5 Things California: Asm. Arambula, Rx in legislature, CalAIM renewal

This edition of “5 Things We’re Watching” features an update on DHCS’s CalAIM renewal application, a conversation with Medi-Cal expansion advocate Asm. Arambula, and an intriguing report from Manifest MedEx revealing a significant drop in preventive care visits during the pandemic.

Please feel free to email me with any tips or suggestions for what you think we should be covering and — as always — thanks for reading!


Eli Kirshbaum
State of Reform

1. CalAIM renewal pending CMS approval

DHCS awaits federal approval on the renewal of its 1115 demonstration and 1915(b) waiver to continue its CalAIM initiative. The five-year renewals were submitted to CMS on June 30. After certifying the application as complete on July 15, CMS is now holding the required federal 30-day public comment period to collect stakeholder input before issuing a final decision. In its application, DHCS included a summary and responses to some of the over 270 comments it received during the state’s own public comment period, held between April 6 and May 6.

A prominent stakeholder demand received during the state’s comment period came from FQHCs, who oppose the state’s proposed transition to the fee-for-service Medi-Cal Rx program. They say the program’s elimination of 340b cost savings will cause FQHCs to lose money and limit their ability to provide medications to underserved individuals. Another notable request was for DHCS to require coverage of all FDA-approved MAT treatments. Some stakeholders say the current language would potentially exclude the injectable naltrexone treatment option.


2. Rx cost saving initiatives stall in the legislature

Lawmakers have put forward a variety of prescription drug policy initiatives this session, including Sen. Richard Pan’s bill to eliminate deductibles on medications for those with chronic conditions. While this bill has been held in committee since early June, Dr. Shane Desselle, professor of pharmacology at Touro University, said it’s a “tremendous idea.” Another bill from Asm. Adrin Nazarian, which has been held in committee since May, would require health plans to provide information on prescriptions at the request of enrollees — an effort to reduce out-of-pocket costs for patients.

Jennifer Reck, project director at the National Academy for State Health Policy, told me that some of the most impactful prescription drug policy in the state has come from the executive branch. Gov. Newsom’s 2019 executive order mandating a statewide transition to a fee-for-service delivery model for Medi-Cal-covered drugs is delayed indefinitely due to Centene Corporation’s unanticipated acquisition of Magellan Health in January.


3. Q&A: Asm. Arambula on expanding Medi-Cal

Despite securing key Medi-Cal expansions in California’s 2021 budget agreement, Asm. Joaquin Arambula, MD, is continuing to push for universal expansion of the program. After Summer Recess, he hopes to advance AB 4, his “Health for All” initiative calling for universal Medi-Cal coverage, out of the Senate Suspense File and toward passage. He believes too many Californians are “being excluded from accessing a health care safety net that they pay into.”

In this Q&A, Arambula also discusses his bill to limit utilization management restrictions on medication access, which passed its first chamber and now sits in the Assembly Appropriations Committee. He said his experience as an emergency room doctor with patients who struggled with the utilization management process inspired him to sponsor AB 347, describing it as “a big step forward for us as a state.”


4. Possible PPE reimbursement for providers

California providers could receive reimbursement for PPE from health plans during future public health crises if Sen. Josh Newman’s SB 242 clears its last legislative hurdle. The bill is a response to the pandemic experience of providers, who confronted both a loss in patient revenue and a rise in PPE cost. This crippled small and medium practices who were already struggling financially, forcing some to close.

Testifying in support of the bill in the Assembly Health Committee, Dr. Ariane Terlet said, “The cost of PPE has gone up exponentially since the start of the pandemic … And while the costs have gone down significantly(from the initial increase), they’re still two-to-three times the price that we paid originally.” The committee passed SB 242 last week, and the bill will likely face a vote on the Assembly floor when the legislature returns from Summer Recess on August 16.


5.  Preventive care visits plummeted in 2020

A recent report from Manifest MedEx, California’s largest nonprofit health information exchange, shows preventive care visits in the state decreased by 20-41% in 2020. The report examined claims data from 4 million Californians that revealed steep declines in areas like preventive care, ambulatory services, and care for younger individuals resulting from deferred care and a strained health system amidst the pandemic.

Perhaps the most severe consequence of neglected preventive care visits is delayed cancer diagnosis. Colonoscopies — which fell by 90% during April and May of 2020 — as well as mammograms and PET scans all saw notable decreases. “It will be important to close the gap in screening and monitor whether colorectal cancer, as well as other cancer types, will be diagnosed at later stages in California over the next few years,” the report says.