ahf aca workshop: robin hodgkin, director of imperial county health department
DESCRIPTION
AHF started their ACA Workshop with opening remarks from Alliance Healthcare Foundation's Executive Director Nancy Sasaki. Program Officer Sylvia Barron introduced the first presenter, Robin Hodgkin, Director of Imperial County Health Department. About the Event: To help those in Imperial County prepare for how the Affordable Care Act will impact work the community, Alliance Healthcare Foundation hosted a workshop on Sept. 11, 2013 at the San Diego Gas & Electric Renewable Energy Resource Center in Imperial County. In this workshop, we explored Covered California enrollment with an overview of multiple health plans and eligibility, discussed the community clinic perspective, and considered its potential impact on the underserved in Imperial County. This workshop was free and included a healthy lunch for all attendees. Watch the complete event here: http://www.youtube.com/playlist?list=PL-CwI2rkvFSV1_XYs45kGqdJj_R-jfXHPTRANSCRIPT
An Overview of
Healthcare Changes inImperial County
Robin Hodgkin, MPADirector of the Imperial County Public Health Department
Affordable Care Act
Medi-Cal Managed Care
Triple Aim
Accountable Care Organization
Mental Health Parity Act
Meaningful Use
Healthcare InformationPortability And Accountability Act
Clinical Pathways
Public Health Accreditation
Evidence Based Practice
Mental Health Services Act
Two Changes Impacting Imperial County Residents
Now
Medi-Cal Managed Care
Affordable Care Act
Medi-Cal Managed Care
30 Counties with approximately 90% of Medi-Cal recipients are already in Managed Care
State requiring remaining 28 counties (all rural) transition by the end of 2013
Imperial County to implement: November 1, 2013
Medi-Cal Managed Care
Managed Care
An organized system of healthcare across the spectrum of healthcare providers in a community that is coordinated and administered by a Health Plan
Medical Home Every member assigned a primary care home/PCP Case management and Coordination of Care Emphasis on prevention and wellness Focus on keeping medical services in county as appropriate
Health plans can offer more resources Nurse advice lines Transportation assistance Help getting appointments with specialists Health Education (e.g. chronic care classes) Quality Improvement Programs Grievance systems Threshold languages for health plans Appropriate reading level of member materials
Differences Between Fee for Service andMedi-Cal Managed Care
Public Reporting Healthcare Effectiveness Data and information Set
(HEDIS)/Quality and Outcomes Data Financial Data Retention Data
Designed to assist the member with navigation, decision making and grievances Health Care Options (HCO) Office of the Ombudsman, DMHC
More Differences……
Aid Category Count %Aged 7,100 13.5%
Disabled 7,674 14.6%
Families (& Child) 35,744 67.9%
Other 2,093 4.0%
Total 52,611 100.0%
Imperial County Medi-Cal Eligible
Source: DHCS
Imperial County Health Leadership Forum:
Imperial County Board of Supervisors Imperial County Department of Public Health El Centro Regional Medical Center Pioneers Memorial Health Care District Imperial County Medical Society Clinicas de Salud del Pueblo Imperial County Department of Social Services Imperial County Department of Behavioral Health
Oversight of the Managed Care Transition in Imperial County
Medi-Cal Managed Care System inImperial County
Two-Plan Model Consists of a Local Initiative Health Plan and a
competing commercial Health Plan
Both Health Plans must meet federal and state requirements before serving Medi-Cal beneficiaries.
The Local Initiative Health Plan also works with the healthcare safety net to develop and implement additional initiatives and programs to meet the unique needs of our community. There is also local oversight and participation in quality improvement.
Medi-Cal Managed Care System inImperial County
Our Two Health Plans are –
Local Health Initiative Health Plan:California Health and Wellness
Commercial Health Plan:Molina
Medi-Cal Managed Care System inImperial County
Health Plan Selection
Medi-Cal beneficiaries have the right to choose a Health Plan
If a choice is not made, the beneficiary will be randomly assigned to a Health Plan
Initial Health Plan section opportunity began September 1, 2013 and will end October 25, 2013.
Medi-Cal beneficiary can change their Health Plan selection at any time – the change may take up to 45 days to process.
Health Care Options, a state funded organization, is tasked with helping beneficiaries select their Health Plan.
The Affordable Care Act
Affordable Care Act
Signed into law in March 2010
Designed to be incrementally implemented over several years
Supreme Court decision rendered in March 2012 Upheld the Individual Mandate Gave states more flexibility in mandate to expand
Medicaid (Medi-Cal) coverage
Goals of Affordable Care Act
Expand access to health insurance coverage
Improve Coverage Terms
Improve Healthcare
Improve Health
Not Included in the Affordable Care Act
Public Option
Bi-Partisan Consensus
Tort Reform
Insurance Rate Controls
Undocumented Immigrants
Affordable Care Act - Effective 2011
Dependent coverage up to age 26Preventive services covered at no costNo annual limits on essential benefitsNo lifetime limitsCancellations prohibitedNo pre-existing condition exclusions for
children (under 19)Required appeal process for any denialLong-term care program
Affordable Care Act - Effective 2014
Essential Benefits plan effectiveExpansion of Medi-CalInsurance Exchange operationalEmployers (with more than 50 FTEs) required to
provide health insurance - DelayedIndividuals required to have health insuranceFree Choice Voucher to employees making less
than 400% of poverty levelHealth plans required to report on quality of carePre-existing condition exclusions are prohibited
for all
Newly eligible Medi-Cal beneficiaries could be enrolled from 2014-2018
20,554 estimated0-17 2,49818-64 17,788Over 65 268
Change in eligibility requirements Increase in eligibility income up to 133% FPL Single childless adults No asset test
Affordable Care Act Medi-Cal Expansion
What to Expect and What to Do
The changes will continue to change
Some of the changes will remain controversial
Some of the changes will happen very quickly and some with unfold over the next 2-3 years
Become involved and informed
Know who to contact about what
Contact List for Medi-Cal Managed Care
Health Care Options www.healthcareoptions.dhcs.ca.gov 1-800-430-4263
California Health and Wellness www.cahealthwellness.com (877) 658-0305
Molina www.molinahealthcare.com (888) 665-4621
Medi-Cal Ombudsman: [email protected] 1-888-452-8609