GOOD MORNING EVERYONE. HAPPY MCO
CONVERSATION DAY. IT'S MY
FAVORITE DAY, SO WE HAVE JUST
ONE ITEM ON THE DOCKET. TODAY
WILL BE THE, MCO CONVERSATION.
WE HAVE BROKEN IT DOWN INTO TWO
PANELS. THE FIRST PANEL WILL BE
THE COALITION THÀNH, THAT WAS
ACCOUNTED FOR, INCLUDED IN WHAT
WE HAVE RIGHT NOW IN THE
BREAKDOWNS. WE WILL HEAR FROM
THEM REGARDING WHAT THIS WILL
MEAN TO THEM INCREASING THE
RATES, X, Y, AND Z. THE SECOND
PANEL IS WHAT COULD BE IF WE ADD
ADDITIONAL STAKEHOLDERS TO THE
CURRENT BREAKDOWN AND SO FORTH,
MY ONLY LITTLE FOOTNOTE HERE IS
DEPARTMENT OF FINANCE. I HOPE NO
QUESTION GOES UNANSWERED TODAY.
I HOPE YOU HAVE A SUPERVISOR
HERE TO COME SAVE WHATEVER
DEPARTMENT OF FINANCE, EMPLOYEE
IS HERE TO ANSWER THE QUESTIONS.
I PROMISE I WILL TAKE RECESS. IF
THERE IS NO IF THERE ISN'T A
PERSON THAT'S GOING TO ANSWER
THE QUESTION, I'M JUST GIVING
YOU A HEADS UP RIGHT NOW. SO
PLEASE, IF YOU DON'T HAVE A
SUPERVISOR HERE, GET THEM HERE
TO BE ABLE TO ANSWER ANY
QUESTION I'M GOING TO ASK, OR
WE'RE GOING TO BE HERE ALL DAY
OR ALL NIGHT IF I, WE'RE GOING
TO BE HERE JUST WAITING FOR THAT
QUESTION TO BE ANSWERED,
RESPECTFULLY, OKAY. SO WE'RE
GOING TO KICK IT OFF. I WELCOME,
THE DEPARTMENT, THE REST OF THE
PANEL, ONE PANELIST, LÀ Þ
DEPARTMENT OF FINANCE, TO JOIN
US HERE. WE MIGHT NOT HAVE
ENOUGH, DEPARTMENT. SO WE'LL
JUST START WITH LAO DEPARTMENT
AND DEPARTMENT OF FINANCE. THANK
YOU. AND THEN WE'LL WELCOME THE
REST. OF.
DIRECTOR, WILL YOU BE ANSWERING
THE QUESTIONS? KICKING US OFF?
YES, PLEASE. GO AHEAD. GREAT
GOOD MORNING, CHAIR AND MEMBERS,
MICHELLE BOS, DIRECTOR OF THE
DEPARTMENT OF HEALTH CARE
SERVICES. SO, ASSEMBLY BILL 119
AUTHORIZED AN MCO TAX EFFECTIVE
APRIL 1ST, 2023 THROUGH DECEMBER
31ST, 2026. TAX REVENUES FROM
THIS TAX ARE GOING TO BE USED TO
SUPPORT THE MEDI-CAL PROGRAM,
INCLUDING PRESERVING COVERAGE IN
THE MEDI-CAL PROGRAM AND NEW
TARGETED PROVIDER RATE INCREASES
AND OTHER INVESTMENTS THAT
ADVANCE ACCESS, QUALITY, AND
EQUITY FOR OUR MEDI-CAL MEMBERS
AND PROMOTE ADDITIONAL PROVIDER
PARTICIPATION IN MEDI-CAL. WE
OBTAINED FEDERAL APPROVAL OF
THIS MCO TAX ON DECEMBER 15TH,
2023 FROM THE FEDERAL GOVERNMENT
. THE 20 2425 GOVERNOR'S BUDGET
PROPOSED TO INCREASE THE MCO TAX
TO GENERATE AN ADDITIONAL $1.5
BILLION IN NET STATE REVENUE FOR
THE TAX PERIOD OF JANUARY 1ST,
2024, THROUGH DECEMBER 31ST,
2026, BY RAISING THE PER
ENROLLEE TAX ON MEDI-CAL LIVES
TO MAXIMIZE REVENUE WITHIN THE
FEDERALLY APPROVED STRUCTURE,
THANK YOU TO YOUR EARLY ACTION
ON THIS MODIFIED PROPOSAL. WITH
THE PASSAGE OF SB 136. AND WE
SUBMITTED THE MODIFIED MCO TAX
PROPOSAL TO CMS ON MARCH 27TH OF
2024, THEREBY PROVIDING THE
OPPORTUNITY TO SECURE THE TAX
EFFECTIVE JANUARY 1ST, 2024. IN
TOTAL, THE TAX WILL GENERATE
$34.7 BILLION IN TOTAL TAX
REVENUES, INCLUDING 29 20.9
BILLION AND NET STATE REVENUE,
OF WHICH 12.9 BILLION IS
PROPOSED TO SUPPORT THE MEDI-CAL
PROGRAM AND MAINTAIN A BALANCED
BUDGET. AND ABOUT 8 BILLION IS
PROPOSED FOR TARGETED PROVIDER
RATE INCREASES AND OTHER
INVESTMENTS, IN TERMS OF THE
2024 TARGETED RATE INCREASES, WE
DEVELOPED WHAT WE CALLED THE
PHASE ONE TARGETED RATE
INCREASES THAT WERE EFFECTIVE
JANUARY ONE, 2024. AND THESE
WERE FOR PRIMARY CARE OBSTETRIC
CARE, INCLUDING DOULAS AND NON
SPECIALTY MENTAL HEALTH SERVICES
FOR MEDI-CAL MEMBERS. AGAIN,
THIS WAS EFFECTIVE JANUARY ONE,
2024, THIS APPLIES TO BOTH THE
FEE FOR SERVICE DELIVERY SYSTEM
AS WELL AS MEDI-CAL MANAGED CARE
PLANS. ESSENTIALLY, WE INCREASE
THESE RATES TO 87.5% OF THE
LOWEST MEDICARE RATE IN
CALIFORNIA. THIS IS INCLUSIVE OF
ELIMINATING THE AB 97 PROVIDER
PAYMENT REDUCTIONS AND
INCORPORATING THE APPLICABLE
PROPOSITION 56 SUPPLEMENTAL
PAYMENTS INTO THE BASE. WE
RECEIVED APPROVAL OF THESE
TARGETED RATE INCREASES IN A
STATE PLAN AMENDMENT. A MANAGED
CARE PLANS WILL NEED TO UPDATE
PROVIDER CONTRACTS AND SYSTEMS
TO IMPLEMENT THESE RATE
INCREASES. WE'VE OUTLINED THE
FOLLOWING TIMETABLE FOR OUR
MANAGED CARE PLANS TO ACHIEVE
FULL COMPLIANCE, AND WE ARE IN
CONTINUED DISCUSSIONS WITH OUR
PLANS AND PROVIDERS ON THIS
TIMETABLE. BUT FOR FEE FOR
SERVICE PROVIDER ARRANGEMENTS,
MANAGED CARE PLANS MUST FULLY
IMPLEMENT THE 2024 RATE
INCREASES ON A GO FORWARD BASIS
AS OF JULY 31ST OF AND COMPLETE
RETROACTIVE CLAIM ADJUSTMENTS BY
OCTOBER 31ST, AND THEN FOR
CAPITATED PROVIDER PAYMENT
PROVIDER ARRANGEMENTS. SO
MANAGED CARE, MANAGED CARE
PROVIDER ARRANGEMENTS TO MEET
THIS RATE INCREASE NO LATER THAN
DECEMBER 31ST, 2024 FOR 2025,
TARGETED RATE INCREASES IS THE
SECOND PHASE OF THESE RATE
INCREASES, AND WE SUBMITTED A
DETAILED POLICY MEMO REGARDING
THESE EIGHT THESE RATE INCREASES
AND IN COMPLIANCE WITH TRAILER
BILL LANGUAGE THAT WAS APPROVED
AS PART OF LAST YEAR'S BUDGET, I
WILL TURN IT OVER TO LINDY
HARRINGTON, OUR ASSISTANT STATE
MEDICAID DIRECTOR, TO GO INTO
THE DETAILS OF THE 2025 RATE
INCREASES. FOR PROFESSIONAL
SERVICES, EFFECTIVE JANUARY 1ST,
2025, WE ARE TARGETING ANNUAL
INVESTMENTS OF $2.4 BILLION,
WITH 975 MILLION COMING FROM THE
PROVIDER RESERVE FUND FOR
PRIMARY AND SPECIALTY CARE,
OBSTETRIC CARE, INCLUDING DOULAS
AND NON SPECIALTY MENTAL HEALTH
SERVICES. 250,000,100 MILLION
COMING FROM THE RESERVE FUND FOR
EMERGENCY DEPARTMENT PHYSICIAN
SERVICES, WE PROPOSE TO INCREASE
RATES TO TARGET SPECIFIED
PERCENTAGES OF MEDICARE FOR
THESE SERVICES ON A PROCEDURE
CODE BASIS, AND TO REQUIRE OUR
MEDI-CAL MANAGED CARE PLANS TO
PAY NO LESS THAN THE INCREASED
RATE TO THEIR NETWORK PROVIDERS.
BASED ON OUR EXPERIENCE WITH THE
INCREASES FROM 2024, WE ARE
EXPLORING OPTIONS TO STREAMLINE
INCREASES FOR MANAGED CARE SUB
CAPITATED ARRANGEMENTS WHILE
ENSURING THAT FUNDING REACHES
PROVIDERS, WE PROPOSE TO
ELIMINATE AB 97 REDUCTION
PAYMENT REDUCTIONS FOR ALL
PROFESSIONAL SERVICES, AS WE ARE
PROPOSING TO INCREASE RATES TO
100% OF MEDICARE FOR PRIMARY
CARE AND SPECIALTY OFFICE
VISITS, PREVENTATIVE SERVICES
AND CARE MANAGEMENT, MATERNAL
CARE SERVICE NON-SPECIALTY
MENTAL HEALTH SERVICES, VACCINE
ADMINISTRATION, VISION SERVICES
90% OF MEDICARE FOR EMERGENCY
DEPARTMENT PHYSICIAN VISITS, AND
80% OF MEDICARE FOR OTHER
PROCEDURE CODES COMMONLY
UTILIZED BY PRIMARY CARE
SPECIALISTS AND EMERGENCY
DEPARTMENT PROVIDERS. WE INTEND
TO APPLY THE INCREASES BROADLY
ACROSS PROCEDURE CODES IN THESE
SERVICE CATEGORIES, COVERING THE
VAST MAJORITY OF CODES COMMONLY
UTILIZED BY PHYSICIANS. WE ARE
ALSO PROPOSING TO INCLUDE
HEARING AIDS AND AUDIOLOGY
SERVICES WITHIN THIS DOMAIN, AND
TO INCREASE THE BENEFIT CAP ON
HEARING AIDS. OUR THE HEARING
AID COVERAGE FOR CHILDREN
PROGRAM USES THESE SAME RATES AS
MEDI-CAL, SO THE HCP PROVIDERS
WOULD SEE THE SAME INCREASE, AND
WE ARE GENERALLY PROPOSED TO
STRUCTURE THE MEDI-CAL TARGETED
RATE INCREASES FOR THOSE
PROFESSIONAL SERVICES TO 80% OF
MEDICARE FOR MOST SERVICES. MANY
AUDIOLOGY SERVICES DO NOT HAVE A
MEDICARE RATE. SO FOR THESE
SERVICES, WE ARE INTENDING TO
REVIEW RATES FROM COMMERCIAL
PAYERS AND OTHER GOVERNMENTAL
PROGRAMS TO ESTABLISH AN 80% OF
MEDICARE EQUIVALENT BENCHMARK.
WE ARE ALSO PROPOSING TO ADOPT A
MEDICARE LOCALITY STRUCTURE AND
TO SET MEDI-CAL RATES TO TARGET
PERCENT OF THE MEDI-CAL RATE
APPLICABLE IN THE LOCALITY. THIS
WILL IMPROVE THE ALIGNMENT OF
MEDI-CAL RATES TO LOCAL COST
DIFFERENCES, AND IN FUTURE
YEARS, WE PROPOSE TO MAINTAIN
GEOGRAPHIC RATES IN RELATION TO
THE MEDICARE RATE IN EFFECT, FOR
THE LOCALITY. WE ARE PROPOSING
TO ALLOCATE $200 MILLION, 80
MILLION OF THE RESERVE FUND FOR
ADJUSTMENTS DESIGNED TO PROMOTE
EQUITY AND PROVIDER
PARTICIPATION IN LOCALITIES
WHERE MEMBERS MAY FACE
CHALLENGES WITH ACCESS TO
EQUITABLE HEALTH CARE DUE TO
HEALTH CARE WORKER SHORTAGES,
AND TO ADDRESS SOCIAL DRIVERS OF
HEALTH, WE ARE PROPOSING TO
IMPLEMENT THE EQUITY ADJUSTMENT
FOR SPECIFIED CATEGORIES OF
PROCEDURE CODES ON A GEOGRAPHIC
BASIS IN LOCALITIES IDENTIFIED
USING AN EQUITY INDEX. THE
EQUITY ADJUSTMENT WOULD RAISE
THE RATE FOR THESE CODES ABOVE
100% OF MEDICARE FOR HIGH NEED
LOCALITIES. WE, IN CONJUNCTION
IN CONSULTATION WITH
STAKEHOLDERS, WILL DEVELOP AN
EQUITY INDEX USING A COMPOSITE
OF EXISTING DATA SOURCES, WHICH
MAY INCLUDE STATUS AS A HEALTH
CARE WORKER, SHORTAGE AREA
STATUS AS A RURAL OR FRONTIER
AREA, CONCENTRATION OF MEDI-CAL
MEMBERS AS A PERCENT OF REGIONAL
POPULATION, AND BROADER MEASURES
OF SOCIAL DRIVERS OF HEALTH SUCH
AS THE HEALTHY PLACES INDEX. WE
ARE STILL WORKING CLOSELY WITH
OUR STAKEHOLDERS TO DEVELOP
THOSE INDICES. LOCALITIES MAY BE
ESTABLISHED BASED ON
METROPOLITAN STATISTICAL AREAS,
COUNTIES OR SUB COUNTY SERVICE
AREAS. THE INDEX BASED
ADJUSTMENT FACTORS WILL BE
APPLIED BY GROUPING LOCALITIES
INTO PERCENTILES OR TIERS BASED
ON SCORE. AND WE'RE PROPOSING TO
APPLY ADJUSTMENT FACTORS TO
PROCEDURE CODES USED FOR PRIMARY
CARE AND SPECIALTY OFFICE
VISITS, INCLUDING PREVENTATIVE
SERVICES AND CARE MANAGEMENT,
VISION AND VACCINE
ADMINISTRATION, MATERNITY CARE
SERVICES, AND NON SPECIALTY
MENTAL HEALTH SERVICES FOR
OUTPATIENT AND ED FACILITY
SERVICES. EFFECTIVE JANUARY 1ST,
2025, WE ARE TARGETING ANNUAL
INVESTMENT INVESTMENTS OF
APPROXIMATELY 490 MILLION FOR
COMMUNITY AND HOSPITAL
OUTPATIENT SERVICES, INCLUDING
HOSPITALS AND AMBULATORY,
AMBULATORY SURGICAL CENTERS. 725
MILLION FOR EMERGENCY DEPARTMENT
FACILITY SERVICES. WE PROPOSE TO
TRANSITION HOSPITAL OUTPATIENT,
AMBULATORY SURGICAL CENTER
REIMBURSEMENT TO AN OUTPATIENT
PROSPECTIVE PAYMENT SYSTEM OR
OPS METHODOLOGY. NO SOONER THAN
JANUARY 1ST, 2027, AND WE ARE
PROPOSING TO EXPLORE AND ENGAGE
STAKEHOLDERS ON TRANSITIONING
EMERGENCY DEPARTMENT FACILITY
REIMBURSEMENT TO AN OPS
METHODOLOGY. NO SOONER THAN
JANUARY ONE OF 2027, AN OPS
REIMBURSED US OUTPATIENT
FACILITIES FOR SERVICES USING A
SINGLE BUNDLED PAYMENT FOR EACH
EPISODE OF CARE. SIMILAR TO
INPATIENT DIAGNOSIS, DIAGNOSTIC
RELATED GROUP, OR DRG
REIMBURSEMENT. THE AMOUNT OF THE
BUNDLED PAYMENT VARIES BY ACUITY
AND COMPLEXITY OF THE SERVICES.
THE OPS IS INTENDED TO IMPROVE
INCENTIVES RELATED TO PATIENT
CARE DELIVERY AND ENCOURAGE
ECONOMIC AND EFFICIENT
REIMBURSEMENT OF SERVICES OVER
TRADITIONAL FEE FOR SERVICE
SYSTEMS, WHICH HAVE AN INCENTIVE
FOR VOLUME BILLING. WE ARE
PROPOSING TRANSITION FEE
INCREASES TO BASELINE
REIMBURSEMENTS IN THE FEE FOR
SERVICE AND MANAGED CARE
DELIVERY SYSTEMS. BEGINNING IN
2025, UNTIL THE IMPLEMENTATION
OF THE OPS METHODOLOGY, THE
TRANSITIONARY BASELINE INCREASES
WILL APPLY. WILL APPLY UNIFORMLY
DETERMINED PERCENTAGE OR DOLLAR
INCREASES TO CURRENT
REIMBURSEMENT LEVELS IN THE FEE
FOR SERVICE AND MANAGED CARE
DELIVERY SYSTEMS. WE PROPOSE TO
CALIBRATE THE OPS TO BE BUDGET
NEUTRAL RELATIVE TO INCREASED
BASELINE REIMBURSEMENTS IN THE
PRECEDING TWO YEARS, AND TO
PROVIDE ONGOING ADJUSTMENTS
BASED ON CHANGES TO MEDICARE
RATES. WE ARE PROPOSING TO
GEOGRAPHICALLY VARY
REIMBURSEMENT UNDER THE NEW OPS
METHODOLOGY, IN ALIGNMENT WITH
THE GEOGRAPHIC LOCALITIES UNDER
THE MEDICARE OPS, WE ARE
PROPOSING TO APPLY REGIONAL OR
HOSPITAL SPECIFIC EQUITY
ADJUSTMENTS TO OUTPATIENT
SERVICES TO MITIGATE
REIMBURSEMENT DISPARITIES AND
FUTURE RISK OF HOSPITAL CLOSURES
UNDER ABORTION SERVICES,
EFFECTIVE JANUARY 1ST, 2025. WE
ARE TARGETING INVESTMENTS OF 90
MILLION OF THE RESERVE FUND
ANNUALLY FOR ABORTION SERVICES,
75 MILLION FOR BASE RATE
INCREASES, AND $15 MILLION TO
CONTINUE THE ABORTION
SUPPLEMENTAL PAYMENT PROGRAM. WE
ARE PROPOSING TO INCREASE RATES
FOR SURGICAL AND MEDICATION
ABORTIONS TO $1,150, INCLUDING
FOLDING IN THE EXISTING
PROPOSITION 56 SUPPLEMENTAL
PAYMENTS. WE ARE PROPOSING TO
VARY THE RATE FOR ABORTION
SERVICES BASED ON THE 32
MEDICARE GEOGRAPHIC REGIONS AND
THE MEDICARE GEOGRAPHIC PRICE
INDEX, AND WE ARE PROPOSING TO
CONTINUE THE ABORTION
SUPPLEMENTAL PAYMENT PROGRAM
WITH FUNDING FROM THE RESERVE
FUND FOR THE DURATION OF THE
CURRENT MCO TAX. WE ARE NOT
CURRENTLY PROPOSING INVESTMENT
SPECIFIC TO FAMILY PLANNING IN
MEDI-CAL DUE TO EXISTING HIGH
LEVELS OF REIMBURSEMENTS FOR THE
MOST COMMONLY USED FAMILY
PLANNING SERVICES, ESPECIALLY
AFTER ACCOUNTING FOR THE
PROPOSITION 56, SUPPLEMENTAL
PAYMENTS FOR GROUND EMERGENCY
MEDICAL TRANSPORTATION SERVICES,
EFFECTIVE JANUARY 1ST, WE ARE
TARGETING INVESTMENTS OF $50
MILLION OF THE RESERVE FUND
ANNUALLY FOR GROUND EMERGENCY
MEDICAL TRANSPORTATION SERVICES.
WE ARE PROPOSING TO ADOPT
MEDICARE'S PRICING SYSTEM TO
VARY GMT BASED RATES BY
COMPLEXITY, LOCALITY AND RURAL
STATUS. WE ARE PROPOSING TO
ELIMINATE THE 10% AB 97
REDUCTION AND TO INCREASE BASE
RATES TO BETWEEN 50 AND 60% OF
THE MEDICARE BASE RATE IN 2025.
WE ARE CURRENTLY CONSULTING WITH
STAKEHOLDERS TO DETERMINE THE
IMPACT OF CERTAIN ADJUSTMENT
FACTORS AND THE DESIGN OF THESE
ADJUSTMENT FACTORS WILL
INFLUENCE THE FINAL PERCENTAGE
OF MEDICARE BASE RATE THAT CAN
BE ACHIEVED IS THAT FOR ALL
PRIVATE COMPANIES AS WELL.
THAT'S FOR THAT'S FOR ALL GROUND
EMERGENCY MEDICAL
TRANSPORTATION. SO THAT'S THE
BASE RATE THAT WOULD BE PAID TO
ALL. OKAY THANK YOU, AND WE ARE
PROPOSING IN FUTURE YEARS TO
MAINTAIN THE MEDI-CAL BASE RATES
IN RELATION TO MEDICARE RATES
FOR OUR DESIGNATED PUBLIC
HOSPITALS PARTNERS. WE ARE
PROPOSING THAT EFFECTIVE JANUARY
1ST, 2025, WE ARE TARGETING
INVESTMENTS OF APPROXIMATELY
$375 MILLION, 150 MILLION OF THE
RESERVE FUND ANNUALLY FOR
DESIGNATED PUBLIC HOSPITALS.
WE'RE PROPOSING TO TRANSITION
REIMBURSEMENT FOR DESIGNATED
PUBLIC HOSPITAL INPATIENT
SERVICES FROM CERTIFIED PUBLIC
EXPENDITURES TO A DRG OR
DIAGNOSTIC RELATED GROUP TYPE
METHODOLOGY. ADDITIONAL PAYMENTS
TO RECONCILE DF'S TO 100% OF
COSTS WOULD OCCUR IF EITHER MORE
THAN ONE HALF OF DF'S RECEIVED
BELOW 100% OF COST UNDER THE DRG
METHODOLOGY, OR MORE THAN ONE
QUARTER OF DF'S RECEIVE BELOW
BELOW 75% OF COST. UNDER THE DRG
METHODOLOGY, THE NONFEDERAL
SHARE OF THE ADDITIONAL COST
RECONCILIATION PAYMENTS WOULD
CONTINUE TO BE FUNDED USING
CERTIFIED PUBLIC EXPENDITURES AS
IT IS TODAY. WE HAVE PROPOSED TO
SUNSET THE RECONCILIATION OF
100% OF COST USING A PHASED
APPROACH APPROACH. THIS IS NOT
JEOPARDIZE THE FINANCIAL
SUSTAINABILITY OF DRG FUNDING TO
DF'S ONLY AFTER TWO CONSECUTIVE
YEARS IN WHICH A COST
RECONCILIATION IS NOT TRIGGERED.
WE HAVE, HOWEVER, ENGAGED WITH
THE CALIFORNIA ASSOCIATION OF
PUBLIC HOSPITALS ON THIS
PROPOSAL AND ARE COMMITTED TO
WORKING TOGETHER TO MITIGATE
THEIR CONCERNS RELATED TO THE
SUNSETTING OF THE COST
RECONCILIATION, AND WE ARE
CONTINUING TO WORK WITH THEM TO
EVALUATE THE EXTENT TO WHICH THE
PROPOSED DRG METHODOLOGY WOULD
COVER THEIR MEDI-CAL COSTS, SUCH
ANALYZES ARE HIGHLY DEPENDENT ON
ENROLLMENT AND OTHER
PROJECTIONS, WHICH ARE UNCERTAIN
DUE TO COVERAGE, EXPANSIONS, AND
TRANSITIONS THAT OCCURRED IN
2024 AND ONGOING REDETERMINATION
PROCESS. WE EXPECT ADDITIONAL
CLARITY IN THE COMING MONTHS.
QUICK QUESTION WHEN YOU WERE
TALKING ABOUT THE COMMUNITY AND
HOSPITAL OUTPATIENT EMERGENCY
DEPARTMENT SECTION, WE WERE
MOVING TO OPS FROM DRG. NO, NO,
NO, NO. SO TODAY, FOR THOSE THEY
ARE PAID ON A CODE BASE, JUST A
SIMPLE, FEE FOR SERVICE BASIS.
IT'S NOT A BUNDLED PAYMENT.
WE'RE LOOKING TO TRANSITION THEM
TO A PAYMENT METHODOLOGY THAT IS
SIMILAR TO DRG FOR OUTPATIENT
SERVICES. OKAY. BUT OKAY.
PERFECT THANK YOU. AND SO WE ARE
ALSO MOVING TO DO THE SAME FOR
THE FOR THE DESIGNATED PUBLIC
HOSPITALS. OKAY. WHEN DO YOU
ANTICIPATE WILL HAVE MORE
INFORMATION ON THAT. AT THE END.
YOU SAID WE'RE STILL WAITING. SO
WE'RE WE'RE CONTINUING TO WORK
WITH THEM. AND WE HOPE TO HAVE
SOMETHING FOR MAY REVISION.
OKAY. AND THE MAY REVISION ON
THE PLAN FOR THE TRANSITION OR
ON THE COST RECONCILING PIECE OF
IT. YES. OKAY. THANK YOU SO
MUCH. WE'VE HEARD THEIR CONCERNS
AND ARE WORKING TO KIND OF
ADDRESS THOSE CONCERNS. THANK
YOU. FOR OUR, FEDERALLY
QUALIFIED HEALTH CENTERS, UNDER
THE NON-340B SUPPLEMENTAL
PAYMENT PROGRAM, EFFECTIVE
JANUARY 1ST, 2025, THE
DEPARTMENT IS TARGETING
INVESTMENTS OF 50 MILLION OF THE
RESERVE FUND ANNUALLY FOR
SERVICES AND SUPPORTS PROVIDED
BY FEDERALLY QUALIFIED HEALTH
CENTERS AND RURAL HEALTH
CLINICS. WE ARE ENGAGED IN
ONGOING EFFORTS TO TRANSITION
THE EXISTING $105 MILLION FEE
FOR SERVICE SUPPLEMENTAL PAYMENT
PROGRAM FOR THESE COMMUNITY
CLINICS INTO A MANAGED CARE
DIRECTED PAYMENT ARRANGEMENT,
EFFECTIVE JANUARY 1ST OF 2025.
THE DIRECTED A PAYMENT
ARRANGEMENT WILL PROVIDE ONE
UTILIZATION BASED PAYMENTS AND
TWO PERFORMANCE BASED QUALITY
PAYMENTS. WE WILL DIRECT THE
MANAGED CARE PLANS TO REIMBURSE
NETWORK FQHCS AND RHCS, AND ADD
ON PAYMENT FOR QUALIFYING
SERVICES ON A PER VISIT BASIS,
SIMILAR TO WHAT WE DO UNDER THE
EXISTING FEE FOR SERVICE
PROGRAM. IN ADDITION, DCS WILL
DIRECT MANAGED CARE PLANS TO
REIMBURSE NETWORK FQHCS AND
RHCS, A PERFORMANCE BASED
QUALITY OR PAYMENT EQUIVALENT TO
THE DIFFERENCE BETWEEN THE
TARGETED ANNUAL POOL AMOUNT AND
THE ACTUAL UTILIZATION BASED
PAYMENT. SO THIS WILL ALLOW KIND
OF A BALANCER TO ENSURE THAT WE
STAY WITHIN OUR APPROPRIATED
AMOUNT, THIS SHIFT WILL HELP
STREAMLINE AND REDUCE PAYMENT
DELAYS WHICH HAVE OCCURRED IN
THE CURRENT FEE FOR SERVICE
PROGRAM DUE TO CHALLENGES THAT
REQUIRE MANUAL ACTIONS AND
PROCESSES TO RECONCILE, AND
UNDER THE MANAGED CARE DIRECTED
PAYMENT, MANAGED CARE PLANS WILL
PAY A PROSPECTIVELY ESTABLISHED
PAYMENT RATE ALONGSIDE REGULAR
CLAIMS PROCESSING. IN THE
MEANTIME, FOR THE REMAINING
PROGRAM PERIOD THROUGH THE END
OF CALENDAR YEAR 2024, THE
DEPARTMENT HAS ADDED ADDITIONAL
QUALITY CONTROL AND UPDATED
PROCEDURES TO ENSURE PAYMENTS
ARE MADE TIMELY TO THE CLINICS.
AND THOSE ARE OUR INVESTMENTS,
ON THE BEHAVIORAL HEALTH
THROUGHPUT, WE DO NOT,
UNFORTUNATELY, HAVE ADDITIONAL
DETAILS TO SHARE AT THIS TIME ON
THE PROPOSED DOMAIN. THE
GOVERNOR'S BUDGET PROPOSED THESE
INVESTMENTS TO BEGIN. EFFECTIVE
JANUARY OR JULY 1ST OF 2025. DO
WE, DIRECTOR, DO WE ANTICIPATE
MORE INFORMATION IN THE MAY
REVISE OR WHEN DO WE WHEN DO YOU
THINK WE'LL HAVE THIS PLAN? WE
HOPED BY MAY REVISE. OKAY OKAY.
THERE THERE ARE A COUPLE OF
THINGS I THINK WE'RE MISSING.
THE HEALTH CARE WORKFORCE LABOR
MANAGEMENT COMMITTEE, SO THAT,
PROPOSAL WILL BE IMPLEMENTED
THROUGH THE DEPARTMENT THROUGH
HØI. DO WE HAVE ANY INFORMATION
ON WHAT THAT'S GOING TO LOOK
LIKE? IT'S OUR UNDERSTANDING
BASED ON KIND OF INITIAL
CONVERSATIONS, BASED ON INITIAL
CONVERSATIONS, THAT IT IS KIND
OF DOLLARS TO SUPPORT LABOR
MANAGEMENT COMMITTEES THAT WORK
WITH OUR MEDI-CAL PROVIDERS THAT
ARE MEDI-CAL PROVIDERS AND KIND
OF, THINKING THROUGH HOW YOU CAN
SUPPORT WHETHER IT'S THROUGH
TRAINING AND ETC. I THINK SAU
MIGHT BE ABLE TO SPEAK TO A
LITTLE BIT MORE OF IT AS THEY'RE
WORKING WITH HCCI ON THE
PROPOSAL. I'M NOT SURE IF YOU
CAN ANSWER THIS QUESTION, OR
MAYBE WHEN THE PANELISTS COME UP
ON THE GRADUATE MEDICAL
EDUCATION PROGRAM, HOW WILL WE
KNOW? SO, THE INVESTMENTS FOR 75
MILLION ANNUALLY FROM MEDI-CAL
PROVIDER FROM FROM THE FUND TO
èC TO EXPAND GRADUATE MEDICAL
EDUCATION WOULD THAT BE SO?
THOSE DOLLARS ARE WERE
APPROPRIATE ARE GOING TO THE
UNIVERSITY OF CALIFORNIA. AND SO
IS IT A ONE TIME OR ANNUALLY
THAT'S AN ANNUAL HOW WILL WE
KNOW THAT WE'VE MET THE GOALS OF
THIS INVESTMENT? IS THERE A
CERTAIN AMOUNT OF NUMBER OF
EXPANDED SLOTS AT OTHER SCHOOLS?
ARE WE TRACKING IF THEY'RE NOT
MEETING THOSE SLOTS, DOES THAT
MONEY COME BACK TO US? DO THEY
KEEP THAT MONEY AND ROLL OVER
FOR MORE SLOTS? WE CAN FOLLOW UP
WITH èC, BUT WE DON'T
ADMINISTER THE PROGRAM, SO I'M
NOT SURE HOW. MAYBE ADJACENT.
KONSTANTINOS, JUST TO EMPHASIZE
THAT A LOT OF THAT,
IMPLEMENTATION IS REALLY LEFT TO
THE UNIVERSITY. THERE IS AN
EXISTING, GRADUATE MEDICAL
EDUCATION PROGRAM AT UC THAT'S
MOSTLY FUNDED BY PROPOSITION
$56. AND THIS, PROVIDES
ADDITIONAL FUNDING TO THAT. BUT
THAT THAT PROGRAM IS,
IMPLEMENTED BY THE UNIVERSITY.
THEY CONTRACT WITH ANOTHER
ENTITY TO, TO ADMINISTER THE
GRANTS. AND SO THAT THAT'S NOT
SPECIFIED IN THE LEGISLATION,
WHAT THE GOALS ARE OR THE HOW
THE OUTCOMES WOULD BE TRACKED.
YEAH, I GUESS I MEAN, IT'S TO
ACHIEVE THE GOAL OF INCREASING.
I'M HOPING WE'RE MEETING THE
GOAL OF INCREASING. I WAS GOING
TO ASK AND MAYBE WE CAN FOLLOW
UP AT A LATER DATE WITH MAYBE
SOMETHING WITH EDUCATION SO WE
CAN GET OUR ARMS AROUND THAT.
BUT DO WE KNOW ALSO JUST LIKE
REGIONALLY AROUND AROUND THE
STATE WHERE THOSE. RIGHT.
BECAUSE I KNOW LIKE MERCED IS
TRYING TO START A MEDICAL
PROGRAM TOO. IS IT GOING TOWARDS
JUST GRADUATING PEOPLE? IS IT
GOING TOWARDS EXPANSION OF THE
INFRASTRUCTURE FOR MEDICAL
SCHOOL RESIDENCIES, RESIDENCIES?
YEAH. THAT'S RIGHT. SO IT'S FOR
IT'S FOR, IT'S REALLY FOR
RESIDENCY PROGRAMS AND IT'S,
IT'S THEY'RE MOSTLY ADMINISTERED
AS, LIKE COMPETITIVE GRANTS TO
DIFFERENT RESIDENCY PROGRAMS,
NOT JUST UC PROGRAMS, BUT OTHER
PROGRAMS ACROSS THE STATE. AND
SOME OF THEM SUPPORT, LIKE
EXISTING, SLOTS, AND SOME OF
THEM ARE USED TO EXPAND THE
NUMBER OF SLOTS. SO THEY HAVE
DIFFERENT PURPOSES, BUT THEY'RE
PRIMARILY FOR RESIDENCY
PROGRAMS. AND THAT'S AND THAT'S
EQUITABLE ACROSS THE STATE AS
FAR AS WE KNOW, I DON'T HAVE THE
DATA AT HAND ON ON HOW THAT'S
DISTRIBUTED THROUGHOUT THE STATE
. BUT THERE ARE SPECIFIC AREAS.
SO IT FOCUSES ON PRIMARY CARE
AND EMERGENCY CARE. SO THERE ARE
SPECIFIC MEDICAL AREAS THAT IT
FOCUSES ON. I'M JUST HOPING, YOU
KNOW WE'RE ALWAYS WE'RE SHORT A
LOT FROM BILINGUAL AND SO FORTH.
YOU KNOW CULTURALLY APPROPRIATE
THOSE WITH LIVED EXPERIENCE. AND
SO FORTH. SO I JUST WANT TO MAKE
SURE THAT WE'RE, WE'RE WE'RE
WE'RE REACHING THAT GOAL OF
INCREASING THE, THE KIND OF
PEOPLE WE WANT. RIGHT OR NEED, I
MEAN, THE KIND OF PEOPLE WE NEED
RIGHT NOW. SENATOR. THANK YOU,
MADAM CHAIR. YOU KNOW, I USED TO
CHAIR A SUB ONE OF THIS
OPERATION, AND I REMEMBER I
REMEMBER THIS APPROPRIATION AND
ALSO THE PROP 56 DISCUSSION,
SOMEBODY MUST GET A REPORT
SOMEWHERE. I'M CURIOUS AS TO
WHERE THESE SLOTS ARE
DISTRIBUTED AND WHAT RESIDENCY
PROGRAMS THEY FUND, SO I REALIZE
IT'S NOT NECESSARILY WITHIN THE
JURISDICTION OF THIS COMMITTEE,
BUT IT HAPPENS TO BE IN OUR
AGENDA. SO MAYBE WHEN YOU ALL
HAVE TIME, YOU COULD THROUGH THE
CHAIR, YOU COULD OBTAIN FROM THE
BIG èC WHERE THE MONEY GOES AND
WHICH RESIDENCY PROGRAMS IT
FUNDS, AND I DON'T REMEMBER EVER
RECEIVING THAT IN SUB ONE. MAYBE
WE DID, BUT THAT WOULD BE
APPRECIATED. THANK YOU. THE
SPECIAL GUEST TODAY, THE BPA,
AND THEN I WANTED TO GO BACK TO
THE EQUITY INDEX. WHAT
STAKEHOLDERS ARE WE PUTTING
TOGETHER FOR COMING UP WITH THIS
INDEX. SURE. SO WE HAVE BEEN
MEETING WITH OR THE DEPARTMENT
HAS BEEN MEETING WITH SEVERAL.
WE'VE BEEN MEETING WITH
PROVIDERS. OUR MANAGED CARE
PLANS KHN, SOME LOCAL HEALTH
JURISDICTIONS WHO'VE ALSO RAISED
IN THE CENTRAL VALLEY, SOME SOME
IDEAS AS WELL. 200 MILLION IS A
LOT OF MONEY, WHEN DO YOU THINK
WE WILL HAVE A DETAILED
UNDERSTANDING OF HOW WE'RE GOING
TO ADDRESS THE GOALS OF THE
EQUITY PORTION OF, OF THIS TAX?
SO WE'RE HOPING TO HAVE MORE
DETAILS AT MAY REVISION ON THIS
KIND OF BASED ON SOME OF THE
FEEDBACK WE'VE RECEIVED, BUT
THAT IS OUR GOAL IS TO HAVE MORE
DETAILS AT MÀ. REVISION. OKAY
ANY FURTHER QUESTIONS?
COLLEAGUES ON THE DEPARTMENT'S
PORTION? I THINK THAT CONCLUDES
MY QUESTIONS AS WELL. AND,
DIRECTOR, I GUESS ONE LAST THING
IS THE TPL ON ALL OF THIS.
WAITING UNTIL MAY REVISE AS
WELL. HAS SHE NOT ALL THE FINAL
DETAILS. WE'RE CONTINUING TO
WORK ACROSS THE ADMINISTRATION
ON GETTING THIS OUT, IDEALLY
HAVING SOME LANGUAGE OUT BEFORE
MAY REVISION, BUT CONTINUING TO
WORK ON THAT. OKAY IT'S MY
BIRTHDAY THIS WEEKEND. MAYBE
IT'S A BIRTHDAY GIFT. I GET THE
TBL THIS WEEKEND. OH, WORTH A
TRY. OKAY, NOW I'M GOING TO,
TURN TO LEO. JASON AND I
APOLOGIZE THERE, YOU KNOW, WE
DID HAVE AN INITIAL DISCUSSION
WITH èC, AND THERE MAY BE SOME
ADDITIONAL POINTS I MIGHT BE
HELPFUL TO THE COMMITTEE TO WHEN
WE MET WITH èC AND TALKED ABOUT
IT, A LOT OF THE MCO TAX FUNDS
HADN'T YET BEEN DISTRIBUTED, AND
THAT'S BECAUSE THE STATE WAS
STILL WAITING ON FEDERAL
APPROVAL, WHICH CAME IN LATE
2023. AND SO THERE WAS STILL A
LOT OF, SOME UNCERTAINTY WITH
HOW THEY WOULD FUNDS WOULD BE
IMPLEMENTED. BUT, THERE WAS SOME
DISCUSSION AROUND, POTENTIALLY
USING SOME OF THOSE FUNDS FOR,
FOR OTHER TYPES OF MEDICAL
SPECIALTIES THAN PRIMARY CARE
AND EMERGENCY CARE, LIKE OTHER
SPECIALTY GROUPS. THAT'S
SOMETHING THAT'S ALLOWED UNDER
THE PROPOSITION 56 PROGRAM, BUT
IT'S SOMETHING THAT THAT THAT
WAS ALSO IT'S ALSO WAS ALSO SORT
OF UNDER CONSIDERATION. SO THERE
WAS SOME UNCERTAINTY NOW THAT
THE FUNDS ARE BEING ARE ARE
CURRENTLY BEING DISTRIBUTED,
THERE PRESUMABLY WOULD BE MORE
INFORMATION NOW. THAT'D BE
GREAT. I LOVE THE PROGRAM. I
THINK, YOU KNOW, WE NEED TO HELP
PEOPLE GET INTO, THIS WORKFORCE.
WE NEED A LOT OF THEM ALL ACROSS
CALIFORNIA. I JUST WANT TO MAKE
SURE, YOU KNOW, WE'RE REACHING
THOSE PEOPLE. AND IT'S NOT THE
SAME KIND OF AN INDIVIDUALS THAT
WE'VE ALWAYS HAD COMING THROUGH
THIS POOL, GETTING A DIVERSE
POOL, RYAN, DO YOU HAVE ANYTHING
TO REPORT ON THIS SECTION ON? DO
YOU HAVE A PRESENTATION? YEAH,
YEAH, WE HAVE SOME ADDITIONAL
COMMENTS I'D BE HAPPY TO SHARE.
GO AHEAD, SO BEFORE WE DIVE INTO
THE LEÓN COMMENTS, THERE ARE TWO
KEY POINTS OR JUST KEY ASPECTS
OF THE PROPOSAL. I JUST WANT TO
EMPHASIZE, I KNOW THERE'S A LOT
HERE. AND ACTUALLY ON PAGE SEVEN
IS OF YOUR AGENDA AS A VERY
ROUGH SUMMARY OF THE MAJOR AREAS
OF WHERE THE FUNDS ARE GOING TO,
BUT GENERALLY THERE ARE TWO KEY
ASPECTS. THE FIRST IS THAT THERE
ARE MANY RATE INCREASES IN HERE,
BUT THE ADMINISTRATION IS ALSO
PROPOSING TO CHANGE THE WAY
MEDI-CAL PAYS PROVIDERS IN MANY
CASES. SO FOR EXAMPLE, TYING
RATES TO HOW TO BENCHMARKING
RATES TO THE TO THE MEDICARE
RATES OR DEVELOPING NEW PAYMENT
SYSTEMS FOR HOSPITALS. SO I JUST
WANT TO EMPHASIZE THAT NOT WE'RE
NOT JUST TALKING ABOUT INCREASES
IN SOME CASES. WE'RE TALKING
ABOUT CHANGES IN THE WAY RATES
ARE SET. AND THE SECOND THING TO
EMPHASIZE IS THAT MUCH OF THE
PROPOSAL WHEN WE REVIEWED IT IN
JANUARY IS CONCEPTUAL. MUCH OF
IT STILL APPEARS TO BE
CONCEPTUAL, MAJOR PARTS ARE
UNDER DEVELOPMENT. FOR EXAMPLE,
WE JUST TALKED ABOUT THE EQUITY
INDEX. THAT WOULD BE AN EXAMPLE
OF ONE WHERE THE ADMINISTRATION
IS STILL WORKING WITH
STAKEHOLDERS TO DETERMINE HOW
THAT WOULD BE USED. SO, SO GIVEN
THOSE TWO ASPECTS, WE HAD A
NUMBER OF POINTS THAT WE RAISED
IN OUR ANALYSIS BACK IN, LATE
JANUARY. AND I JUST WANTED TO
EMPHASIZE THREE KEY POINTS FROM
THAT, JUST FOR THE SAKE OF TIME,
THE FIRST IS THAT, YOU KNOW,
IT'S REASONABLE FOR THE
LEGISLATURE, YOU KNOW, GIVEN THE
AMOUNT OF MONEY HERE INVOLVED,
THAT IT WOULD NOT ONLY USE THE
FUNDS TO PROVIDE INCREASES, BUT
ALSO CONSIDER, CHANGES IN THE
WAYS RATES ARE SET. WE'D
RECOMMEND THAT THE LEGISLATURE
FOCUS ANY OF THOSE CHANGES ON,
ON WAYS THAT REALLY MAKE THE
EXISTING SYSTEM MORE RATIONAL
AND EFFECTIVE. YOU KNOW, FOR
EXAMPLE, WITH REGARD TO MANY
SORTS OF PROVIDER RATES,
TYPICALLY THE STATE HASN'T HAD A
CONSISTENT APPROACH TO SETTING
RATES AND ADJUSTING THEM OVER
TIME. THEY'VE HAD PERIODS WHERE
THEY'VE INCREASED AND THEN
DECREASED, BUT THEY HAVEN'T BEEN
SORT OF CONSISTENT. SOME OF THE
PROPOSAL WOULD BENCHMARK RATES
TO A PERCENT OF MEDICARE AND
THEN ADJUST THAT MOVING FORWARD
OVER TIME. AND SO THAT SEEMS
LIKE THAT POTENTIALLY WOULD BE
MORE RATIONAL, BECAUSE IT WOULD
NOW HAVE A MORE CONSISTENT WAY
OF SETTING RATES OVER TIME,
RATHER THAN IT BEING SUBJECT TO
PERIODS WHERE THERE IS MORE
CAPACITY IN THE BUDGET OR LESS
CAPACITY IN THE BUDGET. YOU
KNOW, THAT SAID, MANY OF THE
ADMINISTRATION'S PROPOSALS, THE
DETAILS MATTER, SO, FOR EXAMPLE,
HOW THE NEW HOSPITAL PAYMENT
SYSTEMS WOULD WORK, WHAT THE
EFFECTS OF THOSE WOULD BE, HOW
THE SUPPLEMENTAL PAYMENT WOULD
WORK FOR CLINICS. THESE DETAILS,
THESE DETAILS MATTER A BIT WHEN
WE'RE TRYING TO ASSESS THE
ULTIMATE, YOU KNOW, MERITS OF
THE OF THE PARTICULAR PROPOSALS.
SECOND, IMPLEMENTATION AND
LEGISLATIVE OVERSIGHT ALSO WILL
BE KEY FOR THIS PACKAGE, GIVEN
THE EXPANSIVE NATURE OF THE
PROPOSED INCREASES, THERE'S RISK
THAT THE STATE AND MANAGED CARE
PLANS, WHO ALSO WOULD HAVE TO
IMPLEMENT MANY OF THESE RATE
INCREASES, WOULD FACE
IMPLEMENTATION HURDLES. THESE
HURDLES COULD DELAY THE TIMING
OF WHEN PROVIDERS RECEIVE RATE
INCREASES. GIVEN THESE
UNCERTAINTY, HIS WE HAVE A
COUPLE OF RECOMMENDATIONS FOR
THE LEGISLATURE TO CONSIDER VERY
BROADLY. ONE IS WHEN THE
ADMINISTRATION IS CONSIDERING
NEW APPROACHES TO RATE
INCREASES, WE THINK WOULD BE
REASONABLE FOR THE LEGISLATURE
TO AUTHORIZE, THE ADMINISTRATION
FURTHER STUDYING AND ANALYZING
THE IMPACTS OF THAT. BUT WE'D
ALSO RECOMMEND THAT THE
LEGISLATURE DIRECT THE
ADMINISTRATION TO COME BACK WITH
MORE DETAILED PROPOSALS WHEN
THEY'RE AVAILABLE, RATHER THAN
AUTHORIZING, PARTS THAT ARE
STILL CONCEPTUAL. AND THEN
SECONDLY, WE'D ALSO RECOMMEND
THAT THE LEGISLATURE ADOPT
REPORTING REQUIREMENTS. THESE
WERE THESE WOULD BETTER TRACK
SORT OF IMPLEMENTATION OAN, BUT
ALSO EARLY INDICATIONS OF
OUTCOMES RESULTING FROM THE RATE
INCREASES. AND THEN OUR THIRD
KEY POINT IS THAT FINANCIAL
SUSTAINABILITY ALSO WILL MATTER
A BIT THIS YEAR. THIS IS ONE OF
THE FEW AREAS OF THE BUDGET
WHERE THERE IS, YOU KNOW, SOME
MORE FUNDING AVAILABLE FOR
AUGMENTATIONS, THERE IS A
POTENTIAL, THOUGH NOT CERTAIN
SHORTFALL IN THAT PACKAGE,
HOWEVER, AND THAT'S BECAUSE THE
FEDERAL GOVERNMENT HAS SIGNALED
THAT IT MIGHT CHANGE THE RULES
AROUND APPROVING THE MCO TAX.
AND THE ADMINISTRATION HAS SAID
THAT THOSE RULE CHANGES, THEY'RE
UNKNOWN, BUT THEY COULD RESULT
IN THE NEXT TAX BEING MUCH
SMALLER THAN THIS ONE. WHERE
THAT TO OCCUR, THERE WOULD BE A
SHORTFALL IN THE IN THE, THE
FUNDING PLAN THAT WOULD NEED TO
BE ADDRESSED. TYPICALLY, THE
LEGISLATURE WOULD TURN TO THE
GENERAL FUND FOR BACKFILLING
THAT. HOWEVER, AS THIS COMMITTEE
HAS DISCUSSED EARLIER, THE
GOVERNOR'S BUDGET ASSUMES THAT
THERE ARE DEFICITS IN THE OUT
YEARS. AND IF THE LEGISLATURE,
YOU KNOW, DIDN'T HAVE CAPACITY
IN THE GENERAL FUND TO MAKE
THESE BACKFILLS, IT COULD FACE
PRESSURE TO UNDO MANY OF THESE
AUGMENTATIONS. AND THAT THAT
COULD BE VERY DISRUPTIVE,
PARTICULARLY FOR PROVIDERS. AND
THE DEPARTMENT THAT HAD SPENT
SEVERAL MONTHS AND EVEN YEARS
ADJUSTING TO THE NEW SYSTEM. SO
WE THINK WE THINK A CONSIDERING
THAT WILL BE WILL BE KEY FOR THE
LEGISLATURE. TYPICALLY THE MAIN
APPROACH, IT'S A IT'S A BIGGER
STRUCTURAL BUDGET ISSUE. IT
INVOLVES ADOPTING AN OVERALL
GENERAL FUND PACKAGE THAT HAS
CAPACITY AND ANTICIPATES THERE
BEING A POTENTIAL SHORTFALL, BUT
WE THINK THAT'LL BE THAT'LL BE A
MAJOR ISSUE FOR THE LEGISLATURE
TO CONSIDER, WITH THAT AVAILABLE
FOR QUESTIONS. THANK YOU. RYAN,
I YOU PROMPTED A QUESTION I HAD
TOTALLY FORGOT TO BRING UP.
DIRECTOR, THIS IS GOING ON TILL
2627. ORIGINALLY, WE HAD A PLAN
TO DO ONE EXTRA YEAR, BUT WE'RE
GOING TO WE'RE CUTTING IT AT 26.
27. WHAT IS YOUR PLAN FOR 27 AND
ON ON HOW WE'RE GOING TO BE
PROVIDING THESE REIMBURSEMENT
RATES. SO WE ARE USING SOME OF
THE KIND OF THE OUTYEAR RESERVE
FUND TO AS A SOLUTION FOR KIND
OF THE IMMEDIATE BUDGET. STATE'S
BUDGET SITUATION. SO TO YOUR
POINT THAT THOSE RESERVES FUNDS
TO PROVIDE THE RATE INCREASES IN
28, 20, 28 OR SO, YOU KNOW, WE
WILL BE, THE MCO WILL BE UP FOR
RENEWAL FOR 2027. SO THERE IS
THE OPPORTUNITY TO AGAIN, GO
BACK TO THE FEDERAL GOVERNMENT
WITH AN MCO PROPOSAL,
NOTWITHSTANDING POTENTIAL
CHANGES AT THE FEDERAL LEVEL. WE
DO THINK THAT THERE WOULD STILL
BE SOME OPPORTUNITY FOR MCO. AND
I THINK ALSO, YOU KNOW, IN 28,
29, WE MAY BE IN A DIFFERENT
STATE FISCAL SITUATION AS WELL.
SO IT'S REALLY USING THOSE
DOLLARS TODAY SO THAT WE DIDN'T
HAVE TO SUSTAIN SIGNIFICANT
CUTS. JASON, YOU DIDN'T CORRECT
ME. I KEEP CALLING YOU RYAN. I'M
SORRY I WAS DOING SO GOOD WITH
YOUR NAMES, OKAY, LET ME SEE IF
ANYTHING FOR RIGHT NOW, I THINK.
I THINK WE'RE GOOD FOR SENATOR
EGGMAN. IF I COULD JUST ASK
MAYBE TO THE DIRECTOR. AND I'M
ASSUMING ON. SO WE'RE GOING TO
RAISE THE RATES, BUT THAT WE'RE
RECALCULATING HOW WE DO THAT.
AND I IMAGINE WE'RE WORKING WITH
STAKEHOLDERS ON THAT, JUST
BECAUSE THAT'S ONE OF THE
THORNIEST ISSUES THAT WE'RE
TRYING TO DEAL WITH, WITH, WITH
MEDI-CAL IS RATES AND
REIMBURSEMENT AND THE PROCESS
FOR GETTING REIMBURSED. SO WE'RE
WORKING CLOSELY WITH
STAKEHOLDERS ON THAT. WE ARE
WE'VE BEEN HAVING MULTIPLE
MEETINGS WITH ALL THE
STAKEHOLDER GROUPS THAT ARE
IMPACTED BY THE BY THE VARIOUS
PROPOSALS AND HAVING IN DEPTH
CONVERSATIONS, AND WE'LL
CONTINUE TO DO THAT. ALL RIGHT.
AND THE PLAN WILL BE IN MAY.
YES, WE'LL HAVE THAT. WE'LL HAVE
THAT. AND YOU BROUGHT UP YOU
MADE ME THINK OF ANOTHER POINT
WHY IT'S SO IMPORTANT. THIS IS
GOING TO FLUCTUATE FOR YEARS TO
COME. AND IT'S SO IMPORTANT FOR
US TO NOT LOCK IN TO WHAT WE
DECIDE THIS YEAR. AS LONG SAU
FOR THE UPCOMING YEARS, BECAUSE
WE DON'T KNOW WHAT THE BUDGET'S
GOING TO LOOK LIKE. MOVING ON,
MOVING FORWARD. AND WE WANT TO
MAKE SURE WE HAVE SOME
FLEXIBILITY IN MOVING AROUND
DOLLARS MOVING FORWARD. WHAT I
MEAN IS, I WOULD HOPE THAT
WHATEVER IS DECIDED AT THE END
OF THE DAY FOR THE MCO TAX IS
NOT GOING TO BE CEMENTED IN FOR
YEARS TO COME. I HOPE THAT IT
ALLOWS US SOME FLEXIBILITY
BECAUSE SOMETHING CAN HAPPEN IN
THE OUTGOING YEARS WHERE WE
REALLY, REALLY, REALLY, REALLY
NEED A BALANCE OF GENERAL FUND,
RIGHT? AND WE NEED TO MOVE SOME
STUFF AROUND. AND IF WE LOCK
EVERYTHING IN THIS YEAR, THAT'S
NOT GOING TO GIVE US SOME
FLEXIBILITY. THINGS CHANGE
AROUND AND SOMETHING CAN HAPPEN
IN THE FEDERAL GOVERNMENT. CMS
COMES UP TO US AND SAYS
EVERYTHING'S 100% MEDICARE,
RIGHT? YOU KNOW, JUST I DON'T
FORESEE THAT HAPPENING, BUT I
JUST I THINK THERE SHOULD BE
SOME FLEXIBILITY IN WHATEVER IS
DECIDED AT THE END OF THE DAY
WITH MCO TAX AND WHAT HAPPENS
MOVING FORWARD. THAT'S ALL I'M
TRYING TO SAY. OKAY, LET'S BRING
UP OUR OUR STAKEHOLDERS FOR THE
REST OF PANEL ONE.
ALL RIGHT. LET'S SEE IF WE HAVE
ENOUGH 0348. YES, WE HAVE TWO
OVER HERE. NICK. OH, I THINK
WE'LL BE OKAY. WE HAVE ONE
EXTRA, BY THE WAY. I THINK I
THINK, YEAH, YEAH, MOVE IT OVER.
THE LAST. REYES ON ONE SIDE OF
THE.
OKAY. SO JOINING US TODAY IN
THIS FIRST PANEL IS, CALIFORNIA
MEDICAL ASSOCIATION, THE
CALIFORNIA HOSPITAL ASSOCIATION,
PLANNED PARENTHOOD AFFILIATES OF
CALIFORNIA, CALIFORNIA PRIMARY
CARE ASSOCIATION, SEIU, LOCAL
HEALTH PLANS, ASSOCIATION OF
HEALTH PLANS, AND THE CALIFORNIA
ASSOCIATION OF PUBLIC HOSPITALS
AND HEALTH SYSTEMS. SO WE'RE
GOING TO START WITH CMA. MR.
THOMPSON. THERE WE GO. THANK YOU
, MADAM CHAIR. MEMBERS, REALLY
FOR THE OPPORTUNITY TO PRESENT,
TO THE COMMITTEE TODAY AND ALSO
FOR THE LEGISLATURE'S SUPPORT
FOR THE FIRST TIME, USING MCO
DOLLARS FOR PROVIDER RATE
INCREASES AND OTHER CRITICAL
INVESTMENTS IN THE MEDI-CAL
SYSTEM. THIS IS THE FIRST MCO
TAX THAT HAS ACTUALLY MADE THOSE
INVESTMENTS BASED ON YOUR
LEADERSHIP LAST YEAR. SO WE JUST
WANT TO TAKE A MINUTE AND THANK
YOU, FOR THAT AND JUST TELL YOU
HOW EXCITED I THINK WE ARE TO
REALLY SEE THE MAJOR INVESTMENTS
THAT ARE MUCH NEEDED IN THE
MEDICAL SYSTEM, AT THE START,
WE'VE BEEN CMA HAS BEEN ASKED TO
ADDRESS THREE OVERALL QUESTIONS,
BASICALLY, THE IMPACT OF THE MCO
TAX ON PHYSICIANS AND PROVIDERS
BEHAVIORS WITHIN THE MEDI-CAL
SYSTEM. MANY CHALLENGES WE'VE
SEEN IN THE 2024 ALLOCATION. AND
FINALLY, BASICALLY WHETHER OR
NOT THE PROPOSED FUNDING IN THE
GOVERNOR'S JANUARY TEN PROPOSAL,
YOU KNOW, IS ADEQUATE TO MEET
THE NEEDS OF THE MEDICAL SYSTEM.
SO JUST ON ON THE FIRST
QUESTION, CMA STRONGLY SUPPORTS
THE GOVERNOR'S JANUARY 10TH
PROPOSAL. THIS IS A MULTI YEAR
AGREEMENT WE REACHED WITH THE
LEGISLATURE AND THE GOVERNOR
LAST YEAR FOR THE FIRST TIME,
REALLY MAKING CRITICAL
INVESTMENTS IN PHYSICIAN
REIMBURSEMENT SERVICES, MEDI-CAL
RATES HAVE NOT BEEN RAISED FOR
PHYSICIAN SERVICES SINCE THE
LATE 1990S. THEY'VE ACTUALLY
BEEN CUT TWO TIMES SINCE THEN.
AND SINCE THEN THE PROGRAM HAS
GROWN EXPONENTIALLY BY THE
AMOUNT OF PEOPLE THEY COVERAGE
AND ALSO HAS EXPANDED BENEFITS.
SO WE'VE ALSO SAID THAT THE
PROVIDER RATES IS ACCESS. IT'S
THE THIRD LEG OF THE STOOL. THE
STATE HAS DONE A GREAT JOB
MAKING A GOOD BENEFIT PACKAGE
AND COVERING ALL ELIGIBLE
INDIVIDUALS. AND REALLY
PROVIDING ACCESS IS KIND OF THE
LAST LEG OF THE STOOL, THAT WE
THINK THAT THE STATE NEEDS TO
TACKLE. AND THE GOVERNOR'S
JANUARY TEN PROPOSAL TAKES A
HUGE STEP TO ACCOMPLISHING THAT
FACT, JUST TO HIGHLIGHT
COMMERCIAL SINCE THE ADOPTION OF
THE ACA, THERE'S BEEN A HUGE
GROWTH IN THE AMOUNT OF PEOPLE
WHO ARE INSURED. BUT THE ACTUAL
COMMERCIAL RATE, PEOPLE WHO ARE
INSURED THROUGH THE COMMERCIAL
PLANS HAS ACTUALLY STAYED FLAT.
ALL THE GROWTH WE HAVE SEEN IN
THE STATE HAS BEEN IN THE
MEDI-CAL SYSTEM, AND WE HAVE TO
MAKE SURE THAT WE'VE GOT ENOUGH
PHYSICIANS, PROVIDERS IN THAT
SYSTEM TO TREAT THE AMOUNT OF
NEW ENROLLEES THAT WE HAVE PUT
INTO THAT SYSTEM. SO. SO FROM
THE PHYSICIAN PERSPECTIVE, OUR
THE MCO PROPOSAL, WHAT WE REALLY
HOPE TO DO IS CHANGE PHYSICIAN
BEHAVIOR. WE WANT PHYSICIANS TO
TAKE MORE MEDI-CAL ENROLLEES TO
THE EXTENT THAT THEY'RE TAKING
THEM, TAKE A LARGER PERCENTAGE.
RIGHT NOW, MEDI-CAL WITH THE
CURRENT RATES OFTEN DOESN'T
COVER COSTS. SO WHAT WE'LL SEE
IN PHYSICIAN GROUPS IS KIND OF
ARTIFICIALLY LIMIT THE AMOUNT OF
MEDI-CAL PATIENTS THAT THEY CAN
SEE, NOT BECAUSE THEY DON'T WANT
TO SEE MORE PATIENTS, BUT THAT'S
JUST THE HARD FINANCIAL PICTURE
THAT THEY HAVE TO DEAL WITH, AND
SO WE WOULD SAY THAT THE
INVESTMENTS CONTAINED IN THE
PROPOSAL THIS YEAR AND ONGOING,
WE HOPE, WILL BE
TRANSFORMATIONAL FOR ACCESS
WITHIN THE SYSTEM. AND WE REALLY
HOPE TO OUR OVERALL GOAL IS
PHYSICIANS GET TO TREAT THE
COMMUNITY AS THEY PRESENT
THEMSELVES. AND RIGHT NOW, NOT
ASKING WHAT INSURANCE COVERAGE
THEY HAVE, BUT JUST TO SAY, HEY,
IF 40% OF THE POPULATION IN A
GIVEN COMMUNITY IS MEDI-CAL, WE
WANT THAT PHYSICIAN PATIENT ROLE
TO BE SEEN 40% MEDI-CAL
PATIENTS. AND WE THINK THIS IS A
CRITICAL, CRITICAL STEP FORWARD,
AS FAR AS IMPLEMENTATION ON THE
2024 RATES, WE DO WANT TO THANK
THE DEPARTMENT. TO THEIR CREDIT,
THEY HAVE BEEN MEETING WITH
STAKEHOLDERS VERY REGULARLY AND
ALWAYS HAD AN OPEN DOOR TO
TACKLE SOME CHALLENGES WHICH ARE
INEVITABLY GOING TO COME UP WHEN
WE'RE DOING NEW POLICY CHANGES
OF THIS MAGNITUDE. I WOULD
HIGHLIGHT, ON 2024, I THINK WE
WERE HOPEFUL TO SEE SOME OF
THOSE RATE INCREASES BE IN
EFFECT, KIND OF ON THE PROVIDER
LEVEL BY JANUARY OF THIS YEAR,
GIVEN THE WAY THAT WE'VE BEEN
ROLLING THIS OUT, IT'S PROBABLY
THE VAST MAJORITY OF THAT MONEY
IS NOT GOING TO GET TO THE
PROVIDERS UNTIL DECEMBER OF THIS
YEAR. SO OFTEN, WE WILL SAY, IS
WHEN WE REACH BUDGET DEALS HERE
IN CALIFORNIA OR HERE IN THE
BUDGET COMMITTEE, EXCUSE ME,
THERE'S A LAG TIME BEFORE
PROVIDERS SEE, SEE THAT CHANGE.
AND SO PART OF WHAT WE'VE ALWAYS
SAID IS PART OF THE MULTI-YEAR
DEAL, WHICH IS SO IMPORTANT. I
THINK THE LAO TOUCHED UPON IT A
LITTLE BIT, IS HAVING MULTI-YEAR
CERTAINTY. AND OBVIOUSLY THIS IS
DIFFICULT WITH HAVING TO BALANCE
A BUDGET. SO WE'RE NOT WE DON'T
WE'RE NOT NAIVE TO THE CONCERNS
THAT THE BUDGET COMMITTEE IS
GOING TO HAVE TO FACE. BUT IF
WE'RE REALLY TRYING TO MOVE
PROVIDER BEHAVIOR, HAVING THAT
MULTI YEAR CERTAINTY, WE WOULD
SAY IS ESSENTIAL. IF IT DIPS UP
AND DOWN AND SOMETIMES
SUPPLEMENTAL PAYMENTS THAT WE'VE
DONE IN 56, YOU MIGHT SEE THOSE
SUPPLEMENTAL PAYMENTS A YEAR, A
YEAR AND A HALF AFTER THE CARES
PROVIDED. AND WE THINK NOT
HAVING THAT DIRECT CONNECTION TO
DIRECT PATIENT CARE SOMETIMES
DOESN'T MOVE PROVIDER BEHAVIOR
IN THE WAY THAT WE WOULD WANT
TO. AND THEN FINALLY, JUST
WHETHER OR NOT THE ALLOCATION
WITHIN THE, KIND OF OVERALL MCO
TAX, WE THINK IS A, WHETHER OR
NOT THAT'S AN APPROPRIATE
WHETHER OTHER INVESTMENTS COULD
BE MADE, I THINK WHAT WE WOULD
SAY IS, LISTEN, THERE'S A LOT OF
INVESTMENTS THAT WE CAN MAKE IN
THE MEDI-CAL SYSTEM. THE MCO TAX
, THE, YOU KNOW, THE 8 BILLION
OF THE 20 OVER THESE PERIODS ARE
GOING TO BE EXTREMELY HELPFUL
INTO INCREASING MORE ACCESS. CAN
WE DO MORE? OBVIOUSLY, I DON'T
THINK EVEN ON THE PHYSICIAN
SERVICES SIDE, WE'RE TAKING
CERTAIN CODES UP TO 87.5% OF
MEDICARE. WE'D LOVE OF ALL OF
MEDI-CAL COULD BE EQUAL TO
MEDICARE, BUT THERE'S A GREAT
NEED IN THIS SYSTEM. AND SO I
THINK WHEN WE'VE LOOKED AT THIS,
ON THE OVERALL DEAL, ABOUT 40%
OF THE MONEY GENERATED FROM THE
MCO TAX IS GOING INTO PROVIDER
RATES. MEDI-CAL INVESTMENTS,
PART OF THE SPENDING PLAN ABOUT
60% IS GOING INTO KIND OF
GENERAL FUND BACKFILL. AND
THAT'S THE AGREEMENT WE REACHED
LAST YEAR. AND WE DO THINK THAT
THAT THE PROPOSAL AS PRESENTED
BY THE GOVERNOR IS VERY NARROWLY
TAILORED TO REALLY MAXIMIZE
ACCESS WITHIN THE SYSTEM. THAT'S
NOT TO SAY THERE'S NOT OTHER
INVESTMENTS THAT AREN'T, THAT WE
COULD MAKE. AND I DON'T THINK
ANYONE IS GOING TO HAVE A
PERFECT PLAN. BUT WE DO THINK
THAT THE PROPOSAL AS WRITTEN IS
A HUGE STEP FORWARD TO CREATE
ACCESS IN THE SYSTEM. SO THANK
YOU FOR YOUR TIME. APPRECIATE
IT. MR. THOMPSON, CAN YOU SHARE?
I THINK YOU MIGHT HAVE SOME
INFORMATION ON THE GRADUATE.
SURE. YEAH. WE CAN, THERE'S A
PROGRAM CALLED CAL MED FOREST.
THERE'S A COUPLE OF PROGRAMS
THAT DO, HIGHLIGHT THE GME
FUNDING. SO WE'RE HAPPY IT'S
ONLINE. WE CAN HAPPILY SEND IT
TO YOU. THEY DEFINITELY DO IT IN
COHORT MODEL. SO EACH YEAR THEY
HAVE SPECIFIC FUNDING. AND
THEY'LL LOOK FOR GRANT
APPLICATIONS FOR RESIDENCY. THE
PROP 56, WHICH IS 40 MILLION A
YEAR, THAT IS LIMITED TO PRIMARY
CARE AND EMERGENCY DEPARTMENT
RESIDENCIES. THERE'S 75 MILLION
WITHIN THE MCO TAX, AND THAT CAN
BE ACROSS SPECIALTIES. AND I
WILL HIGHLIGHT JUST GME FOR US.
WE THINK IS ONE OF THE MOST
IMPORTANT COMPONENTS WITHIN THIS
BECAUSE IT CREATES NEW RESIDENCY
SLOTS. SO WE DON'T WANT TO MAKE
SURE WE'RE NOT JUST GOING, YOU
KNOW, SUPPLANTING EXISTING
RESIDENCY SLOTS THAT WE'RE
ACTUALLY ADDING NEW SLOTS,
BECAUSE WHAT THAT MEANS IS
THAT'S ACTUALLY A PHYSICIAN
PRESENT IN THE COMMUNITY WHO'S
PRACTICING FOR THAT. 3 TO 7
YEARS OF THEIR RESIDENCY
PROGRAM. THERE'S A STRONG
CORRELATION TO RESIDENCY
PROGRAMS AND WHERE A PHYSICIAN
PRACTICES, AT THE END OF THE DAY
. SO WE CAN FOLLOW UP WITH ALL
YOUR OFFICES WITH THAT
INFORMATION. THANK YOU SO MUCH.
NOW TURNING ON TO CHA. THANK
YOU, MADAM CHAIR. I WAS JUST
KIDDING, SENATOR. I JUST WANTED
TO. SO THE 75 THE CORRECT ME STU
, THE 75 MILLION. THERE WAS A
FOUNDATION OR SOMETHING CORRECT
CREATED TO MANAGE THAT RESIDENCY
FUND MONEY TO BE UTILIZED BY
èC. IS THAT CORRECT? KANSEN OF
èC AND èC CONTRACTS WITH A
THIRD PARTY TO ALLOCATE THAT
MONEY. ALL OF THE ALLOCATION,
ALL THE WHERE THE MONEY'S GONE
ALL UP ON A WEBSITE. SO WE CAN
PROVIDE ALL AND IT'S BOTH
PRIMARY CARE AND SPECIALTY
RESIDENCY PROGRAMS. 56 IS
PRIMARY CARE, BUT EMERGENCY
DEPARTMENT THE 75 IT CAN BE
ACROSS THE BOARD AND DO YOU HAVE
YOU HAVE IS IT ON THE WEBSITE
WHERE THE RESIDENCY PROGRAMS ARE
AND WHAT THEY ARE IN TERMS OF
THE 75 MILLION? WELL, THAT'S THE
40. THE 75 HASN'T BEEN ALLOCATED
QUITE THAT WAS LAST YEAR. SO
THAT HASN'T BEEN DISTRIBUTED.
BUT IT'S GOING THROUGH THE
EXISTING PROGRAM. SO WE DO HAVE
THE INFORMATION ON THE ON THE
EXISTING PROGRAM. SO IT WAS 40
THAT I SAW IN SUB ONE. THAT'S
THAT'S FROM PROP 56 MCO ADDS THE
NEW 75 ON TO IT OKAY. THANK YOU.
THANK YOU MADAM CHAIR. MARK
FAROOQ ON BEHALF OF THE
CALIFORNIA HOSPITAL ASSOCIATION,
AS AS YOU AND THIS COMMITTEE HAS
HEARD BEFORE, WE'VE TALKED ABOUT
THE LOW MEDI-CAL REIMBURSEMENT
RATES IN COMBINATION WITH THE
FINANCIAL STRESS EMERGING OUT OF
THE COVID 19 PANDEMIC, AS WELL
AS THE INCREASE IN THE MEDI-CAL
CASELOAD TO 40% SINCE 2019, THAT
THIS HAS BEEN AN UNSUSTAINABLE
COMBINATION. THAT HAS LED TO
OVER HALF OF THE STATE'S
HOSPITALS OPERATING IN THE RED
AND DOZENS AT RISK OF FACING
CLOSURE. THANKFULLY LAST YEAR,
THE LEGISLATURE AND THE GOVERNOR
CAME TOGETHER TO CREATE THE
DISTRESS HOSPITAL LOAN PROGRAM
TO CREATE A SHORT TERME SOLUTION
SHORT TERME RELIEF FOR HOSPITALS
AT RISK OF CLOSURE, AS WELL AS
ADDRESSING THE LONGER TERME
CHALLENGES WITH SIGNIFICANT
FUNDING FROM REAUTHORIZATION OF
THE MCO TAX TO SUSTAIN AND
PROMOTE ACCESS TO CARE FOR
CALIFORNIA'S MOST VULNERABLE
PATIENTS. THE MCO REVENUE THUS
FAR HAS PROVIDED SIGNIFICANT
STATE BUDGET FUNDING TO OFFSET
POTENTIAL REDUCTIONS IN THE
MEDI-CAL PROGRAM. THIS ALSO
INCLUDES USING OVER $3 BILLION
FROM THE PROVIDER RESERVE FUND
AS A BUDGET SOLUTION, SOMETHING
WE WOULD NOTE. THE USE OF THIS
FUND SHOULD NOT, CREATE
ADDITIONAL RISK TO THIS
UNDERLYING SUSTAINABILITY OF
THESE FOUNDATIONAL INVESTMENTS,
THIS YEAR, THE GOVERNOR HAS
REAFFIRMED HIS COMMITMENT TO
USING THE 2.7 BILLION ANNUALLY
IN THE MCO TAX REVENUE TO
IMPROVE ACCESS IN MEDI-CAL,
DESPITE THE STATE'S BUDGET
DEFICIT. THIS FUNDING WILL
PROVIDE A LIFELINE OF SUPPORT TO
HOSPITALS, PARTICULARLY THOSE
THAT SERVE DISPROPORTIONATE
NUMBERS OF MEDI-CAL PATIENTS,
SIGNIFICANTLY INCREASING CHANCES
OF REMAINING OPEN TO SERVE THEIR
COMMUNITIES. WHILE THIS DOES NOT
FULLY ADDRESS THE HISTORICAL
UNDERFUNDING IN THE MEDI-CAL
PROGRAM, IT WILL PARTIALLY CLOSE
THE GAP BETWEEN COST OF CARE AND
HOW MUCH HOSPITALS ARE PAID FOR
THE CARE PROVIDED TO MEDI-CAL
PATIENTS AND PROMOTE EQUITABLE,
EQUITABLE CARE FOR THOSE THAT
ARE OFTEN THE MOST VULNERABLE.
THIS FUNDING IS CRITICAL FOR ALL
HOSPITALS, INCLUDING THOSE THAT
ARE FINANCIALLY DISTRESSED, BUT
THE FINAL DETAILS OF THE RATE
INCREASES WILL DETERMINE, TO THE
EXTENT TO WHICH SPECIFIC
HOSPITALS REMAIN DISTRESSED AND
IF ADDITIONAL STATE SUPPORT WILL
BE NECESSARY. CA IS CURRENTLY
FOCUSED ON HOW THESE INVESTMENTS
CAN BE TARGETED IN THE MEDI-CAL
PROGRAM TO PROTECT CRITICAL
HEALTH CARE SERVICES. WE
APPRECIATE THE DEPARTMENT OF
HEALTH CARE SERVICES WILLINGNESS
TO ENGAGE WITH THE HOSPITAL
FIELD IN DEVELOPING EMERGENCY
AND OUTPATIENT SERVICE IS
PAYMENT METHODOLOGIES THAT MOVE
THE NEEDLE IN THE RIGHT
DIRECTION FOR ALL PARTIES. THE
STATE MANAGED CARE PLANS,
HOSPITALS, AND MOST IMPORTANTLY,
PATIENTS. DHS HAS PROPOSED TO
IMPROVE EMERGENCY DEPARTMENT
OUTPATIENT REIMBURSEMENT IN TWO
PHASES FIRST, TRANSITIONAL
REIMBURSEMENT INCREASES FOR THE
FIRST TWO YEARS, FOLLOWED BY
MORE FUNDAMENTAL REFORMS ON HOW
EMERGENCY DEPARTMENTS AND
OUTPATIENT MEDICAL SERVICES ARE
PAID IN EFFECT. IN THE LONG RUN,
THE GOAL IS TO CONVERT THE STATE
TO A BUNDLED PAYMENT METHODOLOGY
SIMILAR TO THAT USED IN
MEDICARE. AS YOU ALL HEARD
EARLIER, BECAUSE THE
TRANSITIONAL INCREASES GO LIVE
NEXT YEAR. WHILE THE DEEPER
REFORMS WOULD NOT OCCUR UNTIL
2027 AT THE EARLIEST, WE HAVE
FOCUSED ON THE TRANSITIONAL
INCREASES STARTING IN 2025, AND
OUR CONVERSATIONS WITH DCS,
WE'VE SOUGHT TO INCORPORATE
LESSONS FROM THE DEVELOPMENT OF
LAST YEAR'S TARGETED RATE
INCREASES. THE MAIN LESSON WE
HAVE DRAWN IS THAT THOSE HAVE
PROVEN COMPLEX AND DIFFICULT TO
IMPLEMENT. WE HAVE OFFERED
SUGGESTIONS ON HOW THIS PROPOSAL
COULD BE STREAMLINED AND
SIMPLIFIED, BECAUSE THE
TRANSITIONAL INCREASES WOULD
ONLY BE IN EFFECT FOR TWO YEARS
BEFORE DEEPER RATE REFORMS ARE
POTENTIALLY IMPLEMENTED. WE HAVE
URGED DCS TO LEVERAGE EXISTING
PAYMENT PROGRAMS RATHER THAN
CREATING WHOLLY NEW TEMPORARY
ONES, WHICH WOULD SIMPLIFY THE
PROCESS OF FEDERAL APPROVAL AS
WELL AS IMPLEMENTATION FOR ALL
PARTIES. FURTHER DETAILS STILL
NEED TO BE WORKED OUT, INCLUDING
HOW TO ENSURE THAT THE
TIMELINESS OF PAYMENTS, WHICH WE
LOOK FORWARD TO DOING IN CONCERT
WITH THE DEPARTMENT. IN
ADDITION, WE DO HAVE TO SHARE
OUR CONCERN RELATED TO THE
PROPOSED SIX MONTH DELAY IN
FUNDING TO BEHAVIORAL HEALTH
THROUGHPUT AND THE LACK OF
DETAIL AROUND HOW THIS FUNDING
WILL BE USED. BEHAVIORAL HEALTH
THROUGHPUT IS A MAJOR CHALLENGE
IN OUR EMERGENCY DEPARTMENTS AND
INPATIENT BEDS ALIKE, AND THE
DELAY WILL ONLY EXACERBATE THESE
CARE TRANSITION CHALLENGES.
THEREFORE, WE URGE THE
LEGISLATURE TO RESTORE THE
EFFECTIVE DATE OF THIS IMPORTANT
FUNDING STREAM TO JANUARY 1ST,
2025, AND ENSURE THE FUNDING
GOES WHERE IT IS NEEDED. IN
CLOSING, WE THINK THE
ADMINISTRATION FOR ITS
COMMITMENT TO INVESTING IN THE
MEDI-CAL PROGRAM AND SUSTAINING
ESSENTIAL HOSPITAL SERVICES FOR
CALIFORNIA'S MOST VULNERABLE
PATIENTS. WE LOOK FORWARD TO
CONTINUING THE CONVERSATION WITH
THE LEGISLATURE AND
ADMINISTRATION TO ACHIEVE A
FINAL TARGETED RATE INCREASE
PACKAGE THAT CAN BE IMPLEMENTED
SMOOTHLY, SAID HOSPITALS. ON A
MORE SUSTAINABLE PATH AND
IMPROVE THE CAPACITY TO SERVE
MEDI-CAL PATIENTS. THANK YOU.
MR. WHAT ABOUT NUMBER FOUR? DO
YOU THINK THERE'S ANY
ADJUSTMENTS ROOM FOR ANY
ADJUSTMENT TO THE
ADMINISTRATION'S PROPOSAL, THEY
BELIEVE WOULD BETTER IMPROVE
ACCESS TO CARE QUALITY AND I
THINK SO. I SHARE THE COMMENTS
THAT MY COLLEAGUE FROM CMA MADE
EARLIER. I THINK THERE'S ALWAYS
OPPORTUNITIES TO MAKE
IMPROVEMENTS. I THINK AN AREA
THAT WE ARE PARTICULARLY
MONITORING VERY CLOSELY IS THE
IMPLEMENTATION OF EQUITY
ADJUSTMENTS. I THINK THERE'S A
LOT OF ROOM IN THAT SPACE TO
FIGURE OUT HOW DO WE DEFINE WHAT
AN EQUITY ADJUSTMENT MEANS AND
HOW DO WE IMPACT IT IN THOSE
COMMUNITIES, WHETHER WE WHETHER
THAT'S A MEASUREMENT OF
SOCIOECONOMIC STATUS, MEDI-CAL
POPULATION OR GEOGRAPHY, AS YOU
KNOW, THERE ARE HOSPITALS IN
RURAL COMMUNITIES THAT ARE
REALLY SUFFERING THAT COULD
POTENTIALLY BE AN OPPORTUNITY,
BUT ALWAYS ROOM TO MAKE POSITIVE
CHANGES. MOVING TOWARDS PLANNED
PARENTHOOD REPRESENTATIVE. YES,
YOU CAN. COME OFF MY GAME TODAY.
I DON'T KNOW, MADAM CHAIR. IF
YOU I CAN WAIT IF YOU WANT TO.
YOU KNOW WHAT HAPPENS WHEN I
PRESIDED TODAY TOOK ALL MY
ENERGY ON THE FLOOR. SO NOW I'M
OFF MY GAME. SO SENATOR GROVE
AND THEN SENATOR ROTH. THANK
YOU, MADAM CHAIR. I, I DO
APPRECIATE THE FACT THAT YOU ARE
CONTINUING TO WORK ON THE ROOT
CAUSE OF THIS SITUATION, WHICH
IS ACTUALLY THE MEDICARE RATES
OR MEDI-CAL RATES, WHEN I FIRST
STARTED ENGAGING WITH THE VHA
AND THE PLANS, I COULDN'T, AND
YOU WERE SHOWING ME ALL THIS
STUFF AS A BUSINESS OWNER IN
THIS STATE 30 YEARS, THERE'S NO
WAY THAT YOU CAN OPERATE ON THE
RATE REIMBURSEMENTS THAT YOU
GET, BECAUSE IT'S JUST A PATHWAY
TO BANKRUPTCY, WHICH I THINK ALL
OF US IN OUR OUR DISTRICTS,
ESPECIALLY OUR RURAL HOSPITALS,
ARE FACING, AND WE KEEP PUTTING
BAND-AIDS ON IT, WHICH WE
APPRECIATE BECAUSE WE WOULDN'T
BE HERE TODAY IF AND WE WOULDN'T
HAVE TULARE AND WE WOULDN'T HAVE
RIDGECREST IN MY DISTRICT IF WE
DIDN'T DO THOSE THINGS. BUT WE
STILL HAVEN'T ADDRESSED THE ROOT
CAUSE WITH THE MEDI-CAL
REIMBURSEMENT RATES, SO I DO
CONCUR WITH WHAT YOU SAID. I
ALSO WANT TO BRING TO LIGHT AND
THIS IS JUST A I'M SURE THE, THE
PERCENTAGES MIGHT BE A LITTLE
BIT DIFFERENT, BUT SOMETHING
ELSE THAT HASN'T BEEN ADDRESSED
AND WHY IT'S SO IMPORTANT, I
REALIZE THAT WE CAN SAY AS
LEGISLATURE, OH, THERE'S ACCESS
TO HEALTH CARE OR WE, YOU KNOW,
MEDI-CAL FOR ALL, BUT IF YOU
CAN'T GET IN TO SEE A DOCTOR,
WHO CARES? I MEAN, IF YOU DON'T
HAVE I MEAN, WHO CARES IF YOU
CAN'T GET IN TO SEE A DOCTOR?
WHY DOES IT MATTER THAT YOU HAVE
THAT CARD THAT SAYS YOU HAVE
HEALTH CARE INSURANCE,
ESPECIALLY WITH REIMBURSEMENT
RATES? I HAD A PROVIDER PROVIDE
ME SOME INFORMATION. THE DATA HE
HAS TO REPORT, THE TIME HE
SPENDS WITH A PATIENT, THE
CONSULT THAT HE DOES, HE GETS
$42 AND IT'S HE SAYS ROUGHLY
ABOUT $165 SITUATION. THAT IS A
PATHWAY TO BANKRUPTCY. THERE'S
NO WAY TO DO IT. ON TOP OF THAT,
YOU HAVE LEASE INCREASES OR
BUILDING COST. I KNOW ONE
HOSPITAL HAS LIKE A $44,000 A
MONTH PAYMENT, WHICH IS PROBABLY
SMALL, BUT IT'S A RURAL AREA,
YOU HAVE A 5% INCREASE EVERY
YEAR IN COMPOUNDING ON, LEASE OR
RENTAL PROPERTY OR PURCHASING A
BUILDING. YOU HAVE AN 18%
INCREASE OF OVERHEAD BECAUSE OF
INCREASE OF MINIMUM WAGE AND
POLICIES THAT COME OUT OF THE
BUILDING. YOU GOT SUPPLIES
INCREASED BY 10, STAYING OPEN
TILL MIDNIGHT IN THIS ONE
SPECIFIC, URGENT CARE STATE.
THEY HAVE SEVERAL URGENT CARES
THROUGHOUT THE STATE. BUT THIS
THEY STAY OPEN TILL MIDNIGHT TO
ALLEVIATE THE COST FOR PLANS FOR
SOMEBODY GOING TO A HOSPITAL
EMERGENCY AND CLOGGING THAT UP.
THEY CAN GO TO THESE URGENT
CARES WHERE YOU PAY HALF OR LESS
THAN HALF OF WHAT'S THERE. SO I
THINK THE MEDICAL COMMUNITY WORK
COMP INCREASES GONE UP 10.
MEDICAL INSURANCE FOR THE STAFF.
I KNOW MINE AND MY BUSINESS.
WHEN I GOT MY BLUE CROSS PLAN,
JUST SAYING IT WAS 28% MORE THAN
I PAID LAST YEAR FOR MY
BUSINESS. JUST THROWING THAT OUT
THERE. I'M NOT THE ONLY ONE. SO
BUSINESS INCLUDING HOSPITALS AND
PROVIDERS ARE. AND THEY'RE
INDEPENDENT, BUILDINGS WHERE
THEY OPERATE OUT OF FOR CARE.
AND THESE, THESE URGENT CARES,
THEIR COSTS ARE GOING UP. AND
WE'RE NOT ADDRESSING THE FACT
THAT THE REIMBURSEMENT RATE HAS
BEEN CUT. AND I APPRECIATE YOU
BRINGING THAT UP. WE HAVEN'T HAD
AN INCREASE AND IT'S ACTUALLY
GONE DOWN. AND THAT IS THE ROOT
CAUSE OF THIS ENTIRE SITUATION.
THAT IS THE ROOT CAUSE THAT WILL
SOLVE THE GENTLEMAN NEXT TO USE
PROBLEM WITH WAGE INCREASES AND
BENEFITS. THAT IS THE ROOT CAUSE
WHEN IT COMES TO MAKING SURE
THAT WE DON'T HAVE STANDBY
EMERGENCY ROOMS AND HOSPITALS.
THAT IS A ROOT CAUSE TO MAKE
SURE THAT WE DO HAVE, MATERNITY
CARE. AND YOU DON'T TELL A WOMAN
IN A RURAL COMMUNITY SHE HAS TO
DRIVE 2.5 HOURS BEFORE SHE HAS
HER BABY. THAT IS THE ROOT
CAUSE. I WANT TO APPLAUD THE
ADMINISTRATION AND DOCTOR GHALY.
EVERY TIME I'VE CALLED THEM IN A
PANIC, I GOT TWO DAYS TO COVER
MY EMERGENCY ROOM, OR THEY'RE
GOING TO CLOSE. THEY STEP UP AND
THEY ADDRESS STUFF. BUT THAT'S
ALL PIECE, PIECE STUFF. IT'S NOT
GOING TO THE ROOT CAUSE IS TO
ADDRESS THESE RATES. AND SO
THANK YOU FOR CONTINUING THAT
FIGHT AND CONTINUING TO BRING IT
UP. BECAUSE I THINK IF WE CAN
GET THE STATE AND THE
LEGISLATURE AND THE GOVERNOR TO
AGREE THAT EVEN IF WE JUST PICK
THE TOP 25 CODES THAT WE USE
CONTINUOUSLY AND INCREASE THOSE
TO WHERE THEY NEED TO BE, THEN I
THINK THAT THAT WOULD BE A HUGE
IMPACT, BUT IT HAS TO START AT
RATE INCREASES, AND THAT'S THE
ROOT CAUSE CAUSE ANALYSIS. AND
PEOPLE DON'T KNOW WHAT A ROOT
CAUSE ANALYSIS IS. YOU FIND OUT
WHAT THE PROBLEM IS AND YOU FIX
IT FROM THE ROOT, WHICH HELPS
ALL THESE OTHER THINGS THAT FLOW
EASY, INCLUDING BENEFITS FOR
EMPLOYEES. THE WAY YOU, YOU
KNOW, OFFER TIME AND YOU KNOW,
ALL THIS STUFF THAT BENEFITS.
YOU HAVE TO HAVE THE MONEY TO DO
IT. SO I THANK YOU FOR
CONTINUING THAT FIGHT. AND I
JUST WANT TO THROW OUT TO THE
PLANS AT MY RATES WENT UP, LIKE
SIGNIFICANTLY. AND I THINK OTHER
BUSINESSES ARE TAKING THAT. AND
I UNDERSTAND WHY YOU HAVE TO DO
IT AS WELL, BECAUSE YOU HAVE TO
OPERATE WITHIN THIS SYSTEM. AND
I THINK IF WE JUST FIX THIS
ISSUE WITH THE RATES WHERE WE
HAVE THE ABILITY TO DO IT, WE
CAN, WE CAN BE SUCCESSFUL IN
MAKING SURE WE DON'T HAVE ANY
MORE HOSPITAL CLOSURES. AND OUR
EMPLOYEES ARE ALSO TAKEN CARE
OF. THANK YOU. MA'AM. YOU KNOW,
ONE OF THE GOOD THINGS IS JUST
EVEN LAST YEAR, WE'VE I'M
LOOKING AT ALL THE CODES, OVER
700 CODES THAT WE'RE THAT WE
ALREADY INCREASED, FOR RATES
THAT MANY YET DO WE HAVE THAT
MONEY YET LAST YEAR'S MONEY, DO
WE HAVE LAST YEAR'S MONEY YET
ARE WE STILL OPERATING ON THE
MONEY BEFORE OVERALL? OKAY. BUT
I KNOW WE MADE THE RATE
INCREASES, BUT THEY DON'T HAVE
THE MONEY YET. YEAH. AND THE AND
I AGREE WITH YOU ON THE
BEHAVIORAL HEALTH OUTPUT. RIGHT,
AND I THINK ALSO WHAT JASON SAID
AT LAO, I THINK IT'S REALLY
GRINDHOUSES ALL THESE BIG
HEADLINES AND STUFF, BUT THE
DETAILS ARE REALLY WHAT'S REALLY
IMPORTANT, RIGHT? ENSURING THIS
ACTUALLY GETS OUT TO OUT THE
DOOR IN THE HANDS OF PROVIDERS
AND HOSPITALS AND SO FORTH. SO
WE CAN SEE ACTUAL CHANGE. RIGHT,
BECAUSE BECAUSE MAYBE THE NEXT
MCO TAX WON'T BE AS HIGH. RIGHT.
AND WE'LL HAVE TO APPLY FOR
THAT, I THINK IN, IN A YEAR OR A
YEAR AND A HALF TO GET THAT
GOING FOR A CERTAINTY. I THINK
SOMEONE ELSE ALSO OCCURS TO BE
ABLE TO OPERATE IN UNDERSTANDING
THAT YOU'RE GOING TO GET THIS
AGAIN. RIGHT. AND JUST ON THE
CHAIR'S POINT, GOING BACK TO THE
RATE INCREASES AND GOING BACK TO
THIS, YOU KNOW, IT'S ALL WELL
AND GOOD TO SAY YOU HAVE A
MEDICAL CARD THAT SAYS YOU'RE
COVERED, BUT YOU CAN'T GET
ACCESS TO CARE. AND IT'S ALL
WELL AND GOOD TO SAY WE'VE
INCREASED RATES FOR 700 CODES,
BUT YOU DON'T HAVE THE MONEY.
THEY'RE NOT. THE MONEY HASN'T
BEEN RELEASED TO YOU YET. I
MEAN, IT'S LIKE YOU'RE I DON'T
WANT TO SAY YOU'RE SCARED TO
ANSWER A QUESTION. DO THEY HAVE
THE MONEY? DO THEY HAVE THE
MONEY YET? IS IT GONE TO THEM?
SOMEBODY AT THAT END OF THE
TABLE? YES, MA'AM. THEY'RE SO
PART OF THE RAIDS STARTED IN
JANUARY 2024. ON PAPER IN
JANUARY 2024, ON PAPER, AND A
LOT OF WHAT WE'RE TALKING ABOUT
RIGHT NOW IS FOR US TO AGREE FOR
THE NEXT FISCAL YEAR. EXACTLY.
YEAH. AND WHAT I'M SAYING IS, IS
THAT I'M JUST TRYING TO MAKE THE
POINT THAT WE'VE TOLD THEM THIS
IS YOUR RATE, BUT THEY'RE NOT
GETTING THAT RATE NOW. IT'S WE
AGREED JANUARY 2024. THAT WOULD
BE THE NEW RATE. BUT WHEN IS THE
FIRST TIME IT CHECK'S BEEN
DELIVERED FOR THAT NEW RATE TO
ANYBODY, A PROVIDER OR A
HOSPITAL. SO ALL THIS LÀ COUPONS
FROM THE LOCAL HEALTH PLANS. AND
I'LL GET TO THIS A LITTLE BIT
MORE IN MY TESTIMONY. BUT I
THINK ANY TIME THERE IS A
SIGNIFICANT CHANGE IN THE WAY
THAT WE'RE, YOU KNOW, FINANCING
THE MEDI-CAL PROGRAM, THERE ARE
A NUMBER OF STEPS TOWARDS
IMPLEMENTATION AND THAT IS THAT
IS WHERE WE ARE. I MEAN, WE HAVE
THE CODE LIST. WE'RE STILL
AWAITING FINAL GUIDANCE. AND
I'LL KIND OF TALK THROUGH AT A
VERY HIGH LEVEL, SOME OF THE
STEPS THAT HAVE TO BE TAKEN TO
GET THE DOLLARS OUT THE DOOR,
BECAUSE THAT IS WHAT WE WANT TO
WE WANT TO GET THE DOLLARS TO
PROVIDERS. AND I'M NOT BEING
ACCUSATORY. YEAH. TRYING TO MAKE
A POINT THAT IT'S WE DID
AUTHORIZE RATE INCREASES, BUT NO
ONE'S GETTING THEM. THEY HAVE
NOT GOT THEM YET, AND THAT WAS
JUST THE POINT. BUT YET NEW LAWS
HAVE TAKEN PLACE TO INCREASE
COST. SO THEY WERE OPERATING AT
A DEFICIT ALREADY. WE AUTHORIZED
NEW IN RATE INCREASES. THE
INCREASED COST HAVE ALREADY GONE
TO EFFECT. EVERYBODY'S PAYING
INCREASED COST ON WAGES, FICA,
FEDERAL FOOD AID WORKERS, COMP
LIABILITY INSURANCE RATE
INCREASES ON MEDI-CAL OR MEDICAL
INSURANCE FOR EMPLOYEES. ALL OF
THAT HAS GONE UP. JANUARY 1ST,
2024. AND WHEN THEY PAID THEIR
BILL FEBRUARY 1ST, IF THEY PAY
IT ON A MONTHLY BASIS LIKE I DO,
THEY'VE PAID THE INCREASE, BUT
THE RATE INCREASE TO OFFSET
THOSE COSTS, THEY DON'T HAVE A
DIME OF THAT. SO I JUST WANT TO
MAKE THAT POINT AND SAY WE HAVE
TO GET TO THAT POINT FASTER. NO
OFFENSE NEEDED ANY WAY, BUT I
WANT YOU TO THAT POINT BECAUSE I
NEED THEM TO GET THEIR MONEY.
OKAY SO THEY CAN TAKE CARE OF
THAT GUY. I THINK I JUST HAVE A
QUICK QUESTION. I THINK NUMBER,
THE QUESTION NUMBER THREE, IN
THE ANALYSIS RELATED TO THE
HOSPITAL ASSOCIATION SEEMS TO BE
THE MOST SALIENT. YOU KNOW,
WE'VE SPENT A LOT OF TIME ON
DISTRESSED HOSPITALS, AND I'M
HAVING A DIFFICULT TIME, EVEN
THOUGH I'VE BEEN AROUND HERE A
WHILE TRYING TO FIGURE OUT
EXACTLY WHAT'S NEEDED. SO THE
QUESTION IS THIS HAVE YOU ALL
DONE ANY MODELING BASED ON THE
PROPOSED REIMBURSEMENT RATE
CHANGES WITH RESPECT TO ONE OR
MORE OF YOUR MOST DISTRESSED
HOSPITALS? TO SEE WHAT THE
QUESTION IS, WHAT THE IMPACT
WOULD BE AND WHETHER IT IMPACTS
THE FINANCIAL SUSTAINABILITY OF
THESE HOSPITALS, OR IS IT TOO
LITTLE, TOO LATE, NOT ENOUGH.
SOME HOSPITALS THAT HAVE A HIGH,
PAYER MIX OF MEDI-CAL ARE SIMPLY
NEVER GOING TO BE SUSTAINABLE.
THANK YOU, SENATOR, FOR THE
QUESTION. WE ARE CERTAINLY
TRYING TO GET AN ANALYSIS OF HOW
THESE RATE INCREASES WILL IMPACT
THIS QUESTION RELATED TO
DISTRESSED HOSPITALS. I THINK
THEIR CURRENT STAGE WE'RE IN IS
IN THESE DISCUSSIONS THAT WE'RE
HAVING HERE TODAY, DISCUSSIONS.
DC'S TRYING TO DETERMINE WHERE
THINGS DO LAND ON THE
REIMBURSEMENT RATES TO MAKE A
DETERMINATION OF, YOU KNOW, WHAT
IMPACT THAT WILL HAVE ON
DISTRESSED HOSPITALS, I THINK TO
YOUR POINT, AND IT ALSO DEPENDS
ON THE VARIOUS CODES AND WHICH
HOSPITALS ARE DOING WHICH
PROCEDURES AND EMERGENCY ROOM
VOLUMES AND, BUT, BUT WE, WE
KNOW THE ONES THAT ARE IN MOST
DISTRESS. YOU DO. YEAH. SOME OF
THEM ARE IN THE NEWSPAPER. THOSE
OF US ARE NOT QUITE AS INFORMED
CAN PROBABLY FIGURE IT OUT. AND,
YOU KNOW, WE'VE THE DISTRESSED
HOSPITAL FUND IS MY
UNDERSTANDING IS NOW DEPLETED
AND I'VE PUT PUT SOME PRESSURE
ON THOSE THAT HAVE AN ABILITY TO
DO SOMETHING ABOUT IT TO REFILL
THAT TO SOME LEVEL, EVEN IN A
DISASTROUS BUDGET YEAR. BUT WE
OUGHT TO KNOW PRETTY QUICKLY,
CHOP, CHOP, WHETHER THIS MONEY
IS DOING ANYTHING OTHER THAN
STICKING A FINGER IN THE DIKE TO
KEEP THE FLOODWATERS FROM
OVERTAKING US, AND THAT IS SORT
OF SOMETHING THAT YOU CAN DO
THAT WE CAN'T DO, BECAUSE SOME
OF THEM ARE YOUR MEMBERS AND YOU
CAN WORK WITH THE ADMINISTRATION
AND THE DATA THAT'S OUT THERE,
PROJECTED OR OTHERWISE, TO
FIGURE OUT WHETHER IT WORKS
BETTER TO DO IT NOW THAN ONCE
THE STUFF'S IN CONCRETE AND THEN
WE CAN'T CHANGE IT. AM I MAKING
SENSE? YEAH, ABSOLUTELY. I AGREE
WITH WHAT YOU'RE SAYING. AND
THAT IS AN ANALYSIS I WOULD SAY
AT THIS POINT, STILL WORKING ON
THAT TO MAKE THAT DETERMINATION.
WE DO THINK THERE ARE SOME IF
YOU LOOK AT THE ECONOMICS
ARRIVING OUT OF THE COVID 19
PANDEMIC AND THE IMPACT THAT HAS
HAD ON ON CERTAIN HOSPITALS,
RIGHT. YOU HAVE TO OVERALL MCO
FUNDING IS GOING TO OBVIOUSLY
STABILIZE, ACCESS AND STABILIZE
MANY HOSPITALS. BUT I WOULD SAY
AT THIS MOMENT, WE DON'T KNOW
THIS, YOU KNOW, THE TOTAL SUM OF
THOSE, THAT WOULD BE ABSOLUTELY
PROTECTED THROUGH THESE
INCREASED RATES. AND THERE IS
ALSO AS WAS POINTED OUT EARLIER,
THE LAG TIME OF WHEN THE PLAN
COMES OUT AND IT'S PASSED, AND
GETTING THAT MONEY OUT THE DOOR.
SO I THINK THERE'S ALSO EVEN IF
YOU HAVE HOSPITALS THAT BY NEXT
YEAR WOULD BE FEELING A MUCH
MORE FISCAL SUSTAINABILITY,
SUSTAINABLE GROUND, THERE'S SOME
LAG TIME WHERE THEY MAY STRUGGLE
IN THE INTERVENING TIME. I KNOW
CERTAINLY THERE'S HOSPITALS IN
IN DISTRICTS AROUND THE STATE
WHERE THIS THIS POTENTIAL DELAY
RIGHT. THEY HAVE SIX MONTHS TO A
YEAR TO GET HELP. AND THIS THIS
PROCESS MAY TAKE A LITTLE BIT
LONGER. WELL, IT'S PARTICULARLY
CRITICAL BECAUSE WE'RE ALSO
DEALING WITH SEISMIC IN ANOTHER
COMMITTEE AND SEISMIC EXTENSIONS
THAT SEEM TO BE COMING AT US
LIKE ACORNS OUT OF THE TREE. AND
WE'RE GOING TO HAVE TO GET A
HANDLE ON IT AND BUILD A
STRUCTURE SO THAT WE CAN SORT OF
STEP HOSPITALS DOWN THE ROAD TO
MAKING SURE THEIR HOSPITALS ARE
ABLE TO CONTINUE TO FUNCTION. I
SAW A STATISTIC, I THINK I
REMEMBER IT CORRECTLY. YOU KNOW,
WHEN YOU TAKE A LOOK AT THE
NONSTRUCTURAL AND THE STRUCTURAL
, ONLY 232, 232 OF OUR
HOSPITALS, YOU WOULD KNOW, ARE
GOING TO BE CAPABLE OF PROVIDING
SERVICES TO PATIENTS AFTER A
MAJOR EARTHQUAKE, WHICH IS NOT A
VERY LARGE PERCENTAGE OF OUR
HOSPITALS IN THE STATE. SO WE'RE
GOING TO HAVE TO DO IT. AND WITH
RESPECT TO THE DISTRESSED
HOSPITALS, MY POINT HERE IS WE
NEED TO GET A HANDLE ON WHAT
THEIR FINANCIAL CONDITION REALLY
IS WITH EVERYTHING THAT THE
STATE CAN DO TO INCREASE
MEDI-CAL REIMBURSEMENTS, TO SEE
WHAT THEY'RE GOING TO BE ABLE TO
AFFORD, WHAT THEY'RE NOT GOING
TO BE ABLE TO AFFORD. AND THEN
IN THE SEISMIC AREA, EXPLORE
ALTERNATIVE FUNDING MECHANISMS,
IF ANY OF THOSE EXIST, TO TRY TO
GET HOSPITALS UP TO SNUFF SO
THEY PROVIDE SERVICES TO
VULNERABLE PEOPLE IN CRITICAL
AREAS OF THE STATE. THAT'S ALL
FROM ME. BUT I LOOK FORWARD TO
WHATEVER YOU'RE ABLE TO GIVE US.
THANK YOU, MADAM CHAIR. THANK
YOU. GO BACK. I'M GOING TO GO
BACK TO SENATOR GROVE. I JUST
HAVE A QUESTION BASED ON THE
ANSWER THAT YOU GAVE ME. JUST A
FEW MINUTES AGO. YOU SAID THAT
YOU'RE IN THE PROCESS, AND IT
DOES TAKE TIME TO CHANGE THIS
SYSTEM SO THAT THOSE RATES CAN
GO OUT, WHAT'S THE. AND I KNOW
YOU'RE GOING TO SPEAK ABOUT IT
BASED ON THE ACTUAL OR THE
IMPLEMENTATION DATE THAT YOU'RE
GOING TO MAKE THIS HAPPEN. THE
RATE SHOULD HAVE BEEN EFFECT
JANUARY 1ST, I GUESS. RIGHT OR
NOT. SO THE RATE INCREASES WERE
AUTHORIZED, RIGHT. BUT EFFECTIVE
JANUARY 1ST. SO FOR ALL SERVICES
THAT WERE PROVIDED ON AN AFTER
JANUARY 1ST, PROVIDERS WILL GET
THAT INCREASED RATE FOR THOSE
SERVICES. BUT IT WILL BE RETRO
RIGHT BACK TO JANUARY 1ST. YEP.
THAT'S RIGHT. IT'S RETROACTIVE.
IT IS. MAKE SURE THEY GET THEIR
MONEY OKAY. THANK YOU. OKAY MISS
LISA, I'M GOING TO COME BACK TO
YOU. OKAY TO DIFFERENT. JUST I'M
GOING TO GO THROUGH THE AGENDA,
THE WAY IT WAS PUT OUT ON THE
AGENDA. SO I'M GOING TO GO WITH
PUBLIC HEALTH, PUBLIC HOSPITALS.
GOOD MORNING. MY NAME IS ERICA
MURRAY. I'M THE PRESIDENT AND
CEO OF THE CALIFORNIA
ASSOCIATION OF PUBLIC HOSPITALS
AND HEALTH SYSTEMS. THANK YOU
FOR THE OPPORTUNITY TO SPEAK TO
YOU. TODAY. WE REPRESENT THE 21
PUBLIC HEALTH CARE SYSTEMS
ACROSS CALIFORNIA. THEY'RE
MOSTLY COUNTY OWNED AND
OPERATED. WE ALSO REPRESENT THE
FIVE UNIVERSITY OF CALIFORNIA
HEALTH SYSTEMS, THREE OF WHICH
USED TO BE THEIR LOCAL COUNTY
HOSPITAL. THE NAMES OF SOME OF
THE HOSPITALS WE REPRESENT,
RIVERSIDE UNIVERSITY HEALTH
SYSTEM, SAN JOAQUIN GENERAL LA
COUNTY GENERAL, ALL, YOU GET THE
IDEA. THESE ARE THE HOSPITALS
THAT PRIMARILY SERVE THOSE WHO
ARE ON MEDI-CAL AND WHO ARE
UNINSURED. ALTHOUGH THEY'RE JUST
6% OF ALL HOSPITALS, THEY
PROVIDE A THIRD OF ALL HOSPITAL
CARE FOR MEDI-CAL IN THE STATE.
THEY OFFER A RANGE OF
COMPREHENSIVE SERVICES BEYOND
HOSPITAL CARE, TRAUMA BURN
TRAINING. THEY TRAIN HALF OF ALL
HOSPITALS OF ALL DOCTORS AND
HOSPITALS IN THE STATE, AND THEY
PROVIDE IMPORTANT PRIMARY AND
PREVENTIVE CARE BECAUSE OF VERY
LOW MEDI-CAL RATES, THE MCO TAX
REPRESENTS IMPORTANT FUNDING TO
HELP COVER PUBLIC HEALTH CARE
SYSTEMS COSTS TO MAINTAIN ACCESS
FOR THE MOST MARGINALIZED LOW
INCOME, RESIDENTS IN OUR STATE.
WE REALLY APPRECIATE THE
INCLUSION IN THE MCO TAX OF $150
MILLION THAT'S TARGETED TO
PUBLIC HEALTH CARE SYSTEMS. IT'S
IMPORTANT FOR TWO REASONS.
FIRST, BECAUSE MOST OF THE
PRIMARY CARE THAT'S OFFERED BY
PUBLIC HEALTH CARE SYSTEMS
OCCURS IN FQHCS FEDERALLY
QUALIFIED HEALTH CENTERS, HEALTH
CENTERS, PUBLIC FQHCS THAT,
BECAUSE OF THE WAY THEY ARE
PAID, ARE NOT ELIGIBLE FOR THE
$291 MILLION ALLOCATED FOR
PRIMARY CARE STARTING IN 2024,
OR THE $975 MILLION EARMARKED
FOR PHYSICIAN AND NON-PHYSICIAN
PROFESSIONAL SPECIALTY CARE. THE
SECOND, THE $150 MILLION FOR
PUBLIC HEALTH CARE SYSTEMS,
REPRESENTS AN EFFORT BY THE
ADMINISTRATION WORKING WITH THE
LEGISLATURE AND WITH AND WITH US
AND OTHER STAKEHOLDERS TO
ADDRESS A LOOMING AND HUGE
STRUCTURAL DEFICIT. TO YOUR
QUESTION, SENATOR ROTH, WE ARE
NOT DISTRESSED HOSPITALS YET,
BUT WE ARE FACING A 3 TO $4
BILLION STRUCTURAL DEFICIT THAT
MUST GET ADDRESSED. AND THE $150
MILLION THAT'S TARGETED TO WHAT
ARE CALLED DESIGNATED PUBLIC
HOSPITALS REPRESENTS AN
IMPORTANT PIECE OF THAT PUZZLE.
BECAUSE YOU'RE A PUBLIC
HOSPITALS. ARE YOU ELIGIBLE TO
APPLY FOR THE FUNDING. THAT WAS
SHOULD THERE BE ANOTHER, ROUND
OF THAT FUNDING FOR DISTRESSED
HOSPITALS? BECAUSE YOUR FUNDING
IS A LITTLE DIFFERENT. IT IS
DIFFERENT. WE ARE ELIGIBLE TO
APPLY. OKAY, WE ARE LOOKING WE
ARE WORKING CLOSELY WITH THE
ADMINISTRATION ON ON OTHER WAYS,
TO TRY TO ADDRESS OUR STRUCTURAL
DEFICIT. OKAY. THANK YOU. JUST A
LITTLE BIT OF BACKGROUND ON THE
150 MILLION AND THE DEPARTMENT
EXPLAINED THIS A BIT, BUT I WANT
TO MAKE SURE PEOPLE UNDERSTAND,
SINCE 2005, PUBLIC HEALTH CARE
SYSTEMS HAVE BEEN PROVIDING THE
NONFEDERAL SHARE FOR INPATIENT
FEE FOR SERVICE DOLLARS FOR THE
FOR THOSE PATIENTS, THE 150
MILLION WOULD BE CONVERTED TO A
DRG STRUCTURE, WHICH IS A MORE
VALUE BASED PAYMENT, WHICH WHICH
WE FULLY SUPPORT. HOWEVER, THAT
150 MILLION DOESN'T COME
ANYWHERE CLOSE TO COVERING THE
COSTS OF PROVIDING THOSE
SERVICES. THE DEPARTMENT HAS
PROPOSED TO PHASE OUT, THE COST
BASED SUPPLEMENTAL THAT WOULD
NEED TO BE LAYERED ON, AND WE
HAVE REAL CONCERNS ABOUT THAT
BECAUSE WE DO CONSTANTLY NEED TO
BE COVERING OUR COSTS. AND WE AS
AS WAS MENTIONED, WE'VE BEEN
HAVING VERY PRODUCTIVE
CONVERSATIONS WITH THE
DEPARTMENT, AND WE'RE LOOKING
FORWARD TO A RESOLUTION IN THE
MAY REVISE. SO WHAT WOULD IT
LOOK LIKE ONCE THAT'S IN THIS
TRANSITION IS YOU UTILIZE THE
$150 MILLION FIRST AND THEN GO
BACK TO THE ORIGINAL SYSTEM.
CORRECT. WELL WE WOULD WE WOULD
CONVERT THESE PAYMENTS TO A DRG
AND THEN WE WOULD USE WE WOULD
IT'S CALLED CERTIFIED PUBLIC
EXPENDITURES. WE WOULD PUT UP
THE STATE SHARE TO COVER THE
DELTA OF THOSE TO PART OF THE
DELTA TO COVER THOSE COSTS. AND
YOU START WORKING ON THAT. IS IT
EASY TO TRANSITION BACK AND
FORTH LIKE THAT? IT'S JUST THE
NOTHING ABOUT PUBLIC HEALTH CARE
SYSTEM FINANCING IS EASY OR
SIMPLE, BUT IT'S SOMETHING THAT
WE UNDERSTAND IN THE DEPARTMENT.
WE'VE BEEN WE'VE BEEN DOING THIS
FINANCING AT THE I DON'T THINK
ANYTHING IS EASY IN THIS WHOLE
SPACE OF HEALTH CARE. RIGHT
OKAY. YES. NO, IT'S NOT EASY,
BUT IT'S KNOWN AND DOABLE. OKAY
IN ADDITION, I THINK IT'S
IMPORTANT TO NOTE, IN ADDITION
TO THE 150 MILLION PUBLIC HEALTH
CARE SYSTEMS SHOULD RECEIVE,
THEIR EQUITABLE SHARE OF OTHER
BUCKETS OF FUNDING. WE'VE BEEN
IN DISCUSSIONS WITH VHA AND
OTHERS ABOUT THE EMERGENCY
DEPARTMENT BUCKET, THE COMMUNITY
OUTPATIENT, THE GME REPRODUCTIVE
HEALTH BECAUSE WE PROVIDE SUCH A
COMPREHENSIVE RANGE OF SERVICES,
WHAT'S IMPORTANT TO KNOW AND
SPECIFIC TO YOUR QUESTION,
SENATOR, IS THE FOR PUBLIC
HEALTH CARE SYSTEMS, THE MCO TAX
REPRESENTS A REALLY IMPORTANT
AND INSUFFICIENT SOLUTION TO OUR
FINANCING CHALLENGES. THIS IS
NOT GOING TO SOLVE WHAT FOR
HOSPITALS IN PARTICULAR. AND
HEALTH CARE SYSTEMS THAT
PREDOMINANTLY SERVE MEDI-CAL.
WHEN YOU HAVE RATES THAT ARE SO
LOW, YOU AND YOU'RE WORKING TO
TRY TO COVER YOUR COSTS THROUGH
SUPPLEMENTAL PAYMENTS, THESE MCO
TAX DOLLARS WILL BE AN IMPORTANT
PART OF THOSE SUPPLEMENTAL
PAYMENTS, BUT WE'RE GOING TO
NEED OTHERS. AND WE'VE BEEN IN
CONVERSATIONS WITH THE
DEPARTMENT AND ALL OF YOU TO TRY
TO FIND ITS WHAT WE DO. WE ARE
CREATIVE AND, AND TRY TO FIND
WAYS TO COVER THOSE COSTS. AND
I'M, I'M HOPEFUL THAT WE WILL.
BUT IT'S IMPORTANT FOR YOU TO
RECOGNIZE HOW IMPORTANT YET
INSUFFICIENT THESE MCO TAX
DOLLARS ARE. BUT YOU'LL BE
ELIGIBLE FOR THE ED, YES. AND
EVERY EVERY PROVIDER CODE THAT
IS GETTING REIMBURSED, I MEAN,
INCREASED YOU WILL BE ELIGIBLE
AS WELL, WITH THE EXCEPTION OF
THOSE FIRST TWO BUCKETS OF
PRIMARY AND SPECIALTY CARE,
BECAUSE FQHCS ARE NOT ELIGIBLE
FOR THOSE AND MOST OF OUR
PRIMARY AND SPECIALTY CARE ARE
PROVIDED IN FQHCS. OKAY. SENATOR
ROTH, I'M JUST CURIOUS, DO THE
DOES YOUR OBLIGATION AS A COUNTY
HOSPITAL TO TAKE CARE OF, LOCAL
JAIL INMATES IMPACT YOUR
FINANCIAL YOUR FINANCIAL
FINANCIAL SITUATION VERY MUCH?
AND IN WHAT WAY AND HOW IS THAT
FUNDED, IT IT VARIES BY COUNTY.
AND FOR SOME COUNTIES, THEY
PROVIDE THE COST OF COVERING
THOSE SERVICES. OTHER COUNTIES
PASS THOSE. THE COSTS OF MEDICAL
SERVICES FOR INMATES ONTO THE
PUBLIC HEALTH CARE SYSTEM. SO IT
RANGES, BUT IT DOES IN MANY
INSTANCES CONTRIBUTE TO
FINANCIAL DISTRESS FOR PUBLIC
HEALTH CARE SYSTEMS BY PASSING
THE COSTS ONTO THE PUBLIC HEALTH
SYSTEM. WHAT DOES THAT MEAN?
THAT MEANS IT GOES ONTO OUR
BOOKS. SO IT'S NOT UNREIMBURSED
CARE, IT'S YES. WE JUST WE
PROVIDE IT AND THEN TRY TO
ABSORB THOSE COSTS AND TRY TO
COVER THOSE COSTS. OTHER WAYS.
JUST CURIOUS. THANK YOU. THANK
YOU. THANKS VERY MUCH. I
APPRECIATE THE TIME. PERFECT.
THANK YOU SO MUCH. NOW WE WILL
MOVE ON TO PLANNED PARENTHOOD.
GOOD MORNING, CHAIR AND MEMBERS
OF THE COMMITTEE. I'M LISA
MATSUBARA. I USE SHE HER
PRONOUNS FOR PLANNED PARENTHOOD
AFFILIATES OF CALIFORNIA. WE
REPRESENT THE SEVEN PLANNED
PARENTHOOD AFFILIATES WHO
OPERATE OVER 100 HEALTH CENTERS
THROUGHOUT THE STATE. TOGETHER,
THEY PROVIDE 1.3 MILLION PATIENT
VISITS ANNUALLY IN CALIFORNIA.
AND THEY ARE TRUSTED COMMUNITY
PROVIDER. PLANNED PARENTHOOD IS
COMMITTED TO PROVIDING EQUITABLE
AND AFFORDABLE ACCESS TO THE
FULL RANGE OF SEXUAL AND
REPRODUCTIVE HEALTH CARE FOR
THEIR PATIENTS, 80 TO 90% OF
WHOM RELY ON MEDI-CAL AND FAMILY
PACKED FOR CARE. WHILE ABORTION,
FAMILY PLANNING, CANCER
SCREENINGS, AND STI CARE ARE
CORE SERVICES FOR OUR
AFFILIATES, THE AFFILIATES
ACTUALLY PROVIDE AN EXPANDING
RANGE OF OTHER SERVICES THAT
REALLY BETTER ENCOMPASS THEIR
PATIENT NEEDS, INCLUDING
NON-SPECIAL, K¾T, BEHAVIORAL
HEALTH CARE, GENDER AFFIRMING
CARE, AND PRIMARY CARE. THAT'S
WHY PLANNED PARENTHOOD IS PART
OF THIS COALITION, TO ADVOCATE
FOR A NEW MCO TAX THAT PROVIDES
A SUSTAINABLE SOLUTION TO ENSURE
THAT PATIENTS THAT RELY ON
MEDI-CAL CAN RECEIVE HIGH
QUALITY, AFFORDABLE,
APPROPRIATE, AND TIMELY HEALTH
CARE. WE STRONGLY SUPPORT THE
ADMINISTRATION'S PROPOSAL TO
MAKE THESE CRITICAL INVESTMENTS
IN MEDI-CAL THROUGH THE TARGETED
RATE INCREASES. THESE
INVESTMENTS ARE A PATHWAY FOR
SUSTAINED, PREDICTABLE, AND LONG
TUM FUNDING IN A WAY THAT REALLY
TRANSFORMS THE QUALITY OF CARE
PATIENTS RECEIVE AND REFLECTS
OUR STATE'S COMMITMENT TO HEALTH
EQUITY. IT WILL DIRECTLY IMPROVE
ACCESS TO MEDI-CAL SERVICES,
IMPROVE HEALTH OUTCOMES BY
INCREASING AVAILABLE RESOURCES
FOR CURRENT MEDI-CAL PROVIDERS,
AND BY INCENTIVIZING NEW
PROVIDERS TO ENROLL IN MEDI-CAL
WITH REGARDS TO THE DEPARTMENT'S
2425 PROPOSAL FOR TARGETED RATE
INCREASES, SPECIFICALLY AS IT
RELATES TO FAMILY PLANNING AND
ABORTION, WE SUPPORT THE
PROPOSED INCREASES TO BASE RATES
FOR ABORTION SERVICES. WE KNOW
THAT IMPROVING MEDI-CAL
REIMBURSEMENT STRENGTHENS
CALIFORNIA'S NETWORK OF ABORTION
PROVIDERS, AND STUDIES HAVE
SHOWN THAT STATE MEDICAID
PROGRAMS PLAY A CRITICAL ROLE IN
IMPROVING AND ADDRESSING
INEQUITIES IN ACCESSING ABORTION
AND FAMILY PLANNING SERVICES FOR
THEIR RESIDENTS. WE ALSO APPLAUD
THE DEPARTMENT'S PROPOSAL TO
RELY ON BASE RATE INCREASES
RATHER THAN SUPPLEMENTAL
PAYMENTS, TO IMPROVE OVERALL
REIMBURSEMENT RATES AND REDUCE
ADMINISTRATIVE BURDENS, WHILE
SUPPLEMENTAL PAYMENTS HAVE BEEN
CRUCIAL FOR ABORTION AND FAMILY
PLANNING SERVICES OVER THE PAST
FEW YEARS, THE PLANNED
PARENTHOOD AFFILIATES HAVE FACED
CONSIDERABLE CHALLENGES IN
OBTAINING PAYMENT IN A TIMELY
MANNER. WE ARE ACTUALLY STILL
TRYING TO RECOVER PAYMENTS FROM
PROP 56 GOING BACK TO 2020 AS A
FREEDOM OF CHOICE PROVIDER,
PLANNED PARENTHOOD CONTINUES TO
MOSTLY BE DEPENDENT ON MEDI-CAL
FEE FOR SERVICE RATES, AND THIS
LEADS TO A CONSIDERABLE
ADMINISTRATIVE BURDEN FOR BOTH
AFFILIATES AND THE PLANS WE'RE
REALLY EAGER TO BE A PART OF THE
MEDI-CAL TRANSFORMATION, AND THE
PROPOSAL BEFORE THE LEGISLATURE
TODAY WILL HELP SEXUAL AND
REPRODUCTIVE HEALTH CARE
PROVIDERS LIKE PLANNED
PARENTHOOD TO MOVE TOWARDS A
VALUE VALUE DRIVEN REIMBURSEMENT
MODEL THAT REALLY INTEGRATES
WITH THE DEPARTMENT'S VISION FOR
MEDI-CAL FUTURE. THERE'S ALSO A
CRITICAL OPPORTUNITY FOR SEXUAL
REPRODUCTIVE HEALTH CARE
PROVIDERS IN MEDI-CAL TO HELP
MEET KEY QUALITY METRICS FOR
MATERNAL HEALTH, STIS, CANCER
SCREENINGS, AND OTHER GAPS IN
HEALTH EQUITY. ACCORDINGLY WE
URGE THAT THE DEPARTMENT ALSO
ALLOCATE FUNDS TOWARDS FAMILY
PLANNING INVESTMENTS THAT
MAXIMIZE THE IMPACT OF THIS
FUNDING THROUGH FEDERAL MATCHING
FOR FAMILY PLANNING SERVICES. WE
ARE GRATEFUL FOR THE CONTINUED
PARTNERSHIP WITH THE DEPARTMENT
OF HEALTH CARE SERVICES ON HOW
TO OPERATIONALIZE THE PROPOSED
INVESTMENTS FOR ABORTION AND
FAMILY PLANNING IN A WAY THAT
BEST SUPPORTS CALIFORNIA'S
MEDI-CAL BENEFICIARIES AND
FURTHERS THE INCLUSION OF SEXUAL
REPRODUCTIVE HEALTH CARE
PROVIDERS IN THE MEDI-CAL
TRANSFORMATION. I APPRECIATE THE
INVITATION TO SPEAK TODAY, AND I
WELCOME ANY QUESTIONS THAT YOU
MIGHT HAVE. I DON'T KNOW IF I
MISSED NUMBER THREE OF YOUR
RESPONSE, OR IF YOU WERE JUST
GOING TO SAY DITTO TO, WELL, Ã
AND CMA. YEAH. SO, IN TERMS OF,
HOW NUMBER THE THIRD QUESTION,
THE ADJUSTMENTS TO THE PROPOSAL.
YES, YES. SO THAT WAS, WE HAVE
PROVIDED A COUNTER PROPOSAL TO
THE DEPARTMENT WITH REGARDS TO
MAXIMIZING THE FAMILY PLANNING
MATCH AT THE FEDERAL LEVEL, TO
ALLOCATE SOME OF THE 90 MILLION
TOWARDS FAMILY PLANNING RATES
AND NOT JUST ABORTION SERVICES.
SO WE CAN REALLY FULLY MAXIMIZE
THE FEDERAL MATCH. AND IF I'M
NOT MISTAKEN, I THINK THE
DEPARTMENT TOUCHED ON THIS PART
RIGHT. HERE, ME I'LL TURN THESE
PAGES WITH REGARDS TO THE
CURRENT PROP 56 RATES. OKAY. NO
OKAY. NOT CORRECT. THANK YOU SO
MUCH. YEAH OKAY. ANY QUESTIONS
ON THIS OKAY. WE'RE NOW GOING TO
MOVE TOWARDS I BELIEVE CPCA
OKAY. THERE WE GO. GOOD MORNING
MADAM CHAIR AND MEMBERS. DENNIS
CUEVAS ROMERO WITH THE
CALIFORNIA PRIMARY CARE
ASSOCIATION. CPCA REPRESENTS
OVER 1300 COMMUNITY HEALTH
CENTERS FQHCS RURAL HEALTH
CENTERS THROUGHOUT THE STATE,
REALLY APPRECIATE THE INVITATION
TO BE PART OF THIS, VERY
IMPORTANT DISCUSSION. AS WE ALL
KNOW, THERE HAS BEEN A HISTORIC,
LONG UNDER, UNDERINVESTMENT IN
THE MEDI-CAL PROGRAM AND PRIMARY
CARE. SO THIS CONVERSATION IS
INCREDIBLY CRITICAL AND A
HISTORIC INVESTMENT INTO PRIMARY
CARE. SO WE REALLY APPRECIATE,
THIS CONVERSATION THÀNH, AS IT
RELATES TO HOW, OUR HEALTH
CENTERS ARE GOING TO, AND OUR
PATIENTS ARE GOING TO, SEE
BENEFIT THROUGH THE MCO TAX.
THERE ARE A COUPLE OF SPECIFIC
BUCKETS WE WANTED TO TALK ABOUT,
THE SUPPLEMENTAL PAYMENT POOL,
FOR NON-HOSPITAL 340 B CLINICS
THAT IS INCREDIBLY IMPORTANT FOR
OUR MEMBERS, CURRENTLY, THE
GENERAL FUND PROVIDES $105
MILLION FOR, OUR CLINICS TO
ADDRESS THE ISSUE THAT WAS
CREATED WHEN THE STATE
TRANSITIONED TO MEDI-CAL. OUR
HEALTH CENTERS, UNFORTUNATELY,
WERE, LOST A CHUNK OF FUNDING
THAT THEY WERE ABLE TO
SUPPLEMENT THEIR, THEIR
PAYMENTS, PARTICULARLY PROGRAMS
FOR OUR PATIENTS, THAT ADDRESS
SOCIAL DETERMINANTS OF HEALTH
ISSUES. SO THE SUPPLEMENTAL
PAYMENT IS GOING TO DOUBLE THAT
TO, 200, 205 MILLION OR UP TO
$225 MILLION PER YEAR. THAT'S
ESPECIALLY CRITICAL. BUT I DO
WANT TO NOTE THAT, YOU KNOW, NOT
ALL OF OUR HEALTH CENTERS
PARTICIPATE IN THE 340 B
PROGRAM. SO, IT IS INCREDIBLY
IMPORTANT, BUT IT DOES NOT REACH
ALL OF OUR MEMBERS. SO JUST
WANTED TO FLAG THAT, THERE ARE
OTHER PROGRAMS, PARTICULARLY THE
GRADUATE MEDICAL EDUCATION THAT
WE FIND ESPECIALLY CRITICAL, YOU
KNOW, HEALTH CENTERS, AS MY
COLLEAGUE FROM THE PUBLIC
HOSPITALS MENTIONED, WE PROVIDE
CARE AND IT'S OFTENTIMES REALLY
DIFFICULT TO RECRUIT AND RETAIN
WORKFORCE AT OUR FQHCS. AND SOME
OF OUR HEALTH CENTERS DO HAVE
TEACHING HEALTH CENTERS. SO THE
ABILITY TO BRING IN AND TRAIN
THOSE, RESIDENTS IS INCREDIBLY
CRITICAL BECAUSE AS MY COLLEAGUE
FROM CMA MENTIONED, WHERE YOU
TRAIN, I THINK IT'S ABOUT CLOSE
TO 70. IF YOU TRAIN, YOU'LL STAY
WHERE YOU TRAIN. SO THAT'S
CRITICALLY IMPORTANT. I DO ALSO
WANT TO MENTION, SIMILAR TO THE
COMMENT FROM THE PUBLIC
HOSPITALS, OUR FQHCS ARE CANNOT
ACCESS THE TARGETED RATE
INCREASES WHILE THOSE PAYMENTS
WILL BE SENT TO OUR FQHCS, WE
SEE THAT MONEY GETS RETURNED, AT
LEAST UNDER THE CURRENT PROPOSAL
, IN ITS ANNUAL RECONCILIATION
PROCESS. SO THE CONCEPT OF THE
INVESTMENT IN PRIMARY CARE FOR
FQHCS IS, IS FANTASTIC. AND I
THINK IT'S WELL THOUGHT OUT, BUT
UNFORTUNATELY, AS CURRENTLY
PROPOSED, OUR HEALTH CENTERS
WILL NOT BE ABLE TO KEEP THE
TARGETED RATE INCREASES. CAN YOU
EXPLAIN THAT TO ME AGAIN? SO
YOU'LL GET THE INCREASE AND THEN
YOU'LL HAVE TO GIVE IT BACK? YES
SO THERE'S AN ANNUAL
RECONCILIATION PROCESS. AND
BECAUSE HEALTH CENTERS GET PAID,
OR REIMBURSED FOR THEIR SERVICES
OR WITH THEIR, WHAT'S CALLED THE
PROSPECTIVE PAYMENT SYSTEM,
THEIR RATE, ANY, ANY, ANY MONEY
ON TOP OF THE PCP RATE AT THE
END OF THE YEAR GETS RECONCILED,
BECAUSE WE HAVEN'T SUBMITTED
THAT WAIVER TO BE ABLE TO
INCREASE THAT OR THAT IS THE
CURRENT STRUCTURES FOR HEALTH
CENTER PAYMENT. AND IT AND IT
WORKS THE OTHER WAY. SO IF
HEALTH CENTERS DON'T, GET
UNDERPAID AND DON'T GET THEIR PS
RATE AT THE END OF THE YEAR,
THERE'S WHAT'S CALLED A RAP
PAYMENT. AND THE MANAGED CARE
PLANS THEN HAVE TO MAKE HEALTH
CENTERS WHOLE. BUT THE BECAUSE
WE HAVE OUR SET PS RATE THE WAY
OUR OUR PAYMENT IS STRUCTURE IT.
WE CANNOT RECEIVE ANY FUNDING ON
ON ON TOP OF OUR PS RATE. AND
MAYBE THIS IS A QUESTION FOR YOU
TO DIRECTOR OR, WHAT OUR
CONVERSATIONS LOOKING LIKE TO
ADDRESS THAT ISSUE. WE. DENNIS,
DO YOU WANT ME TO TAKE THIS? HI,
LINDA HARRINGTON, ASSISTANT
STATE MEDICAID DIRECTOR. SO I
THINK WHAT WHAT DENNIS IS
TALKING ABOUT IS, FEDERALLY
QUALIFIED HEALTH CENTERS ARE
REIMBURSED UNDER THE RPS, SO
THEY RECEIVE AT LEAST PS WHEN
THEY ARE REIMBURSED FOR THE
SERVICES PROVIDED AND THE FEE
FOR SERVICE DELIVERY SYSTEM THEY
RECEIVE THAT PS RATE, WHICH IS
HIGHER THAN GENERALLY THE FEE
FOR SERVICE RATES THAT ARE PAID
FOR THE SERVICES THEY GET. THEY
GET AN ENCOUNTER RATE THAT
COVERS THE AVERAGE COST OF
PROVIDING SERVICES ACROSS, SO
THEY GET THAT HIGHER RATE WHEN
THEY'RE REIMBURSED FROM THE
MANAGED CARE PLANS, THEY'RE
REIMBURSED, SIMILAR TO PROVIDERS
THAT PROVIDE SIMILAR SERVICES.
SO THEY RECEIVE PAYMENT ON THAT
LIKE CODE BASED OR ON A
CAPITATION BASIS. THEY THEN, GET
WHAT WE CALL THE RAP PAYMENT, IF
THAT. THAT DOES NOT TOTAL UP TO
THEIR PS, THE STATE MAKES A
PAYMENT TO THE FEDERALLY
QUALIFIED HEALTH CENTERS FOR
EACH VISIT TO BRING THEM UP TO
THAT, TO THAT PS RATE. SO WHAT
DENNIS IS TALKING ABOUT IS WHEN
THESE RATE INCREASES GO IN, THE
REVENUE FROM MANAGED CARE PLANS
WILL GO UP, BUT THAT RAP
COMPONENT WILL COME DOWN BECAUSE
THEY WILL BE RECEIVING A HIGHER
AMOUNT. THEIR PAYMENT WILL STAY
AT THE PS RATE. AND THAT'S A
THAT'S A EXCUSE ME, THAT'S A
FEDERAL LEVEL, REIMBURSEMENT
LEVEL AND PAYMENT STRUCTURE. CAN
WE DO SOMETHING ABOUT THAT? IT
SEEMS LIKE IT'D BE GREAT FOR THE
RATES TO GO UP, BUT THEY'RE NOT
GOING TO REAP THE BENEFITS. YES.
CORRECT. SO WE THE REIMBURSEMENT
STRUCTURE IS NOT PROPOSED TO
CHANGE IT STILL CONTINUES TO BE.
BUT WE CAN WE CAN CHANGE THAT.
RIGHT. WE WOULD HAVE TO DO
SIGNIFICANT WORK WITH THE
FEDERAL GOVERNMENT TO MAKE A
CHANGE TO THE PS RATE. AND WE
WOULD HAVE TO DO SOME. CORRECT
ME IF I'M WRONG, EVERYONE IN
THIS TABLE WILL GET RATE
INCREASES. YES, EXCEPT EXCEPT
THIS STAKEHOLDER. IS THAT
CORRECT? AM I READING THIS
CORRECTLY? SO RIGHT. SO WE'RE
TAKING THAT INVESTMENT OF
DOLLARS AND PUTTING IT IN THE
340 BE NON-HOSPITAL SUPPLEMENTAL
PAYMENT POOL TO INCREASE THAT TO
INVEST IN THAT PROGRAM. SO YOU
WILL AT THE END GET INCREASES.
THERE WILL BE INCREASES ON FOR
THE HEALTH CENTERS THAT
PARTICIPATE IN THE 340 BE
SUPPLEMENTAL PAYMENT, BUT NOT
ALL FACILITIES WILL BE REACHED.
CORRECT. AND ALL THE OTHER
STAKEHOLDERS, ALL THEIR
FACILITIES WILL BE REACHED
EXCEPT THIS STAKEHOLDER. ALL THE
HOSPITALS ARE ELIGIBLE. ALL THE
PROVIDERS ARE ELIGIBLE. PLANNED
PARENTHOOD ALL CLINICS ARE
ELIGIBLE. REGARDLESS THIS
STAKEHOLDER ONLY A PORTION
ELIGIBLE. JUST TRYING TO FIGURE
THAT PART, HOW WE REACH THAT
CONCLUSION. SO WE WORKED WITH
OUR PARTNERS AT KPCA TO COME UP
WITH THE PROPOSAL THAT THAT YOU
SEE BEFORE YOU. SO THIS WAS KIND
OF THE AGREED UPON WHAT WHAT WE
MOVED FORWARD WITH WAS WORKING
IN CONJUNCTION WITH OUR PARTNERS
AT KPCA. THE PROPOSAL THAT THAT
YOU SEE TO KPCA, WE'RE OKAY WITH
THIS WITH THE INCREASE FOR THE
340 BE ABSOLUTELY THAT WE ARE WE
ARE WE HAVE BEEN WORKING WITH
THE DEPARTMENT TO WORK ON THAT,
TO TRANSITION TO A DIRECTED
PAYMENT, TO I WILL JUMP TO
QUESTION THREE. I THINK WE WOULD
REQUEST AND WE HAVE BEEN HAVING
CONVERSATIONS WITH THE
DEPARTMENT ABOUT BEING ABLE TO
ACCESS THE INCREASE AND HOLD ON
TO THE ADDITIONAL FUNDING FOR
THE TARGETED RATE INCREASES,
BECAUSE IF WE TRULY WANT TO
INVEST IN PRIMARY CARE FOR US,
IT IS CHALLENGING WHERE HEALTH
CENTERS FQHCS PROVIDE CARE TO A
THIRD OF THE MEDI-CAL PATIENTS
TO NOT BE ABLE TO HAVE THAT. AND
FRANKLY, WE THINK THAT THERE YOU
KNOW, THE CHALLENGE OF GOING
THROUGH THE RECONCILIATION
PROCESS AT THE END OF THE YEAR
IS A BURDEN I CAN IMAGINE ON THE
DEPARTMENT AND CERTAINLY ON OUR
HEALTH CENTERS, AND, YOU KNOW,
IF WE TRULY WANT TO INVEST, WE
WOULD URGE THE LEGISLATURE AND
THE ADMINISTRATION TO ALLOW
HEALTH CENTERS TO KEEP THE, THE,
THE RATE INCREASES AND NOT HAVE
THAT BE SUBJECT TO
RECONCILIATION AT THE END OF THE
YEAR. WE'RE TALKING ABOUT
EQUITY. MY DISTRICT IS CLOSE TO
100% COMMUNITIES OF COLOR. WHERE
DO THEY GO TO THESE TWO
STAKEHOLDERS, MY COMMUNITY
MEMBERS GO TO PUBLIC HOSPITALS.
MY MOM GOES TO A PUBLIC HOSPITAL
AND CLINICS AND INCLUDING
PLANNED PARENTHOOD CLINICS. SO
IF WE'RE TALKING ABOUT EQUITY,
WE WANT TO MAKE SURE WE'RE
COVERING EVERY SINGLE I IT JUST
SEEMS, AT LEAST IN THIS TABLE,
SEEMS UNFAIR THAT ONLY ONE
STAKEHOLDER DOESN'T GET THE FULL
BENEFITS OF WHAT WE'RE PROPOSING
HERE. WELL, I JUST WANT IS THIS
SUBJECT TO A WAIVER PROCEDURE
WHERE WE COULD GO IN FOR A
WAIVER TO I MEAN, WE'RE WE'RE
PAYING THE MONEY, RIGHT? RIGHT.
SO WE SO TODAY, FEDERALLY
QUALIFIED HEALTH CENTERS AND RHC
RURAL HEALTH CLINICS ARE THE
ONLY CLINICS THAT RECEIVE THE
PROSPECTIVE PAYMENT SYSTEM RATE
SO THAT CPS RATE THE IT'S
SIGNIFICANTLY HIGHER IN
REIMBURSEMENT THAN, THAN OTHER
PROVIDERS. SO THE AVERAGE RATE
TODAY ACROSS CLINICS IS
APPROXIMATELY $225 PER VISIT,
AND SO WE DO HAVE REQUIREMENTS
FROM THE FEDERAL GOVERNMENT
THAT, THAT YOU HAVE TO PAY AT
LEAST. PS YES, SO WE'RE SAYING
THEY GET PAID MORE THAN OTHERS
IN GENERAL PER VISIT. YES BUT
NOBODY GETS PAID ENOUGH. AND I
THINK THAT'S A COMMON THEME.
RIGHT AS I'VE CAUGHT OUR
COLLEAGUES HAVE MENTIONED, I
THINK THIS IS AN ABSOLUTELY A
HISTORIC INVESTMENT, BUT IT'S
SOMETHING THAT YOU KNOW, MANY OF
THE STAKEHOLDERS HERE SAY THAT,
YOU KNOW, THIS IS PROBABLY A
LONG TIME COMING, AND WE SHOULD
BE HAVING CONTINUED
CONVERSATIONS ON HOW TO FURTHER
INCREASE INVESTMENTS. OKAY,
THANK YOU. NOPE. THANK YOU SO
MUCH. WE'RE GOING TO MOVE ON TO
SEIU. THANK YOU, MADAM CHAIR.
MATT LEGGETT WITH SEIU
CALIFORNIA. VÀ. I APPRECIATE THE
OPPORTUNITY TO COME HERE AND
SPEAK ABOUT THIS IMPORTANT ISSUE
, YOU KNOW, I THINK I'LL ECHO A
LOT OF THE COMMENTS THAT WERE
MADE BY THE FELLOW PANELISTS. I
DID WANT TO SAY ON THE FRONT
END, YOU KNOW, FROM OUR VIEW, WE
THINK THAT THIS PROPOSAL DOES
STRIKE A BALANCE BETWEEN
SUPPORTING THE GENERAL FUND AND
TRYING TO AVERT SOME OF THE
WORST CUTS THAT WE'RE GOING TO,
YOU KNOW, UNFORTUNATELY,
POTENTIALLY HAVE TO CONSIDER
THIS YEAR. AND THEN ALSO
INVESTING IN THE MEDI-CAL
PROGRAM TO MAKE SURE THAT WE'RE
ACTUALLY DELIVERING ON THIS
PROMISE OF NOT JUST COVERAGE,
BUT ACCESS, WHICH WE THINK IS
CRITICALLY IMPORTANT, AND SO,
YOU KNOW, APPRECIATE ALSO ON THE
FRONT END, THE LEGISLATURE AND
THE ADMINISTRATION, PURSUIT FOR
ADDITIONAL FEDERAL MONEY AND
WOULD JUST URGE AND ECHO SOME OF
THE COMMENTS, BY PLANNED
PARENTHOOD AND OTHERS AROUND
MAXIMIZING FEDERAL FUNDS. I
MEAN, IT'S THE SMART THING TO DO
BUDGET WISE. AND HOW DO WE GET
MORE MONEY TO SUPPORT OUR HEALTH
CARE SYSTEMS IN CALIFORNIA, WE
ALSO, YOU KNOW, SEE THESE, FOR
THE FIRST TIME OF REALLY GOING
BACK TO INVEST IN THE PROGRAM
AND THE MEDI-CAL PROGRAM, WHERE
OFTEN THE MCO TAX WAS USED TO
SUPPORT THE PROGRAM, BUT ALSO
SUPPORT THE GENERAL FUND. AND SO
FOR THAT, WE THINK, YOU KNOW,
DELIVERING ON THIS PROMISE OF
CARE IS CRITICALLY IMPORTANT. I
KNOW IT'S SOMETHING THAT EVERY
MEMBER ON THIS PANEL HAS TALKED
ABOUT, I DID WANT TO, YOU KNOW,
SORT OF HIGHLIGHT FROM A WORKER
PERSPECTIVE, ONE OF THE CRITICAL
THINGS IS REALLY JUST THERE IS,
YOU KNOW, CONTINUES TO BE A
WORKFORCE CRISIS. AND THIS IS
NOT GOING TO GO AWAY IN ONE
YEAR. IT'S GOING TO TAKE
SUSTAINED INVESTMENT TO TRY TO
MEET THE NEED, BECAUSE IT DIDN'T
HAPPEN OVERNIGHT EITHER. THE
PANDEMIC DEFINITELY MADE IT
WORSE, WITH 1 IN 5 HEALTH CARE
WORKERS CONSIDERING LEAVING THE
PROFESSION. WE HAVEN'T SEEN, YOU
KNOW, THE FULL EXTENT OF THAT
YET BECAUSE PEOPLE ARE STILL
CONSIDERING RETIREMENT. PEOPLE
ARE STILL CONSIDERING, YOU KNOW,
CHANGING CAREERS. AND SOMETIMES
THAT CAN TAKE SOME TIME, YOU
KNOW, BUT THIS SHORTAGE EXISTS
FROM PRIMARY CARE PHYSICIANS TO
ALLIED HEALTH PROFESSIONALS,
REALLY, ACROSS THE BOARD, I DID
WANT TO HIGHLIGHT A COUPLE OF
THE PROPOSALS. ONE OF THEM BEING
AND IT'S BEEN TALKED ABOUT, BUT
GRADUATE MEDICAL EDUCATION,
WHICH IS REALLY JUST A CLEAR,
EASY WAY TO MAKE SURE THAT WE
ARE STARTING TO DO THAT DOWN
PAYMENT FOR OUR WORKFORCE
PIPELINE, TO MAKE SURE WE HAVE
ENOUGH PROVIDERS TO BE ABLE TO
SEE THE PATIENTS THAT WE NEED,
ONE STUDY RECENTLY HIGHLIGHTED
BY 2030, CALIFORNIA IS GOING TO
BE IN A SHORTAGE OF ABOUT 10,000
PRIMARY CARE PHYSICIANS. SO
REALLY, YOU KNOW, TO ADDRESS
THIS CRISIS OF ACCESS, WE HAVE
TO MAKE SURE THAT WE HAVE ENOUGH
PROVIDERS IN THE SYSTEM TO THAT
WILL TAKE MEDI-CAL TO BE ABLE TO
DO THAT. GME IS ONE OF THE FIRST
AND EASIEST WAY TO DO THAT, AS
MY COLLEAGUE FROM THE CLINICS
MENTIONED, CALIFORNIA DOES HOLD
THE DISTINCTION OF BEING THE
STATE THAT HAS THE HIGHEST LEVEL
OF, GME GRADUATES RETAINED IN
THE STATE. SO IT'S A LITTLE BIT
MORE THAN 72% OF ALL OF OUR GME
GRADUATES WILL STAY IN
CALIFORNIA AND PRACTICE IN
CALIFORNIA. AND, YOU KNOW, BY
THE NATURE OF WHEN THEY'RE DOING
OFTEN THEY'RE PUTTING ROOTS DOWN
WHERE THE GRADUATE MEDICAL
EDUCATION RESIDENCY SLOTS ARE.
AND SO CONTINUING TO SERVE THOSE
COMMUNITIES. AND SO, YOU KNOW,
APPRECIATE THE CONSIDERATION OF
THAT PROPOSAL AND DO WANT TO
OFFER OUR SUPPORT FOR THAT
PROPOSAL AS WELL, DID WANT TO
TALK ABOUT THE MEDI-CAL
WORKFORCE POOL AS WELL. I KNOW
THAT'S ONE THAT'S BEEN A COUPLE
QUESTIONS ON, BUT JUST FOR THAT
PROPOSAL, YOU KNOW, WE ARE, AS I
TALKED ABOUT, THE PHYSICIAN
SHORTAGE, WE'RE ALSO IN A
SHORTAGE OF ALLIED HEALTH
PROFESSIONALS, PARTICULARLY YOU
KNOW, THOSE ARE EVERYONE. AND I
COULD, YOU KNOW, GO THROUGH THE
CPT CODES OR THE JOB
CLASSIFICATIONS. I'M NOT SURE
WHICH ONE. THERE'S MORE OF. I
WOULD SAY THERE'S A LOT OF
DIFFERENT CLASSIFICATIONS WHERE
WE NEED IN HEALTH CARE. FROM
MEDICAL ASSISTANTS TO
RESPIRATORY THERAPISTS, RN'S,
LVNS AND OTHERS, AND WE SEE THIS
WORKFORCE POOL AS REALLY FUNDING
AND BRINGING TOGETHER THAT
PARTNERSHIP TO TRY TO ADDRESS IT
AS AN INDUSTRY AND SOMETHING
WHERE SOMETIMES THE SEED
FUNDING, WHERE YOU GET PEOPLE
TOGETHER, YOU KNOW, STARTING UP
TRAINING PROGRAMS IS REALLY
EXPENSIVE AND REALLY DIFFICULT
AND ADMINISTRATIVE BURDEN. SO
GETTING THIS FUNDING TO HELP
CREATE THESE PROGRAMS THEN HELPS
ENSURE THAT THEY'RE GOING TO
CONTINUE THROUGH THE UPS AND
DOWNS OF THE STATE BUDGET. AND
SO SEE THAT AS A CRITICAL NEED,
WE ADDITIONALLY SEE THIS AS A
WAY TO TRY TO ADDRESS FROM THE
LOCAL NEEDS. SO IF WE'RE DOING
SOMETHING JUST LOOKING AT
STATEWIDE, WE MAY SAY, HEY, WE
NEED, YOU KNOW, 10,000 MORE
PHYSICIANS DOESN'T REALLY MATTER
WHERE THEY ARE. YOU KNOW, WITH
THE MEDI-CAL WORKFORCE WILL AT
LEAST SEE US. VISION OF IT IS WE
COULD DO SOME OF THE TARGETED
FUNDING IN PLACES LIKE LOS
ANGELES OR OTHERS THAT MAYBE
NEED THE TRAINED ADDITIONAL
MEDICAL ASSISTANTS THAT SPEAK
SPANISH AS A NATIVE LANGUAGE OR,
YOU KNOW, IN THE CENTRAL VALLEY,
POTENTIALLY, YOU KNOW, GROW THE
NUMBER OF RESPIRATORY THERAPISTS
WE HAVE, YOU KNOW, THE FROM OUR
VIEW, THE FUNDING IS NOT OVERLY
PRESCRIPTIVE AND REALLY TRYING
TO GET THE WORKERS AND
MANAGEMENT TOGETHER AND THE
INDUSTRY TOGETHER TO SAY, WHAT
DO WE NEED TO TRY TO MEET THE
CARE NEEDS OF OUR PATIENTS? AND
THAT'S THE GOAL OF THAT PROGRAM.
WE ALSO SEE THAT MCO FUNDING IS
A REAL OPPORTUNITY TO NOT JUST
INCREASE ACCESS, BUT ALSO DIRECT
QUALITY AND WE THINK THAT
THERE'S A REAL OPPORTUNITY, AS
WE'RE LOOKING AT HOW TO PUT THE
PROGRAM TOGETHER BEFORE THEY GET
SET IN CONCRETE TO THINK LIKE,
HOW ARE WE GOING TO MAKE SURE
THAT WE'RE NOT JUST SAYING, HEY,
BASED ON PURELY UTILIZATION,
LET'S GIVE YOU MORE MONEY, BUT
HOW DO WE GET THAT DELIVERY
SYSTEM TO, YOU KNOW, PUSH
FORWARD AND SAY, HOW ARE WE
GOING TO MEET THE NEEDS OF OUR
MOST VULNERABLE? HOW ARE WE
GOING TO DO THAT? SO, YOU KNOW,
WE'LL HIGHLIGHT THAT. I THINK
THERE'S SOME CONVERSATION OF THE
FUNDING FOR THE 340 B CLINIC. WE
THINK THAT'S A REAL OPPORTUNITY
TO TRY TO DIG IN AND SAY, HOW DO
WE REALLY SERVE THE NEEDS OF OUR
CLINIC PATIENTS BETTER WITH
STANDARDS AND WORKFORCE, AND
LOOK FORWARD TO ONGOING
CONVERSATION ON THAT, AND THEN
FINALLY, I'LL JUST QUICKLY, YOU
KNOW, SORT OF WRAP UP, I ALSO
WANTED TO SHARE OUR SUPPORT
AROUND THE PUBLIC HOSPITAL
FUNDING AND APPRECIATE THE WORK
THAT THE DEPARTMENT'S DONE
ALREADY TO TRY TO ADDRESS SOME
OF THE INITIAL CONCERNS THAT
FOLKS AND STAKEHOLDERS HAD WITH
THE PROPOSAL TO MAKE SURE THAT
WE'RE INVESTING OVERALL IN OUR
PUBLIC HEALTH CARE SYSTEM. AND
WE ALSO SHARE THE CONCERN AROUND
THE LONG TUM SUSTAINABILITY OF
THAT PROGRAM TO MAKE SURE THAT
THESE PUBLIC HOSPITALS ARE, YOU
KNOW, CONTINUING TO BE ABLE TO
SERVE THE COMMUNITIES THAT
THEY'RE DOING SO CURRENTLY, SO
FINALLY, I'LL JUST SAY THANK YOU
VERY MUCH FOR THE OPPORTUNITY TO
SPEAK. YOU KNOW, WE SEE
WORKFORCE AND THE INVESTMENTS
FROM PROPOSED BY THE
ADMINISTRATION AS A REAL
POSITIVE THING TO NOT JUST MAKE
SURE THAT WE HAVE ACCESS, BUT WE
HAVE THEN THE WORKERS AND
PROVIDERS THERE TO ACTUALLY BE
ABLE TO DELIVER ON THAT ACCESS.
THANK YOU VERY MUCH, MATT. HOW
DO YOU THINK YOUR MEMBERS WOULD
BENEFIT FROM THIS? SO I THINK
OUR MEMBERS WORK, YOU KNOW, YOU
TALKED ABOUT EVERY PROVIDER. OUR
MEMBERS WORK IN, EVERY PROVIDER
THAT'S UP HERE. AND SO, YOU
KNOW, HAVING MORE MONEY IN OUR
PROVIDERS MEANS THAT YOU CAN
HIRE ADDITIONAL STAFF THAT YOU
CAN, YOU KNOW, PAY WORKERS MORE,
RETAIN WORKERS MORE. AND THEN
FROM THE WORKFORCE PERSPECTIVE,
IN PARTICULAR, BOTH THE GME
PROGRAM AND THE MEDI-CAL
WORKFORCE POOL, WE SEE AN
OPPORTUNITY TO, ELEVATE THE
WORKFORCE, SO HAVE MORE
PROVIDERS. BUT THEN ALSO ON THE
MEDI-CAL WORKFORCE POOL, IN
PARTICULAR, IT GIVES US
OPPORTUNITY TO DO CRADLE TO
CAREER SORT OF PROGRAMS TO HELP
SOMEONE, YOU KNOW, MAYBE THEY'RE
A MEDICAL ASSISTANT. THEY SPEAK
SPANISH. NOW WE WANT TO TRAIN
THEM UP TO BE AN LVN OR CURRENT
EMPLOYEES FOR BOTH CURRENT AND
POTENTIALLY FUTURE EMPLOYEES AS
WELL. SO LET'S TALK ABOUT THIS
MEDICAL WORKFORCE POOL. IF I
HEARD CORRECTLY, SEED FUNDING TO
GET PEOPLE TOGETHER TO CREATE
THESE WORKFORCE PROGRAMS. BUT
WEEKS AGO WE TALKED ABOUT
WORKFORCE PROGRAMS THAT WE'RE
LOOKING TO CUT. SO WHY ARE WE
INVESTING IN BRAND NEW PROGRAMS
THAT HAVE NO DETAIL WHATSOEVER
FOR AND DELAYING OTHER WORKFORCE
PROGRAMS IN THE SUBCOMMITTEE?
THIS IS MY QUESTION TO EVERYONE
HERE. I'M NOT SURE WHAT'S
HAPPENING. YOU DON'T WANT TO BE
OVERLY OVERLY PRESCRIPTIVE. I'M
NOT GOING TO VOTE ON ANYTHING
OUT OF THIS MCO TAX THAT DOESN'T
HAVE DETAILS, BECAUSE WE SPEND
OUT SO MUCH MONEY ON EVERYTHING.
WE JUST DID AN AUDIT ON
HOMELESSNESS. THERE'S NO
OUTCOMES, THERE'S NO
DELIVERABLES. AND ALL THE MONEY
WE'RE INVESTING IN THIS WHOLE
MCO TAX, THERE'S $275 MILLION OF
NØ WITH NO DETAIL PLAN
WHATSOEVER. I I UNDERSTAND YOUR
PLAN. YOUR PLAN. I UNDERSTAND
YOUR PLAN. I DON'T UNDERSTAND
THIS MEDICAL WORKFORCE POOL.
BECAUSE IF WE'RE HERE AND I'LL
READ VERBATIM WHAT THIS IS
INTENDED FOR, EQUITY MCO TAX IS
TO BALANCE TWO THINGS TO BALANCE
THE GENERAL FUND AND TO SUPPORT
MEDI-CAL INVESTMENTS TO ENSURE
ACCESS, QUALITY AND EQUITY. I
DON'T SEE HOW THE MEDICAL
WORKFORCE BOARD DOES THAT. IT'S
LOOKING TO GET PEOPLE TOGETHER.
WE'RE AT A POINT RIGHT NOW IS I
DON'T NEED TO HAVE A GROUP OF
PEOPLE TO COME TOGETHER AND TELL
US WHAT WE NEED TO DO. I'VE SAID
THIS COMMENT SO MANY TIMES IN
THIS SUBCOMMITTEE, WE HAVE DATA
ON TOP OF DATA ON TOP OF DATA OF
WHAT IS NEEDED TO CLOSE THE GAP
IN OUR HEALTH CARE SYSTEM. WE
DON'T NEED ANOTHER GROUP OF
STAKEHOLDERS COMING TOGETHER TO
TELL US THE SAME THING THAT
ANOTHER REPORTER ALREADY TOLD US
WE NEED TO NOW DO ACTION AND
INVEST IN THE THINGS WE KNOW IS
GOING TO WORK. WHAT'S GOING TO
WORK IS WE HAD A WE'RE GOING TO
BE POTENTIALLY DELAYING, LOANS
FOR CLINICAL SOCIAL WORKERS,
LOANS FOR OUR ENDS, ALL THAT IS
BEING DELAYED FOR THOSE
INVESTMENTS IN WORKFORCE PLANS
ALREADY IN PLACE, SYSTEM ALREADY
IN PLACE IN HCI. BUT WE'RE GOING
TO DELAY THAT. AND WE'RE GOING
TO INVEST $75 MILLION IN
SOMETHING THAT WE HAVE NO
DETAILS ON CREATING A BRAND NEW
PROGRAM. THAT PART ACCEPTS
UPSETS ME AND MCO BECAUSE THE
NEXT PANEL, WE'RE GOING TO HEAR
ABOUT THINGS THAT ARE HAPPENING
RIGHT NOW WITH VULNERABLE
PATIENTS AND HOW WE CAN UTILIZE
SOME OF THE MONEY TO CLOSE THE
GAP IN EQUITY OF THINGS THAT ARE
HAPPENING RIGHT NOW. SO, I MEAN,
I'M JUMPING THE GUN. I WAS GOING
TO SAY I WAS GOING TO SAY MY
WHOLE SPIEL ON THIS, BUT ON THIS
PART, I GET IT. WE NEED A
TARGET. WE NEED TO GET MORE
PEOPLE IN ALL OF THIS SYSTEMS.
BUT IF STAKEHOLDERS ARE COMING
TO ME TO ASK, HEY, VOTE ON
SOMETHING THAT IS NOT UP AND
RUNNING, BUT ALSO VOTE ON
SOMETHING TO DELAY THAT IS UP
AND RUNNING, HOW AM I SUPPOSED
TO JUSTIFY THAT VOTE? I
UNDERSTAND THAT WE NEED TO
INVEST IN OUR CURRENT PROVIDERS
NOW. CNAS DO SO MUCH WORK LVNS
DO, AND WE'RE WE'RE BLEEDING IN
THAT WE'RE BLEEDING. I KNOW THEY
NEED SUPPORT. BLESS THEIR HEARTS
. THEY DO SO MUCH WORK AND THEY
DON'T GET ENOUGH THINGS. I GET
IT, WE NEED TO TALK TO THEM. WE
NEED TO MAKE SURE THAT WE'RE
ELEVATING THEM IN, IN IN THEIR
CAREER LADDER. I DON'T THINK
THIS IS GOING TO DO IT. AND
UNLESS I AM MISSING THE MARK
COMPLETELY, VÆ COLLEAGUES,
UNLESS YOU SEE SOMETHING ELSE
THAT'S WHERE I STAND ON THAT.
MADAM CHAIR, JUST TO COMMENT,
YOU KNOW, I'VE BEEN A BIG
SUPPORTER OF CONTINUING TO
INCREASE GME FUNDING AND OF
COURSE, MEDICAL SCHOOLS AND ONE
IN THE CENTRAL VALLEY AND ALL
THAT. OF COURSE, THE COST AND
THE TIME THAT IT TAKES TO TRAIN
PHYSICIANS AND TAKE THEM THROUGH
A FULL RESIDENCY PROGRAM AND GET
THEM IN PRACTICE, IT'S A PRETTY
LONG, PRETTY LONG PERIOD OF
TIME. I DO THINK OVER, OVER
TIME, WE NEED TO ALSO FOCUS
MAYBE ON PHYSICIAN ASSISTANT
TRAINING PROGRAMS AND NURSE
PRACTITIONER MASTER'S DEGREE
PROGRAMS FOR OUR EXISTING CADRE
OF NURSES AROUND THE STATE.
BECAUSE FRANKLY, I THINK THOSE
ALLIED HEALTH PROFESSIONALS ARE
GOING TO BE KEY TO DELIVERING
SERVICES IN OUR MOST RURAL AND
MOST ISOLATED PARTS OF THE STATE
WHERE WE'RE GOING TO HAVE
DIFFICULT TIME ATTRACTING
PHYSICIANS IN SUFFICIENT NUMBERS
TO DO THE JOB, AND WHETHER IT'S
WITH PRACTICE AGREEMENTS OR
INDEPENDENT PRACTICE, THAT'S A
DEBATE THAT, YOU KNOW, GOES ON
ALL THE TIME. I DO THINK WITH
CMA'S HELP RECENTLY, WE'VE MADE
SOME SIGNIFICANT PROGRESS AND
ARE CONTINUING TO MAKE PROGRESS
IN THAT REGARD. WITH RESPECT TO
NURSES, NURSE PRACTITIONERS AND
PAS. BUT I THINK WE'RE GOING TO
HAVE TO PROVIDE AN EQUAL AMOUNT
OF ATTENTION TO OUR PHYSICIAN
ASSISTANT AND NURSE PRACTITIONER
TRAINING PROGRAMS IN OUR CSUS,
FOR EXAMPLE. AND IT'S GOING TO
REQUIRE A LITTLE BIT OF MONEY
BECAUSE, OF COURSE, AS WITH
EVERYTHING ELSE, CLINICAL
PLACEMENTS THERE ARE DIFFICULT
TO COME BY AND WE'RE GOING TO
HAVE TO DESIGN A PROGRAM WHERE
PERHAPS WE PROVIDE SOME
REIMBURSEMENT, PARTICULARLY IN
THE CLINICAL SETTINGS,
REIMBURSEMENT TO THOSE WHO ARE
PROVIDING THE SUPERVISION AND
TRAINING FOR THE PAS WHO WERE
FINISHING THEIR TRAINING AND
PERHAPS NURSE PRACTITIONERS AS
WELL. SO I JUST WANTED TO MAKE
THOSE COMMENTS BECAUSE IT TIES
IN TO, SIR, WHAT YOU WERE SAYING
IN YOUR REMARKS. SO THANK YOU,
MADAM CHAIR. AND I WOULD LOVE TO
SEE THIS DETAILED PLAN AND
SAYING, HEY, WITH $75 MILLION,
WE'RE GOING TO PAY FOR CNA
CERTIFICATION, THÀNH, WE'RE
GOING TO PAY FOR LVN
CERTIFICATION. WE'RE GOING TO
PAY FOR PA'S LOAN REPAYMENT.
THAT'S OUR WORKFORCE IS
BLEEDING. AND THE WAY WE ADDRESS
THAT IS TO PAY THE COST OF
BECOMING XYZ, BECAUSE THAT'S HOW
IT'S PREVENTING A LOT OF PEOPLE
FROM FROM BECOMING THAT, YEAH.
YEAH I DON'T KNOW IF YOU HAVE
ANYTHING, SENATOR. NO, I WOULD
JUST SAY THE THING WE'RE AND
MAYBE AND MAYBE ANOTHER TALK
WITH HCI ABOUT HOW THIS WILL
SUPPORT THE PLANS THAT ARE
ALREADY IN PLACE, BECAUSE
THERE'S ALREADY A MULTITUDE OF
WORKFORCE PLANS AND GETTING
PEOPLE OUT THERE PLANS. SO MAYBE
WE NEED TO DO SOME LOOK AT RIGHT
AT THE OUTCOMES FOR THOSE, OKAY,
WE'RE GOING TO BE MOVING ON TO I
KNOW YOU GAVE A LOT OF REMARKS
ALREADY, BUT WE'LL GO BACK TO
YOU TO PUT IT ALL TOGETHER.
SURE. THANK YOU, CHAIR AND
COMMITTEE MEMBERS, LINDA
KOOPMANS WITH THE LOCAL HEALTH
PLANS OF CALIFORNIA, LPCC
REPRESENTS THE 17 LOCAL
COMMUNITY BASED MEDI-CAL MANAGED
CARE PLANS THAT COLLECTIVELY
COVER OVER 70% OF MEDI-CAL
MANAGED CARE BENEFICIARIES.
SINCE LAST YEAR, LPCC HAS BEEN
PART OF THE COALITION. THAT'S
ADVOCATED FOR REINVESTING THE
MCO REVENUE INTO THE MEDI-CAL
PROGRAM. AND WE REALLY COMMEND
THE LEGISLATURE AND THE
ADMINISTRATION FOR YOUR
COMMITMENT TO DOING THAT. WE ARE
SUPPORTIVE OF THE
ADMINISTRATION'S PROPOSAL TO
CONTINUE WHAT WAS COMMITTED IN
LAST YEAR'S BUDGET FOR FUTURE
RATE INCREASES IN THE MEDI-CAL
PROGRAM, AND WE BELIEVE THAT THE
MCO FUNDING IS CRITICAL BOTH IN
THE SHORT TERME, FOR INVESTING
IN THE MEDI-CAL PROVIDERS AND
BRINGING MORE PROVIDERS MORE
PROVIDERS INTO THE SYSTEM AND IN
THE LONG TERME TO ENSURE THE
ONGOING VIABILITY OF THE
MEDI-CAL, THE SAFETY NET AND
ALSO THE FUTURE MEDI-CAL
WORKFORCE. SO I'LL BRIEFLY
RESPOND TO THE QUESTIONS THAT
WERE POSED IN THE COMMITTEE
AGENDA AND HAPPY TO ANSWER ANY
OTHERS AT THE APPROPRIATE TIME,
SO FIRST IS HOW LOCAL PLANS WILL
IMPLEMENT THE RATE INCREASES FOR
2024. AND THEN THE SECOND IS
LESSONS LEARNED THAT WE HOPE
INFORM 2025. SO SINCE THE BUDGET
WAS PASSED LAST YEAR, LOCAL
PLANS HAVE BEEN WORKING CLOSELY
WITH DCS ON HOW TO BEST
OPERATIONAL SIZE. THE RATE
INCREASES IN MANAGED CARE AS
CHAMPIONS OF INVESTING THESE
DOLLARS IN MEDI-CAL PROVIDERS,
THE LOCAL PLANS WANT TO GET IT
RIGHT. HOWEVER, GIVEN THE
COMPLEXITY OF THE MEDI-CAL
DELIVERY SYSTEM, INCLUDING
CAPITATION AND DELEGATED
ARRANGEMENTS, IMPLEMENTING ANY
SIGNIFICANT CHANGES TO MEDI-CAL
FINANCING LIKE WHAT IS PROPOSED
IN DHS POLICY PAPER WILL BE
SIMILARLY COMPLEX.
IMPLEMENTATION IN 2024 REQUIRES
FINAL DCS GUIDANCE AS A
PRECURSOR TO INFORMING PROVIDERS
ABOUT THE RATE CHANGES.
CONFIGURING SYSTEMS TO REFLECT
THE NEW RATES. ANALYZING
CAPITATED ARRANGEMENTS TO ASSESS
WHETHER THE RATES ARE PROJECTED
TO MEET THE MINIMUM FEE SCHEDULE
REQUIREMENTS, AND UPDATING OR
AMENDING PROVIDER CONTRACTS AS
NEEDED. WHILE THESE ARE SOME OF
THE FUNDAMENTAL STEPS THAT PLANS
ARE TAKING TO IMPLEMENT THE RATE
INCREASES, THESE ALSO LOOK
DIFFERENT BASED ON THE PLAN'S
NETWORK PAYMENT ARRANGEMENTS AND
PROVIDER AGREEMENTS, AS WE ALL
HAVE AN INTEREST IN GETTING THE
DOLLARS FLOWING TO PROVIDERS AS
QUICKLY AS POSSIBLE. BUT WE ALSO
KNOW THAT IMPLEMENTATION IS NOT
AS SIMPLE AS FLIPPING A SWITCH.
TO THAT END, LOCAL PLANS WANT TO
CONTINUE TO WORK CLOSELY WITH
DCS IN THE COMING MONTHS. GIVEN
THE SCOPE AND THE MAGNITUDE OF
THE CHANGES PROPOSED FOR 2025,
AND IT WILL BE CRITICAL THAT
PLANS GET FINAL GUIDANCE AS SOON
AS POSSIBLE, WE WOULD HOPE THAT
THIS WOULD COME EARLIER THAN
THAN 2024. GUIDANCE AS AGAIN,
THAT GUIDANCE IS THE BASIS FOR
ALL OF THE WORK THAT HAS TO BE
DONE TO GET THE DOLLARS IN THE
HANDS OF THE PROVIDERS. THE
COMMITTEE ASKED A QUESTION
REGARDING HOW THE TARGETED RATE
INCREASES ARE AFFECTING RATE
NEGOTIATIONS WITH PROVIDERS AND
OVERALL, I WOULD SAY IT'S JUST
TOO EARLY TO SAY HOW MCO FUNDING
WILL WILL IMPACT THOSE RATE
NEGOTIATIONS. I'LL NOTE THAT
BECAUSE 2024 RATE INCREASES WERE
MORE LIMITED THAN WHAT IS
PROPOSED FOR 2025, IT WILL MEAN
THAT WHILE MANY PROVIDERS WILL
SEE AN INCREASE IN THEIR RATES
THIS YEAR, MANY OTHERS WILL NOT
BECAUSE THEY ARE ALREADY
RECEIVING AT OR ABOVE THE RATES
THAT ARE REQUIRED IN THE NEW
MINIMUM FEE SCHEDULE FOR 2024.
OF COURSE, THAT WILL LOOK
DIFFERENT IN 2025 GIVEN THE
MAGNITUDE OF THE INVESTMENTS IN
THE FUTURE, WE BELIEVE THE NEW
MINIMUM FEE SCHEDULE WILL SERVE
AS AN EQUALIZER TO SOME EXTENT
BECAUSE IT RAISES THE
REIMBURSEMENT FLOOR. BUT WE ALSO
KNOW THAT RATES WILL ALWAYS VARY
BY AND EVEN WITHIN REGIONS, AND
DCS APPROACH TO ALIGN WITH
MEDICARE LOCALITIES ACKNOWLEDGES
THAT. LASTLY WITH RESPECT TO
RECOMMENDED ADJUSTMENTS TO THE
PROPOSAL TO BETTER IMPROVE
ACCESS, QUALITY AND EQUITY, I'D
SAY WITH AS WITH ANY POLICY, THE
DETAILS ARE CRITICAL. AND AS
YOU'VE SPOKEN TO, CHAIR, SO WE
ENCOURAGE DCS TO EXPLORE
TOGETHER WITH THOSE OF US AT
THIS TABLE AND OTHER
STAKEHOLDERS, OPPORTUNITIES
WITHIN THE PROPOSAL TO ALLOW
FLEXIBILITY TO BE RESPONSIVE TO
LOCAL NEEDS, AND TO ADDRESS
PROVIDER SHORTAGES AND TO BEST
TARGET THE FUNDING TO GET THE
DOLLARS TO THE PROVIDERS THAT
NEED IT MOST. AND I'LL CLOSE BY
SAYING WE APPRECIATE THE
COMMITMENT BY BOTH THE
ADMINISTRATION AND THE
LEGISLATURE TO USING THE MCO TAX
AS AN OPPORTUNITY TO REALLY MAKE
AN IMPACT ON MEDI-CAL
BENEFICIARIES. THANK YOU. DOES
IT DOES ADDING TAKE AWAY IMPACT
ON LOCAL HEALTH PLANS AT ALL?
MEANING LET ME REPHRASE THAT.
MEANING IS ADDING MORE TO THE
INCREASES, REMOVING INCREASES.
DOES THAT IMPACT YOU IN ANY WAY?
SO ALL OF THE RATE INCREASES OR
THE VAST MAJORITY OF THE RATE
INCREASES BECAUSE MOST MEDI-CAL
BENEFICIARIES ARE IN MANAGED
CARE, THOSE DOLLARS WILL FLOW
THROUGH US. SO THE BIGGEST
IMPACT IS WORKING VERY
DILIGENTLY AND CLOSELY WITH DHS
AND OUR PROVIDERS TO IMPLEMENT
IT AND GET THE DOLLARS OUT. YEAH
OKAY. SO POTENTIALLY ADDING MORE
IS JUST MORE WORK TO GET OUT.
YEAH. AND I THINK THE LAO
ACTUALLY MADE A VERY GOOD POINT
EARLIER WHEN THEY SAID WE'RE NOT
ONLY INCREASING FUNDING, WE'RE
CHANGING HOW WE'RE FINANCING THE
MEDI-CAL PROGRAM. IN MANY WAYS,
AND THAT'S JUST DIFFICULT WORK,
BUT BUT NECESSARY AND SOMETHING
WE'RE VERY SUPPORTIVE OF, OF
COURSE. AND I MEAN, WE'VE DONE
PART OF IT NOW. THE REST FOR
NEXT YEAR. ARE WE ARE WE
PREPARED? ARE THE, I THINK WE
HAVE WE HAVE SOME FOUNDATION AND
SOME LESSONS LEARNED FROM 2024
BECAUSE AT LEAST WITH
PROFESSIONAL SERVICES, THE
DEPARTMENT'S PROPOSING TO KIND
OF EXPAND UPON THAT AND INCREASE
THE MAGNITUDE OF THOSE RATE
INCREASES, BUT I THINK, YOU
KNOW, COMING BACK TO ONE OF MY
COMMENTS, I THINK THE BIGGEST
NEED TO ENSURE THAT DOLLARS CAN
GET OUT THE DOOR MORE QUICKLY
THAN THEY WILL THIS YEAR IS
GETTING GUIDANCE SOON AND
QUICKLY. AND I KNOW THAT IS ALSO
DIFFICULT AND TAKES A LOT OF
WORK, YOU KNOW, FOR THE
DEPARTMENT AS WELL. BUT I THINK
THAT'S THE BIGGEST NEED TO MAKE
2025, MORE EXPEDITED THAN THAN
2024. OKAY, OKAY, OUR FINAL
PANELIST FROM THE ASSOCIATION OF
HEALTH PLANS. THERE WE GO. HELLO
MADAM CHAIR AND MEMBERS, NICK
LOUISOS WITH THE CALIFORNIA
ASSOCIATION OF HEALTH PLANS, WE
REPRESENT 43 LICENSED HEALTH
PLANS IN THE STATE OF CALIFORNIA
THAT DELIVER COORDINATED CARE,
HIGH QUALITY, COORDINATED CARE
TO ABOUT 27 MILLION
CALIFORNIANS. AND THAT INCLUDES
MEDI-CAL MANAGED CARE
BENEFICIARIES TO THE TUNE OF
14.1 MILLION CALIFORNIANS IN THE
MEDI-CAL PROGRAM. OUR CAPS
MEMBERS IN THE COMMERCIAL MARKET
AND PUBLIC PROGRAMS, YOU KNOW,
PAY THEY FUND THE MCO TAX AND
WILL BE RESPONSIBLE FOR
DELIVERING THE TARGETED RATE
INCREASES, ALONG WITH, OUR
MUTUAL MEMBERS, WITH THAT, WE
SHARE WITH LRPC, YOU KNOW, VMC,
I JUST WANTED TO EMPHASIZE THE
MCO TAX IS REAL, AND I FEEL LIKE
I NEED TO SAY THAT AT EVERY
HEARING BECAUSE I'VE HEARD
LEGISLATORS AND INTEREST GROUPS
TESTIFY THAT THIS IS A TAX THAT
NOBODY PAYS, AND THAT IS JUST
WRONG. YOU KNOW, THE INDIVIDUALS
AND EMPLOYERS IN YOUR DISTRICT
DO PAY THE TAX. IT IS A REAL AND
THEY SEE IT IN THEIR PREMIUMS.
THEREFORE SUPPORTING THANKFUL.
WE'RE THANKFUL FOR. YEAH. WELL,
WE REALLY ARE, WELL, YOU KNOW,
WE FEEL WE HAVE TO SAY THAT
BECAUSE IT'S NEVER EASY FOR CAP
TO COME TO AGREEMENT TO SUPPORT
THE MCO, TAC BECAUSE OF THE
IMPACT ON THE COMMERCIAL MARKET,
AND IT INCREASES THE COST OF
COVERAGE FOR OUR CONSUMERS.
NEVERTHELESS, CALIFORNIA'S
HEALTH PLANS HAVE BEEN ABLE TO
COME TOGETHER AND SUPPORT THE
MCO TAX IN LAST YEAR'S BUDGET
BECAUSE WORKING WITH THE
ADMINISTRATION, YOU KNOW,
SPECIFICALLY THE DEPARTMENT OF
HEALTH CARE SERVICES AND WITH
THE LEGISLATURE, WE WERE ABLE TO
ACHIEVE AN MCO TAX PACKAGE THAT
SATISFIES OUR BASIC PRINCIPLES
THAT THE TAX IS AFFORDABLE TO
OUR CUSTOMERS, AND THAT FINALLY,
IT IS INVESTED TOWARDS IMPROVING
THE MEDI-CAL DELIVERY SYSTEM.
AND I WOULD JUST SAY NO
ORGANIZATION HAS CLAMORED LONGER
EXCEPT PERHAPS LRPC THAT WE
ACHIEVE AN MCO TAX, THAT IS
INVESTED IN THE MEDI-CAL
DELIVERY SYSTEM. AND TO MAKE
IMPROVEMENTS AND NOT JUST
SUPPLANT, RESOURCES, BUT THAT
SUPPLEMENT THEM. SO, IT WAS
EXTRAORDINARILY EXTRAORDINARY TO
SEE THE COALITION FORMED LAST
YEAR TO HELP MAKE THIS HAPPEN
AND, OF COURSE, TO WORK WITH THE
LEGISLATURE AND THE
ADMINISTRATION ON THIS. YOU
KNOW, OUR SPENDING PRIORITIES
LAST YEAR, AS HEALTH PLANS WERE
DIRECTED TOWARDS IMPROVING
PRIMARY CARE AND SPECIALTY CARE
AND GRADUATE MEDICAL EDUCATION
AND A COUPLE OF OTHER ITEMS, WE
ARE PLEASED. LIKE OTHERS, TO SEE
THAT THE GOVERNOR, IN HIS
PROPOSED BUDGET, IS HONORING TO
KEEP THE COMMITMENTS TOWARDS
INCREASING FUNDING FOR MEDI-CAL
PROVIDERS, WHICH WE DO BELIEVE
WILL SIGNIFICANTLY IMPROVE
ACCESS TO QUALITY HEALTH CARE
FOR MEDI-CAL ENROLLEES. WE'RE
ALSO SUPPORTIVE OF THE EARLY
ACTION ITEM SB 136 TO INCREASE
THE MEDI-CAL COMPONENT OF THE
MCO TAX TO HELP WITH OUR BUDGET
CRISIS, AT THE SAME TIME, CAP
DOES STRONGLY BELIEVE THAT THE
MCO TAX REVENUES SHOULD BE USED
TO FUND IMPROVEMENTS TO THE
MEDI-CAL PROGRAM AND NOT JUST
BACKFILL EXISTING SPENDING. SO
WE DO KNOW THAT THE
ADMINISTRATION'S PROPOSAL DOES
GRADUALLY SHIFT, YOU KNOW, SOME
RESOURCES, $3.1 BILLION OVER THE
LIFE OF THE TAX FROM THE
MEDI-CAL PROVIDER PAYMENT
RESERVE FUND TO THE GENERAL
FUND. AND THAT COULD LIMIT THE
ABILITY TO FUND ADDITIONAL,
INVESTMENTS IN THE MEDI-CAL
PROGRAM, CAP DOES BELIEVE THAT
THE INVESTMENTS MADE POSSIBLE BY
THE MCO TAX MUST REMAIN
CONSISTENT WITH THE INTENT OF
LAST YEAR'S BUDGET AGREEMENT,
AND WE URGE THE LEGISLATURE TO
ENSURE THAT THE FUNDS BE
DIRECTED TO THE MEDI-CAL
DELIVERY SYSTEM AND NOT PROGRAM
AREAS UNINTENDED BY BY LAST
YEAR'S BUDGET, SO I'LL GET TO I
KNOW YOU WILL ASK ME THIS
QUESTION, SENATOR, SO I WILL
JUST GET TO THE ARE THERE ANY
ADJUSTMENTS IN THE
ADMINISTRATION'S PROPOSAL THAT
YOU BELIEVE WOULD BETTER IMPROVE
ACCESS TO CARE, QUALITY CARE, OR
EQUITY FOR MEDI-CAL
BENEFICIARIES? AND I WOULD ECHO
THE SENTIMENT, THAT OTHERS HAVE
ALREADY RAISED. AND, YOU KNOW,
WE WOULD LIKE TO WORK WITH THE
DEPARTMENT TO REPURPOSE THE
HEALTH EQUITY APPROACH TO MORE
DIRECTLY ADDRESS THE UNIQUE
NEEDS OF LOCAL COMMUNITIES, WITH
THE GOAL OF INCREASING
UNDERREPRESENTED PROVIDERS, AND
IMPROVE ACCESS QUALITY AND
ADVANCE EQUITY, YOU KNOW, WE
AGREE THAT ADDRESSING THIS ISSUE
IS VERY IMPORTANT. SO OUR GOALS
ARE ALIGNED. I THINK, YOU KNOW,
WE WOULD JUST LIKE TO, YOU KNOW,
WORK THROUGH AN ALTERNATIVE
APPROACH THAT THAT WOULD HAVE
MORE IMPACT. SO ON TO THE TREE,
YOU KNOW, I'LL PROBABLY ECHO A
LOT OF THINGS THAT LINDA SAID,
BUT, YOU KNOW, HEALTH PLANS WERE
VERY PROUD TO SUPPORT, IMPROVING
CALIFORNIA'S MEDI-CAL PROGRAM
SINCE MANY OF OUR MEMBERS ARE
OBVIOUSLY HEAVILY INVESTED IN
THAT PROGRAM, OUR MEMBERS ARE
CURRENTLY WORKING WITH THE
DEPARTMENT OF HEALTH CARE
SERVICES ON HOW TO EFFECTUATE
THE TREE AND MAKING THESE
IMPROVEMENTS IN PRIMARY CARE AND
SPECIALTY CARE. AND WE'RE VERY
APPRECIATIVE THAT THE DEPARTMENT
BRINGS IN HEALTH PLAN
REPRESENTATIVES TOGETHER TO MEET
AND DISCUSS THE TRA
IMPLEMENTATION AND THE
OPPORTUNITIES THEY HAVE PROVIDED
TO OUR PLANS TO SHARE FEEDBACK
ON KIND OF THE TECHNICAL ASPECTS
OF THIS, IMPLEMENTATION OF THESE
RATE INCREASES IS COMPLEX, IT'S
UNPRECEDENTED. AND REGULATORY
GUIDANCE IS NEEDED FROM THE
DEPARTMENT. AND THIS GUIDANCE
CONTINUES TO EVOLVE AND IS NOT
YET IN ITS FINAL FORM. RECEIVING
THAT GUIDANCE AS SOON AS
POSSIBLE WILL BE CRITICAL TO THE
IMPLEMENTATION OF THESE RATES IN
2024, AND WE HOPE TO LEVERAGE
LESSONS LEARNED IN THIS YEAR FOR
2025, BY BUILDING ON, YOU KNOW,
AND TESTING THE METHODOLOGIES
THAT WILL BE USED IN THIS YEAR.
ON THAT NOTE, IT'S AGAIN, IT'S
CRITICAL FOR GUIDANCE TO COME
OUT, FOR 2025 RATE INCREASES.
AND, YOU KNOW, WE BELIEVE THEY
NEED THAT GUIDANCE SHOULD COME
OUT AS EARLY AS THIS SUMMER, IF
WE'RE GOING TO HIT THE GROUND
RUNNING NEXT YEAR. SO
CALIFORNIA'S HEALTH PLANS I'LL
JUST CLOSE WITH THIS. ARE VERY
PROUD IN PROVIDING MEDI-CAL
MANAGED CARE, TO, TO BILLIONS OF
BENEFICIARIES IN THIS STATE. AND
WE DEFINITELY WANT TO BE A PART
OF THE DISCUSSIONS ABOUT HOW TO
EFFECTUATE THESE INCREASES
MOVING FORWARD. THANK YOU. YEAH,
I WOULD JUST SAY WHAT EVERYBODY
SAID ON THAT, ON THAT EQUITY
MONEY THAT THAT WE REALLY NEED
TO MEASURE, NOT JUST COMING TO A
DEAL, BUT HAVING IMPACT ON WHAT
WE'RE TRYING TO HAVE IMPACT ON.
I THANK YOU SO MUCH TO EACH
PANELISTS THAT CAME AND SPOKE
AND GAVE THEIR PERSPECTIVE. AND
I'LL SAY SOME REMARKS BEFORE WE
MOVE ON TO THE NEXT PANELIST. IN
THE PAST TWO MONTHS, THIS
COMMITTEE HAS HAD TO HEAR
PROPOSALS ON DELAYS AND CUTS ON
AGREEMENTS THAT THE DEPARTMENT
CAME TO WITH THOSE CERTAIN
ADVOCATES. AND I HEARD THAT
SENTIMENT BEING MENTIONED IN
THIS IN THIS PANEL, THE ID
POPULATION MADE AN AGREEMENT IN
2019 FOR RATE REFORM, AND THE
DEPARTMENT IS COMING TO
PROPOSING TO DELAY THAT. THE
FOSTER ADVOCATES MADE AN
AGREEMENT WITH THE DEPARTMENT ON
INCREASED RATES FOR SLPS IN THE
DEPARTMENT'S COMING BACK TO
NEGATE THAT AGREEMENT. I THINK
THAT JUSTIFICATION FOR WHAT WAS
AGREED ON LAST YEAR DOES NOT
STAND THIS YEAR, BECAUSE THERE
ARE VARIOUS EXAMPLES OF WHAT
THIS SUBCOMMITTEE HAS HAD TO
LISTEN TO ALREADY, AND PROPOSALS
ON AGREEMENTS THAT THOSE CERTAIN
STAKEHOLDERS MADE WITH THE
DEPARTMENT. SO IF CUTS TO FOSTER
CARE IS ON THE TABLE, EVEN
THOUGH THAT WAS AGREED ON, IF
CUTS, TO CALWORKS AND SO MANY
THINGS THAT WERE AGREED ON IS ON
THE TABLE, THEN THE MCO TAX,
WHAT WAS AGREED ON LAST YEAR FOR
ME AND I DON'T SPEAK FOR MY
COLLEAGUES, IS ON THE TABLE FOR
REARRANGEMENT, BECAUSE THERE HAS
BEEN NO PATTERN OF WHAT THE
DEPARTMENT HAS COME TO US AND
SAY, HEY, WE'RE HOLDING THE LINE
ON EVERYTHING THAT WE'VE AGREED
UPON, AND WE'RE ONLY PROPOSING
CUTS OR DELAYS FOR THINGS THAT
ARE BRAND NEW. IF THERE WAS
GOING TO BE A PATTERN, I
WOULDN'T SAY THIS, BUT THERE
HASN'T BEEN. SO THAT'S WHERE I
STAND ON THAT THING. I KNOW THE
GME PROGRAM. I THINK THAT'S
GREAT. I HOPE I DIDN'T COME OFF
AS SAYING THAT THAT SHOULDN'T BE
A PROGRAM IN THE MCO TAX. I
THINK THAT'S PHENOMENAL.
ANYTHING THAT WE ARE DOING TO
INVEST IN OUR WORKFORCE IS GOING
TO BE GREAT. ALL I WANT IS JUST
SOME DELIVERABLES, OUTCOMES,
ACCOUNTABILITY AND ENSURING
WE'RE MEETING THE GOALS OF WHAT
WHAT WAS INTENDED. AND THIS
GROUP OF STAKEHOLDERS OUTSIDE OF
THE PLANS, THERE ARE ONLY FOUR
STAKEHOLDERS THAT ARE REAPING
THE BENEFITS. THAT'S IT FOR
HOSPITALS KI¾M DOCTORS,
PROVIDERS, PROVIDERS AS A WHOLE.
PLANNED PARENTHOOD AND CPCA FOR
I DO NOT THINK THAT IS A ROBUST
STAKEHOLDER COALITION. I DO NOT
THINK SO. FOR A TAX THAT WILL
BRING US CLOSE TO $28 BILLION
OVER THE NEXT COUPLE OF YEARS,
7.1 OF THOSE BILLION TO MEDI-CAL
REIMBURSEMENT RATES, I THINK,
MORE PEOPLE SHOULD HAVE BEEN AT
THE TABLE. WHEN WE'RE TALKING
ABOUT EQUITY, THE PEOPLE WE'RE
GOING TO HEAR NEXT IS BECAUSE
THEY HAVEN'T HAD THE EQUITABLE
SHARE, PERHAPS BECAUSE THEY
DON'T HAVE THE ABILITY TO BE AT
THE BIG DOG TABLE. BUT I HAVE
THE ABILITY TO BE AT THE BIG DOG
TABLE, AND I CAN REPRESENT AND
BRING THE VOICES OF THOSE PEOPLE
TO THIS TABLE TO ENSURE THAT YOU
LISTEN TO WHAT ELSE WE CAN ADD
TO THIS, BECAUSE WE'RE DEALING
WITH THE DEFICIT, WE DON'T KNOW
WHEN WE'RE GOING TO COME BACK TO
THE TABLE. WE SHOULDN'T MAKE NEW
FRIENDS. WE NEED TO MAKE NEW
FRIENDS. WE SHOULD LET THESE NEW
FRIENDS BE PART OF THIS
ASTRONOMICAL, BEAUTIFUL
APPROACH. AND I THINK THE HEALTH
PLANS FOR COMING TO THE TABLE ON
THIS, I DO THANK THEM FOR COMING
TO THE TABLE ON THIS. AND I WE
WOULDN'T HAVE THIS WITHOUT
Y'ALL. AND I THANK CMA FOR BEING
INSTRUMENTAL IN COMING TO THE
TABLE AND SAYING, HEY, WE COULD
DO SOMETHING ELSE DIFFERENTLY
WITH THE MCO TAX. WE COULD
INVEST IN OUR MEDI-CAL
REIMBURSEMENT RATES. THERE ARE
THINGS YOU'RE GOING TO HEAR FROM
IN THE NEXT PANEL THAT, IN FACT,
SAVES US A LOT OF MONEY FOR
HOSPITALS. YOU'RE GOING TO HEAR
FROM PRIVATE DUTY NURSING. SO
YOU HAVE PATIENTS IN YOUR
HOSPITALS THAT ARE TAKING UP A
BED MONTHS AND YEARS ON END
BECAUSE THERE'S NO ROOM FOR THEM
TO LIVE WITH THEIR FAMILIES,
BECAUSE THERE'S NO PRIVATE DUTY
NURSING. YOU'RE GOING TO HEAR
ABOUT PEOPLE LEAVING THESE THESE
WORKPLACES BECAUSE WE'RE NOT
PAYING THEM ENOUGH. WE'RE
TALKING ABOUT WORKFORCE. SO MANY
OF THE ENTITIES THAT YOU'RE
GOING TO HEAR FROM ARE
STRUGGLING BECAUSE PEOPLE DON'T
CAN'T WORK IN THESE. ADDRESSING
THE MOST VULNERABLE THINGS
BECAUSE WE'RE NOT PAYING THEM
ENOUGH. WE'RE GOING TO BE
TALKING ABOUT INDIVIDUAL GIRLS
WITH DISABILITIES, CHILDREN WITH
COMPLEX NEEDS THAT NEED SUPPORT.
SO WE CAN STILL ADDRESS THOSE
NEEDS. I NEED EVERYONE TO HAVE
IT UP IN MIND BECAUSE WE NEED
NEW FRIENDS HERE, BECAUSE THIS
IS JUST A GREAT OPPORTUNITY FOR
US TO CLOSE THE GAP ON SO MANY
THINGS. AND THE NUMBER YOU'RE
GOING TO HEAR. I ADDED ALL THE
NUMBERS UP OF WHAT THE REQUEST.
THERE'S THREE UNKNOWN, BUT IT'S
GOING TO BE $107.8 MILLION FOR
THE FIRST YEAR. AND 164.6
MILLION ONGOING. THAT IS LESS
THAN THE 200 MILLION THAT IS
BEING ASKED FOR EQUITY WITH NO
PLAN. WE'RE NOT ASKING FOR A LOT
OF MONEY OUT OF THE $28 BILLION
WE'RE GOING TO INVEST IN THIS.
IT'S NOT A BIG ASK. IT'S SUCH A
SMALL CHUNK. AND IT'S NOT EVEN
DIVING INTO ANY OF YOUR
ALLOCATED FUNDS. I SPOKE ABOUT
THE 275 MILLION, WHICH INCLUDES
THE LABOR WORKFORCE. WE
POTENTIALLY DON'T EVEN NEED TO
TOUCH THAT. IT'S JUST A 200
MILLION EQUITY PART THAT WE
COULD REARRANGE ELSEWHERE. SO
THOSE ARE MY REMARKS ON THAT.
BEFORE WE START WITH OUR NEXT
PANEL. THANK YOU
.
WE'RE FINALLY GOING TO CLEAN UP
THE INDEPENDENT NURSE
PRACTITIONER RULES SO THEY CAN
ACTUALLY PRACTICE INDEPENDENTLY.
IF YOUR POSITION TO SPEAK, WE
CAN SWAP OUT WHEN IT'S YOUR
TURN. IF YOU NEED TO SPEAK.
OKAY. WE'RE GOING TO BE HEARING
FROM, EIGHT DIFFERENT PROPOSALS.
ASK REQUESTS TO BE INCLUDED IN
THE MCO TAX. WE'RE GOING TO
START OFF WITH THE CALIFORNIA
ASSOCIATION OF HEALTH SERVICES
AT HOME. I ASK THAT YOU
INTRODUCE YOURSELF. I DON'T
RECOGNIZE EVERY SINGLE ONE OF
YOU. SO I DON'T KNOW WHERE TO
TURN TO, INTRODUCE YOUR NAME AS
WELL. HI, SENATOR DEAN CHALICE.
I'M THE PRESIDENT AND CEO OF THE
CALIFORNIA ASSOCIATION FOR
HEALTH SERVICES AT HOME SERVING
HOME HEALTH, HOSPICE AND HOME
CARE PROVIDERS AROUND THE STATE.
AND I'M HERE TODAY TO TALK TO
YOU ABOUT MEDICALLY FRAGILE
CHILDREN AGAIN. I WAS HERE LAST
YEAR AND I'M HAPPY TO BE INVITED
BACK, THESE ARE MEDI-CAL
BENEFICIARIES, AND THESE KIDS
ARE REALLY SICK AND THEY NEED
THE KIND OF CARE TO BE TREATED
AT HOME THAT THEIR FAMILIES
CAN'T PROVIDE. AND SO WE HAVE TO
RELY ON PRIVATE DUTY NURSING TO
TAKE CARE OF. AND THESE ARE
HIGHLY SPECIALIZED AND HIGHLY
SKILLED. BOTH RNS AND LVNS THAT
TAKE CARE OF THEIR FEEDING TUBES
AND THEIR THEIR VENTILATORS AND
PROVIDE OTHER SPECIALTY CARE FOR
THEM. UNFORTUNATELY, BECAUSE OF
THE WOEFULLY INADEQUATE, YOU'RE
GOING TO HEAR THAT A LOT.
PROBABLY MEDI-CAL REIMBURSEMENT
RATES FOR THIS SERVICE WERE NOT
ABLE TO ATTRACT THE NURSES AND
PAY THEM WHAT THEY DESERVE TO
TAKE CARE OF THESE KIDS. SO THE
END RESULT IS THESE KIDS END UP
STAYING IN THE HOSPITAL, DESPITE
THE FACT THAT THEY'VE BEEN
AUTHORIZED BY MEDI-CAL TO
RECEIVE THE PRIVATE DUTY NURSING
SERVICES AT HOME, BECAUSE WE
CAN'T FIND THE PROVIDERS TO TAKE
CARE OF THEM. SO THEY END UP
STAYING IN THE HOSPITAL AT FIVE,
SEVEN, $10,000 A DAY. WHEN OUR
ESTIMATE, OUR BEST ESTIMATE, IS
THAT WE CAN TAKE CARE OF THEM AT
HOME FOR ABOUT $1,500 A DAY,
DEPENDING ON ON THEIR CONDITION.
WE'RE ASKING FOR A 40% INCREASE
FOR THIS. THIS SPECIALTY CARE,
CENTERS, THESE FAMILIES AND
THEIR PATIENTS HAVE SUFFERED
ENOUGH. IT'S TIME TO GET THEM
OUT OF THE HOSPITAL. IMAGINE
HAVING A CHILD IN A HOSPITAL
THAT, YOU KNOW, SHOULD BE HOME,
CAN BE HOME AND SHOULD BE HOME,
BUT THEY CAN'T GET OUT OF THE
HOSPITAL. SO THANK YOU FOR
TAKING THE TIME TO LISTEN TO
THIS. SENATOR MENGIBAR, I
APPRECIATE YOUR ZEAL AND YOUR
COMMITMENT ON THIS ISSUE AS
WELL. AND WE'RE HAPPY TO WORK
WITH YOU TO SEE WHAT WE CAN DO
TO GET THESE KIDS BACK HOME WITH
THEIR FAMILIES WHERE THEY
BELONG. THANK YOU. I VISITED ONE
OF THOSE HOMES, IN MY DISTRICT,
AND THERE WAS A PRIVATE DUTY
NURSE AT THAT HOME, AND I WAS
ABLE TO SPEAK TO THE MOM, AND
THE NURSE WAS. I DIDN'T HAVE A
TIME, A MOMENT TO SPEAK TO US
BECAUSE SHE WAS SO BUSY WITH THE
CHILD. WHEN WE TALK ABOUT
EQUITY, IMAGINE IF YOU WERE A
PARENT WITH NO ACCESS TO A CAR,
TO A CAR, AND YOU WANT TO VISIT
YOUR KID EVERY SINGLE DAY AND
YOU HAVE TO TAKE MULTIPLE BUSSES
TO GET TO THE HOSPITAL TO VISIT
YOUR KID. AND PERHAPS BECAUSE
MOST OF THE TIME, MAYBE THEY ARE
AT A CHILDREN'S HOSPITAL OR A
SPECIALIZED HOSPITAL, IT'S NOT
YOUR LOCAL ONE. WE WANT TO TALK
ABOUT EQUITY. THIS WOULD REMOVE
BARRIERS FROM ACCESSING A
VISITING YOUR CHILD, AS A
PARENT, BECAUSE THEN YOU WOULD
HAVE YOUR CHILD AT HOME WITH
YOU. ABSOLUTELY, SENATOR. AND
ALLOWS PEOPLE STOP OFF AT THE
HOSPITAL ON THEIR WAY TO WORK.
THEY GO TO WORK, THEY STOP OFF
AT THE HOSPITAL ON THE WAY BACK.
THEY GO TAKE CARE OF THEIR
FAMILIES AND MAYBE THEY'LL GET
BACK TO THE HOSPITAL A THIRD
TIME TO TUCK THEIR CHILD IN AND
KISS THEM GOOD NIGHT. AND THERE
WAS A RECENT ANALYSIS AND
SHOWCASED HOW MUCH THE STATE
WOULD SAVE. YES AND YES. AND
WE'VE SHARED THAT WITH THE
COMMITTEE. THE ESTIMATE IS ABOUT
175 MILLION A YEAR. IT'S A
SAVINGS TO THE MEDI-CAL PROGRAM.
IT'S SOMETHING THAT WOULD BE
GOOD FOR EVERYBODY. THANK YOU SO
MUCH. THANK YOU, WE'RE GOING TO
MOVE ON TO CALIFORNIA
ASSOCIATION OF ADULT DAY
SERVICES. WHO IS LYDIA? I'M
RIGHT HERE. HI GOOD MORNING,
SENATOR MENGIBAR AND MEMBERS,
THANK YOU FOR THE INVITATION TO
BE HERE TODAY. I AM LYDIA
MICHAILIDIS, AND I SERVE AS THE
INTERIM EXECUTIVE DIRECTOR FOR
THE CALIFORNIA ASSOCIATION FOR
ADULT DAY SERVICES, REPRESENTING
PROVIDERS OF MEDI-CAL FUNDED
COMMUNITY BASED ADULT SERVICES
KNOWN AS CBAS, THANK YOU AGAIN
FOR YOUR INVITATION. I'M NO
EXPERT IN HEALTH CARE FINANCING,
NOR THE MANAGED CARE TAX, BUT I
DO CONSIDER MYSELF AN EXPERT IN
ADULT DAY SERVICES POLICY AND
FINANCING, INCLUDING OUR CBAS
AND ADULT DAY PROGRAMS, AND HAVE
DEVOTED MY 30 YEAR CAREER TO
PROGRAM DEVELOPMENT POLICY AND
ORGANIZING TO SUPPORT THIS MODEL
OF CARE. AND I DO KNOW A LITTLE
BIT ABOUT THE PARTICIPANTS WE
SERVE. AND I HAVE A FAMILY
MEMBER ON MEDI-CAL WHO SUFFERS
FROM SEVERE MENTAL ILLNESS, I'M
HERE TO ASK FOR YOUR
UNDERSTANDING AND HELP OUR SMALL
BUT DEVOTED PROVIDER COMMUNITY,
AND THE PARTICIPANTS AND
FAMILIES THEY SERVE HAVE BEEN
BUFFETED BY FORCES FOR MORE THAN
A DECADE THAT ARE BEYOND THEIR
CONTROL AND ARE IN CRISIS TODAY.
FIRST, THE GREAT RECESSION, WITH
ATTEMPTS TO ELIMINATE THIS
PROGRAM, WHICH ULTIMATELY FAILED
DUE TO LEGAL CHALLENGES AND
ULTIMATELY COST THE STATE MORE
THAN IT SAVED. DURING THIS TIME,
RATES WERE CUT 10. WELL, Y'ALL
RESTORED THE RATES IN 2019 FOR
MANAGED CARE PLANS. FAILED TO DO
SO. TWO ARE MAKING PROGRESS TO
DO THE RIGHT THING, AND TWO ARE
STILL A WORK IN PROGRESS. MOST
CENTERS ARE BEING REIMBURSED AT
THE MINIMUM MEDI-CAL RATE OF $76
A DAY FOR 2024 SERVICES WITH 200
$9. JUST CALCULATING INFLATION,
THAT RATE NUMBER ALONE SHOULD BE
$122 PER DAY. NO BUSINESS CAN
SURVIVE, LET ALONE THRIVE, BEING
PAID WITH $2,009. IN TODAY'S
ECONOMIC INFLATIONARY
ENVIRONMENT, AND UNIQUELY FOR
OUR CENTERS, THERE IS NO
MEDICARE OR PRIVATE INSURANCE
PAYER TO MAKE UP THAT DIFFERENCE
. FEDERAL VÀ DOES PAY, THOUGH.
IT'S HARD TO GET A CONTRACT AND
THEY PAY TWICE THE MEDI-CAL
RATE. SENATOR MELO, I'VE BEEN
AROUND LONG ENOUGH TO REMEMBER
SENATOR MELO IN PERSON, WHO WAS
A FIERCE CHAMPION OF ADULT DAY
HEALTH AND OLDER ADULTS AND A
REAL VISIONARY. HE PROJECTED WAY
BACK IN THE 1980S THAT WE NEEDED
600 CENTERS ACROSS THE STATE. AT
OUR PEAK, WE HAD 364. TODAY,
THERE ARE ONLY 294 CENTERS. MANY
COUNTIES HAVE NOT ONE PROGRAM
FIVE YEARS. IN FIVE YEARS, 18
CENTERS HAVE CLOSED. SO MARIN
COUNTY NOW HAS NO ADULT DAY
HEALTH. SAN JOAQUIN COUNTY LOST
ITS ONLY CENTER. OTHERS ARE
HANGING ON BY A FISCAL THREAD.
THE PANDEMIC, WITH THE STRESSORS
THAT IT BROUGHT CONTINUES TO
RESONATE TODAY. 5000 PEOPLE
COULD NOT RETURN TO OUR CENTERS
WHEN THEY WERE TOLD THAT THEY
HAD TO, BECAUSE THEY HAD
DECOMPENSATED DECONDITIONED OR
PASSED AWAY, AND THEY COULD NOT
SUSTAIN A FOUR HOUR PROGRAM DAY.
THEN WE HAD MAJOR CASH FLOW
PROBLEMS BECAUSE OF MEDI-CAL
CAL-AIM CHANGES. AND EVEN THOUGH
WE'VE PROVEN OUR GRIT AND
RESILIENCE, WE ARE AT A BREAKING
POINT. THE LATEST ASSAULT WAS
THE HEALTH CHANGE HEALTH CARE
CYBERATTACK THAT STOPPED
REIMBURSEMENTS FOR SIX WEEKS.
AND I DO HAVE TO ACKNOWLEDGE
DEPARTMENT OF HEALTH CARE
SERVICES AND LÀ CARE THAT WORKED
WITH ME TO PROVIDE SOME CASH
ADVANCES TO CENTERS THAT WERE
GOING TO CLOSE THEIR DOORS
WITHOUT THAT HELP, WORKFORCE
CHALLENGES HAVE BEEN DISCUSSED.
IF I MAY SHARE TWO QUICK
STORIES. HOME AVENUE IN DOWNEY
IS A CENTER THAT'S BEEN AROUND
FOR MORE THAN 20 YEARS. THEIR
FOUNDER, NEIL PINEDA, IS A NURSE
WITH 50 YEARS OF EXPERIENCE. SHE
IS STILL WORKING. SHE CLIMBED
THE ROOF OF HER CENTER THE OTHER
DAY TO LOOK FOR A LEAK. AS A
MATTER OF FACT, THERE'S A JACK
IN THE BOX ON THEIR CORNER WITH
A HUGE BANNER SAYING $20 AN
HOUR. COME WORK FOR US. HER
DIRECT CARE STAFF SEE THAT
BANNER EVERY DAY ON THEIR WAY TO
WORK. SHE CANNOT AFFORD TO PAY
THOSE HARD WORKING, DEDICATED
STAFF $20 AN HOUR TODAY AND SHE
CAME TO SACRAMENTO. SHE WAS IN
THIS BUILDING YESTERDAY. BEFORE
SHE LEFT, SHE TOLD HER STAFF
WITH TEARS IN HER EYES, TO
PLEASE HANG IN THERE. I'M COMING
TO SACRAMENTO TO FIGHT FOR A
WAGE INCREASE FOR YOU. BUT NEIL
AND HER SOCIAL WORKER DAUGHTER
ARE EXHAUSTED, FIGHTING EVERY
DAY TO KEEP THEIR DOORS OPEN AND
TO KEEP HER STAFF FROM FLEEING
TO A BETTER PAYING JOB. EVEN
MANAGED CARE COMPANIES ARE
TAKING STAFF FROM OUR CENTERS
AFTER THEY HAVE BEEN WELL
TRAINED. AND THIS FAMILY DOES
THIS WORK FOR HER COMMUNITY, BUT
THEY'RE AT A BREAKING POINT. A
CENTER IN VENTURA, OXNARD, ADHD,
TOLD ME HER DRIVERS HAVE BEEN
APPROACHED FIVE TIMES IN THE
LAST YEAR TO COME WORK FOR FEDEX
OR UPS, BECAUSE THEY MAKE A LOT
MORE MONEY, AND WE KNOW THAT
STAFF TURNOVER IS HARMFUL TO
PARTICIPANTS. IT UPENDS DEEP,
TRUSTING RELATIONSHIPS,
INTERRUPTS ROUTINES, COSTS,
LAWCENTER TIME AND RESOURCES.
AND THAT'S ONLY IF YOU CAN FIND
A QUALIFIED PERSON WHO IS OF THE
COMMUNITY OF THE CULTURE AND
SPEAKS THE LANGUAGE OF THE
PARTICIPANTS. THAT IS WHAT OUR
CENTERS ARE KNOWN FOR AND WHAT
THEY DO BEST. AND ADD ON TOP OF
THAT IS WILLING TO WORK FOR LOW
WAGES. SO TRY TO DO ALL THIS FOR
950 AN HOUR, WHICH IS WHAT OUR
RATE CALCULATES TO OVER A SIX
HOUR DAY, AND THEN TRY TO FIND
QUALIFIED STAFF WHEN YOU HAVE TO
COMPETE WITH THE 25 HOUR MINIMUM
WAGE FOR HEALTH CARE WORKERS
THAT YOU ALL PASSED DOESN'T
APPLY TO CBAS, BUT EVERYONE
KNOWS ABOUT IT. I NEED TO WRAP
UP. I KNOW I ALSO, THE LAST
THING I JUST NEED TO SAY IS THAT
IS A COMPLETE MYTH, THAT THERE'S
ANY TYPE OF NEGOTIATION GOING ON
BETWEEN AN INSURANCE COMPANY AND
OUR CBAS PROVIDERS. JUST TWO
DAYS AGO, A MANAGED CARE PLAN
TOLD ONE OF MY MEMBERS TO HIS
FACE, WE DON'T NEGOTIATE RATES,
SO PLEASE UNDERSTAND THIS.
BELIEVING THAT THERE IS A
NEGOTIATION BETWEEN A SMALL
BUSINESS, A SMALL FAMILY
OPERATED BUSINESS, OR A
NONPROFIT AND A HUGE INSURANCE
COMPANY IS A MYTH AND IT IS
HARMFUL TO DEVELOPING POLICY AND
RATE STRUCTURES THAT WORK. AND
THAT'S WHY WE'RE SPONSORING AB
2428 BY LISA CALDERON TO SET A
RATE FLOOR, AND WHY I'M TRYING
TO HELP OUR MEMBERS FIGURE OUT
HOW TO TALK TO THEIR PLANS ABOUT
RATES. WE CAN'T PRETEND THAT WE
CAN ACHIEVE EQUITY, ACCESS AND
QUALITY BY PAYING RATES THAT
BELONG IN ANOTHER DECADE AND ARE
COMPLETELY DISCONNECTED FROM
COST. THANK YOU VERY MUCH. THANK
YOU. LYDIA. LYDIA, CAN YOU TALK
TO ME? WHY? WHY? WE BELIEVE. ARE
YOU YOU BELIEVE THAT THIS WOULD
BE A NÓ FISCAL HAVE NO FISCAL
IMPACT. WE'RE STILL WORKING WITH
THE DEPARTMENT OF HEALTH CARE
SERVICES ON ANY KIND OF FISCAL
IMPACT. WAY DEEP IN THE
ACTUARIAL SET RATE. WEEDS. AND I
KNOW THAT SCOTT IS VERY FAMILIAR
WITH THIS, AS ARE MANY IN THIS
ROOM, BECAUSE MOST OF THE PLANS
DID RESTORE THE RATES, BUT THE
FOUR DID NOT. AND TWO OF THEM
DID START RESTORING THE RATES
RETROACTIVELY. AND THERE'S A TWO
YEAR SETTLE UP LOOKBACK PERIOD.
I CAN'T TELL YOU WHAT THE FISCAL
IMPACT IS. I DON'T KNOW IF THE
STATE CAN BECAUSE THERE'S ALL
THESE INTERVENING FACTORS HERE
THAT ARE, I THINK, GOING TO MAKE
IT VERY DIFFICULT. BUT LET'S
JUST BE CLEAR. THIS IS SUCH A
SMALL AMOUNT OF THE INSURANCE
COMPANY BUSINESS. IT'S WHAT YOU
GUYS CALL BUDGET DUST. AND IT
WILL MAKE A HUGE DIFFERENCE IN
KEEPING THESE CENTERS ALIVE IN
THEIR COMMUNITY TO SERVE THESE
VERY VULNERABLE PEOPLE. JUST
LIKE YOU'RE GOING TO HEAR FROM
MY OTHER COLLEAGUES AROUND THIS
TABLE, WE CANNOT CONTINUE TO
OPERATE WITH RATES THAT DO NOT
EVEN REMOTELY REFLECT COSTS AND
DO NOT REFLECT THE COMPLEXITY OF
THE POPULATIONS WE SERVE, WHO
ARE GETTING MORE AND MORE
COMPLEX EVERY DAY. BECAUSE
PEOPLE ARE GETTING DISCHARGED
FROM HOSPITALS FASTER. WAS THERE
A SPECIFIC PERCENTAGE YOU'RE
LOOKING TO INCREASE? WELL, JUST
INFLATION ALONE, NOT EVEN TAKING
INTO ACCOUNT MINIMUM WAGE
INCREASES IS $122 A DAY RIGHT
NOW WE'RE AT 76. I HAVEN'T DONE
THE MATH TO CALCULATE THAT, BUT
SCOTT I CAN SEE IS WORKING ON
THAT RIGHT NOW. WE HAVE THE
NUMBER 122. YOU SAID 122. YES
AND I HAVE TO SAY VETERANS
ADMINISTRATION PAYS ABOUT TWICE
THAT IN THEIR PUBLISHED RATES.
OH AND THEY PAY FOR
TRANSPORTATION SEPARATELY. IF
THE CENTER DOESN'T PROVIDE IT
THEMSELVES. SO IT LOOKS LIKE
THAT'S WHERE I'LL BE IN ABOUT 50
YEARS. WELL, I, WE HOPE TO BE
THERE FOR YOU. OKAY. THANK YOU
SO MUCH. YOU'RE WELCOME. WE'RE
GOING TO NOW MOVE ON TO, MAY I
CAN YOU AND FORGIVE MY IGNORANCE
IS THERE A DISTINCTION BETWEEN
YOU AND OR THE WAY YOU BILL AND
THE PACE PROGRAMS WHICH SEEM TO
BE. YES, ABSOLUTELY, ABSOLUTELY.
BECAUSE PACE IS ON AN ALL
INCLUSIVE CAPITATED RATE BASIS,
MEDICARE AND MEDI-CAL DOLLARS.
THIS PROGRAM WAS SPECIFICALLY
DESIGNED BY LEO MCCARTHY AND
OTHERS BACK IN THE DAY TO BE A
MEDI-CAL ONLY PROGRAM, BECAUSE
WE ARE AN ALTERNATIVE TO NURSING
HOMES. SO WE PAY. WE ARE PAID A
DAILY RATE FOR ALL THE SERVICES
THAT ARE REGULATORILY REQUIRED
TO BE PROVIDED NURSING, SOCIAL
WORK, TRANSPORTATION, MEALS, OT,
PT, SPEECH ON AND ON FOR 76
BUCKS A DAY. IN SOME CASES 68.
OKAY, AND YOU DON'T DEAL WITH
ANY POPULATION OVER 65. JUST
UNDER 60. OH NO NO, NO. WE SERVE
ANYONE 18 AND OVER 18 TO DEATH.
YEAH. SO THEN YOU DO HAVE THE
MEDI MEDS. WE ABSOLUTELY DO.
THAT'S THE BULK OF THE FOLKS
THAT WE SERVE. BUT YOU JUST
DON'T DO THE CAPITATED RATE. YOU
DO. YEAH. AND THERE'S NO
MEDICARE DOLLARS. IT'S MEDI-CAL
ONLY. YEAH THANK YOU. SO BUT WHY
NOT GO TO A CAPITATED LIKE THE
PACES? WE HAVE APPROACHED OUR
MANAGED CARE. SOME MANAGED CARE
PLANS WITH THAT. I'VE HAD A
CRASH COURSE IN MANAGED CARE
FINANCING OVER THE YEARS, AND
STILL NO EXPERT. AND WE HAVE
APPROACHED A COUPLE OF PLANS,
SAY, HEY, WOULD YOU LIKE TO TRY
THAT AS AN EXPERIMENT? AND I'VE
BEEN REBUFFED AT EVERY, EVERY
TURN FOR COMING TO THEM WITH
VARIOUS IDEAS. SO I WE'RE IT'S
JUST ME AND A COUPLE OF STAFF.
WE DON'T HAVE A LOT OF RESOURCES
TO INVENT SOMETHING NEW. OKAY.
AND I ASK BECAUSE YOU MENTIONED
SAN JOAQUIN COUNTY LOST THEIRS.
YES. BUT WE DO HAVE A, YOU KNOW,
A NEW ROBUST IT. YES, AND SOME
OF THE NEW PACES ARE NOT OPEN TO
THE PUBLIC. THEY'RE ONLY SERVING
PEOPLE WITHIN THE PACE INSURANCE
PRODUCT, IF YOU WILL. SO THEN
THAT DOES EXCLUDE PEOPLE WHO ARE
JUST COMING FROM THE COMMUNITY.
SO LOVE TO CHAT WITH YOU MORE
ABOUT THAT SOMETIME. I'M JUST
CURIOUS. THIS FAILURE TO
NEGOTIATE IS THAT ACROSS THE
STATE WITH THE MANAGED MEDI-CAL
MANAGED CARE PLANS. I MEAN, I
KNOW I'M DOWN IN RIVERSIDE
COUNTY, SO WE HAVE IEHP KNOW
EVERY PLAN IS DIFFERENT. I'VE
GOTTEN TO KNOW MANY, MANY OF
THEM, AND WE HAVE HAD SOME
SUCCESS WITH SOME OF THE PLANS
VOLUNTARILY RAISING RATES. THEY
TEND TO BE COUNTY OPERATED,
HEALTH SYSTEMS, COAST COUNTIES,
THAT ARE CLOSER, A LITTLE CLOSER
TO THE COMMUNITY, IF YOU WILL.
SO NO, IT IS NOT UNIVERSAL, BUT
NO ONE NO PLAN IS PAYING
ANYTHING CLOSE TO WHAT IT
ACTUALLY COSTS TO PROVIDE THE
SERVICE. YEAH. THANK YOU FOR
THAT QUESTION. THANK YOU, MOVING
ON TO OUR OUR THIRD SPEAKER FROM
THE CONGREGATE LIVING HEALTH
FACILITIES ASSOCIATION, THÀNH.
HELLO, EVERYONE. THANK YOU FOR
GIVING US THE OPPORTUNITY TO BE
HERE TODAY. MY NAME IS MARIAM
VOSKANIAN. I'M A REGISTERED
NURSE AND I OWN AND OPERATE A
CONGREGATE LIVING HEALTH
FACILITY. I'M THE PRESIDENT OF
THE CONGREGATE LIVING HEALTH
FACILITY ASSOCIATION AS WELL.
AND WE STARTED THIS ASSOCIATION
THÀNH ACTUALLY JUST LAST YEAR TO
GET ATTENTION FOR DESPERATE
FIGHT AND INCREASE OUR DAILY
REIMBURSEMENT RATE AND TO BE
RECOGNIZED AS A MANAGED CARE
LONG TUM CARE PROVIDER FOR
MEDI-CAL RECIPIENTS, FOR THOSE
WHO DON'T KNOW, A CONGREGATE
LIVING HEALTH FACILITY, ALSO
KNOWN AS A CLIFF, IS A 6 TO 18
PERSON RESIDENTIAL HOME THAT
PROVIDES 24 HOURS A DAY, SEVEN
DAYS A WEEK MEDICAL CARE TO
PEOPLE WHO ARE IN NEED OF A
LOWER LEVEL OF MEDICAL CARE THAN
ACUTE CARE HOSPITAL, BUT REQUIRE
MORE CARE THAN A NURSING HOME.
ASIDE FROM MEDICAL CARE, OUR
RESIDENTS ALSO RECEIVE 24 HOUR
NURSING SUPPORTIVE CARE IN
ADDITION TO PHARMACY, DIETARY,
SOCIAL, RECREATIONAL, PITOT,
STREET, EVERYTHING AND SO MUCH
MORE. OUR PATIENTS THRIVE
BECAUSE THEY LIVE IN A COMMUNITY
AND IN RESIDENTIAL SETTINGS.
DESPITE THE MANY SEVERE
DISABILITIES THAT THEY CAN HAVE,
THEY PARTICIPATE IN COMMUNITY
EVENTS, OUTINGS, RELIGIOUS
GATHERINGS. SOME EVEN HOLD JOBS
WHILE LIVING IN OUR FACILITIES.
OUR PATIENTS, HAVE COME TO LIVE
IN CLIFFS FOR MANY DIFFERENT
REASONS. DIAGNOSIS IS SUCH AS
CAR ACCIDENTS, SPORTS INJURIES,
STROKES AND ALS. THE AVERAGE AGE
OF OUR PATIENT IS ABOUT 44 YEARS
OLD. THEY OFTEN DO NOT HAVE
FAMILIES OR THEIR MEDICAL CARE
NEEDS ARE SO MUCH THAT THEIR
FAMILY MEMBERS CANNOT MANAGE
THEM AT HOME. MANY ARE
QUADRIPLEGIC, WHICH MEANS THEY
CAN'T MOVE ANY OF THEIR LIMBS.
AND SOME ARE ON VENTILATORS AND
THEREFORE GRAPPLE WITH MANY
DEFICITS SUCH AS MOTOR SKILLS OR
COMMUNICATION. MOST OF OUR
PATIENTS ONLY NOT ONLY REQUIRE
24 HOUR MEDICAL CARE, BUT ARE
ALSO REQUIRE MAXIMUM ASSISTANCE
WITH ACTIVITIES OF DAILY LIVING
SUCH AS FEEDING, TOILETING,
BATHING ANYTHING THAT WE TAKE
GRANTED ON A DAILY BASIS. WITH
ALL DUE RESPECT TO SENIORS
SENDING OUR PATIENTS TO LIVE IN
A NURSING HOME IS VERY
INAPPROPRIATE AND CALLOUS. OUR
PATIENTS WHO CHOOSE TO LIVE IN A
CLIFF ARE PATIENTS WHO CHOOSE TO
LIVE IN A CLIFF. I'M SORRY
BECAUSE THEY HAVE THE DESIRE TO
LIVE A FULFILLING LIFE AND DO
NOT WANT TO BECOME
INSTITUTIONALIZED. THEY OFTEN
HAVE PERSONAL DESIRES AND NEEDS,
SUCH AS DECORATING THEIR ROOMS
TO THEIR TASTES, SUCH AS USING
HARRY POTTER POSTERS AND
BRINGING IN THEIR PERSONAL
FURNITURE AND OTHER ITEMS TO
MAKE THEM FEEL AS CLOSE TO HOME
AS POSSIBLE. MANY OF OUR
PATIENTS WANTED TO ATTEND THIS
HEARING TODAY TO ASK FOR YOUR
SUPPORT FOR A RATE INCREASE.
UNFORTUNATELY DUE TO THEIR
DISABILITIES, OUR PATIENTS ARE
NOT PHYSICALLY ABLE TO MAKE THE
LONG TERME THE LONG TRIP VIA CAR
OR AIRPLANE. SOME OF US ARE FROM
SOUTHERN CALIFORNIA, BUT I AM
HERE IN FRONT OF YOU DISTRICT.
YEAH FROM YOUR DISTRICT. BUT I
AM HERE IN FRONT OF YOU TODAY TO
RESPECTFULLY SHARE WITH YOU THAT
OUR DAILY REIMBURSEMENT RATE OF
$490 HAS NOT BEEN INCREASED, NOT
EVEN $1, SINCE 1983. I MEAN,
THAT'S THAT'S HARD TO BELIEVE.
WHILE OTHER PROVIDERS HAVE
RECEIVED SOME SORT OF
SUPPLEMENTAL RATE ADJUSTMENTS,
INCREASES FOR COLAS, GRANTS OR
EVEN RELIEF FUNDING DURING THE
PANDEMIC, I WANT TO SAY THAT WE
RECEIVE NOTHING OVER THE LAST 40
YEARS. WE ARE ASKING YOU TODAY
TO INCREASE OUR DAILY RATE FROM
490 TO 675, AN INCREASE OF $185
FOR THE 229 MEDI-CAL WAIVER
PATIENTS WE SERVE. WHILE IN NO
WAY IS OUR SMALL RATE INCREASE
PROPOSAL TO COMMISERATE WITH OUR
CURRENT COSTS, WE FULLY
RECOGNIZE AS THE STATE'S DIRE
FISCAL SITUATION. AND SO WE ARE
ASKING FOR A SMALL AMOUNT OF
RELIEF JUST TO KEEP OUR DOORS
OPEN. WE JUST CANNOT WAIT.
ANOTHER YEAR. OUR PATIENTS
CANNOT WAIT ANOTHER YEAR. WE DO
NOT KNOW THE NUMBERS, BUT WE
REGULARLY HEAR OF CLIFFS
CLOSING, AFTER DESPERATELY
TRYING TO KEEP THEIR DOORS OPEN,
OUR PATIENTS AND OUR FAMILIES,
OUR PATIENTS, OUR FAMILIES TO
US, WE CANNOT POSSIBLY EVEN
FATHOM THE IDEA OF CLOSING AND
MAKING THEM MOVE. THAT'S BEYOND
OUR COMPREHENSION. THÀNH. BUT IT
IS VERY REAL FOR EVERY SINGLE
ONE OF OUR CLIFFS IN CALIFORNIA.
WHEN WE WERE FOUNDED, YOU COULD
BUY A GALLON OF MILK FOR A
DOLLAR. THE MEDIAN PRICE OF A
HOME IN LÀ WAS $49,000. THE
MEDIAN PRICE TODAY IN LÀ IS $1
MILLION, WITH A 95% INCREASE.
JUST ALONE, OUR CDF LICENSING
FEE FOR CLIFFS HAVE INCREASED
700% SINCE I STARTED MY CLIFF IN
2012, YOU KNOW? SO AGAIN, THE
REIMBURSEMENT RATE ADJUSTMENT
FOR CLIFFS SINCE 1983 HAS BEEN
ZERO. AS YOU CAN IMAGINE, ALL OF
OUR OPERATIONAL COSTS HAVE
SKYROCKETED SINCE 1983. THERE'S
LABOR, INSURANCE, FOOD, MEDICAL
SUPPLIES. WE ARE DESPERATE TO
PAY OUR STAFF. SO OUR LVNS OR
CNAS, A FAIR WAGE AND MAKE
IMPROVEMENTS TO OUR PATIENTS
HOMES AND INVEST IN MODEL MODERN
MEDICAL TECHNOLOGIES TO BETTER
CARE FOR OUR PATIENTS AND EASE
THE WORK OF OUR STAFF. UPDATING
A HOME MODIFICATION
MODIFICATION, SOMETHING LIKE
JUST ADDING A WHEELCHAIR RAMP
COULD WIPE OUT THE ENTIRE CLIFFS
BUDGET, A SURPLUS. YOU MAY ASK
HOW WE KEEP OUR DOORS OPEN WITH
SUCH A DEPLORABLE MEDI-CAL
REIMBURSEMENT RATE? OUR PATIENTS
WHO DO NOT RECEIVE MEDI-CAL MAY
HAVE SOME LIMITED COVERAGE
THROUGH AVENUES SUCH AS WORKERS
COMP OR OTHER HEALTH PLANS SUCH
AS PRIVATE INSURANCES AND OTHER
COVERAGE THROUGH HEALTH PLANS.
I'M SORRY I LOST MY SPACE. SO TO
START WRAPPING UP. OKAY, OKAY.
SO, USUALLY THESE OTHER
COVERAGES WILL PAY NURSING HOMES
ABOUT $1,000 A DAY. THE HEALTH
PLAN OFFERS CONTRACTS FOR US
WITH TEMPORARY RATES THROUGH
LETTERS OF AGREEMENTS. AND
THAT'S HOW WE ARE ABLE TO KEEP
THESE PRIVATE PAY PATIENTS IN
THEIR HOMES. CLIFF SHOULD BE
PLAYING A MUCH LARGER ROLE ALSO
IN TAKING PATIENTS FROM
HOSPITALS SO THAT THESE LONG
TERME HOSPITAL PATIENTS DON'T
STAY IN HOSPITALS AND EAT UP
DOLLARS. WE CAN PROVIDE THE SAME
CARE LONG TERME CARE FOR THESE
PATIENTS THAT NURSING HOMES AND
SUBACUTE FACILITIES PROVIDE IN
OUR HOMES. SO WE'RE ASKING TO
NOT ONLY GET A REIMBURSEMENT
RATE INCREASE, BUT ALSO TO BE
ABLE TO TAKE THESE PATIENTS IN
OUR HOMES AND BECOME A MANAGED
CARE BENEFIT BECAUSE WE'RE NOT
CLIFFS ARE NOT EVEN A MANAGED
CARE BENEFIT AT THIS POINT.
FINAL THOUGHT SO IN CLOSING, WE
WANT TO, TRULY ACKNOWLEDGE THE
STATE'S FISCAL SITUATION, BUT WE
HAVE NO CHOICE BUT TO BEG FOR A
SMALL AMOUNT OF AN INCREASE TO
KEEP OUR DOORS OPEN. THANK YOU.
ARE YOU COURT? WERE YOU GOING TO
. YEAH. I'M SORRY. I'M COURT
GREEN. I OAN FOR CONGREGATE
LIVING, HEALTH CARE FACILITIES
IN, SENATOR ROTH'S DISTRICT, SO
I JUST WANTED TO BE HERE TO
ANSWER QUESTIONS. OKAY. AND WE
HAVE SOMEBODY FROM MISS GROVES
DISTRICT, AND THEN. HELLO. MY
NAME IS JULIA RYAN. I AM FROM
FRESNO, CALIFORNIA, AND WE OWN
THREE CONGREGATE LIVING HEALTH
FACILITIES IN FRESNO. AND HERE
TO ANSWER ANY QUESTIONS AS WELL.
THANK YOU SO MUCH, SENATORS. ANY
QUESTIONS ON THIS TOPIC OKAY.
THE PAST THREE SPEAKERS I'VE
VISITED, I VISITED A HOME I'VE
WORKED OUT WITH SOME MEMBERS AT
CBAS. WE'RE DOING SOME
EXERCISING, AND I'VE VISITED
AND, A CLIFF, YOU KNOW, LOOKING
TO WHATEVER WE TALK ABOUT HERE
HAVE SOME KIND OF UNDERSTANDING
OF THESE THINGS AND SEEN
FIRSTHAND. AND I SPOKE TO A
PATIENT, THERE AND YOU KNOW, HOW
AND I DID SEE HIS ROOM, RIGHT?
HOW DECORATED IT WAS. IT WAS
REALLY GREAT. OKAY. SO MOVING ON
TO OUR NEXT SPEAKER, FROM THE
CHILDREN'S PARTNERSHIP. HI. HI.
I'M NOT YET. THERE WE GO. THERE
WE GO. HI, I'M KRISTEN GOLDEN
ESTÁ WITH THE CHILDREN'S
PARTNERSHIP, AND I WANTED TO
THANK YOU ALL FOR HAVING US BE
ABLE TO SHARE WITH YOU A
PROPOSAL ON MULTIYEAR,
CONTINUOUS MEDI-CAL COVERAGE FOR
YOUNG CHILDREN IN 2022.
CALIFORNIA WAS ONE OF THE FIRST
STATES IN THE NATION TO ENACT
MULTIYEAR, CONTINUOUS COVERAGE
FOR YOUNG CHILDREN. 0 TO 5. AND
NOW WE NEED FUNDING SO IT CAN BE
IMPLEMENTED. THIS CONTINUOUS
COVERAGE POLICY PROTECTS YOUNG
CHILDREN FROM HAVING GAPS IN
THEIR MEDI-CAL COVERAGE. ONCE
ENROLLED, THE LITTLE ONES CAN
STAY COVERED WITH NO ANNUAL
ELIGIBILITY RENEWALS UNTIL THEY
TURN AGE FIVE. THIS IS NOT A
NEW, A NEW INVESTMENT. THIS IS A
PROTECTION ON THE STATE'S
EXISTING OBLIGATIONS TO THE
MEDI-CAL CHILDREN. CONTINUOUS
COVERAGE IS A FUNDAMENTAL IS A
FOUNDATIONAL TO ENSURING THAT
MEDI-CAL INVESTS IN REFORMS
ALREADY MADE, ARE SET UP FOR
SUCCESS. ALSO, PROTECTING
CHILDREN'S MEDI-CAL COVERAGE IS
A NECESSARY FIRST STEP TO
ENSURING ACCESS. YOU HEARD FROM
THE PANEL BEFORE HERE THAT
HAVING A COVERAGE CARD IS
NECESSARY, BUT NOT SUFFICIENT.
YOU NEED TO BE ABLE TO GET INTO
A DOCTOR'S OFFICE, BUT I WANT TO
EMPHASIZE THAT IT'S NECESSARY.
IF YOU DON'T HAVE THE CARD,
YOU'RE NOT ABLE TO TAKE
ADVANTAGE OF GETTING THAT
ACCESSIBLE. HEALTH CARE SERVICE.
SO YOU NEED THE CARD. SO
IMPROVING MEDI-CAL PARTICIPATION
AND ACCESS IS FOR NAUGHT. IF THE
CHILDREN IN THEIR FAMILIES LOSE
THE MEDI-CAL COVERAGE TO PAY FOR
THEIR HEALTH CARE SERVICES, THEY
CAN'T GET IN THE DOOR. A PRIMARY
PURPOSE OF THE MCO TAX REVENUE
IS TO STRENGTHEN MEDI-CAL AND
INCREASE ACCESS, PARTICULARLY
EARLY, FOCUSING ON PREVENTIVE
AND PRIMARY CARE AND NOT
PRIORITIZING WHAT IS EFFECTIVELY
ALREADY THE STATE'S
RESPONSIBILITY OF KEEPING
ELIGIBLE CHILDREN COVERED
UNDERMINES A MASSIVE INVESTMENT
THAT THE STATE HAS MADE IN
DIFFERENT REFORMS LIKE CAL, AIM,
THE PROVIDER RATE INCREASES, THE
CHILDREN'S YOUTH AND BEHAVIORAL
HEALTH INITIATIVE. ALL THOSE ARE
FOR NAUGHT IF YOU DON'T HAVE THE
CHILD THERE TO WITH THE
COVERAGE. IF ELIGIBLE YOUNG
CHILDREN ARE DROPPED FROM
MEDI-CAL, THEY'RE NOT ABLE TO
TAKE ADVANTAGE OF ALL THIS GOOD
WORK. MANY OF THE RECENT REFORMS
ARE IN PART IN RESPONSE TO
DECADES OF MEDI-CAL DISMAL
PERFORMANCE IN HEALTH CARE
ACCESS, PARTICULARLY FOR
CHILDREN WITH PREVENTIVE CARE
NEEDS AND ACCESS TO MENTAL
HEALTH SERVICES. A 2018 STATE
AUDIT FOUND THAT ONLY ABOUT HALF
OF MEDI-CAL CHILDREN ARE
RECEIVING PREVENTIVE SERVICES,
AND THE FOLLOW UP IN 2022 DIDN'T
HAVE MUCH IMPROVEMENT.
SIMILARLY, AN AUDIT THIS PAST
YEAR, MEDI-CAL CHILDREN WERE
FOUND TO NOT HAVE ADEQUATE
ACCESS TO MENTAL HEALTH
SERVICES. HOW CAN A HEALTH PLAN
EFFECTIVELY MANAGE A CHILD'S
CARE? AND HOW CAN THE DOCTORS
AND CLINICS AND HOSPITALS
PROVIDE TIMELY CARE IF THE CHILD
LOSES MEDI-CAL DURING SOME OF
THEIR MOST CRITICAL
DEVELOPMENTAL YEARS? THE CURRENT
MEDI-CAL UNWINDING RESULTS ARE
DEMONSTRATING THE IMPACT, EVEN
DESPITE DHS LAUDABLE EFFORTS TO
MAKE ELIGIBLE RENEWAL EASIER IN
THE LAST FEW MONTHS, OVER
300,000 CHILDREN HAVE LOST THEIR
MEDI-CAL COVERAGE. THAT'S ABOUT
80,000 YOUNG CHILDREN, AND THESE
CHILDREN ARE STILL ELIGIBLE, THE
DISENROLLMENT RATE IS THE IS DUE
TO PROCEDURAL REASONS. THE VAST
MAJORITY OF THEM LONG WAIT
TIMES. THEY DIDN'T GET RENEWAL
FORMS. THEY SUBMITTED THEM, BUT
THEY DIDN'T GET RECEIVED BY THE
COUNTY. NOT ON THEIR FAULT, BUT
THEY'RE LOSING COVERAGE EVEN
SHORT GAPS IN COVERAGE ARE GOING
TO BE DEVASTATING, PARTICULARLY
FOR CHILDREN WITH SPECIAL HEALTH
CARE NEEDS WHO ARE REQUIRING
LIFE SAVING MEDICATIONS,
INTERVENTIONS, AND FOR YOUNG
CHILDREN THAT NEED FREQUENT
WELL-CHILD VISITS IN THE FIRST
FIVE YEARS OF LIFE, WHEN 90% OF
BRAIN DEVELOPMENT IS OCCURRING,
CHILDREN REQUIRE AT LEAST 14
WELL-CHILD VISITS FOR SCREENING
AT SPECIFIED AGES FOR EARLY
DETECTION AND DEVELOPMENTAL
DELAYS. A CHILD CAN'T GO BACK IN
TIME TO GET TO MAKE UP A MISSED
AGE. A SENSITIVE SCREEN, OR
MISSED OPPORTUNITY FOR AN EARLY
INTERVENTION BY ONE EXAMPLE
THAT'S JUST REALLY HEART
WRENCHING. WAS A FAMILY WITH AN
18 MONTH OLD, WAS SCREENED FOR
POSSIBLE DEVELOPMENTAL DELAYS,
AND REALLY NEEDED A MORE
THOROUGH ASSESSMENT. BUT SHE
LOST HER MEDI-CAL COVERAGE AND
IT TOOK HER MOTHER SEVERAL
MONTHS TO GET COVERAGE
REINSTATED, DELAYING VITAL EARLY
INTERVENTION FOR THIS LITTLE
ONE. THIS DELAYED THIS DELAY
ACCOUNTED FOR A SIGNIFICANT
PORTION OF THE LITTLE ONE'S LIFE
AND BRAIN DEVELOPMENT. AND YOU
CAN IMAGINE THE STRESS THAT THAT
MUST BE CAUSING FOR THE FAMILY
TO NOT KNOW THE ANSWER BECAUSE
THEY DIDN'T HAVE THE COVERAGE TO
GET THAT ASSESSMENT. MOST
IMPORTANTLY, CONTINUOUS COVERAGE
WORKS. WE'VE SEEN THAT IN THE
NATIONAL DEMONSTRATION THAT WE
HAD DURING THE PANDEMIC THAT
WHEN YOU HAVE CONTINUOUS
COVERAGE, YOU DON'T HAVE GAPS IN
COVERAGE AND CHILDREN CAN BE
ABLE TO GET THE SERVICES THEY
NEED. IT IS ALSO A COST
EFFECTIVE AND A POWERFUL ACCESS
STRATEGY, THE FEDERAL WINDOW OF
OPPORTUNITY IS UPON US RIGHT NOW
. WE ASK THAT YOU MOVE AND
APPROVE THAT THEY MOVE FORWARD
WITH A WAIVER NOW, BECAUSE WE
DON'T KNOW WHAT A CHANGE IN A
FEDERAL ADMINISTRATION WILL MEAN
NEXT YEAR. IF ONE SHOULD OCCUR.
SO WE REALLY NEED TO MOVE
FORWARD WITH THIS PROPOSAL NOW,
WE THANK YOU AGAIN FOR, HEARING
THIS PROPOSAL, AND WE HOPE THAT
YOU'LL BE ABLE TO FUND IT FOR
IMPLEMENTATION. THANK YOU. AND I
BELIEVE THIS WOULD HELP ADDRESS
I THINK WE TALKED ABOUT IT A
COUPLE OF WEEKS AGO. HOW YOU
KNOW, WE FARE VERY LOW COMPARED
TO OTHER STATES. YES. ON THE 0
TO 3 OR 0 TO 5 IN CHILDREN
ACCESS. YES. AND VISITS. RIGHT.
YES. WE'RE BELOW THE STATE, THE
NATIONAL AVERAGE. SO ALL THESE
INVESTMENTS, WILL BE GOOD. BUT
WE ALSO NEED TO MAKE SURE THE
KIDS KEEP THEIR COVERAGE SO THAT
THEY CAN GET INTO THOSE VISITS,
ESPECIALLY WHEN THEY'RE YOUNG,
WHEN THEY HAVE SO MANY THAT THEY
NEED. OKAY OKAY. MOVING ON TO
THE NEXT, TOPIC FROM CALIFORNIA
PAN ETHNIC HEALTH NETWORK. THANK
YOU. CELINE BETTENCOURT HERE, ON
BEHALF OF THE CALIFORNIA PAN
ETHNIC HEALTH NETWORK, C-PEN, WE
ARE A STATEWIDE HEALTH CARE
CONSUMER ADVOCACY ORGANIZATION
FOCUSED ON REDUCING AND
ELIMINATING RACIAL HEALTH
DISPARITIES IN HEALTH CARE AND
ACCESS AND OUTCOMES. WE REALLY
APPRECIATE YOUR COMMENTS THUS
FAR REGARDING EQUITY AND HOW WE
CONNECT THIS TO HEALTH OUTCOMES
AND MEASURE OUR SUCCESS IN
INVESTMENTS. CGRTS, AND WE DO
APPRECIATE THE ADMINISTRATION'S
EFFORTS TO INCORPORATE EQUITY
CONSIDERATIONS WITHIN THE
TARGETED RATE INCREASE PROPOSAL
AND ARE SUPPORTIVE OF EQUITY
ADJUSTMENTS TO INCENTIVIZE
PROVIDERS TO PARTICIPATE IN
MEDI-CAL, SPECIFICALLY IN
REGIONS WHERE COMMUNITY MEMBERS
EXPERIENCE BARRIERS AND ACCESS
TO CARE, I WILL BE DISCUSSING
OUR RECOMMENDATIONS TO
STRENGTHEN AND FOCUS THE
ADMINISTRATION'S PROPOSAL, BUT I
DO WANT TO START OFF WITH THE
WITH THE WORKFORCE THAT HAS BEEN
EXCLUDED FROM ANY MCO TAX FUNDED
INCREASE THUS FAR, AND THAT'S
COMMUNITY HEALTH WORKERS,
PROMOTORAS REPRESENTATIVES AND
HEALTH REPRESENTATIVES, THESE
ARE PROVIDERS THAT PROVIDE
CRUCIAL SERVICES IN UNDERSERVED
LOW INCOME COMMUNITIES OF COLOR.
FOR DECADES, THE MAJORITY OF THE
UPPER WORKFORCE ARE WOMEN AND
PEOPLE OF COLOR, SPECIFICALLY
LATINA WOMEN. THEIR SERVICES
INCLUDE CULTURALLY APPROPRIATE
HEALTH PROMOTION, EDUCATION,
ASSISTANCE IN ACCESSING MEDICAL,
SOCIAL SERVICES, CARE
COORDINATION, AND PATIENT
ADVOCACY. IN MUCH MORE. KSHB PR
IS REALLY ARE THE GLUE BETWEEN
PATIENTS AND PROVIDERS. THEY
FILL THE GAPS IN THE CURRENT
WORKFORCE. THEY REDUCE COSTS.
THEY INCREASE ACCESS AND IMPROVE
HEALTH OUTCOMES. SPECIFICALLY
FOR COMMUNITIES OF COLOR, THE
MOST MOST WORKERS ARE EARNING
BETWEEN 16 AND $30 PER HOUR, BUT
THEIR RATE REALLY ONLY COVERS
ABOUT 38% OF THEIR TOTAL COSTS.
THESE WAGES FOR THESE WORKERS
ARE TRAPPED IN A CYCLE OF
POVERTY AND ARE NOT SUFFICIENT
TO ATTRACT OR BUILD THE HEALTH
CARE WORKFORCE THAT CALIFORNIA
NEEDS. INDIVIDUALS SHOULD BE
ALLOWED TO BILL FOR THE
PREVENTATIVE SERVICES THAT THEY
PROVIDE, AT A MINIMUM OF 87.5%
OF THE MEDICARE RATE, WHICH IS
COMPARABLE TO THE OTHER ENHANCED
RATES OF THE OTHER PROVIDERS WHO
WHO PROVIDE THE SAME SERVICES
AND UTILIZE THE SAME SERVICE
CODES. MOVING ON, I ALSO WANT TO
DISCUSS OUR RECOMMENDATIONS FOR
THE DEPARTMENT'S PROPOSAL AND
HOW THAT COULD BE STRENGTHENED
BY UTILIZING A METHODOLOGY THAT
SPECIFICALLY ACCOUNTS FOR RACIAL
DISPARITIES, RATHER THAN
FOCUSING SOLELY ON GEOGRAPHY,
WHICH HAS BEEN SHOWN TO MASK
DISPARITIES, ESPECIALLY FOR
SMALLER RACIALLY AND ETHNICALLY
DIVERSE POPULATIONS THAT ARE
GEOGRAPHICALLY DISPERSED AND
OFTEN NOT ADEQUATELY REPRESENTED
IN DATA SETS. WHILE THE
DEPARTMENT'S METHODOLOGY
IDENTIFIES SERVICE CODES IN
PARTICULAR LOCALITIES, IT IS
UNCLEAR HOW ONLY TARGETING
SERVICE CODES WILL ENSURE AN
EQUITABLE DISTRIBUTION OF FUNDS
ACROSS PROVIDER TYPES. TO ENSURE
THAT THESE ADJUSTMENTS
MEANINGFULLY ADVANCE HEALTH
EQUITY FOR MEDI-CAL MEMBERS,
THEY MUST BE INTENTIONALLY
DESIGNED TO CLOSE RACIAL
DISPARITIES AND DISPARITIES
EXPERIENCED BY OTHER GROUPS. SO
WE RECOMMEND THAT THE DEPARTMENT
IDENTIFY PROVIDERS THAT, PROVIDE
UNDERUTILIZED AND EFFECTIVE
SERVICES FOR SPECIFIC
POPULATIONS. FOR EXAMPLE, MENTAL
HEALTH SCREENING AND PRIMARY
CARE FOR LATINA AND BLACK
PATIENTS, PROVIDERS THAT SERVE A
HIGHER THAN AVERAGE PERCENTAGE
OF MEDI-CAL MEMBERS, AS NATIONAL
RESEARCH HAS FOUND THAT
PROVIDERS THAT SEE MORE MEDICAID
PATIENTS ACTUALLY END UP TAKING
MORE MEDICAID PATIENTS,
PROVIDERS THAT SERVE A HIGHER
THAN AVERAGE PERCENTAGE OF
MEDI-CAL PATIENTS WITH
DISABILITIES, LGBTQ PLUS
PATIENTS, AND DISPROPORTIONATE
NUMBERS OF SPECIFIC RACIAL AND
ETHNIC GROUPS SUCH AS BLACK AND
NATIVE HAWAIIAN AND PACIFIC
ISLANDER POPULATIONS, AND THEN
PRACTICES THAT UTILIZE TEAM
BASED CARE AS RESEARCH HAS ALSO
FOUND THAT PRACTICES THAT
INCORPORATE PROVIDERS LIKE NURSE
PRACTITIONERS AND NURSE MIDWIVES
ARE MORE LIKELY TO ACCEPT NEW
MEDICAID PATIENTS. WE ALSO
RECOMMEND THAT PROVIDERS
RECEIVING ANY EQUITY ADJUSTMENT
BE REQUIRED TO PARTICIPATE IN
THE STATE'S DATA EXCHANGE
FRAMEWORK, WHICH GOING FORWARD,
WOULD HELP ADDRESS THE
INCOMPLETE DATA CONCERNS THAT
THE DEPARTMENT HAS IDENTIFIED.
AND FURTHERMORE, THE DESIGN OF
THE EQUITY INDEX USED TO
IDENTIFY THE LOCALITIES COULD BE
IMPROVED BY USING A MORE
COMPREHENSIVE SET OF DATA
SOURCES BEYOND WORKFORCE RELATED
INDICATORS SUCH AS MEDI-CAL
MEMBER CLAIMS DATA, HEALTH
DISPARITIES DATA, AND OTHER
TYPES OF ANALYZES THAT CONSIDER
SMALLER POPULATIONS THAT ARE
OFTEN EXCLUDED IN BROAD AREA
BASED SOCIAL INDICES, LIKE THE
HEALTHY PLACES INDEX. THESE
ANALYSIS CAN INCLUDE DIRECT
ENGAGEMENT WITH COMMUNITIES
THROUGH REGIONAL SURVEYS AND
LISTENING SESSIONS, AS WELL AS
RESEARCH METHODS LIKE USING
MULTI-YEAR POOLED DATA AND
OVERSAMPLING. THIS DATA SHOULD
ALSO BE USED TO ASSESS THE
EFFECTIVENESS OF THE EQUITY
ADJUSTMENTS BY ESTABLISHING
BENCHMARKS FOR PROVIDERS THAT
DEMONSTRATE A REDUCTION IN
RACIAL DISPARITIES ACROSS THE
SERVICES THEY PROVIDE. AS SUCH,
THE INCLUSION OF SOCIAL RISK
FACTORS ALONE IN AN EQUITY INDEX
WILL NOT NECESSARILY TRANSLATE
TO IMPROVEMENTS IN SOCIAL
DETERMINANTS OF HEALTH THAT ARE
NON WORKFORCE RELATED, IN SHORT,
THE DEPARTMENT, TO THE BEST OF
ITS ABILITY MUST DEVELOP METHODS
TO TRACK IF MEMBERS ACCESS TO
CARE AND HEALTH OUTCOMES
IMPROVES. BECAUSE OF THESE
ADDITIONAL PAYMENTS, CPN
STRONGLY SUPPORTS THE
ESTABLISHMENT OF AN EQUITY
ADJUSTMENT AND RECOMMENDS A
STATE LED PUBLIC STAKEHOLDER
ENGAGEMENT PROCESS FOR
RECOMMENDATIONS AND FEEDBACK ON
THE EQUITY INDEX AND THE ROLLOUT
OF THE ADJUSTMENTS, AND WE URGE
THE LEGISLATURE TO CONSIDER
THESE INVESTMENTS THAT CENTER
MEDI-CAL MEMBERS AND REALLY
ADVANCE RACIAL HEALTH EQUITY.
THANK YOU, THE LAO RECOMMENDS
ONE OF THE RECOMMENDATIONS WAS
REGARDING POTENTIALLY HOLDING
OFF ON SOME PARTS THAT DON'T
AREN'T FULLY COOKED, BEING THIS
BEING ONE OF THEM, DO YOU DO YOU
STAND ON THAT SAME PAGE THAT
WORK ON GETTING THE FULL DETAIL
OF THIS BEFORE ROLLING IT OUT?
WE SEE THIS AS AN INVESTMENT
RIGHT NOW IN HOW WE CAN SUPPORT
COMMUNITIES OF COLOR AND ADVANCE
RACIAL HEALTH EQUITY, AND WE
WOULD WANT TO WORK WITH THE
DEPARTMENT AND HOW WE CAN REALLY
CLARIFY VÌ IN THE METHODOLOGY
AND WORK THIS THROUGH, WE
DEFINITELY BELIEVE THIS IS A
FOUNDATION AND HOW WE IDENTIFY,
COMMUNITIES THAT THAT HAVE BEEN
HISTORICALLY UNDER-INVEST. AND I
CAN SEE THE EQUITY INDEX BEING
USED FOR OTHER AREAS. WE WANT TO
MAKE SURE THAT IT'S SOLID, THAT
IT DOESN'T EXCLUDE POPULATIONS,
WE WOULD ENCOURAGE THEM THE
LEGISLATURE, YOU KNOW, LOOK AT
THE OTHER PROVIDERS THAT HAVE
BEEN EXCLUDED WHEN THINKING
ABOUT WHAT TO DO WITH INEQUITY,
WITH THE EQUITY MONEY THAT'S
BEEN PROPOSED, AND OUR PRIORITY
THEN WOULD BE FOR THE PRS TO
RECEIVE THAT RATE INCREASE AS
THEY ARE MOST DIRECTLY IMPACTING
EQUITY AT THIS VERY MOMENT, OKAY
. OKAY. NEXT TOPIC. HI, LINDA
FROM THE WESTERN CENTER ON LAW
AND POVERTY. GOOD AFTERNOON,
LINDA HèA WITH WESTERN CENTER ON
LAW AND POVERTY. FIRSTLY I WANT
TO THANK YOU FOR MAKING ROOM AT
THE TABLE OR ACTUALLY CREATING
THE TABLE FOR US TO DISCUSS THE
NEED TO TIMELY IMPLEMENT SHARE
OF COST REFORM, WHICH WAS
INCLUDED IN THE 2022 BUDGET AND
NOW NEEDS TO BE FUNDED. THE
SHARE OF COST PROGRAM ACTS AS A
CRITICAL PATHWAY TO HEALTH CARE
COVERAGE FOR LOW INCOME, OLDER
ADULTS AND PEOPLE WITH
DISABILITIES WHO HAVE
SIGNIFICANT HEALTH CARE NEEDS.
BUT ARE JUST ABOVE THE FREE
MEDI-CAL INCOME LIMIT. A SHARE
OF COST IS THE AMOUNT AN
INDIVIDUAL MUST PAY FOR HEALTH
CARE. BEFORE MEDI-CAL KICKS IN.
A PERSON'S SHARE OF COST IS
THEIR MONTHLY INCOME -$600, AND
IS BASED ON THE ANTIQUATED IDEA
THAT AN INDIVIDUAL CAN LIVE OFF
OF $600 A MONTH. THIS OUTDATED
INCOME LIMIT FORCES PEOPLE TO
SPEND MORE THAN HALF OF THEIR
INCOME ON HEALTH CARE EVERY
MONTH. AS A RESULT, OLDER ADULTS
AND PEOPLE WITH DISABILITIES ARE
PUSHED INTO EXTREME POVERTY,
WHICH MAY EXPLAIN WHY CALIFORNIA
HAS THE HIGHEST RATE OF SENIOR
POVERTY IN THE NATION AND AN
INCREASING NUMBER OF PEOPLE
EXPERIENCING HOMELESSNESS WITH A
DISABILITY. THINK ABOUT IT.
COULD YOU LIVE ON $600 A MONTH?
THAT'S WHAT THE PROGRAM DEMANDS
OF OLDER ADULTS AND PEOPLE WITH
DISABILITIES WHO NEED CARE. WHEN
PEOPLE CAN'T ACCESS HEALTH AND
AT HOME CARE, THEY OFTEN END UP
HOSPITALIZED OR
INSTITUTIONALIZED OR HAVE TO
RELY ON ALREADY STRETCHED FAMILY
MEMBERS TO PROVIDE UNPAID CARE.
IN SOME CASES, FAMILIES MAKE THE
IMPOSSIBLE CHOICE OF PAYING FOR
THEIR HEALTH CARE OR MAKING RENT
AND HAVING FOOD ON THE TABLE.
THIS IS AN EQUITY ISSUE. IT'S
NOT FAIR THAT OLDER ADULTS AND
PEOPLE WITH DISABILITIES ARE THE
ONLY POPULATION FORCED TO PAY SO
MUCH TO OBTAIN ESSENTIAL HEALTH
CARE. MOST LOW INCOME
INDIVIDUALS RECEIVE THEIR HEALTH
CARE FOR FREE, OR AT MOST DO NOT
HAVE TO PAY MORE THAN 8.5% OF
THEIR INCOME ON HEALTH CARE
COVERAGE. YET LOW INCOME OLDER
ADULTS AND PEOPLE WITH
DISABILITIES WHO ARE ONLY A
DOLLAR ABOVE THE LIMIT FOR FREE
MEDI-CAL AND LIVE ON FIXED
INCOMES ARE EXPECTED TO PAY OVER
60% OF THEIR MONTHLY INCOME ON
HEALTH CARE EXPENSES. SHARE OF
COST REFORM WOULD RAISE THE
MAINTENANCE NEED INCOME LEVEL.
THAT $600 TO 138% OF THE FEDERAL
POVERTY LEVEL. THE FREE MEDI-CAL
LIMIT, SO THAT IF YOU'RE $1
ABOVE THE MEDI-CAL LIMIT, YOUR
SHARE OF COST IS $1 INSTEAD OF
THAT THOUSAND PLUS. WE, ALONG
WITH 70 ORGANIZATIONS, URGE THE
LEGISLATURE AND ADMINISTRATION
TO DITCH THE DEDUCTIBLE AND
TIMELY IMPLEMENT SHARE OF COST
REFORM. THANK YOU SO MUCH,
LINDA. MOVING ON TO OUR NEXT
SPEAKER FROM CALIFORNIA
CHIROPRACTIC ASSOCIATION. MADAM
CHAIR AND MEMBERS OF THE
SUBCOMMITTEE, LLOYD FRIESEN,
REPRESENTING THE CALIFORNIA
CHIROPRACTIC ASSOCIATION.
CERTAINLY. THANK YOU FOR
INVITING US TO THE BIG DOG TABLE
TO HAVE A DISCUSSION ABOUT OUR
ISSUES, I WANTED TO QUOTE YOU,
I'M GOING TO LIMIT MY REMARKS TO
JUST THE TWO QUESTIONS THAT THE
COMMITTEE HAS REQUESTED. THE
FIRST ONE IS, CAL KAIROS,
REQUEST TO REINSTATE, THE
CHIROPRACTIC BENEFIT TO
MEDI-CAL. HISTORICALLY DOCTORS
OF CHIROPRACTIC AND THE BENEFITS
OR THE SERVICES THEY PROVIDE
HAVE BEEN AN OPTIONAL BENEFIT.
AND WE'VE HAD TO GO TO THE
LEGISLATURE TO AND THE
ADMINISTRATION TO BUDGET FUNDING
FOR THE SERVICES THAT WE
PROVIDE. AND AND, FOLLOWING THE
FINANCIAL CRISIS IN 2010, MANY
OF THE OPTIONAL BENEFITS WERE
RESTORED, BUT NOT CHIROPRACTIC
SERVICES FOR MEDI-CAL
RECIPIENTS. SO OVER THE PAST
THREE YEARS, THE ASSOCIATION HAS
COME WITH A BUDGET REQUEST TO
REINSTATE THAT BENEFIT TO THIS
SUBCOMMITTEE. AND WE'VE HAD,
SENATOR MENGIBAR AND, SKINNER
SUPPORT THAT REQUEST. WEST.
UNFORTUNATELY, WHEN IT GOES TO
THE ADMINISTRATION AND THE
LEADERSHIP OF THE ASSEMBLY AND
THE SENATE, THEY HAVE NOT SEEN
FIT TO AGREE WITH THEM. AND THE
FUNDING HAS NOT BEEN GIVEN TO
INCLUSION OF DOCTORS OF
CHIROPRACTIC, WE TO THE POINT
THAT'S BEEN MADE SEVERAL TIMES
HERE. AND CERTAINLY SENATOR
MENGIBAR SAID IT BEFORE WE CAME
UP ON THIS, THIS, PANEL IS THAT
THERE'S GOT TO BE A COST SAVINGS
ASSOCIATED WITH AN INCREASE IN
WHATEVER BUDGETARY, DOLLARS ARE
GOING TO BE PLACED INTO THE
MEDI-CAL BUDGET. AND WE WOULD
SAY THAT THERE ARE NUMEROUS
STUDIES THAT SHOW THAT INCLUSION
OF CHIROPRACTIC SERVICES IN A
BENEFIT PLAN WILL ACTUALLY
REDUCE HOSPITALIZATIONS BY 42,
SURGICAL INTERVENTIONS BY 32,
REDUCTION IN ADVANCED DIAGNOSTIC
EVALUATIONS, AND SO ON. WITH A
CONSERVATIVE MANAGEMENT OF
CHIROPRACTIC, MANIPULATIVE
THERAPY AND OTHER SERVICES THAT
WE PROVIDE, IT SEEMS UNFAIR THAT
, PEOPLE THAT HAVE, EMPLOYER
SPONSORED HEALTH CARE WORKERS
COMPENSATION, THE VA, FEDERALLY
QUALIFIED HEALTH CENTERS, RURAL
HEALTH CARE CENTERS, AND OTHER
DELIVERY SYSTEMS HAVE THE
OPPORTUNITY TO SEEK CHIROPRACTIC
DOCTORS. MEDI-CAL DOES NOT, SO
WE AGAIN, REQUEST THE PROPOSAL
TO RESTORE THE BENEFIT. THE
SECOND ASK IS AN ISSUE WHERE THE
IN THE TIMES WHEN CHIROPRACTIC
BENEFITS HAVE BEEN IN PLACE IS
THAT THE CLINICAL SITUATION HAS
BEEN LIMITED TWO VISITS PER
MONTH, IRRESPECTIVE OF THE
CLINICAL NECESSITY OF THE
PATIENT. SO WHAT WE'RE
REQUESTING IS A 24 VISIT, CAP,
IF YOU WILL, OR 24 VISIT PER
YEAR OPPORTUNITY TO MAKE SURE
THAT THE CLINICAL NEEDS OF THE
PATIENT ARE ADDRESSED DURING A
PARTICULAR EPISODE OF CARE. AND
ONCE AGAIN, THERE ARE NUMEROUS
STUDIES THAT SUPPORT OUR ASK IN
TERMS OF COST SAVINGS, AS YOU'VE
ARTICULATED IN ADDITION OR IN
COMPARISON TO THE COST. AND IT'S
FOR THESE REASONS AND THE
DISCUSSION THAT'S TAKEN PLACE
HERE TODAY THAT OUR ASK IS
CONSISTENT, CONSISTENT WITH THE
DISCUSSION WITH RESPECT TO
WORKING AS A TEAM TO DELIVER
QUALITY, COST SAVING SERVICES TO
MEDICARE, EXCUSE ME, MEDI-CAL
BENEFICIARIES. THANK YOU. I
APPRECIATE THAT. AND THEN OUR
LAST SPEAKER COMES FROM THE
CALIFORNIA ORTHOTIC AND
PROSTHETIC ASSOCIATION. THANK
YOU, CHAIR AND MEMBERS, MY NAME
IS SPENCER GREEN, AND I'M A
CERTIFIED ORTHOTIST AND
PROSTHETIST, AS WELL AS THE
CURRENT PRESIDENT OF THE
CALIFORNIA ORTHOTIC AND
PROSTHETIC ASSOCIATION, OR COPA.
I ENTERED INTO THIS FIELD TO
DESIGN, FABRICATE, AND FIT
DEVICES THAT IMPROVE MOBILITY
AND QUALITY OF LIFE FOR
INDIVIDUALS WITH PHYSICAL
CHALLENGES. ORTHOTICS LIKE THIS
ARE BRACES THAT SUPPORT
DYSFUNCTIONAL LIMBS, AND
PROSTHETICS ARE DEVICES THAT
REPLACE AN AMPUTATED LIMB. MANY
DEVICES THAT ORTHOTISTS AND
PROSTHETISTS PROVIDE ARE CUSTOM
MOLDED TO THE PATIENT, AND ARE
THE RESULT OF A CAREFUL
EVALUATION IN A MOLD OF THE LIMB
AND SEVERAL OUTPATIENT FOLLOW UP
VISITS WHICH ENSURE APPROPRIATE
FIT, FUNCTION, AND OUTCOME. WHEN
PATIENTS DO NOT RECEIVE
CONSISTENT CARE, THEIR
INDEPENDENCE, MOBILITY, AND
QUALITY OF LIFE SUFFER IN DIRECT
CORRELATION WITH THESE IMPACTS.
THE COST TO THE HEALTH CARE
SYSTEM INCREASES AS THE
CALIFORNIA ORTHOTIC AND
PROSTHETIC ASSOCIATION IS HERE
TO ADVOCATE FOR THE HUNDREDS OF
THOUSANDS OF DEVICE USERS IN
CALIFORNIA WHO RELY ON OUR
MEMBERS TO PROVIDE THEM WITH
CARE. TODAY, THE AVERAGE
REIMBURSEMENT FOR ORTHOTIC AND
PROSTHETIC DEVICES BY THE
MEDI-CAL PROGRAM IS 49% OF THE
CURRENT MEDICARE PAYMENT, AND IS
THE LOWEST IN THE UNITED STATES.
COPA IS REQUESTING MCO TO
INVESTMENT TO INCREASE
REIMBURSEMENT TO NO LESS THAN
80% OF PREVAILING MEDICARE RATES
. AS A RESULT OF THE STAGNANT
MEDI-CAL FEE SCHEDULE, THE COST
OF THE ORTHOTIC OR PROSTHETIC
DEVICE IS OFTEN MORE THAN THE
REIMBURSEMENT. THEREFORE
PROVIDERS ARE FACED WITH THE
DILEMMA TO PROVIDE THE DEVICE AT
A LOSS OR TO DENY CARE TO
MEDI-CAL BENEFICIARIES WHEN CARE
IS DENIED. THIS VULNERABLE
POPULATION OF MOBILITY
CHALLENGED CALIFORNIANS ARE
REQUIRED TO TRAVEL FURTHER TO
ACCESS NECESSARY CARE. AS A
RESULT, MANY PATIENTS DECIDE TO
FORGO TREATMENT AND RESORT
RESORT TO USING A WHEELCHAIR OR
OTHER ASSISTIVE DEVICE, WHICH
DECREASES INDEPENDENCE,
PRODUCTIVITY, AND ABILITY TO
COMPLETE ACTIVITIES OF DAILY
LIVING. ACHIEVING REASONABLE
REIMBURSEMENT WILL ENCOURAGE
PROVIDERS TO REENGAGE WITH THE
MEDI-CAL PROGRAM, WHICH WILL
RESULT IN DECREASED USE OF PAIN
MEDICATION, DECREASED RELIANCE
ON TRANSPORTATION SERVICES,
INCREASED OPPORTUNITY TO GAIN
EMPLOYMENT, AND INCREASED
QUALITY OF LIFE. THE GOOD NEWS
IS THAT THE SAVINGS TO THE
HEALTH CARE SYSTEM OUTWEIGHS THE
INVESTMENT IN ORTHOTIC AND
PROSTHETIC CARE, A NET POSITIVE
IMPACT FOR CALIFORNIA. COPA HAS
CONTEMPLATED THE IMPACT OF A
RATE INCREASE, WHICH IS SOMEWHAT
DIFFICULT TO QUANTIFY DUE TO
INCONSISTENT REPORTING. HOWEVER,
WE CAN EXTRAPOLATE OUT THE
IMPACT BY EXAMINING THE LARGEST
PROVIDER OF OMP DEVICES IN THE
STATE. OVER THE LAST TEN YEARS,
THEY HAVE CLOSED CLINICS AND
HIGH MEDI-CAL DENSITY AREAS
SECONDARY TO BUSINESS
CHALLENGES, INCLUDING
REIMBURSEMENT FOR DEVICES.
EXAMPLES INCLUDE GILROY,
BURBANK, SANTA CRUZ, WOODLAND,
FAIRFIELD, GRASS VALLEY, PINOLE,
LODI, RED BLUFF, CHICO, AND
OROVILLE, TO NAME A FEW. UPON
MCO TAX INVESTMENT, WE WOULD
EXPECT TO SEE IMPROVED ACCESS TO
CARE IN BRICK AND MORTAR
FACILITIES OR MOBILE CARE UNITS.
THERE'S A WELL DOCUMENTED LINK
BETWEEN ACCESS, QUALITY OF LIFE
AND DECREASED HEALTH CARE COST.
WHEN YOU ARE MOBILITY
CHALLENGED, YOU'RE LIKELY YOUR
LIKELIHOOD OF ACCESSING CARE
INCREASES. THE CLOSER TO YOUR
HOME YOU ARE. SEVERAL RECENT
PEER REVIEWED STUDIES HAVE
QUANTIFIED THE IMPACT OF
ORTHOTIC AND PROSTHETIC CARE.
SOME RELEVANT FACTS FROM THESE
STUDIES ARE THAT DEVICE USERS
WHO ARE EMPLOYED HAVE A HAVE 3.6
TIMES GREATER ODDS OF REACHING
INCREASED MOBILITY COMPARED TO
THOSE THAT ARE UNEMPLOYED. THIS
UNDERSCORES THE CORRELATION
BETWEEN EMPLOYMENT AND MOBILITY
FOR LOWER LIMB PROSTHESIS USERS.
ANOTHER STATISTIC IS THAT
RECEIVING A PROSTHESIS WITHIN
THREE MONTHS OF AMPUTATION
RESULTS IN $25,000 LESS HEALTH
CARE SPEND IN THE FIRST YEAR,
COMPARED TO THOSE THAT RECEIVED
NO PROSTHESIS AT ALL. LASTLY,
PATIENTS WHO RECEIVED A LOWER
EXTREMITY BRACE INCURRED MORE
THAN $1,900 LESS HEALTH CARE
SPEND IN 18 MONTHS AFTER
RECEIVING THE DEVICE AS COMPARED
TO THOSE THAT RECEIVED NO
DEVICE. IN CONCLUSION, MEDI-CAL
BENEFICIARIES DESERVE EQUITABLE
ACCESS TO ORTHOTIC AND
PROSTHETIC CARE QUALITY CARE
STRENGTHENS THE MEDI-CAL PROGRAM
BY DECREASING SPEND ELSEWHERE IN
THE SYSTEM AND PROMOTES
INDEPENDENT, HEALTHY AND
PRODUCTIVE LIVES TO VULNERABLE
CALIFORNIANS. WE ARE A STATE
THAT THAT PRIDES ITSELF ON
SUPPORTING OUR PEOPLE IN NEED.
OUR CURRENT STATUS OF HAVING THE
LOWEST RELATIVE REIMBURSEMENT
FOR ORTHOTIC AND PROSTHETIC
DEVICES IN THE COUNTRY IS NOT
CONSISTENT WITH OUR WORDS. WE
APPRECIATE YOUR CONSIDERATION TO
SUPPORT ORTHOTIC AND PROSTHETIC
DEVICE USERS BY INVESTING MCO
TAX MONEY IN THE CATEGORY OF
OTHER OUTPATIENT SERVICES. THANK
YOU FOR THE OPPORTUNITY TO SPEAK
TODAY. THANK YOU. DIRECTOR, I
DON'T KNOW IF ON ANY OF THE
TOPICS WE TALKED ABOUT, YOU'RE
LIKE, HEY, WE ALREADY FIGURED
THIS OUT. THEY DON'T. THEY'RE
TOTALLY FINE OR ANYTHING SIMILAR
TO THAT. YOU'RE CLOSE TO THAT. I
JUST WANT TO MAKE SURE THERE'S
NOTHING IN THE WORKS OR PLAN FOR
ANY OF THE TOPICS WE'VE TALKED
ABOUT. I MEAN, I WOULD JUST SAY
THANK YOU TO THE, THE KIND OF
THE PROVIDERS AND THE PROVIDER
ASSOCIATIONS FOR YOUR COMMITMENT
TO MEDI-CAL AND TO THE PANELISTS
WHO ADVOCATE ON BEHALF OF OUR
MEMBERS. I MEAN, I THINK TO SOME
OF THE EARLIER POINTS BEFORE,
YOU KNOW, THERE ARE PROBABLY
OPPORTUNITIES FOR MANY, MANY,
MANY MORE INVESTMENTS IN THE
MEDI-CAL SPACE, YOU KNOW, BUT
NOTWITHSTANDING THE STATE'S
FISCAL SITUATION, I THINK, YOU
KNOW, ARE WE KIND OF WE HAVE OUR
PROPOSAL BEFORE YOU. AND I KNOW
THERE WILL BE FURTHER
CONVERSATION. OWENS OKAY, JUST
WANTED TO CLARIFY THAT. OKAY,
GREAT. THANK YOU SO MUCH FOR
COMING TO THE TABLE. AND, I
MEAN, I APPRECIATE HEARING ALL
YOUR REQUESTS AND SEE HOW AS WE
CAN SEE WHAT ELSE WE CAN DO, AND
I WANT TO CORRECT MYSELF. I GOT
MY NUMBERS MIXED UP. IT'S $20.8
BILLION THAT WE'RE WORKING WITH
FOR THE MCO TAX, AND 7.1 OF THEM
IS FOR MEDI-CAL REIMBURSEMENTS.
AND WHILE WE DON'T HAVE THREE,
ACTUAL NUMBERS FOR REQUESTS FROM
THE STAKEHOLDERS HERE, THAT
AMOUNTS TO CLOSE TO JUST 1% OF
THE TOTAL ALLOCATION. IF WE WERE
TO FUND EVERY SINGLE ONE OF
THESE STAKEHOLDERS, AMOUNTS TO
1. THAT'S IT. IF WE WENT A
DIFFERENT ROUTE AND WE DIDN'T
JUST ALLOCATE 1% AND WE LOOKED
AT THE EQUITY OR THE LABOR
WORKFORCE, THEN IT WOULD
WOULDN'T IT WOULD STILL LEAVE
MONEY LEFT OVER UNDER THE EQUITY
AND LABOR WORKFORCE. I'M
IMPLORING THE DEPARTMENT,
IMPLORING THE DEPARTMENT AND THE
OTHER STAKEHOLDERS ONCE AGAIN
IMPLORING THAT WE FIND WAYS TO
INCLUDE NEW FRIENDS IN THIS
PROPOSAL, BECAUSE THE THINGS WE
TALKED ABOUT HERE ARE
PREVENTATIVE IN NATURE. SOME
WILL SAVE US MONEY IN, IN THE
LONG RUN. AND WE'RE NOT TALKING
ABOUT GENERAL FUND MONEY,
BECAUSE THIS IS REGARDLESS OF
THE CURRENT STATE OF OUR OF OUR
OF OUR, BUDGET SITUATION,
BECAUSE THIS IS MONEY THAT IS
OUTSIDE OF THAT. I THESE ARE
ENTITIES THAT ARE HELPING OUR
MOST VULNERABLE INDIVIDUALS,
THIS ISN'T SOMETHING THAT IS AN
OPTION FOR PEOPLE. I DON'T THINK
IT'S AN OPTION. IF YOU NEED A
PROSTHETIC, THAT'S THE ONLY
OPTION YOU HAVE. OR IF YOU'RE
TRYING TO NOT BE ISOLATED AS AN
OLDER ADULT AND DEALING WITH
DEPRESSION OR ANXIETY, IT'S
HELPFUL TO GO TO ADULT DAY
PROGRAMS. IF YOU'RE AN
INDIVIDUAL WITH COMPLEX NEEDS
WHO PERHAPS, MAYBE HAS NO FAMILY
MEMBER TO TAKE CARE OF THEM AND
NEEDS A HIGHER LEVEL CARE THAN A
SNIFF, CLIFF IS YOUR ONLY OPTION
OR COMMUNITY HEALTH WORKERS WHO
I KNOW VERY, VERY WELL BECAUSE I
LED A TEAM OF COMMUNITY HEALTH
WORKERS IN MY DISTRICT, AND I
KNOW THAT SOMETIMES THEY'RE THE
ONLY TRUSTED MESSENGERS. AND WE
TALK ABOUT EQUITY. YOU CAN TALK
ABOUT EQUITY WITHOUT COMMUNITY
HEALTH WORKERS BECAUSE THEY'RE
THE ONES THAT OUR COMMUNITIES
TRUST OR PRIVATE DUTY NURSES TO
ENSURE THAT OUR PARENTS ARE NEXT
TO THEIR KIDS EVERY SINGLE DAY
AND NOT HAVE TO MAYBE PENCIL IN
WHEN THEY CAN GO VISIT THEM
BECAUSE THEY'RE SO FAR AWAY AND
ALL OF THIS WILL HELP THE
WORKFORCE. EVERY SINGLE ONE OF
INVESTMENTS OR CONTINUOUS
MEDI-CAL COVERAGE FOR OUR KIDS.
THE WHOLE POINT OF THIS IS FOR
KIDS, RIGHT? TO ENSURE THAT
WE'RE COVERING AND ENSURING WE
HAVE ACCESS TO MEDI-CAL, WE
HEARD THE STORY OF SOMEONE
HAVING TO WAIT TILL THEY GET,
REFERRED AGAIN OR ADDED BACK ON
TO MEDI-CAL TO GET COVERAGE, AND
WE KNOW SEEKING. I'VE GONE TO A
CHIROPRACTOR FOR BACK ISSUES AND
THAT'S PREVENTATIVE FROM SURGERY
OR ANYTHING. RIGHT. THAT SAVES
ALL OF THESE RURAL PREVENTATIVE,
SO AGAIN, I'M IMPLORING THAT WE
COME BACK TO THE TABLE AND LOOK
AT WHAT ELSE WE CAN DO TO TAKE
ADVANTAGE OF THE MCO TAX FOR THE
FIRST TIME EVER IN INVESTMENTS
IN MEDI-CAL COLLEAGUES. SENATOR
EGGMAN, I WOULD JUST LIKE TO
CONCUR WITH THE CHAIR AND ALSO
JUST RAISE THE POINT AS AS YOU
ALREADY DONE THAT, WHAT WE KEEP
TALKING ABOUT, WE NEED MORE
HEALTH CARE WORKERS. WE NEED TO
INCREASE THE AMOUNT WE HAVE
HEALTH CARE WORKERS IN FRONT OF
US RIGHT NOW THAT AREN'T BEING
PAID EQUITABLY. SO IF WE WANT TO
REALLY INVEST IN EQUITY, WE NEED
TO LOOK AT WHAT WE ALREADY HAVE.
1960, 19, 83, 40 YEARS. WERE YOU
BORN YET, MADAM CHAIR? I WAS NOT
BORN YET. ALL RIGHT. I WAS
BEFORE MY TIME. MADAM CHAIR, I
WILL SAY THAT, YOU KNOW, I THINK
TO SOME EXTENT THIS IS NOT THE
ADMINISTRATION FAULT, WE TEND TO
FOCUS AROUND HERE ON THE ISSUE
OR THE PROJECT OR THE PROGRAM
THAT'S THE NEWEST AND SEXIEST
THAT GETS THE MOST ATTENTION IN
THE NEWSPAPER. AND WE OFTEN
DON'T COME BACK AND TAKE A LOOK
AT THE PROGRAMS THAT HAVE BEEN
AROUND FOR A LONG TIME THAT NEED
HELP, AND NOTHING LIKE A GOOD
BUDGET CRISIS TO FORCE US TO DO
THAT. AND IT REALLY REQUIRES
MORE THAN JUST THE THREE,
SOMETIMES FOUR PEOPLE WHO SIT ON
THIS SUBCOMMITTEE. TO DO THAT,
WE'RE GOING TO HAVE TO TAKE A
LOOK AT THE BUDGET HOLISTICALLY
AND TAKE A LOOK AT THE PROGRAMS
THAT, AS OUR CHAIR, OUR SUPERB
CHAIR, BY THE WAY, HAS SAID,
TAKE CARE OF THE MOST VULNERABLE
IN OUR CRITICAL COMMUNITIES
WHERE THERE ARE NO OTHER
SERVICES OR THERE ARE NO OTHER
SERVICES THAT MEET THE NEED. AND
WE'RE GOING TO NEED TO FIGURE
OUT HOW TO PROPERLY FUND THEM.
AND IF THAT MEANS WE JETTISON
SOME HIGH VISIBILITY, SEXY
PROJECTS THAT DON'T COME
ANYWHERE CLOSE TO WHAT YOU DO
EVERY SINGLE DAY FOR THE PEOPLE
THAT WE CARE THE MOST ABOUT,
THEN I GUESS WE'RE GOING TO OPEN
THE DOOR AND THROW THEM OUT
WITHOUT A PARACHUTE. THANK YOU,
MADAM CHAIR. I'VE OFTEN SAID
INSTEAD OF INNOVATION GRANTS, WE
SHOULD DO SUSTAINABILITY GRANTS.
SUSTAINABILITY. THAT REMINDS ME
OF THE ONE THING THE INNOVATION
ACCELERATOR PROGRAM THAT I'VE
MENTIONED IN THIS COMMITTEE.
WHAT'S IT FOR? WE ALREADY KNOW
WHAT WE NEED TO CLOSE THE GAP.
AND WE'RE PUTTING ASIDE WHAT IS
IT, $40 MILLION FOR THAT 7474
FOR TO TELL US WHAT WE NEED TO
DO TO CLOSE THE GAP ON EQUITY
FASTER. IT'S RIGHT HERE IN FRONT
OF US, YOU'RE RIGHT, SENATOR
ROTH. YOU'RE RIGHT. I MEAN, I
THINK MY PLEA SHOULD BE DIRECTED
TO THE STAKEHOLDERS. WE HEARD IN
PANEL ONE TO BE LIKE, DON'T
FIGHT US IN OUR REQUESTS TO
INCLUDE MORE FRIENDS. I THINK
THAT'S WHERE MY PLEA SHOULD GO.
EMPLOYING THOSE STAKEHOLDERS
TONIGHT. PHOTOS BECAUSE YOU'RE
RIGHT. DEPARTMENT. I MEAN, AT
THE END OF THE DAY, YOU'RE LIKE,
WE'RE JUST GETTING OUR ORDERS
AND WE'RE GOING WITH IT. YOU'RE
RIGHT. SO IT'S THE OTHER
STAKEHOLDERS, I HOPE I HOPE YOU
HEARD WHAT'S AT STAKE HERE, AND
YOUR MEMBERS ARE GETTING A HUGE
PIECE OF THE PIE. THEY'RE JUST
ASKING FOR A CRUMB. THAT'S ALL
THEY'RE ASKING FOR. SO WITH THAT
, THANK YOU SO MUCH. PANEL TWO.
WE'RE GOING TO MOVE INTO PUBLIC
COMMENT. IF YOU'D LIKE TO
PROVIDE COMMENT ON ANYTHING
RELATED TO THE MCO TAGS, PLEASE
STEP FORWARD. DEPENDING ON MANY
PEOPLE WE SEE, I WILL JUST A
TIME. GIVE ME A SECOND. KELLY I
THINK WE COULD DO A MINUTE EACH.
GO AHEAD. THANK YOU. CHAIR KELLY
LARUE WITH RESILIENT ADVOCACY ON
BEHALF OF PHI HEALTH AND AIR
AMBULANCE PROVIDER HERE IN
CALIFORNIA FOR THE MEDI-CAL AIR
AMBULANCE INDUSTRY, OBTAINED A
MEDI-CAL SUPPLEMENTAL RATE
EXPENDITURE AUTHORITY LAST YEAR
AS PART OF THE BUDGET AGREEMENT,
BUT WAS NOT AN ALLOCATION.
UNFORTUNATELY AIR AMBULANCE
PROVIDERS APPRECIATE THE
DISCUSSION TODAY ON MAINTAINING
CRITICAL SERVICES FOR
CALIFORNIANS. WE LOOK FORWARD TO
CONTINUING THE BUDGET
DISCUSSIONS FROM LAST YEAR TO
FUND THE MEDI-CAL RATE FOR
CRITICAL AIR AMBULANCE TRANSPORT
SERVICES TO HOSPITALS ACROSS
CALIFORNIA, VÀ, AND TO MAINTAIN
EMERGENCY SURGE CAPACITY. THANK
YOU BOTH. THANK YOU SO MUCH.
MADAM CHAIR, GOOD AFTERNOON.
GOOD AFTERNOON. IT IS AFTERNOON
NOW, THANK YOU FOR A THOUGHTFUL
HEARING. I WOULD KIDANI
REPRESENTING THE CALIFORNIA
CHILDREN'S HOSPITAL HOSPITAL
ASSOCIATION. WE WANT TO ECHO AND
ALIGN OUR COMMENTS WITH OUR
COLLEAGUES AT THE HOSPITAL
ASSOCIATION. WE SUPPORT THE
SPENDING PLAN THAT WAS AGREED TO
LAST YEAR, KEEPING IT VERY
SIMPLE AND SUCCINCT AND THEN
HAVING CONVERSATIONS GOING
FORWARD. BUT AGAIN, THANK YOU
FOR YOUR THOUGHTFUL HEARING.
VERY ENLIGHTENING. HAVE A GOOD
DAY. THANK YOU. TAKE CARE. GOOD
AFTERNOON, MADAM CHAIR.
HONORABLE MEMBERS, DAVID CAMPOS,
ON BEHALF OF THE COUNTY OF SANTA
CLARA AND OUR VALLEY HEALTH CARE
SYSTEM, IT'S ACTUALLY THE SECOND
LARGEST PUBLIC HEALTH SYSTEM IN
THE STATE. AND I'M SO GRATEFUL
TO HEAR THE CONVERSATION AND
DISCUSSION AROUND EQUITY. THE
REALITY IS THAT PUBLIC HOSPITALS
ARE THE ONES THAT SERVE THE MOST
VULNERABLE IN THESE COMMUNITIES.
AND WE APPRECIATE THE WORK OF
THE ADMINISTRATION OF THE PUBLIC
HEALTH HOSPITAL SYSTEM. BUT I DO
WANT TO SAY THAT WE HAVE
CONCERNS ABOUT OUR PUBLIC HEALTH
SYSTEM. YOU'RE TALKING ABOUT 150
MILLION BEING CAPPED FOR PUBLIC
HOSPITALS. AND WHILE WE
APPRECIATE THE AMOUNT WE ARE
CONCERNED ABOUT THE ABILITY TO
HAVE ENOUGH RESOURCES TO DO
EVERYTHING THAT'S EXPECTED OF US
BECAUSE OF THAT, WE ALSO BELIEVE
THAT IT'S IMPORTANT THAT WE HAVE
ACCESS TO OTHER CATEGORIES
WITHIN THE MCO. AND OF COURSE,
AS WE MOVE AWAY FROM THE COST
BASED PAYMENT, WE NEED TO MAKE
SURE THAT THAT WE'RE TAKING INTO
CONSIDERATION THE IMPACT THAT IT
WILL HAVE IN A DAY TO DAY BOTTOM
LINE OF HOSPITALS. THANK YOU.
GOOD AFTERNOON. LINDA WEI WITH
WESTERN CENTER ON LAW AND
POVERTY. IN ADDITION TO OUR
PREVIOUS COMMENTS RELATED TO THE
SHARE OF COST REFORM, WE SUPPORT
RAISING THE REIMBURSEMENT RATE
FOR COMMUNITY HEALTH WORKERS
PROMOTORAS AS TRUSTED COMMUNITY
MESSENGERS THAT WILL THAT WILL
HELP IN ADVANCING HEALTH EQUITY
AS WELL AS SUPPORT, TIMELY
IMPLEMENTATION OF THE MULTIYEAR
CONTINUOUS ELIGIBILITY FOR
CHILDREN UP TO AGE FIVE, AS THIS
IS CRITICAL TO KEEP COVERAGE
DURING THIS IMPORTANT
DEVELOPMENT TIME. THANK YOU.
THANK YOU. GOOD AFTERNOON. MY
NAME IS ANDREA MACKIE. I JUST
WANT TO SAY I'M BORN AND RAISED
IN SAN FERNANDO VALLEY, AND I'M
A MIXED FILIPINO COMMUNITY
HEALTH WORKER WHO SERVED
PATIENTS WITH DIABETES OUT IN
PANORAMA CITY. ON BEHALF OF THE
STEERING COMMITTEE FOR THE
COMMUNITY HEALTH WORKER
PROMOTORA AND REPRESENTATIVES
POLICY COALITION, WE SUPPORT
RAISING THE REIMBURSEMENT RATES
FOR COMMUNITY HEALTH WORKERS AND
PROMOTORAS TO AT LEAST 87.5% OF
THE MEDI-CAL MEDICARE RATE. THE
CURRENT RATE ONLY COVERS 38% OF
COST, AND IT PREVENTS US FROM
DOING THE IMPORTANT CRITICALLY,
CULTURALLY, AND LINGUISTICALLY
APPROPRIATE CARE FOR OUR
COMMUNITY MEMBERS THAT I WAS
ABLE TO SEE REDUCING EMERGENCY
DEPARTMENT RATES, REDUCING
HOSPITALIZATIONS BY 68. SO WE
CANNOT CONTINUE THIS WITHOUT
RAISING THE RATE. THANK YOU.
THANK YOU SO MUCH. SENIOR
PANORAMA CITY. GOOD AFTERNOON,
CHRISTINE SMITH WITH HEALTH
ACCESS CALIFORNIA HEALTH ACCESS
SUPPORTS MULTI YEAR CONTINUOUS
ENROLLMENT IN MEDI-CAL FOR
CHILDREN UNDER FIVE TO IMPROVE
AND ENSURE ACCESS TO THE. THIS
CRITICAL PROGRAM. WE ALSO
SUPPORT ELIMINATING SHARE OF
COSTS AND EXPANSION OF AND ALSO
SUPPORT THE EXPANSION OF
ELIGIBILITY FOR MEDI-CAL FOR
MEDICALLY NEEDY ADULTS, OLDER
ADULTS AND PERSONS WITH
DISABILITIES. WE ECHO THE
COMMENTS OF C-PEN REGARDING THE
DCS EQUITY ADJUSTMENTS PROPOSAL
AND ALSO SUPPORT INVESTMENTS IN
THE COMMUNITY, HEALTH WORKERS
AND PROMOTORAS CGRTS. THANK YOU.
THANK YOU. TURN MEMBERS KATHY
MOSSBERG WITH THE FIRST FIVE
ASSOCIATION. JUST WANT TO ALIGN
OURSELVES WITH THE COMMENTS MADE
FOR OUR FROM THE COLLEAGUE FROM
CHILDREN'S PARTNERSHIP 0 TO 5 ON
0 TO 5 CONTINUOUS ELIGIBILITY.
IT'S GOOD POLICY. IT'S BEEN
TESTED. WE KNOW IT'S BROUGHT
DOWN THE CHURN RATE TO UNDER 1.
WE KNOW THAT THESE ARE IMPORTANT
YEARS FOR THESE YOUNG KIDS. AND
WE ENCOURAGE THIS COMMITTEE TO
MOVE THIS POLICY FORWARD. THANK
YOU FOR YOUR TIME. MADAM CHAIR,
MEMBERS TIM MADDEN, REPRESENTING
THE CALIFORNIA CHAPTER OF THE
AMERICAN COLLEGE OF EMERGENCY
PHYSICIANS AND WE ARE IN SUPPORT
OF THE ADMINISTRATION'S PROPOSAL
AROUND THE MCO TAX, WE'RE VERY
APPRECIATIVE OF THE INCLUSION OF
EMERGENCY PHYSICIANS AND THE
INCREASE TO OUR REIMBURSEMENT
RATES. THIS WILL GO A LONG WAYS
TO HELP ENSURE THAT OUR
EMERGENCY DEPARTMENTS ARE
PROPERLY STAFFED WITH EMERGENCY
PHYSICIANS. AND WE'RE JUST VERY
THANKFUL TO THE DEPARTMENT FOR
THEIR STAKEHOLDER PROCESS AND
ALLOWING US TO COME IN AND TALK
TO THEM ABOUT IT. THANK YOU.
THANK YOU. GOOD. GOOD AFTERNOON.
COMMITTEE CHAIR MEMBERS. MY NAME
IS JARED GIARRUSSO. CLOAK. ON
BEHALF OF THE UNIVERSITY OF
CALIFORNIA ACADEMIC HEALTH
CENTERS AT UC DAVIS, UCSF, UC
IRVINE, UCLA, UC RIVERSIDE, AND
UC SAN DIEGO. AS YOU HEARD, OUR
ACADEMIC MEDICAL CENTERS ARE
DESIGNATED PUBLIC HOSPITALS FOR
THEIR REGIONS AND THEIR SYSTEMS,
AND THEIR COMMUNITIES. OUR
COMMENTS ARE ALIGNED WITH THE
CALIFORNIA ASSOCIATION OF PUBLIC
HOSPITALS AND HEALTH CENTERS,
AND WE SUPPORT THE PROPOSED
TARGETED PROVIDER RATE
INCREASES, AS WELL AS THE $150
MILLION INVESTMENT IN PUBLIC
HOSPITALS THAT WE BELIEVE WILL
HELP US EXPAND ACCESS, QUALITY
AND EQUITY WITHIN MEDI-CAL.
THANK YOU. THANK YOU. THANK YOU,
MADAM CHAIR AND MEMBERS, SARAH
BRIDGE ON BEHALF OF MAXIM
HEALTHCARE SERVICES, ONE OF THE
LARGEST PROVIDERS OF PRIVATE
DUTY NURSING SERVICES IN
CALIFORNIA. JUST REALLY WANT TO
THANK YOU FOR YOUR LEADERSHIP.
THANK THE COMMITTEE FOR THE
THOUGHTFUL WORK ON THESE PANELS
TODAY. UNDERSCORE THE COMMENTS
MADE BY PANEL TWO. WE ARE REALLY
REQUESTING A RATE INCREASE TO
ENSURE THAT WE CAN GET PROVIDERS
TO CARE FOR OUR MEDICALLY
FRAGILE PEDIATRIC PATIENTS, GET
THEM OUT OF THE HOSPITAL AND
INTO THEIR HOMES WITH THEIR
FAMILIES. KNOW THAT'S IMPORTANT
TO YOU AND ALL THE MEMBERS OF
THE COMMITTEE REALLY WANT TO
UNDERSCORE ONE FINAL POINT THAT
WE KNOW THAT A RATE INCREASE OF
JUST 40% CREATES A SAVINGS, A
SIGNIFICANT ANNUAL SAVINGS TO
THE STATE OF $175 MILLION
ANNUALLY. AND SO IF WE CAN GET
THIS RATE INCREASE DONE, WE KNOW
THAT WE CAN SAVE MONEY IN THE
FUTURE. SO REALLY LOOKING FOR
YOUR SUPPORT ON THIS PROPOSAL.
THANK YOU. THANK YOU. GOOD
AFTERNOON, MADAM CHAIR. MEMBERS
NORA LIN WITH CHILDREN NOW,
CHILDREN NOW IS IN STRONG
SUPPORT OF THE MULTIYEAR
CONTINUOUS ENROLLMENT POLICY FOR
YOUNG CHILDREN. AND WE CALL ON
LAWMAKERS TO MOVE FORWARD WITH
ITS IMPLEMENTATION. THANK YOU.
THANK YOU FOR YOUR COMMENTS.
GOOD AFTERNOON. KATIE LAYTON, ON
BEHALF OF THE CHILDREN'S
SPECIALTY CARE COALITION,
REPRESENTING OVER 3000 PEDIATRIC
SPECIALTY PHYSICIANS THROUGHOUT
THE STATE, PEDIATRIC SPECIALISTS
ARE CRITICAL SAFETY NET
PROVIDERS FOR CHILDREN AND YOUTH
WITH MEDICAL COMPLEXITY. BUT
THIS NETWORK IS AILING FROM
CHRONIC UNDERFUNDING. OVER THE
LAST 20 YEARS. AND FOR A NUMBER
OF PEDIATRIC SUBSPECIALTIES,
WE'RE NOW SEEING 50% OF
FELLOWSHIP SLOTS GOING UNFILLED.
THE MCO TAX IS AN OPPORTUNITY TO
BRING MUCH NEEDED RATE
STABILIZATION TO THIS PHYSICIAN
WORKFORCE, WHICH RELIES VERY
HEAVILY ON MEDI-CAL FUNDING TO
SUSTAIN THE NETWORK. SO WE'RE SO
PLEASED TO SEE THE FOCUS ON
SPECIALTY CARE IN THE 2025 PLAN.
WE WANT TO THANK DCS FOR
PROPOSING TO BRING E AND M CODES
FOR SPECIALTY CARE OFFICE VISITS
AT PARITY WITH MEDICARE. THEIR
POLICY PAPER ALSO OUTLINES THAT
PROCEDURE CODES WILL BE BROUGHT
TO 80% OF MEDICARE. WE REALLY
LOOK FORWARD TO FURTHER DETAILS
ON THIS PLAN, AND ULTIMATELY,
WE'D LOVE TO SEE ALL PEDIATRIC
CODES AT PARITY WITH MEDICARE,
AS THIS IS REALLY WHAT'S NEEDED
TO STABILIZE THE NETWORK,
IMPROVE THE PIPELINE OF
PROVIDERS, AND ULTIMATELY MOVE
THE NEEDLE ON ACCESS. SO THANK
YOU TO BOTH THIS COMMITTEE AND
THE ADMINISTRATION FOR YOUR
CONTINUED WORK ON THIS. THANK
YOU. GOOD AFTERNOON, CHAIR
MEMBERS. MY NAME IS TRENT
MURPHY. I'M WITH THE CALIFORNIA
ASSOCIATION OF ALCOHOL AND DRUG
PROGRAM EXECUTIVES, WE REALLY DO
APPRECIATE, THE GOVERNOR'S
OFFICE AND THE HCS. SIGNIFICANT
INVESTMENTS IN THIS PROPOSAL,
ESPECIALLY AROUND FQHCS AND
RCCS, AND ALSO THE $300 MILLION
EARMARKED SPECIFICALLY FOR
BEHAVIORAL HEALTH THROUGHPUT. I
WILL BE WORKING WITH THE
ADMINISTRATION GOING FORWARD ON
THE IMPLEMENTATION OF THAT $300
MILLION THROUGHPUT. THANK YOU.
GOOD AFTERNOON, MADAM CHAIR. MY
NAME IS CARL COOK. I'M A
DISABLED AIR FORCE VETERAN. IN
JANUARY 2023, MY RIGHT LEG WAS
AMPUTATED BELOW THE KNEE BECAUSE
OF A CHRONIC INFECTION THAT
RENDERED ME UNABLE TO WALK.
AFTER MY AMPUTATION, I WAS SENT
TO A VA VÀ REHABILITATION
FACILITY IN MARTINEZ SO MY WOUND
COULD HEAL AND I COULD REGAIN
ESSENTIAL LIFE FUNCTIONALITY. MY
WOUND HEALED QUICKLY. I WAS
CASTED FOR A PROSTHETIC LEG AND
MY LEG WAS DELIVERED IN MARCH OF
2023, PHYSICAL THERAPY BEGAN
TEACHING ME HOW TO WALK. I WAS
SENT HOME TWO WEEKS LATER WITH A
WHEELCHAIR, A WALKER, AND A PLAN
TO BE FOLLOWED AT THE OUTPATIENT
METHOD OF VA PHYSICAL THERAPY
CLINIC. THE FOLLOWING TWO MONTHS
INVOLVED A LOT OF FOLLOW UP
VISITS AND TESTING OF PROSTHETIC
COMPONENTS TO PROVIDE ME WITH
THE BEST FUNCTIONALITY. I WAS
WORKING WITH PHYSICAL THERAPY TO
LEARN BALANCE, STRENGTH, AND HOW
TO USE THE WALKER AND EVENTUALLY
WALK WITH MY CANE AS OF JUNE
1ST, 2023, I RETURNED TO MY FULL
TIME JOB AS A BUDGET ANALYST
WITH CALSTRS. I HAVE CONTINUED
TO PARTICIPATE IN PHYSICAL
THERAPY PROGRAMS SUCH AS THE PGA
HOPE GOLF PROGRAM AND
RECREATIONAL THERAPY BOWLING
SESSIONS. I'M AN ACTIVE
MUSICIAN. TO WRAP IT UP, SIR.
SORRY. YES, MA'AM. TODAY I WANT
TO URGE YOU TO ALLOCATE THE MCO
TAX INVESTMENT DOLLARS INTO
ORTHOTIC AND PROSTHETIC CARE.
THANK YOU. THANK YOU SO MUCH.
YES, MA'AM. THANK YOU SIR. THANK
YOU FOR YOUR SERVICE. BUT GOOD
AFTERNOON. MY NAME IS ERICA TOTH
FROM LOS ANGELES COUNTY. I'M A
CLIFF OWNER AND HUMBLY ASKING
THIS PANEL TO HAVE SOME INCREASE
FOR MEDI-CAL. REIMBURSEMENT FOR
WAIVER PATIENTS, ALL THE
PATIENTS, FIVE PATIENTS OUT OF
SIX, THEY'RE ALL MEDI-CAL WAIVER
PATIENTS, AND THEY ARE ALL THE
AGE OF 29 AND 30 BETWEEN 29 AND
35. THESE PATIENTS ARE THE ONES
THEY FALL THROUGH THE CRACKS.
THEY DON'T KNOW WHERE TO GO,
CLIFFS IS THE BEST VIABLE OPTION
. AND WE WOULD LOVE TO KEEP THEM
IN OUR HOMES AND HUMBLY ASKING
FOR YOUR HELP. THANK YOU SO
MUCH. THANK YOU. MY NAME IS
IRENE TUCKER, AND I AM THE OWNER
AND FOUNDER OF TWO CONGREGATE
LIVING HEALTH FACILITY. I'M HERE
ON BEHALF OF, CLIFF ASSOCIATION.
IN ORDER TO STRONGLY SUPPORT THE
RATE INCREASE FOR OUR TYPE OF
BUSINESS, IF NOT FOR US DIRECTLY
WORKING WITH THE PATIENTS. I'M
RESPIRATORY THERAPIST MYSELF,
MIRIAM IS A REGISTERED NURSE.
PEOPLE BEHIND ME, ALL THE HEALTH
PROFESSIONALS. IF NOT FOR OUR
DAILY WORK WITH THE PATIENTS,
OUR FACILITIES WOULD BE CLOSED
BY NOW. SO THIS IS VITAL. THIS
IS VERY IMPORTANT. THIS IS TO
KEEP OUR PEOPLE IN THE
COMMUNITY. THIS IS TO PROLONG
LIFE AND PREVENT THEM FROM
INSTITUTIONAL IZATION, WHICH IS
INEVITABLE UNLESS WE HAVE THE
RATE INCREASE. THANK YOU SO MUCH
FOR YOUR ATTENTION. THANK YOU.
IT'S BEEN. MY NAME IS MARY
WILLIAMS AND I'M ACTUALLY THE
FOUNDER OF CLIFFS. IN 1982, THE
FIRST LOAF, 3535, WAS PASSED IN
1986. AND I CAN VOUCH THAT, WE
HAVE WE HAVE BEEN ABLE TO
PROVIDE SERVICES FOR SO MANY
YOUNG DISABLED INDIVIDUALS TO
HAVE A QUALITY OF LIFE. WE HAVE
SAVED THE GOVERNMENT MILLIONS OF
DOLLARS BECAUSE AS OUR CLIENTS
HAVE NOT GONE BACK TO HOSPITALS,
THEY'RE WORKING. THEY'VE GONE TO
SCHOOL, THEY'VE BEEN ABLE TO GET
AND IT'S A COMMUNITY SERVICE.
AND I'M HERE IN SUPPORT OF
GETTING A RAISE BECAUSE I KNOW
FROM FIRSTHAND THAT WE DIDN'T WE
HAVEN'T HAD A RAISE FOR 40
YEARS. AND I'M SO THANKFUL FOR
YOUR SUPPORT AND WHAT I HEARD
TODAY. THANK YOU SO MUCH. THANK
YOU. HI. MY NAME IS SEAN WELCH.
I'M ACTUALLY MARY WILLIAMS'S
DAUGHTER, AND I GREW UP WHEN I
WAS 15 YEARS OLD WITH FOUR
VENTILATOR QUADRIPLEGICS AS
ROOMMATES IN MY HOME. WE MOVED
INTO A HOME AND THAT'S HOW SHE
STARTED THIS. AND, MÉDICO JUST
SAID, WOW, YOU KNOW, YOU'RE
DOING GREAT. AND 20, IT'S QUITE
THE STORY, OF COURSE, BUT
ANYWAY, I JUST REOPENED THREE
TWO CONGREGATES 2020 AND I JUST
AM OPENING GRAND OPENING MY
THIRD ONE IN MAY AND, IT'S AN
INCREDIBLE SERVICE. I DON'T KNOW
WHAT WE WOULD DO IF WE CANNOT GO
ON AND WE WERE. WE ARE ALL
STRAPPED. WE THERE'S OUR OWN
MONEY IS GOING INTO KEEPING THIS
GOING, HOPING AND PRAYING THAT
WE WILL BE RECOGNIZED AS
SOMETHING THAT SAVES. SO MUCH
MONEY, SO MUCH MONEY. AND THANK
YOU SO MUCH FOR LISTENING TO US.
THANK YOU FOR YOUR COMMENTS.
GOOD AFTERNOON. MY NAME IS
CAROLINA KHLEBNIKOVA. I'M A
CLIFF OWNER IN LOS ANGELES. I'M
HERE ASKING FOR SUPPORT TO FOR
RATE INCREASE FOR CLIFF
INDUSTRY. PLEASE HELP US KEEP
OUR DOORS OPEN FOR OUR CLIENTS.
AND I'M VERY GRATEFUL FOR YOUR
SUPPORT AND CONSIDERATION. THANK
YOU. THANK YOU. GOOD AFTERNOON
EVERYONE. I'M A CLIFF OWNER FROM
GLENDALE. MY NAME IS ANI
ARSENIAN AND I'M HERE IN STRONG
SUPPORT OF THE PROPOSED CLIFF
INVESTORS. THANK YOU SO MUCH.
THANK YOU. GOOD AFTERNOON. MY
NAME IS SARKIS SARKISIAN. I'M
ALSO A CLIFF OWNER IN GLENDALE,
AND I DO STRONGLY SUPPORT THIS,
WELL DESERVED, INVESTMENT IN THE
CLIFF. THANK YOU. THANK YOU.
GOOD AFTERNOON. MY NAME IS ANNA
SAHAKIAN, AND I REPRESENT THE
MOST, UNDERREPRESENTED AREA OF
CALIFORNIA. IT'S FRESNO COUNTY,
CENTRAL VALLEY. WE HAVE REALLY
VERY BIG STRUGGLE WITH SERVICES.
I REPRESENT THE CLIFF HOMES IN
FRESNO, AND I REALLY WANT TO
SUPPORT THE INVESTMENT THAT
STATE IS PROPOSING. AND, IN
SUPPORT FOR CLIFF HOMES. THANK
YOU. HELLO AGAIN. MY NAME IS
JULIA RYAN, AND I'M ALSO FROM
FRESNO, CALIFORNIA. AND WE JUST
LIKE TO GIVE OUR SUPPORT FOR THE
PROPOSAL. AND, I'D JUST LIKE TO
TALK ABOUT ONE OF OUR MOST
RECENT RECENT PATIENTS. HE WAS
IN THE HOSPITAL DUE TO A CAR
ACCIDENT, AND THEN HE WAS, YOU
KNOW, SENT OUT TO ANOTHER
HOSPITAL AND ANOTHER HOSPITAL
AND THEY WERE ALL ALL OVER THE
STATE, AND THE FAMILY WAS ABLE
TO PLACE HIM WITH US AND NOW BE
NEAR HIS FAMILY, WHICH IS GREAT
FOR THE PATIENT. AND IT'S ALSO,
I THINK, A GREAT ASSET TO THE
HOSPITALS AS WELL, BECAUSE
THEY'RE NOT SPENDING AS MUCH
MONEY AND THEY'RE SO IMPACTED
AND OVERFILLED, AND JUST HAVING
A PATIENT THERE JUST BECAUSE HE
NEEDED AN IV SERVICE, I THINK IS
TOO MUCH FOR THE HOSPITAL, YOU
KNOW, TO TAKE ON THOSE KINDS OF
PATIENTS. SO WITH US, WE'RE ABLE
TO HELP THE PATIENTS AS WELL AS
HELP THE HOSPITALS AND ALLEVIATE
THEIR IMPACT. SO THANK YOU VERY
MUCH. THANK YOU. GOOD AFTERNOON.
I'M VAL, I COME FROM FRESNO,
CALIFORNIA. AND HERE TO STRONG
SUPPORT FOR CLIFF PROPOSED
INVESTMENT. THANK YOU. THANK YOU
. GOOD AFTERNOON. CHAIR MEMBERS,
JOHAN CARDENAS WITH THE
CALIFORNIA ETHNIC HEALTH
NETWORK. WE SUPPORT THE SHARED
SHARE OF COST BY WESTERN CENTER
AND THE CONTINUOUS CHILDREN
COVERAGE BY THE CHILDREN'S
PARTNERSHIP. I AM ALSO HERE ON
BEHALF OF THE HAVING OUR SAY
COALITION, WHO SUPPORTS THE
REQUEST TO INCREASE COMMUNITY
HEALTH WORKERS RATES, WE BELIEVE
THAT RAISING THEIR WAGES, WE
REALLY HELP ADVANCE HEALTH
EQUITY BY MAKING A REAL
INVESTMENT IN THE SUCCESS OF THE
NEW BENEFIT THROUGH MEDI-CAL
BENEFICIARIES, AS WELL AS TO
CONTINUE TO SUPPORT MANY OF OUR
MOST UNDERSERVED COMMUNITIES OF
COLOR. THANK YOU. THANK YOU.
GOOD AFTERNOON, CHAIR AND
MEMBERS. MY NAME IS DANNY DURAN.
I WORK AT FIRST FIVE LÀ, AND WE
WANT TO URGE THE COMMITMENT TO
FUND THE CONTINUITY OF MEDI-CAL
COVERAGE FOR CHILDREN AGES 0 TO
5 AS PART OF THIS YEAR'S BUDGET,
THROUGH 2022 2023 BUDGET,
CALIFORNIA WAS ONE OF THE FIRST
STATES IN THE COUNTRY TO ADOPT A
MULTI YEAR CONTINUOUS MEDI-CAL
ENROLLMENT PROTECTION FOR
CHILDREN. PROVIDING CONTINUOUS
MEDI-CAL COVERAGE IS AN
IMPORTANT FIRST STEP TOWARDS
ACHIEVING HEALTH EQUITY FOR
YOUNG CHILDREN IN CALIFORNIA, AS
THREE FOURTHS OF CHILDREN
COVERED BY MEDI-CAL ARE CHILDREN
OF COLOR, COMMUNITIES OF COLOR
ARE DISPROPORTIONATELY IMPACTED
AND ARE MORE LIKELY TO LOSE
THEIR MEDICAL COVERAGE DURING
THE ANNUAL RENEWALS. THE VAST
MAJORITY OF CHILDREN WHO LOSE
THEIR MEDICAL COVERAGE ARE
TERMINATED UNNECESSARILY BECAUSE
THEY REMAIN REMAIN ELIGIBLE.
MOVING FORWARD WITH MULTI YEAR
CONTINUOUS COVERAGE PROTECTS
YOUNG CHILDREN'S HEALTHY
DEVELOPMENT AND ENSURES EXISTING
STATE INVESTMENTS IN CHILDREN'S
MENTAL HEALTH ARE UTILIZED. WE
LOOK FORWARD TO THE CONTINUED
CONVERSATION AND APPRECIATE THE
COMMITTEE'S CONSIDERATION OF THE
MATTER. THANK YOU. THANK YOU SO
MUCH. HELLO, I'M FRANCIS MEJIA
FROM ORANGE COUNTY, CALIFORNIA.
I JUST WANTED TO SHOW MY SUPPORT
FOR THE CONGREGATE LIVING HEALTH
FACILITIES, AND ED, THANKS FOR
YOUR TIME AND CONSIDERATION IN
THIS MATTER. THANK YOU. HI
AGAIN, KRISTEN GOLDEN TESTA.
THANK YOU FOR LETTING US SHARE
ON THE MULTI YEAR CONTINUOUS
COVERAGE. BUT I ALSO WANTED TO
SHARE OUR SUPPORT FOR THE
COMMUNITY HEALTH WORKER RATE
INCREASE AS THEY ARE IMPORTANT
WORKFORCE THAT NEEDS SUSTAINING
AND IMPORTANT EQUITY STRATEGY.
THANK YOU. THANK YOU. MADAM
CHAIR, SENATOR ROTH AND MARTIN
HERE ON BEHALF OF AVIANA HEALTH
CARE, FIRST WE JUST WANT TO
THANK YOU FOR THE REALLY
IMPORTANT WORDS YOU SHARED TODAY
ABOUT NEW FRIENDS. AND NUMBER
TWO, RELATIVE TO PD AND PRIVATE
DUTY NURSING. IT'S NOT OFTEN
THAT WE GET TO SEE CHANGES THAT
ACTUALLY PROVIDE RESPOND TO THE
NEED OF THE CHILD. AT THE SAME
TIME, RESPONDING TO THE BUDGET
ISSUES WITH THE STATE, WITH THE
COST SAVINGS THAT THAT PDM WOULD
PROVIDE. THANK YOU. THANK YOU.
SEEING NO OTHER PUBLIC COMMENT
THAT CONCLUDES BUDGET
SUBCOMMITTEE NUMBER THREE ON
HEALTH AND HUMAN SERVICES.