Health Reform Issues: At A Glance – Issue 10, May 31, 2013
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HEALTHCARE REFORM ISSUES: AT A GLANCE
VOL. 1, ISSUE 10
MAY 31, 2013
A bi-weekly newsletter brought to you by the California Institute for Mental Health
TOP STORIES
Covered CA Identifies
13 Insurance Plans
and Rate Response
ACA Implementation:
A CSAC Position
White House: Asian
Americans, Pacific
Islanders and Care
Medicaid Expansion
Network of Care:
Mental Health
Indicators
Update on Health Care Reform Implementation: Covered California Identifies Thirteen
Health Insurance Plans and the Response to their Released Rates
This May, Covered California announced their selection of thirteen health insurance plans for
2014. The plans are a blend of non-profit and commercial plans along with Medi-Cal and
regional plans. READ MORE
Affordable Care Act Implementation Debate Heats Up: A CSAC Position
Senate and Assembly Budget Committees heard the Governor’s May Revision budget
proposals this May focusing primarily on proposals set forth by the Administration for calculating
county savings associated with the Medi-Cal expansion and the redirection of those funds to a
new realignment of CalWORKs programs. READ MORE
White House: Removing Obstacles to Care for Asian Americans and Pacific Islanders
May is Asian American and Pacific Islander Heritage Month. On the White House website, a
blog this month focused on the variety of facts related to our country’s Asian American and
Pacific Islander communities. READ MORE
Medicaid Expansion
State Refor(u)m is continuing to track state Medicaid expansion activities. A revised chart
includes additional details on key elements of Medicaid expansion bills that have been
introduced in state legislatures, such as proposals to provide coverage to the expansion
population through qualified health plans on the exchange, special requirements related to cost sharing or care
delivery, or options allowing a state to discontinue participation in the expansion. READ MORE
Network of Care for Behavioral Health Adds Community Health Indicators
The Network of Care is a comprehensive, community-based Web portal that serves as a onestop shop for all pertinent information regarding behavioral-health services, support,
knowledge, networking, news and more. They recently added an innovative feature, “Mental
Health Indicators.” READ MORE
Announcement – National Association for Mental Illness (NAMI) Releases Report on
Medicaid Expansion and Mental Health Care READ MORE
California Institute for Mental Health
2125 19th Street, 2nd Floor Sacramento, CA 95818
(916) 556-3480
Health Reform Issues: At A Glance – Issue 10, May 31, 2013
Update on Health Care Reform Implementation: Covered California Identifies Thirteen
Health Insurance Plans and the Response to their Released Rates
Covered California’s “rigorous review” and selection process resulted in a portfolio of plans that
achieve three objectives:
 A robust choice of offerings throughout the state
 Affordable prices
 Access to doctors and hospitals
The tentative selection of health plans will be subject to a rate review by state regulators. New standards for
benefit design will be brought about under the Affordable Care Act and, as a consequence, make direct
comparisons of premiums to be offered and existing premiums in the commercial individual market be difficult.
However, Covered California has stated one frame of reference for premiums to be offered can be done by
comparing future premiums to those offered in the small employer market in California. Both the small employer
market and Covered California are competitive markets and offer guaranteed issue – you cannot be denied for
pre-existing conditions.
Covered California will have an ongoing relationship with its partnering health plans, working collaboratively to
promote care improvements, foster prevention, and seek to reduce costs by promoting better care. Once plan
rates are approved by state regulators, Covered California looks forward to signing final contracts and
beginning the work of enrolling millions of Californians in the following health plans:
• Alameda Alliance for Health
• Anthem Blue Cross of California
• Blue Shield of California
• Chinese Community Health Plan
• Contra Costa Health Plan
• Health Net
• Kaiser Permanente
• L.A. Care Health Plan
• Molina Healthcare
• Sharp Health Plan
• Valley Health Plan
• Ventura County Health Care Plan
• Western Health Advantage
For more information on Covered California, information on health plans selected and additional resources,
please review the following:
Covered California is charged with creating a new insurance marketplace, in which individuals and small
businesses can get access to health insurance. It is overseen by a five-member board appointed by the
Governor and Legislature. Please visit www.CoveredCA.com for more information. There are additional
resources including highlights from the May 23rd press conference, a booklet with the health plans summary,
and frequently asked questions about Covered California Health Plans.
Covered California: Response to Released Rates
There has been some recent controversy surrounding the “rate” that will be set for purchasing standard health
plans in California’s Exchange. There was buzz that the rates would simply be too high for folks who are
currently uninsured. However, now that Covered California has announced the 2014 rates for standard plans,
there is a question that while the rates are “good”, will they be good enough? Some people are cautious about
California Institute for Mental Health
2125 19th Street, 2nd Floor Sacramento, CA 95818
(916) 556-3480
2
Health Reform Issues: At A Glance – Issue 10, May 31, 2013
Californians purchasing health care. People may perceive paying the one-time penalty as a “cheaper” option
and consequently choose to pay to remain uninsured rather than pay to be insured.
The rates Covered California is announcing are two percent above the 2013 average premium to 29 percent
below the rates in California’s most populous markets. This is impressive since the 2014 products include
doctor visits, prescriptions, hospital stays, and more essential benefits. Additionally, there is financial protection
like a maximum out-of-pocket cost of $6,350 which will dramatically reduce the chances of someone filing
bankruptcy because of medical bills.
To have a glance at the rates being offered, visit: http://www.cahba.com/covered-california/rates.htm
Affordable Care Act Implementation Debate Heats Up: A CSAC Position
Counties have been in opposition to the proposal by the Administration and voiced “unanimous
opposition to the Administration’s provisions associated with realignment and significant
concerns with the proposed formula for determining county savings.”
The California State Association of Counties (CSAC) provided the following summary of the Administration’s
approach:
(May Revise) includes a reduction in 2013-14, before any evidence of county savings is produced… the
$300 million estimated redirection for 2013-14 is too much, too soon and will result in immediate
reductions to the county health care safety net. The formula also takes into account all revenues spent
on indigent health care, not just 1991 realignment funds, meaning that the amount that would be subject
to redirection is the entirety of counties’ 1991 health realignment accounts. Finally, the mechanism the
Administration has outlined leaves counties with little if any resources for the provision of health care
services to the remaining uninsured and public health services.
Counties with Public Hospitals will consequently not fare well if the Administration proposal moves
forward, CSAC was sure to point out that a solution had to be found that was acceptable to all 58
counties and that included provider, payer and hybrid counties, meaning counties, that contract for
services; operate clinics but not hospitals; and smaller counties that pool their resources to purchase
health care through the County Medical Services Program (CMSP).
The Senate Budget Subcommittee 3 on Health and Human Services took action to reject the Administration’s
proposal for realignment and left the issue of the proposed formula open. Understanding the significance of the
Medi-Cal expansion, it is likely that there will be continuing discussions with counties, stakeholders, and the
Governor on the issue until the budget is ultimately approved.
For more information, navigate to this link: http://www.csac.counties.org/
White House: Removing Obstacles to Care for Asian Americans and Pacific Islanders
There were a number of different salient facts about the communities including information
about Asian Americans and Pacific Islanders with regard to the Affordable Care Act and other
health issues. Here are some of the points covered in the blog:
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This is the fastest growing ethnic group in the United States
This group comprises many diverse populations with respect to educational and socioeconomic
backgrounds, linguistic characteristics, and unique cultural traditions from their countries of origin
The vibrant cultures represented have different styles and patterns of communication for giving and
receiving information
California Institute for Mental Health
2125 19th Street, 2nd Floor Sacramento, CA 95818
(916) 556-3480
3
Health Reform Issues: At A Glance – Issue 10, May 31, 2013

Many members of the community are not able to achieve their full health potential as disparities in health
care persist, specifically as it pertains to the availability of language assistance services and, historically,
Asian Americans and Pacific Islanders have been less likely to have health insurance than the population
as a whole
The White House indicated that The Affordable Care Act provides one of the most important levers by which we
can advance the vision of reducing health disparities. According to the White House, “the law will remove
obstacles to care that many Asian Americans and Pacific Islanders historically have faced and ensure that they
will have better access to stable, affordable health insurance and high quality health care suited to their needs.”
The hope is the Affordable Care Act expands access to preventive care and reduces health disparities for Asian
Americans and Pacific Islanders by assisting with the early identification and prevention of many diseases that
have a disproportionate impact on this group. Recommended preventive services covered without cost-sharing
under the health care law include well-child visits, blood pressure and cholesterol screenings, Pap smears and
mammograms for women, and flu shots for children and adults.
An estimated 2.7 million Asian Americans and Pacific Islanders with private insurance currently have access to
expanded preventive services with no cost-sharing because of the health care law. Further, the nearly one
million elderly and disabled Asian Americans and Pacific Islanders who receive coverage from Medicare also
have access to an expanded list of preventive services with no cost-sharing including diabetes, colorectal
cancer screening, and bone mass measurement. In addition, young Asian American and Pacific Islander adults
under age 26 who would have been uninsured now have coverage under their parent’s employer-sponsored or
individually purchased health plan. This means that more than 97,000 Asian Americans have gained coverage.
However, there are still barriers to overcome in the provision of culturally competent health care, including
communication in a language that individuals understand. Nearly 61 million people speak a language other than
English at home. Such language barriers impact the ability of individuals and families to adequately access
health care and human services. Additionally, individuals with limited ability to read, speak, write or understand
English are less likely to have a regular source of primary care.
Lastly, there is an opportunity to end insurance discrimination. In the past, insurance companies could deny
coverage to children because of a pre-existing condition such as cancer, asthma, or diabetes. This
discrimination is no longer allowed, and beginning in 2014, insurers are banned from discriminating against
anyone with a pre-existing condition. This is important because, for example, in Hawaii, adult Asian Americans,
Native Hawaiians and other Pacific Islanders have high rates of diabetes.
So there is great optimism with the ACA and the potential to increase access, equity of care and patient
confidence that could be a major driver in the effort to engage and reduce disparities in all communities,
including the Asian American and Pacific Islander community.
For the article, visit http://www.whitehouse.gov/blog/2013/05/23/removing-obstacles-care-asian-americans-andpacific-islanders.
California Institute for Mental Health
2125 19th Street, 2nd Floor Sacramento, CA 95818
(916) 556-3480
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Health Reform Issues: At A Glance – Issue 10, May 31, 2013
Medicaid Expansion
You will also find direct links to statements from governors or executive branches and fiscal and
demographic analyses from states or other institutions.
A chart was developed on the website to record legislation introduced, but does not track the
exact status of bills moving around in state legislatures. Like all State Refor(u)m research, the
chart is a collaborative effort with users of the website. State Refor(u)m captures the health
reform comments, documents, and links submitted by health policy periodically supplements, analyzes, and
compiles key content:
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State & Status of Expansion
•
Governor or Executive Branch Activity
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Legislative Activity: State Bills
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Legislative Activity: Cost Sharing
•
Legislative Activity: Premium Assistance
•
Legislative Activity: Special State Financing
•
Legislative Activity: Severability Clause
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Legislative Activity: Medicaid Program Studies
•
Fiscal & Demographic Analysis: State Government
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Fiscal & Demographic Analysis: Other
Take A Glance: https://www.statereforum.org/node/11675
Network of Care for Behavioral Health Adds Community Health Indicators
The Mental Health Indicators are a spinoff of the new Network of Care for Public Health
Assessment and Wellness, which aggregates population health data from all over the United
States into 170 customized, continuously updated Health Indicators.
Link to on-line announcement:
http://links.mkt3914.com/servlet/MailView?ms=NjI4NjQyOAS2&r=NDQ1OTI4NjM2MQS2&j=NzUyMTIwNTAS1
&mt=1&rt=0
For more information about the Network of Care or to schedule a brief Webcast demo, please contact Bruce
Bronzan at bbronzan@trilogyir.com or (415) 458-5900.
Announcement – National Association for Mental Illness (NAMI) Releases Report on
Medicaid Expansion and Mental Health Care
NAMI released a new report, Medicaid Expansion and Mental Health Care. The report emphasizes the
importance of Medicaid as a financing mechanism for mental health services and makes the case that Medicaid
expansion represents the best chance states have to strengthen mental health systems. Appendices provide
state specific information on the fiscal impact of Medicaid expansion, eligibility figures for people with mental
illness, demographics of the uninsured population with serious mental illness and state status regarding
whether or not to expand Medicaid in 2014.
California Institute for Mental Health
2125 19th Street, 2nd Floor Sacramento, CA 95818
(916) 556-3480
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Health Reform Issues: At A Glance – Issue 10, May 31, 2013
Policy recommendations:
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NAMI calls on states to cover evidence-based mental health services in Medicaid expansion plans and
on Health and Human Services to define a single comprehensive Essential Health Benefit in 2016.
NAMI urges varied and innovative strategies to enroll hard to reach individuals living with mental illness
in Medicaid expansion plans, recommending that navigator contracts be awarded to mental health
agencies or advocacy organizations to conduct education, outreach and enrollment of hard to reach
individuals with mental illness.
NAMI calls on Centers for Medicare and Medicaid Services (CMS) to monitor states and provide
guidance to ensure full compliance with the Early and Periodic Screening, Diagnosis and Treatment
(EPSDT) mandate.
NAMI calls on CMS to abolish the IMD exclusion.
For more information: www.nami.org/medicaidexpansion
Remaining Connected
JUNE
WEBINAR
Bridging Criminal Justice Systems and Community Healthcare: Integration’s Role in Reentry
Tuesday, June 18, 2:00-3:30pm EDT
Register today: www.integration.samhsa.gov/about-us/webinars
In 2014, an estimated 22-30% of people newly eligible for Medicaid will have had contact with local criminal justice
systems. Creating new levels of community engagement will be vital to HRSA-funded safety-net providers given
the complexity of health and behavioral health needs of individuals transiting out of criminal justice systems.
Expanded access to healthcare brings abundant opportunities and showcases the need for new community
partnerships with local criminal justice systems.
Learn why a public health approach will meet this community need, and what providers need to bridge the
integration of primary, behavioral health, and criminal justice. Examine case studies, explore research-based
practices, and gain insight into how health centers can engage criminal justice systems and improve care
coordination.
2013 NAMI National Convention
June 27 – 30, 2013
San Antonio, TX
http://www.nami.org/template.cfm?section=convention
California Institute for Mental Health
2125 19th Street, 2nd Floor Sacramento, CA 95818
(916) 556-3480
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