Medi-Cal revamp in works

OC Register ^ | 7/29/04 | Jim Hinch

[NormsRevenge]

SACRAMENTO – As California's convoluted budget drama winds down, a handful of health experts is quietly finalizing Gov. Arnold Schwarzenegger's next major government shakeup: An overhaul of the health-care safety net larger than any attempted in state history.

Schwarzenegger's top health deputies are preparing a plan to redesign Medi-Cal, California's $31 billion health insurance program for the poor, disabled, blind and elderly.

The plan, tentatively scheduled for release next week, will likely ask the poor to pay more for their health care, allow doctors to withhold care from patients unable to pay and move beneficiaries into managed-care programs, such as the nonprofit HMO that covers Orange County's 339,000 Medi-Cal patients.

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Medi-Cal costs grew 73 percent in the past decade - 4 percentage points less than private insurance plans. Medi-Cal's annual cost per beneficiary - $4,465 - is the lowest of the 10 largest states, and $2,063 less than the national average. At the same time, California's population of elderly residents - who, along with the disabled, are the most expensive to care for - is growing rapidly.

Because Medi-Cal gets half its funding from the federal government, administration officials must get a waiver from Washington to make changes. They plan to apply in September and begin implementation next year.

[grellis]

If I'm not mistaken, the Medi-Cal contract was taken over by Maximus just a few months ago.

Maximus got the Medicare contract here in Michigan three or four years ago (maybe more, but in recent years, anyway). The company has saved the state millions since taking over the contract from EDS, who, in turn, saved the state millions when they got the initial contract when the state privatized it. I think the same will ultimately happen in CA, but it won't be overnight. I hope the company IS given the time to turn the mess around. The worst possible scenario is to hand everything back to the state.

[grellis]

Make all medical and prescription expenses tax deductable.

Sign me up! That would include everything, right? Copays, out of pocket expenses, and the $90 our family shells out weekly just to have coverage, right? Count me in.

[grellis]

I completely agree--I wasn't trying to be sarcastic at all (Ido have my moments !).

Hubby had a brain tumor scare this year. Thank God it turned out to be something very innocuous. Thank God we happened to have a second car we could sell in order to cover our expenses. We spend roughly $300 a month for "coverage". The only reason why we have health insurance at all is for catastrophic possibilities. The nickle-and-diming is what's doing us in.

Just one quick example: Two of our sons see an ENT every two months. Total charge per visit, per child: $65. Our copay: $40. Since the ENT is a BCBS provider, BCBS pays only $7 per visit, per child. For this we pay nearly $300 a month. It makes me grind my teeth.

[Mamzelle]

re: Seriously, it seems to me that if we only insured for catastrophic occurances with $2,500 deductible the cost would be pretty low.)))

Make it a $5K deductable, and require all participants by law to keep $10K in a MSA.

Give the hospitals some legal safe harbor in controlling expenses. At present, they go for the expensive stuff just to generate a "good faith" paper trail for the inevitably courtroom antics of the John Edwards.

If all you're paying is $100/week, you are fortunate for now.

A bad moon is rising--even the well-off will shortly go uninsured.