As Home Republicans take into account making deep cuts to Medicaid, Santa Clara County needs to transition to a “single plan” mannequin for Medi-Cal managed care in hopes of enhancing reimbursement charges. However management of the Santa Clara Household Well being Plan, a county-created public well being company, is pushing again, calling the transfer a “hostile takeover” in a not too long ago filed lawsuit.
The change would require approval from the California Division of Well being Care Providers, and is anticipated to take a number of years. However at Tuesday’s Board of Supervisors assembly, the county took steps to facilitate the transition, with supervisors unanimously deciding to take away a lot of the current governing board for the Household Well being Plan, and set up a brand new one which will probably be largely made up of county staff.
“There’s really an urgent need for an efficient unified and effective Medi-Cal strategy that can mitigate these cumulative impacts and support the stability of these critical safety net services,” County Government James Williams mentioned on the assembly. “Those run directly by our county organization, which again are the most significant in terms of volume and hospital care, but also community clinics and other critical Medi-Cal providers too.”
The Household Well being Plan, created by the Board of Supervisors in 1995, was established as a separate entity slightly than a county division due to the legal responsibility and financial issues of working a Medi-Cal managed care plan. However county officers mentioned these worries by no means materialized, and that the separation has created “significant structural challenges” which have made it “difficult to maximize revenue for the local safety net healthcare system.”
The county, which operates the second-largest county-owned well being and hospital system within the state, is closely reliant on federal revenues associated to Medicaid (known as Medi-Cal in California) and Medicare — public medical insurance packages for low-income and disabled individuals, and people 65 and older.
The Household Well being Plan additionally leans closely on the county, in response to a memo written by Williams, and delegates managed care obligations for roughly 60% of its 300,000 members to the county by way of the county-run Valley Well being Plan. The Santa Clara Valley Healthcare system additionally offers hospital and specialty care companies to the Household Well being Plan’s remaining members, and to these on the personal Medi-Cal plan that’s run by Anthem Blue Cross, additional creating the necessity to transfer to a “single plan” mannequin, the county mentioned.
Supervisor Susan Ellenberg, at Tuesday’s assembly, mentioned each greenback that’s “not reimbursed by our managed care plan is a dollar that must come from the county’s general fund,” which finally might affect different companies.
“As a taxpayer I would want to know that my local government is maximizing efforts to capture state and federal funds before using local funds,” Ellenberg mentioned. “As a Medi-Cal recipient, I would certainly want to know that my care isn’t compromised because my managed care plan has decided not to reimburse the cost of my care to the fullest extent possible.”
A lot of native nurses and docs provided help Tuesday for the transition to a “single plan” county. Dr. Praveen Anchala, a radiologist at Santa Clara Valley Medical Middle and vice chair of the Valley Physicians Group, informed supervisors that the transfer is “vital in removing a litany of bureaucracy and hurdles that physicians are jumping through every day to take care of our patients.”
However Household Well being Plan executives and board members are vehemently against the change. Christine Tomcala, the CEO of the Household Well being Plan, informed supervisors that the proposal “is frankly reprehensible.”
“It disrespects our governing board, our staff and most importantly our members,” she mentioned. “These actions simply cannot be justified, not by promises of higher reimbursement rates or access to our reserves, and not by aspirations for a single plan county model. Because however desirable, none of these things can be accomplished without collaborating with Santa Clara Family Health Plan.”
Final week, the Household Well being Plan filed a lawsuit in opposition to the county in Santa Clara County Superior Court docket, asking a decide to intervene and challenge a short lived restraining order to stop the county’s actions on Tuesday. Within the lawsuit, the Household Well being Plan argued that eradicating the board members would violate state legislation because it’s a “separate entity with its own separate fiduciary duties.”
A decide denied the request.
In an announcement, County Counsel Tony LoPresti mentioned the lawsuit has “no merit.”
“We’re pleased that the court did not intervene to stop the Board of Supervisors from properly exercising its policymaking authority to improve managed care in Santa Clara County,” he mentioned.
A consultant from the Household Well being Plan declined to touch upon the lawsuit.
Supervisors finally determined to incorporate three present board members on the brand new governing board of the Household Well being Plan — a suggestion made by Supervisor Margaret Abe-Koga.
“I do believe that together we can work towards a governance philosophy that ensures we are meeting the urgent and essential needs of our community,” Abe-Koga mentioned. “I always place utmost value in community voices, especially when it comes to oversight rules of government.”
