANCERS THAT ARE NOT
RESPONDING NORMAL CHEMOTHERAPY.
YOU HAVE TO MAKE ABSOLUTELY SURE
IT'S THE RIGHT PRESCRIBER.
THAT IT'S THE RIGHT MEDICINE FOR
THE RIGHT PERSON THAT IS AN
EXTREMELY DANGEROUS DRUG VERY
EFFECTIVE AND IN THE RIGHT
CIRCUMSTANCES AND SO AGAIN
THAT'S GOT TO BE IN THE MOMENT
THAT'S GOT TO BE RIGHT WITH THAT
PRESCRIPTION HITS THE SYSTEM.
AND THAT WOULD BE A PRIOR AUTH
REQUIRED DRUG THAT WE THEN MAKE
SURE THAT IT IS.
PROBABLY A TERTIARY LEVEL ON
COLLEGES THAT YOU KNOW
UNIVERSITY BASED SYSTEM BECAUSE
TO ME THAT DRUG NEEDS TO BE USED
FOR THE RIGHT PEOPLE SO WE DO A
LOT OF CLINICAL WORK RIGHT AT
THE TIME OF THE PRESCRIPTION.
THAT'S ABSOLUTELY NECESSARY TO
PROTECT OUR MEMBERS --
IN TERMS OF RIGHT RIGHT MEMBER
RIGHT PRESCRIBER RIGHT DRUG.
JENNIFER CAN'T MENTIONED IS
ACTUALLY FOR DIFFERENTLY.
BUT AGAIN YOU DON'T WANT ANYBODY
PRESCRIBING HABSI DRUGS ABOUT
FORTY TO SIXTY THOUSAND DOLLARS
FOR THE TREATMENT.
BY THE WAY QUE TRUTH AS A
HUNDRED AND FIFTY THOUSAND
DOLLARS A YEAR FOR THE TREATMENT.
YOU WANT THAT DRUG TO BE
PRESCRIBED IN ONE OF OUR CENTERS
OF EXCELLENCE WHICH ARE TO
COUNTY HOSPITALS LOMA LINDA OR
YOU IN OUR UNIVERSITY BASED
SYSTEM.
YOU WANT THAT DRUG AND THAT CARE
BEING DELIVERED AND THE ONLY WAY
TO DO THAT IS IF WE HAVE THE
INFORMATION RIGHT AT THE POINT
OF THE PRESCRIPTION.
THIRD AREA DIABETES WE HAVE --
CENTER STONE IS WHAT WAS ON OUR
BOARD WE HAVE A PAY FOR
PERFORMANCE PROGRAM FOR
PHARMACIES.
WHERE THEY ARE ACTIVELY ENGAGED
WITH THE DIABETIC MEMBERS COMING
INTO THE PHARMACY AROUND ARE THE
ON THE RIGHT MEDICATIONS TO THE
NEED TO CONSULT WITH A PHYSICIAN?
OR THEY HAVE BEEN TESTED FOR THE
DIABETES SO AGAIN IT'S GOT A
WORKER AT THE TIME OF THE
PRESCRIPTION.
SO THE POINT I'M MAKING IS THAT
WE ACTUALLY DO A LOT OF VERY
CLINICAL WORK AROUND THE
PHARMACY BENEFIT.
AND I HAVE TO SAY IS A POSITION
I SEE THE PHARMACY BENEFIT AS
PART AND PARCEL OF DELIVERING
HEALTHCARE TORE ONE POINT TWO
FOUR MILLION MEMBERS. TO THE
IDEA THAT YOU COULD PULL IT OUT
AND DO IT SEPARATELY. TO ME I'M
GONNA HAVE SOME DIFFICULTY WITH
THAT BECAUSE OF THIS NEED TO BE
ENGAGED AROUND THE TIME OF THE
PRESCRIPTION.
AND THE ABILITY TO WORK WITH
THAT MEMBER AND TREATED
APPROPRIATELY.
SO YOU KNOW JUST JUST A COUPLE
OF FINAL THOUGHTS.
CANNOT DISAGREE AROUND
STANDARDIZING THE BENEFIT THAT
DR DOCTORS CRAZY MY BROTHER'S A
PRACTICING PHYSICIAN.
HE SAYS I GOT THIRTY FOUR
MILLER'S SO HE ALWAYS GIVE ME A
HARD TIME [inaudible]
SO.
BUT I THINK THERE ARE WAYS TO DO
THAT WITHOUT NECESSARILY PULLING
THE BENEFIT COMPLETELY OUT OF
MANAGED CARE I THINK THERE ARE
WAYS TO THINK ABOUT WAYS TO
STANDARDIZE THE BENEFIT ACROSS
THE STATE.
AND YET STILL GIVE THAT CLINICAL
ABILITY AT THE PLAN LEVEL TO
ACTUALLY DEAL WITH OR ONE POINT
TWO FOUR MILLION MEMBERS AND THE
PHYSICIANS THAT WORK FOR THEM.
SO FOR ME I'D REALLY APPRECIATE
THAT THE PLANS AND THOSE OF US
THE CARE SO DEEPLY ABOUT OUR
MEMBERS AND PROVIDERS HAVE THE
ABILITY TO GIVE INPUT.
AND NOT NECESSARILY SEE THIS AS
AN ALL OR NONE SCENARIO THAT
THERE ARE WAYS TO THINK ABOUT IT
WHERE YOU KEEP BOTH PARTS YOU
KEEP STANDARDIZED BENEFIT.
YOU YOU MAXIMIZE REBATES DON'T
CARE GREAT LOVE THAT BUT YOU
MAKE SURE THAT THE PLAN IS THE
ABILITY TO ACTUALLY CARE FOR A
MEMBERS WHICH IS WHAT I CARE
ABOUT.
THANK YOU VERY MUCH FOR YOUR
TIME MUCH APPRECIATED THANK YOU
VERY MUCH.
THIS GLAZER.
MADAM CHAIR AND MEMBERS BARBARA
GLAZER WITH THE CALIFORNIA
HOSPITAL ASSOCIATION
REPRESENTING CALIFORNIANS ABOUT
FOUR HUNDRED HOSPITALS.
CJ STRONGLY SUPPORTS THE
GOVERNOR'S BUDGET WHICH PROPOSES
A NUMBER OF CHANGES AND
INVESTMENTS TO MAKE HEALTHCARE
MORE AFFORDABLE AND THEY'RE FROM
ARE ACCESSIBLE FOR MORE
CALIFORNIANS HIS BUDGET
CONTINUES TO MAKE PROGRESS
TOWARD UNIVERSAL HEALTHCARE
LOCAL SHARED BY ALL OF THIS.
DRIVING THE PUSH TOWARD
AFFORDABILITY THE GOVERNOR'S
EXECUTIVE ORDER TO CREATE A
SINGLE PURCHASER SYSTEM
PERFORMANCE TYPICAL THING
CALIFORNIA IS AN INNOVATIVE
APPROACH TO LOWER THE COST OF
DRUGS ONE OF THE FASTEST RISING
COSTS IN HEALTHCARE TODAY.
THE GOVERNOR'S CJ'S COMMITTED TO
FINDING MORE WAYS TO LOWER THE
COST OF PRESCRIPTION DRUGS.
AT THE STATE AND STATE AS THE
STATE AND STAKEHOLDERS
DEVELOPING NEW BULL PURCHASING
ARRANGEMENT WE ASK THAT THEY
KEEP IN MIND THE POTENTIAL
IMPACT ON CALIFORNIA'S SAFETY
NET HOSPITALS.
AND COMMUNITY HEALTH CENTERS
THAT PARTICIPATE IN THE THREE
FORTY B. DRUG PRICING DISCOUNT
PROGRAM FOR LOW INCOME RESIDENTS.
CONGRESS CREATEDTHE THREE FORTY
B. PROGRAM IN NINETEEN NINETY
TWO TO ENABLE SAFETY NET
HOSPITALS AND COMMUNITY HEALTH
CENTERS. TO STRETCH SCARCE
FEDERAL RESOURCES AS FAR AS
POSSIBLE REACHING MORE ELIGIBLE
PATIENTS AND PROVIDE A MORE
COMPREHENSIVE SERVICES.
IN CALIFORNIA MORE THAN ONE
HUNDRED AND EIGHTY HOSPITAL'S
PARTICIPATE IN AND RELY ON THE
THREE FORTY B. DRUG DISCOUNT
PROGRAM TO SERVE THEIR
COMMUNITIES.
IN ORDER TO QUALIFY FOR THREE
FORTY BE A HOSPITAL MUST BE
EITHER NONPROFIT OR PUBLICLY
OWNED.
CAM TO SERVE A DISPROPORTIONATE
SHARE OF MEDICARE AND MEDICAID
PATIENTS.
THE THREE FORTY B. PROGRAM DOES
JUST THAT HOSPITALS AND
COMMUNITY HEALTH CENTERS ARE
STRETCHING SCARCE FEDERAL
RESOURCES TO EXPAND ACCESS.
AT HOSPITALS THIS MEANS MORE
ACCESS TO ONCOLOGY SERVICES THE
ABILITY TO OFFER MOBILE IN
PRIMARY CARE CLINICS PROVIDE
DIABETES SCREENINGS AND OPERATE
HIV CLINICS.
THESE PROGRAMS AND SERVICES
REACH TO LOCAL COMMUNITIES AND
IMPROVE PATIENT OUTCOMES SUPPORT
MEDICATION ADHERENCE AND REDUCE
THE OUR ADMISSIONS. FOR SOME OF
OUR SMALLER IN RURAL MEMBERS
PARTICIPATING IN THE THREE FORTY
B. PROGRAM CAN LITERALLY MEAN
THE DIFFERENCE BETWEEN STAYING
OPEN AND CLOSING THEIR DOORS.
IN RELATION TO THE GOVERNOR'S
PROPOSAL IT IS IMPORTANT TO KNOW
THAT UNDER THREE FORTY BE
FEDERAL REQUIREMENTS.
CHILDREN'S HOSPITALS
DISPROPORTIONATE SHARE HOSPITALS
IN PRE STANDING CANCERS CENTERS
ARE ACTUALLY PROHIBITED FROM
PARTICIPATING IN A GROUP
PURCHASING ORGANIZATION ALSO
CALL THE GPO.
THE LANGUAGE IN THE EXECUTIVE
ORDER COULD BE INTERPRETED TO
DEFINE CALIFORNIA AS THE GPO.
IF THIS WERE THE CASE THESE
HOSPITALS WOULD BE PROHIBITED
FROM PARTICIPATING IN THE THREE
FORTY BE PROGRAM ALTOGETHER.
LOSING ANY ABILITY TO PURCHASE
DRUGS AT A DISCOUNTED RATE FOR
COMMERCIAL UNINSURED AND
MEDICARE BENEFICIARIES NOT JUST
FOR MEDI CAL ENROLLEES.
IF THE EXECUTIVE ORDERS SEEM TO
BE GPO THE HOSPITAL'S MOST
IMPACT WILL BE THOSE TREATING
THE LARGEST PROPORTION OF MEDI
CAL PATIENTS.
THE FEDERAL REQUIREMENTS WILL
PROHIBIT THESE HOSPITALS FROM
PARTICIPATING IN THE THREE FORTY
B. PROGRAM AND THEY MAY BE
FORCED TO REDUCE OR ELIMINATE
VITAL PATIENT CARE SERVICES.
AND ACCESS TO FREE OR DISCOUNTED
DRUGS FOR THEIR PATIENTS.
WE UNDERSTAND THAT IS PART OF
THE EXECUTIVE ORDER THE
DEPARTMENT OF GENERAL SERVICES
IS PREPARING A REPORT AS IT
PERTAINS TO BOTH PHARMACEUTICAL
PURCHASING FRAMEWORK.
DUE TO THE GOVERNOR'S OFFICE IN
MAY OF THIS SPRING ADDITIONALLY
WE UNDERSTAND THE DEPARTMENT OF
HEALTH CARE SERVICES IS
PREPARING A COMPLETE REPORT IS
IT RELATES TO THE TRANSITION OF
PHARMACY SERVICES.
FULLY TO THE P. PER SERVICE
BENEFIT.
BY JULY TWELFTH.
TWENTY NINETEEN AS BOTH
DEPARTMENTS PREPARE THESE
REPORTS WE OFFER SEVERAL
FUNDAMENTAL QUESTIONS WE HOPE
THEY WILL CONSIDER.
WILL THE STATE PURCHASE THE
DRUGS MANAGE THE INVENTORY AND
HAVE THEM SHIPPED TO HOSPITALS
WILL HOSPITALS HAVE TO KEEP
SEPARATE DRUG INVENTORIES FOR
MEDI CAL PATIENTS ANOTHER.
WELL THE TRANSITION OF THE
PHARMACY BENEFIT FOR MEDI CAL
MANAGED CARE TO MEDI CAL PEEPERS
SERVICE SUPPLY TO ALL DRUGS.
INCLUDING THOSE ADMINISTERED BY
A PHYSICIAN AND HOSPITAL
INPATIENT OUTPATIENT SETTING OR
WILL THE CAR ABOUT ONLY APPLY TO
THOSE DISPENSED BY A PHARMACY.
EITHER WAY IT WILL IMPACT.
THREE FOR HOWEVER THE BILLING
COMPLEXITIES ARE FAR GREATER IF
THE CHANGES APPLIED TO DRUGS AND
MINISTER IN IN PATIENT AND OUT
PATIENT SETTINGS.
UNDER THE MEDI CAL PAPERS
SERVICE CARVE OUT BENEFIT
STRUCTURE FOR MEDI CAL MANAGED
CARE BENEFICIARIES WHO WILL BE
RESPONSIBLE FOR CARE
COORDINATION MEDICATION
ADHERENCE AND UTILIZATION
MANAGEMENT.
AND THEN LASTLY WILL THERE BE
THOUGHT GIVEN TO THE ADDITIONAL
SUPPORT AND SERVICES CURRENTLY
FUNDED BY THE THREE FORTY B.
PROGRAM.
IF SO IS THE LEGISLATURE
CONTEMPLATING HOW TO FILL THE
SIZEABLE FUNDING GAP SO THAT
MEDI CL PATIENTS DON'T
EXPERIENCE ACCESS AND SERVICE
CHALLENGES AS A RESULT OF THIS
PROPOSAL.
C. H. A. STANDS READY TO WORK
WITH THE STATE AND OTHER
STAKEHOLDERS TO CREATE A DRUG
DISCOUNT PROGRAM WHOSE GOAL IS
TO LOWER HEALTHCARE COSTS FOR
ALL OF CALIFORNIA.
WE WOULD LIKE TO PARTNER WITH
THIS STATE AND THIS PROPOSAL IS
DEVELOPED. TO ENSURE THE
CALIFORNIA'S CRITICAL SAFETY NET
HOSPITALS IN COMMUNITY HEALTH
CENTERS WILL BE ABLE TO CONTINUE
TO DELIVER THE ESSENTIAL
SERVICES THEY DO TODAY.
THANK YOU.
THANK YOU NEXT WITNESS.
THANK YOU EVERYONE MADAM CHAIR
MEMBERS OF THE COMMITTEE HAPPY
VALENTINE'S DAY FIRST AND
FOREMOST A SHORTLIST X. SENIOR
DIRECTOR OF HEALTH POLICY AT
PARMA.
THANK YOU FOR THE OPPORTUNITY TO
PARTICIPATE TODAY SO WE REALLY
SEE THIS --
HAVING TO ASPECTS AS WE'VE HEARD
FROM OTHER PANELISTS THE FIRST
BEING THE MOVE TO FEE FOR
SERVICE FROM MANAGED CARE FOR
THE PHARMACY BENEFIT WE REALLY
SEE THIS AS A REINSTATEMENT OF
THE PHARMACY BENEFIT FOR THE
ENTIRE POPULATION THAT WAS USED
AROUND SEVEN YEARS AGO IN THE
STATE OF CALIFORNIA.
WHERE THEY STATE MANAGES THE
PREFERRED DRUG LIST AND ALSO
GETS THE SUPPLEMENTAL REBATES IN
ADDITION TO THAT STATUTORY
REBATES --
OUR PRIORITIES WITH MEDI CAL OR
TO ENSURE A TRANSPARENT
NEGOTIATION PROCESS AND ENSURE
THAT PATIENTS HAVE ACCESS.
TO THE MEDICINES THAT THEY NEED
WE HAVE NO REASON TO BELIEVE AT
THIS TIME THAT THE DEPARTMENT
CHAIRS --
DOES NOT SHARE IN THOSE --
PARTY OR CONCERNS WITH THAT PART
OF THE PROPOSAL --
WITH REGARD TO BALK PURCHASING
OUR UNDERSTANDING IS THAT THE
DEPARTMENT OF GENERAL SERVICES
HAS THE STATUTORY AUTHORITY TO
DO THIS ALREADY --
AND AGAIN WHERE WE HAVEN'T SEEN
THE DETAILS OF THE PROPOSAL YET
WERE MORE LIKELY TO REMAIN
NEUTRAL AND THAT.
THANK YOU FOR THE OPPORTUNITY TO
COME AND SPEAK WITH YOU ALL
TODAY [inaudible]
Q..
GOOD AFTERNOON MADAM CHAIR
MEMBERS THE COMMITTEE MY NAME IS --
JOHN ROSS I'M THE CHIEF
EXECUTIVE OFFICER OF THE
CALIFORNIA PHARMACISTS
ASSOCIATION.
OUR MEMBERS SERVE THE RESIDENTS
OF CALIFORNIA THROUGH A VARIETY
OF PRACTICE SETTINGS INCLUDING
COMMUNITY PHARMACIES STATE IN
PUBLIC COSTING PRIVATE HOSPITALS
CORRECTIONAL FACILITIES IN A
VARIETY OF OTHER SPECIALTY
PRACTICE SETTINGS --
I APPRECIATE DIRECTOR CANCER TO
CHELATION OF OF SOMEWHAT
SEPARATING THE ISSUES BETWEEN
THE TRANSITION IF YOU FOR
SERVICE AND THE BOOK PURCHASING
AND LIKE TO REFLECT MY COMMENTS
IN THAT SAME MANNER.
SEPTA STRONGLY SUPPORTS THE
GOVERNOR'S EXECUTIVE ORDER AND
BUDGET PROPOSAL TO TRANSITION
ALL PHARMACY SERVICES FOR MEDI
CAL MANAGED CARE. TO FEE FOR
SERVICE --
BY JANUARY.
TWENTY TWENTY ONE WE BELIEVE
THIS ACTION A CORRESPONDING
BUDGET PROPOSAL WILL ENHANCE THE
PHARMACY SERVICES AVAILABLE TO
MEDI CAL BENEFICIARIES.
WILL RESULT IN GREATER SAVINGS
TO THE STATE TO CARE FOR THE
BENEFICIARIES.
FROM THE BENEFICIARY PERSPECTIVE
CPA TO BELIEVES A SHIFT TO FEE
FOR SERVICE WILL INCREASE ACCESS
TO CARE --
AS WAS MENTIONED BY DIRECTOR
CAN'T BECAUSE 97% OF PHARMACIES
CURRENTLY PARTICIPATE IN THE FEE
FOR SERVICE PROGRAM.
ON THE OTHER HAND --
PHARMACIST ROUTINELY EXPERIENCE
CONCERNS WITH A NUMBER OF
MANAGED CARE ENTITIES VIEWS
CONTRACTORS PBM TO ADMINISTER
THE PHARMACY BENEFITS BECAUSE AN
INCREASING TREND TOWARD NARROW
PROVIDER NETWORKS WITHIN THIS
MANAGED CARE SERVICE AREAS.
THESE NARROW NETWORKS
DISADVANTAGED BENEFICIARIES FOR
REDUCING ACCESS AND CHOICE OF
PHARMACY PROVIDERS.
AND CREATE IMPEDIMENTS FOR
NAVIGATING CARE.
UNDER A SINGLE FEE FOR SERVICE
SYSTEM BENEFICIARIES AND
PROVIDERS ALIKE ARE BETTER ABLE
TO COORDINATE CARE.
ANY AND COVERAGE AND ENSURE THAT
PATIENTS ARE ABLE TO RECEIVE
THEIR MEDICATIONS.
I WOULD ALSO ENCOURAGE THAT THE
ADMINISTRATION TO USE EXISTING
MEDI CAL FEE FOR SERVICE
PHARMACY CLAIMS ADJUDICATION A
PROVIDER NETWORK MODEL THROUGH
DHS AND IS FISCAL INTERMEDIARY.
WE WOULD NOT BE IN SUPPORT OF A
STATE PROGRAM THAT ADOPTED A
MODEL WHERE THESE FUNCTIONS WERE
OUTSOURCED TO A THIRD PARTY
NAMELY A PVM.
IN THOSE MANAGEDCARE PLANS THAT
USE PEAVEY AMPS FOR THEIR
PHARMACY BENEFIT ADMINISTRATION.
OUR MEMBERS REPORT FREQUENT
CHALLENGES AND FRUSTRATIONS WITH
CONTRACT PROVISIONS FOR
COMMUNICATIONS AND CLAIMS
PROCESSING CHALLENGES.
CONVERSELY PHARMACISTS ARE
GENERALLY PLEASED WITH --
AND ADMINISTRATION OF THE
BENEFIT.
FROM A PRIVATE PROVIDER
PERSPECTIVE WOULD WELCOME THE
ENTIRE STATE ADMINISTRATION OF
THE PHARMACY BENEFIT TO FOLLOW
THE EXISTING MODEL.
NOW FURTHER AS IT RELATES TO THE
STREAMLINING OF PRESCRIPTION
DRUG PROCUREMENT FORMULAE
MANAGEMENT PROCESS THAT WE
BELIEVE THAT THE ADMINISTRATION
SHOULD CONSIDER FORMALIZING A
CALIFORNIA PHARMACY
COLLABORATIVE FOR ANOTHER
STRUCTURE.
THAT REQUIRES ALL STATE FUNDED
AGENCIES TO COURTNEY PROCUREMENT
OF MEDICATIONS AND ESTABLISHED A
SINGULAR CONTRACT A DRUG LIST
RATHER THAN THE VOLUNTARY SYSTEM
IN SOME CASES THAT'S IN PLACE
TODAY.
DOING SO WE DO BELIEVE WOULD
ACHIEVE THE ADMINISTRATION'S
GOAL IN THE EXECUTIVE ORDER OF
LEVERAGING MAXIMUM SAVINGS --
VIA A SINGLE POINT OF CONTROL
ADMINISTRATION THROUGH A STATE
AGENCY.
AND WITHOUT THAT --
SINGLE POINT OF CONTROL WE
BELIEVE THAT THERE WILL BE --
DOLLARS THAT WILL BE LEFT ON THE
TABLE -- AND
NOT CULTIVATED BY THE STATE IN
TERMS OF SAVINGS.
FINALLY WE ALSO BELIEVE THAT
THAT SINGLE SOURCE --
POINT OF CONTRACT WOULD RESULT
IN GREATER TRANSPARENCY IN HOW
ALL AGENCIES OPERATOR
PRESCRIPTION DRUG COVERAGE AS
WELL AS PROCUREMENT.
FINALLY AS ADMINISTRATION LOOKS
TO ADVANCE THIS PROPOSAL WE
BELIEVE ADDITIONAL DISCUSSIONS
ARE NECESSARY AS BEEN RAISED
HERE ON THIS PANEL. TO ENSURE
ACCESS AFFORDABILITY AND
APPROPRIATE PROVIDER
REIMBURSEMENT FOR HIGH COST
SPECIALTY MEDICATIONS AN
ALLOWANCE FOR THE THREE FORTY BE
CONTRACTED DRUG PROGRAM.
THESE ARE JUST A FEW THE
COMPLICATIONS AND IMPORTANT
BENEFITS THAT WE STAND READY TO
ASSIST.
AS THIS PROPOSAL MOVES FORWARD
THANK YOU MADAM CHAIR THANK YOU
VERY MUCH APPRECIATE YOU BEING
HERE ANY QUESTIONS [inaudible]
DOCTOR PAN.
THANK YOU SO VERY MUCH.
APPRECIATE THE UP PRESENTATIONS.
I THINK THAT THERE'S A LOT OF
QUESTIONS OUT THERE --
AND SAID OF C. DRUG --
DELIVERY AND ACCESS IS.
OCCASIONS SAYS THIS OF A COMPLEX
SO -- OR TWO
IN OUR BUDGET SUBCOMMITTEE
HEARINGS WE NEED TO KNOW WHAT'S
GOING TO HAPPEN THE THREE FORTY
BE -- IF
THERE ARE GOING TO BE --
DECREASES AND AND AND FUNDING
THERE HOW WE BACK FILLING THAT --
WE NEED TO LOOK AT SAID NOT ALL
THE MEDICATIONS AS WE GO THROUGH
A AN OUTPATIENT PHARMACY WE HAVE
FIGURE OUT MEDICATIONS BECAUSE
IT FACILITIES PROVIDER PROVIDED.
AND OF COURSE --
IN SOME SENSES --
THIS DOESN'T HAVE TO BE BUT THIS
IS ALL THIS COULD DEAL WITH ON A
RESULT IN A BACKWARD STEP IN
TERMS OF ACTUALLY COORDINATION
OF CARE AND AND VALUE BASED
PURCHASING APPROACHES WHICH IS
REALLY THE WAY WE'RE GOING TO
REALLY BEND OUT COST CURVE.
LONG RUN AND SO --
YOU KNOW --
IS A DOG THESE PHARMACEUTICALS
WORK THEY ACTUALLY NAM THEY'VE
BEEN TESTED THEY'VE BEEN
APPROVED BECAUSE THEY ACTUALLY
MAKE A DIFFERENCE.
SO -- THAT
MEANS THAT ANY SORT OF SYSTEM
YOU CREATE TO BETTER MANAGE CARE --
IF THEY'RE CARVED OUT --
AND THEY'RE NOT CORNING WITH THE
REST OF THE PIECES THAT YOU KNOW
THAT ABOUT THIS THAT --
I'LL PROVIDERS THAT FACILITIES
ETCETERA THEN WE'RE NOT GOING TO
GET THE KIND OF RESULTS WE NEED
SO I APPRECIATE THE RESENTATION
FROM -- FROM
HEALTH PLAN ABOUT GONNA
AFFECTIVELY USE.
MEDICATION --
THAT HAS TO BE PART OF THE MIX
AND IN FACT ACTUALLY FROM A
VALUE BASED PURCHASING POINT OF
VIEW.
WE CAN'T THINK ABOUT ANY AS MUCH
AS EVERYONE'S ANXIOUS ABOUT YOU
KNOW THE CONCERNED ABOUT
PHARMACEUTICAL CLASS WE CAN'T
NESTLE SEPARATE THAT OUT FROM
EVERYTHING ELSE I MEAN WE HAVE
TO LOOK AT HOW DO WE GET THE
BEST VALUE OVER ALL.
RIGHT -- SO --
CERTAINLY I THINK WHEN WE LOOK
AT PHARMACEUTICAL PRICES YOU
KNOW IN ISOLATION THERE'S
CERTAINLY A LOT OF EXAMPLES WE
CAN GIVE WHERE THERE ARE
CHALLENGES WHERE --
PEOPLE UNFORTUNATELY SOME PEOPLE
TAKING ADVANTAGE OF THE FACT
THAT YOU HAVE PATIENTS WHO NEED
THESE MEDICATIONS AND AND OF THE
RAISE PRICES.
BUT WE ALSO NEED TO RECOGNIZE
THAT -- THAT
SOMETIMES --
ACTUALLY TO LOWER THE
UTILIZATION OF OTHER TYPES OF
SERVICES AS WELL AND THAT --
WE NEED TO THINK ABOUT HOW THE
HOW TO CREATE A STRUCTURE WHERE --
THOSE TRADEOFFS --
END UP WITH A NET LOWER COSTS
FOR THE PATIENT RIGHT I MEAN AND
THAT'S IN THE END AS IS WHAT
IT'S ABOUT IS ABOUT WHAT THE
PATIENTS HAVE TO PAY.
TO RIGHT IT'S NOT JUST ABOUT
WHAT'S THE PRICE RATE IT'S
ACTUALLY WHAT THE PATIENTS HAVE
TO PAY SO --
YOU CAN HAVE A LOWER PRICE BUT
IF YOU A MECHANISM THAT EITHER
DENIES THE PATIENT ACCESS OR
THAT ACTUALLY RAISES THEIR OUT
OF POCKET COSTS THAN THAT'S NOT
HELPING THE PATIENT EITHER.
AND NOW THAT'S LESS OF AN ISSUE
IN MEDI CAL LAWYER --
THERE'S A BUT I MEAN THAT'S
AGAIN WE HAVE TO LOOK AT THAT
HOW THAT STRUCTURE OVERALL
BECAUSE SOME OF THESE SOME OF
THE EFFECTS MAY AFFECT ALSO NOT
JUST PATIENTS A MEDI CAL BUT
OTHER PEOPLE USE SIMILAR
FACILITIES I THINK WAS POINTED
OUT BY THE HOSPITAL ASSOCIATION.
SO I LOOK FORWARD I APPRECIATE
THAT -- THAT
THAT ARE --
DIRECTOR DIRECTED THAT THE
DIRECTIVE DTS IS STILL SITTING
IN THE AUDIENCE.
AND I LOOK FORWARD TO HEARING --
SUBCOMMITTEE AND SO I KNOW
THERE'S A STILL A LOT OF THINGS
TO WORK ABOUT --
WORK OUT BUT WE DEFINITELY WANT --
TO YOU'LL BE VERY INTERESTED IN
HOW THESE ISSUES WILL BE
RESOLVED MOVING FORWARD.
THANK YOU THANK YOU VERY MUCH
FOR YOUR TESTIMONY PROCEED WITH
AN OPEN IT UP TO PUBLIC COMMENT.
BOTTOM CHAIR MEMBERS SERRA
FLOCKS CALIFORNIA LABOR
FEDERATION --
I WANT TO SPEAK TO THAT THE BULK
PURCHASING A PRESCRIPTION DRUGS
AND I WANT TO SPEAK ACTUALLY --
TO NOT THE MEDI CAL PIECE OF IT
BUT TO THE STATE AND PRIVATE
PURCHASERS.
THERE ARE SEVENTEEN MILLION
CALIFORNIANS THAT HAVE JOB BASED
COVERAGE SIX MILLION OF THOSE
ARE IN SELF INSURED PLANS --
WHERE THEIR EMPLOYER OR TRUST
FUND PURCHASE PRESCRIPTION DRUGS?
AND THIS IS A HUGE COST BOTH TO
CONSUMERS TO WORKERS AND TO THE
STATE OF CALIFORNIA CALPERS IN
TWENTY FIFTEEN SAID THAT THE
RISING COST OF PRESCRIPTION
DRUGS.
ACCOUNTED 4405% OF THEIR PREMIUM
RATE INCREASES --
A HUGE COST TO BOTH THE STATE
AND TO TWO MEMBERS.
SO ALONG THOSE LINES ATION AS
TGS DOES THE REPORTS OF IS THERE
A WAY TO REMOVE THE BARRIERS SO
THAT THERE COULD BE.
ACTUAL STATE PURCHASING THAT THE
MEDIC CAL AND STATE AND PRIVATE
PURCHASERS.
COULD BE IN ONE BULK POOL I'M IN
ORDER TO HAVE MASSIVE AMOUNTS OF
PURCHASING LEVERAGE --
AND THEN I WOULD ALSO LIKE TO
ALIGN MYSELF WITH THE COMMENTS
OF SENDER STONE I THINK LOOKING
AT EITHER A STATE RUN PBM OR
NONPROFIT PBM HAS HUGE AMOUNT OF
POTENTIALS --
TO BE THE SOLE SUPPLIER OF ALL
PURCHASERS IN THE STATE OF
CALIFORNIA THIS IS SOMETHING
THAT'S NOT UNUSUAL IT'S WITH THE
VETERANS ADMINISTRATION DOES AS
WELL AS THE STATE OF WEST
VIRGINIA --
AND LASTLY I WOULD JUST SAY THAT
WE AS A STATE OF CALIFORNIA HAVE
AN INCREDIBLE RESOURCE SB
SEVENTEEN BECAME A LAW THAT IS
THE FIRST IN THE NATION DRUG
TRANSPARENCY --
LAW WHERE DRUG COMPANIES
ACTUALLY HAVE TO REPORT AND GIVE
A JUSTIFICATION FOR THEIR
EXCESSIVE PRICE INCREASES THAT
IS GOING TO YIELD A WEALTH OF
DATA THAT I THINK CAN HELP
INFORM ANY KIND OF STATE
PURCHASING.
THANK YOU VERY MUCH APPRECIATED
NEXT WITNESS PLEASE.
GOOD AFTERNOON CHAIR MEMBERS
LINDA WAY WITH WESTERN CENTER ON
LAW AND POVERTY TO THE FIRST
PART OF THE AGENDA RELATED TO AT
TO HEALTH FOR ALL YOUNG ADULTS
WE APPRECIATE.
AYE THE GOVERNOR'S PROPOSAL TO
EXPAND FULL SCOPE MEDI CAL UP IT
SIMILAR.
TO A CALIFORNIA IMMIGRANT POLICY
CENTER AND HOW THE AXIS URGE THE
LEGISLATURE TO CONSIDER
EXPANDING COVERAGE TO ALL ADULTS
REGARDLESS OF IMMIGRATION STATUS.
I TO THE SECOND PART WE
APPRECIATE OF THE GOVERNOR'S
PROPOSAL --
TO LOOK AT COST CONTAINMENT
OFFICIAL POSITION BUT WE DO
BELIEVE THAT THERE ARE A LOT OF
AREAS THIS PROVIDES AN
OPPORTUNITY TO IMPROVE.
THAT FEE FOR SERVICE --
UP BY PHARMACY SERVICES
SPECIFICALLY ANY CAR ABOUT
SHOULD RECOGNIZE THE PRIOR
AUTHORIZATION PROCESS.
AND NARROWLY HAS UNDERGONE AS IN
MANAGED CARE ENROLLEE AND
PROVIDE CONTINUITY OF CARE
PROTECTIONS FOR TWELVE MONTHS.
A TO ENSURE INDIVIDUALS WITH
MULTIPLE CHRONIC CONDITIONS DO
NOT SUDDENLY EXPERIENCE
DIFFICULTY IN OBTAINING NEEDED
PRESCRIPTIONS WE RECOMMEND DH CS
ELIMINATE THE SIX MONTH DRUG PER
MONTH.
SOFT CAP ON IN IN THE TREATMENT
AUTHORIZATION PROCESS AND IN
ADDITION WITH THE TREATMENT
AUTHORIZATION REQUEST PROCESSING
SIMILAR TO AN MEDI CAL MANAGED
CARE PLANS WE BELIEVE THAT TIME
LINE.
SHOULD BE APPLIED OF THE TWENTY
FOUR HOURS THERE'S NOT CURRENTLY
A PROCESSING TIMELINE ON THE THE
TREATMENT AUTHORIZATION REQUEST
PROCESS.
AND FINALLY --
WE BELIEVE AN EXTERNAL APPEAL
PROCESS SIMILAR TO THE
INDEPENDENT MEDICAL REVIEW WHERE
A POSITION IS --
PROVIDING THAT THE EXTERNAL
REVIEW AS WELL AS THE THE
SIMILAR TIME LINES SHOULD BE
FOLLOWED IN TERMS OF DUE PROCESS
RIGHTS.
FOR ENROLLEES THANK YOU THANK
YOU NEXT WITNESS.
THANK YOU TURN MEMBERS LINDA
TENER WHAT'S ON BEHALF OF THE
CALIFORNIA PAN ETHNIC HEALTH
NETWORK --
WE CONTINUE IN RESPONSE TO PART
A OF THE HEARING --
WE CONTINUE TO BE CONCERNED
ABOUT THE CHILLING EFFECT THAT
PUBLICCHARGE HAS ALREADY HAD ON
AND UNDOCUMENTED COMMUNITY
MEMBERS --
ANECDOTALLY WE'VE HEARD
HEARTBREAKING STORY FOR GOING
THEIR HEALTHCARE AND PULLING OUT
OF THE MEDI CAL SYSTEM.
ON TO ECHO THE REMARKS OF
SENATOR BELL --
WEEDING OUT REACH IS CRITICAL TO
HELPING COMMUNITIES UNDERSTAND
WHAT THEY ARE ELIGIBLE FOR AND
HOW TO USE THEIR COVERAGE --
I ALSO HEARD CONCERNS FROM
DOCTOR PAN ABOUT THE INFLUX OF
EMERGENCY ROOM VISITS THAT COME%
WITH THE EXPANSION.
OF BECAUSE PEOPLE JUST HAVEN'T
BEEN ACCUSTOMED --
TO GOING ANYWHERE ELSE OTHER
THAN THE ER --
THAT IS ALL TO SAY THAT WE SEE
AN OPPORTUNITY OF FOR THE STATE
TO INVEST IN COMMUNITY BASED OUT
REACH AND ROME AND NAVIGATION
SERVICES. TO REALLY HELP THE
HARDEST TO REACH COMMUNITY
MEMBERS --
THIS* PROGRAM WAS ACTUALLY
PREVIOUSLY FUNDED --
THROUGH AB AT TWO WHICH HAS SIX
SINCE EXPIRED IN THE SUMMER OF
TWENTY EIGHTEEN AND WE FIND NOW
MORE THAN EVER WE REALLY NEED TO
REINVEST IN THE SERVICES --
TO MAKE SURE THAT ALL FOLKS KNOW
EXACTLY WHAT THEY'RE ELIGIBLE
FOR AND HOW TO USE THEIR
COVERAGE IN LIKE A FEDERAL AND
TAXES FASTER ESPECIALLY PUBLIC
CHARGE.
SO THANK YOU FOR YOUR TIME THANK
YOU NEXT WITNESS.
HI GOOD AFTERNOON KEREN MEMBERS
I'M LIZ A SECURE WITH THE
CALIFORNIA OUT PLUS ADVOCATES AN
AFFILIATE OF THE CALIFORNIA
PRIMARY CARE ASSOCIATION.
WHO REPRESENTS? THIRTEEN
THIRTEEN HUNDRED THIRTY
CALIFORNIA COMMUNITY HEALTH
CENTERS AND SIX POINT NINE
MILLION HEALTH CENTER PATIENTS.
HEALTH CENTER SITES ARE SPREAD
ALL OVER THE STATE AND WE'RE LOW
INCOME COMMUNITIES --
BUT WE WOULD LIKE TO SHARE OUR
SUPPORT FOR THE GOVERNOR'S
DIVISION TO REFORM THE
HEALTHCARE DELIVERY SYSTEM
PROVIDE AFFORDABLE COVERAGE AN
AXIS.
AND LOWER THE TOTAL HEALTH CARE
SPENT -- THE
GOVERNOR'S EXECUTIVE ORDER
CREATES A SINGLE PERSON OR SAYS
THE PURCHASER SYSTEM FOR DRUGS
IN CALIFORNIA.
AND ITS WE UNDERSTAND IT'S AN
IMPORTANT PART OF HIS VISION.
HOWEVER THE EXECUTIVE ORDER
DIRECTS THE A CS TRANSITION ALL
PHARMACY SERVICES FOR MEDICAL
MANAGED CARE TO FEE FOR SERVICE
WHICH COULD POTENTIALLY AND THE
SAVINGS HEALTH CENTERS ACCRUED
THROUGH THE THREE FORTY B.
PROGRAM.
AND ULTIMATELY LIMIT THE ACCESS
FOR CALIFORNIA'S LOW INCOME
GOING TO PULL COMMUNITIES.
THE THREE FORTY BE SAVINGS.
PROGRAM ALLOWS HEALTH CENTERS TO
HAVE IN HOUSE PHARMACIES WITH
EXTENDED HOURS --
OFFER TRAVEL VOUCHERS FOR
PATIENTS AND PROVIDE FREE DRUGS
TO THE HOMELESS --
AMONG OTHER VERY NEEDED SERVICES
WHICH WITHOUT THIS FUNDING COULD
BE VERY MUCH CUT.
WE REMAIN COMMITTED AND WILLING
TO PARTNER TO FIND A SOLUTION
WHICH INCLUDES EXPRESS
PROVISIONS PROTECT HEALTH HEALTH
CENTERS ARE CURRENTLY OPERATE
THREE FORTY B. DRUG THIS
COMPARABLE.
WHO STAND TO LOSE FUNDS THAT
FULLY GO TO SUPPORT THE SAFETY
NET?
OUR GOAL IS TO PARTNER WITH THE
STATE AS THEY DEVELOP THIS
PROPOSAL WITH THE GOAL OF
ENSURING THAT HEALTH CENTERS CAN
CONTINUE TO DELIVER THE LEVEL
AND SCOPE OF SERVICES TEY DO
TODAY.
WHICH IS PARTIALLY FUNDED BY
THREE FORTY BE --
AND THEN GOING BACK --
TO THE FIRST PART OF THE HEARING --
WE WANT TO ALSO SHARE OUR FULL
SUPPORT FOR EXPANDING AHMED
ACCOUNT TO ALL THE DOLLS --
AND ALSO WANTED TO ECHO ON
THERE'S ISSUES WITH PUBLIC
CHARTS THAT HOUSE CENTERS HAVE
BEEN SEEING WITHIN THEIR
PATIENTS.
THANK YOU THANK YOU NEXT WITNESS.
KELLY BROOKS ON BEHALF OF THE
CALIFORNIA ASSOCIATION OF PUBLIC
HOSPITALS AND HEALTH SYSTEMS --
FIRST I'D LIKE TO EXPRESS THE
ASSOCIATION SUPPORT FOR
EXPANDING --
HEALTH COVERAGE IN CALIFORNIA
AND WE LIKE TO ENCOURAGE THE
ADMINISTRATION THE LEGISLATURE --
TO WORK WITH COUNTIES TO MAKE
SURE THE FINANCING PORTION OF
THIS DOESN'T ADVERSELY A PAT
AFFECT ON PUBLIC HEALTH AN
INDIGENT SERVICES AT THE LOCAL
LEVEL -- ON
THE SECOND PART OF THE HEARING --
WE WOULD ALIGN OUR COMMENTS WITH
THE CALIFORNIA HOSPITAL
ASSOCIATION WERE VERY SUPPORTIVE
OF THE GOVERNOR'S EFFORTS TO
REDUCE PHARMACY COSTS BUT WANT
TO NOTE THE IMPORTANCE OF THE
THREE FORTY BE. TO SAFETY NET
PROVIDERS AND THE POTENTIAL
IMPACTS WITH THE GOVERNOR'S
PHARMACY PROPOSAL.
I WOULD KNOW THAT ALL PUBLIC --
HEALTHCARE SYSTEMS ARE ELIGIBLE
THREE FORTY BE PROVIDERS --
THE PROPOSAL TO BOTH LEVERAGE
THE PART THE GROUP PURCHASING
AND TO MOVE PHARMACY THE
PHARMACY BENEFIT FROM A MANAGED
CARE TO FEE FOR SERVICE --
COULD JEOPARDIZE THE BENEFIT
THAT WE RECEIVED TODAY AT THREE
FORTY BE.
WE ARE USING THE DRUG DISCOUNTS
TODAY TO PROVIDE BETTER ACCESS
TO DRUGS FOR ALL OF OUR PATIENTS
AND ADMINISTER CRITICAL PROGRAMS
THAT PATIENTS MAY NOT FIND
ELSEWHERE INCLUDING --
HEPATITIS C. HEMOPHILIACS
SERVICE SAYS FOR VULNERABLE
POPULATIONS.
AS A STATE FURTHER EXPLORES WAYS
TO REDUCE DRUG COSTS WE LOOK
FORWARD TO WORKING WITH THE
LEGISLATURE AND ADMINISTRATION
TO ENSURE THAT WE CAN CONTINUE
PROVIDING THESE IMPORTANT
SERVICES AND MITIGATE ANY
POTENTIAL IMPACTS ON THREE FORTY
PROVIDERS.
THANK YOU NEXT WITNESS.
HI KATHY BURKE WITH THE HEALTH
OFFICER'S ASSOCIATION OF
CALIFORNIA FOR SOMEONE ALIGN
MYSELF WITH THE COMMENTS
MICHELLE GIVENS MADE --
ABOUT THE IMPORTANT WORK THAT
LOCAL HEALTH DEPARTMENTS DO WITH
THEIR FUNDING.
AND I ALSO WANT TO MENTION ABOUT
THE PRESCRIPTION DRUG --
COSTS THAT WE WERE THRILLED WHEN
THE DEPARTMENT GENERAL SERVICES
ASKED US WHAT DRUGS ARE THE MOST
EXPENSIVE TO US THAT THEY CAN BE
INCLUDED.
IN THE LIST BUT WE ALSO WANT TO
ADD THAT ANOTHER IMPORTANT
COMPONENT IS THE DRUGS ACOSTA
ZERO BECAUSE WE'RE THERE TOO
EXPENSIVE FOR US TO EVEN BY.
THE ONES THAT WE WOULD LIKE TO
BE ABLE TO AFFORD.
A KEY EXAMPLE OF THAT IS ADULT
IMMUNIZATIONS THAT WE WOULD LOVE
OUR COMMUNITY PROVIDERS TO HAVE
IN THEIR OFFICES BECAUSE
PATIENTS ARE MUCH MORE LIKELY TO
RECEIVE AN IMMUNIZATION IF IT'S
RIGHT THERE --
AND IT'S DIFFICULT TO PURCHASE
OF OTHER WAYS AND IT'S DIFFICULT
FOR PROVIDERS TO KEEP THOSE IN
STOCK THANK YOU.
BARBARA GLAZER WITH THE
CALIFORNIA HOSPITAL ASSOCIATION
I WANTED TO LET YOU KNOW THAT C.
H. A FULLY SUPPORTS THE
EXPANSION OF THE FULL SCOPE MEDI
CAL BENEFITS TO THE YOUNG
UNDOCUMENTED ADULTS --
THIS WILL CERTAINLY GO A LONG
WAY IN IMPROVING ACCESS TO CARE
FOR THESE INDIVIDUALS.
AND HELP TO KEEP THAT CARE MORE
AFFORDABLE THANK YOU THANK YOU
FINAL WITNESS.
AFTERNOON MADAM CHAIR MEMBERS ON
PREDNISOLONE I'M HERE ON BEHALF
THE ASSOCIATION FOR ACCESSIBLE
MEDICINES A AM REPRESENTS THE
GENERIC AND BIOSIMILAR.
MANUFACTURERS AND ALL THE PRE
FIGHT.
THANKS FOR ALLOWING MEIN
STAYING AROUND FOR THE THE LAST
PERSON TO TESTIFY WE DO BELIEVE
THAT GENERIC ABOUT SIMILAR TO
OUR LARGE PIECE OF THE PUZZLE
AND WE APPRECIATE THE GOVERNOR'S.
GOAL TO REDUCE PATIENT CO.
THERE ARE A COUPLE OF POINTS I'D
I'D I WOULD LIKE TO LEAVE YOU
WITH. 90% OF ALL PRESCRIPTIONS
WRITTEN ARE FORTUNATE --
DRUGS ONLY 23% OF THE REVENUE
RESULTS FROM.
THOSE PRESCRIPTIONS AND TWENTY
SEVENTEEN GENERIC DRUGS SAY THE
STATE OF CALIFORNIA TWENTY THREE
POINT FOUR BILLION DOLLARS.
IT'S FOUR POINT SEVEN BILLION A
MEDICAID SEVEN POINT SIX BILLION
A MEDICARE.
AND THE THE REST IN COMMERCIALLY
INSURED AND CASH PAYING
[inaudible]CUSTOMERS.
THE DIFFERENCES BETWEEN THE
BRAND MARKET PLACE IN THE CHIN
GENERIC MARKETPLACE ARE VERY
STARK.
WE SELL ON A VERY NATIONAL LEVEL
THERE'S THREE PURCHASERS THAT BY
90% OF ALL GENERIC DRUGS THOSE
ARE THE THREE WHOLESALERS AFTER
THAT THE GENERIC MANUFACTURERS
ARE VERY LARGELY OUT OF THE COST
STRUCTURE THAT CONTINUES
THROUGHOUT THE REST OF THE
SUPPLY CHAIN.
IN FACT MANUFACTURES TAKE IN THE
GENERIC SPACE ABOUT ONE THIRD.
OF THE REVENUE WHILE THE REST
THE SUPPLY CHAIN TAKES TWO
THIRDS.
THE DIFFERENCE ON THE BRAND SITE
IS THE BRAND MANUFACTURERS TAKE
ABOUT 75% OF THE REVENUE AND THE
REST SPREAD ACROSS THE SUPPLY
CHAIN.
THE GENERIC PHARMACEUTICAL
SPACES ABOUT THE ONLY DECLINING.
SPACE WITH IN HEALTH CARE WERE
DECLINING AT ABOUT 7% ANNUALLY.
I THINK FIVE EARLIER SB
SEVENTEEN WAS WAS BROUGHT UP AND
I THINK SOME VERY INTERESTING
POINTS HAVE ALREADY RESULTED
FROM THAT BILL OF THE TWENTY
FIVE MOST FREQUENTLY PRESCRIBED
GENERIC DRUGS.
THEY COMPRISE THIRTY NINE POINT
9% OF ALL PRESCRIPTIONS FOUR
POINT 8%.
OF THE TOTAL DRUG SPEND AN ONLY
POINT 3%.
OF THE PREMIUM FOR TWENTY FIVE
HIGHEST PER YEAR.
A YEAR OVER YEAR INCREASED
GENERIC DRUGS RESULTED IN ONLY
FOUR POINT 7% OF THE TOTAL DRUG
SPENT.
AND YES THERE ARE SOME VERY
EXPENSIVE GENERIC DRUGS I DON'T
WANT -- TO
DOWNPLAYS FAT FACT.
THE FINAL POINT THAT CAME OUT OF
THE THE DRUG LISTA REQUIRED FROM
THE INFORMATION FROM THE
INSURERS SUPPORT FOR THE TWENTY
FIVE MOST COSTLY GENERIC DRUGS.
SO RESULTED IN 25% OF ALL
PRESCRIPTIONS.
BELOW 8% OF THE TOTAL DRUG SPEND
AND LESS THAN 1% OF HEALTHCARE
PREMIUMS.
THE CENTER FOR CMS NATIONAL
HEALTH EXPENDITURE DATA FROM --
TWENTY SEVENTEEN SHOWS THAT
HOSPITAL EXPENDITURES INCREASED
BY FOUR POINT 6% TO
APPROXIMATELY ONE POINT ONE
TRILLION DOLLARS.
THAT'S GOOD BECAUSE THE PRIOR
YEAR WAS A FIVE POINT 6%
INCREASE.
POSITIONING CLINICAL SERVICES
INCREASED FOUR POINT 2% TO
APPROXIMATELY SEVEN HUNDRED
BILLION DOLLARS ALSO GOOD
BECAUSE THAT'S REDUCTION FROM
FIVE POINT 6%.
THE PRIOR YEAR PRESCRIPTION DRUG
SPEND INCREASED.
POINT 4%. TWO THREE HUNDRED
THIRTY THREE BILLION DOLLARS
AGAIN THESE ARE CMS.
NUMBERS.
THEY CREDITED LARGELY THE
GENERIC DRUG SPACE FOR ENSURING
THAT LOW.
INCREASE POINT 4%.
REGARDING THE PURCHASING POOL AS
PROPOSED BY THE GOVERNOR.
AM DOES NOT TAKE A POSITION ON
ON SOMETHING LIKE THAT AGAIN
BECAUSE MOST GENERICS ARE.
SOLD TO THE THREE WHOLESALERS
BUT WE DO HAVE SOME CONCERNS AND
IT'S KIND OF A LONG RANGE
CONCERNED WITH THIS TYPE OF
THING AND WHEN WE'VE SEEN THIS --
GROWTH FROM STATE TO STATE TO
THE NATIONAL LEVEL [inaudible]
AND THE CONCERN IS AS YOU START
TO GROW THE PURCHASING POOLS.
THAT MEANS YOU'RE ELIMINATING
THE NUMBER OF PURCHASERS WHEN
YOU ELIMINATE THE NUMBER OF
PURCHASERS YOU'RE ELIMINATING A
CERTAIN PERCENTAGE OF TOTAL
SALES.
WHEN YOU LIMóN EIGHT THE TOTAL
NUMBER OF SALES THAT MEANS THAT
THERE'S NOT AS MANY
MANUFACTURERS WHO ARE GOING TO
BE MAKING THOSE SALES?
AND SO THAT STARTS TO NARROW.
THE XIN ROUTE AND IT'S THE
COMPETITION WITHIN THE GENERIC
SPACE THAT DRIVE DOWN PRICES.
AND SO.
AGAIN IT'S IT'S NOT ANY SORT OF
OPPOSITION BUT JUST A THOUGHT TO
LEAVE YOU WITH.
THAT.
THERE ARE SOME LONG RANGE
CONCERNS THAT I THINK NEED TO BE.
CONTEMPLATED AS THIS TYPE OF A
PROPOSAL MOVES FORWARD.
THANK YOU.
THANK YOU VERY MUCH THANK YOU
ARE COMMITTEE MEMBERS --
PANELISTS MEMBERS OF THE
AUDIENCE --
FOR STICKING WITH US AND HAVING
A IMPORTANT FIRST CONVERSATION
ABOUT SOME MAJOR --
EXPANSIONS IN THE GOVERNOR'S --
BUDGET PROPOSAL THANK YOU VERY
MUCH THE HEARING IS ADJOURNED