5 Things California: Medi-Cal Rx, Budget hearing, Post-COVID telehealth policy

We are gearing up for our 2021 Northern California State of Reform Health Policy Conference coming up on April 22nd. Expect almost 400 of your closest friends in California health care at this virtual event where you’ll be able to network and learn about some of the most pressing topics in California health care and health policy. We’d be honored to have you. Early Bird rates end on Friday.

With that, here are 5 things we think are worth watching in California health care for February, including a 6th item with some late breaking news from last night.





With help from Emily Boerger

1. Dr. Garcia says Latino community is in “the eye of the storm”

Dr. Don Garcia is the Medical Director at Clínica Monseñor Oscar Romero, a Federally Qualified Health Center that operates two clinics in Los Angeles and primarily serves Latino and immigrant populations. In this Q&A, Garcia discusses the health disparities facing the Latino community during the COVID-19 pandemic, inequities in the vaccine rollout, and potential solutions to improve the state and local response to the virus.

Dr. Garcia says the Latino population is in the eye of the storm, but no one is hearing their cries for help. “We have 12,000 member lives and we’re surrounded by a community of over a million Latinos. [Oscar Romero] received one shipment of 100 vaccines only. And then [last] week, another 100… And we are the hardest hit population of the pandemic with infection, morbidity and mortality, and positivity. It has no sense… Something is upside down here.”

2. Post-pandemic telehealth policy

DHCS released its post-COVID-19 telehealth policy recommendations earlier this month, highlighting the policy changes enacted during the public health emergency that the department believes should be made permanent. DHCS says it’s looking to “modify or expand the use of synchronous telehealth, asynchronous telehealth, telephonic/audio-only, and other virtual communication, and to add remote patient monitoring to create greater alignment and standardization across delivery systems.”

The 14-page report also details the flexibilities established during the public health emergency that the department does not recommend for continuation. Further details are available in the related proposed trailer bill legislation. The Assembly Committee on Health will take up the topic of post-pandemic telehealth policy in a committee hearing on Tuesday at 2:30pm.


3. Implications of “chronic COVID”

I recently had the opportunity to speak with Dr. Chris Murray, Executive Director of the Institute for Health Metrics and Evaluations (IHME), where I learned something I didn’t know. Based on data from the Novavax COVID vaccine trial, being previously sick with COVID-19 appears to offer no protection from being infected with the new South African strain of the virus.

Without cross-variant immunity, Murray says this data indicates we may be moving to a “world of chronic COVID” where every winter we treat COVID as we do the flu. I outline three immediate things that may change for us in this column. Perhaps the most important is this: hospitals and their current financing models are in trouble. Video of my full conversation with Murray is available here.

4. Budget update from the legislature

The Senate Health and Human Services Budget Subcommittee recently heard testimony from state agencies on proposed changes to the governor’s budget to support new programs and continued expenses. The list of requests includes $7.6 million in 2021-22, $4.1 million in 2022-23, and $1.3 million annually thereafter to implement equity-related proposals at CHHSA.

OSPHD is requesting $11.2 million in 2021-22, $24.5 million in 2022-23, $27.3 million in 2023-24, and $27.3 million annually thereafter to establish an Office of Health Care Affordability. Last week, the subcommittee also held a meeting to discuss funding requests from the Department of Public Health. State of Reform Reporter Sydney Kurle offers a rundown of the funding requests here.


5. Questions emerge about statewide homelessness efforts

A report from the state auditor finds that the “state’s uncoordinated approach to addressing homelessness has hampered the effectiveness of its efforts.” The report finds at least 9 state agencies, overseeing 41 different programs, were allocated $13 billion during FY 2018-19 through 2020-21 to address homelessness, but with no single entity responsible for developing a statewide strategic plan, their efforts are inefficient.

The audit follows a recent LAO report which finds that instead of relying on one-time funding solutions to address homelessness, California would benefit from a clear, long-term strategy. The report dives into the details of the $1.75 billion in one-time General Fund spending related to homelessness proposed in Gov. Newsom’s 2021-22 budget proposal, and poses key questions legislators should ask as they consider the funding requests.


Bonus: Medi-Cal Rx put on hold indefinitely

Late yesterday, DHCS announced they were delaying the April 1 start date of the Medi-Cal Rx initiative. Further information would be provided in May following a “review (of) new conflict avoidance protocols.” The project’s contracted vendor is Magellan Health. In January, the Centene Corporation announced they would be acquiring Magellan Health. Centene operates two Medi-Cal plans: Health Net and California Health and Wellness, as well as two other non-Medi-Cal brands in California. The two Medi-Cal plans serve just under 4 million beneficiaries.

DHCS says “This transaction was unexpected and requires additional time for exploration of acceptable conflict avoidance protocols to ensure that there will be acceptable firewalls between the corporate entities to protect the pharmacy claims data of all Medi-Cal beneficiaries, and to protect other proprietary information.” It says the program “remains of utmost importance,” in spite of repeated operational delays. The first go-live date of January 1 was delayed at the last minute, causing some heartburn among MCOs in California.