Blog: Three For Thought
Kris Calvin, AAP-CA CEO
For questions or comments on Three For Thought, contact Kris at kcalvin@aap.net. You are invited to post or share these updates. Thanks for your interest in AAP-CA advocacy and activities!
Special Alert: The State Budget Process and Proposed Cuts to Children’s Health Services
AAP-CA actively and aggressively advocates in the state budget process on behalf of children and pediatricians .This year will be particularly challenging since the cuts to children’s health services proposed by the Governor together represent the most significant change to the public sector delivery of health care to children in California in over a decade.
These include:
- The elimination of the Healthy Families Program (HF) and movement of one million HF children into Medi-Cal managed care over the next 9 months.
- Reduction of state payment to Healthy Families plans by 25%.
- Expansion of Medi-Cal managed care to all counties in California, including rural counties that are currently only fee-for-service.
- Creation of a process to streamline the ability of the state to reduce Medi-Cal benefits, with a goal of saving the state $75 million this year.
- New stringent income restrictions on eligibility for the Medical Therapy Program for children and families.
- $200 million in General Fund cuts to the Department of Developmental Disabilites.
AAP-CA is committed to working with the state to encourage smart choices and to develop creative strategies to close the budget gap. We understand that structural changes must occur in California’s revenues and expenditures—if California continues “business as usual”, with the same tax rules and rates and the same expenditure commitments we had last year, the state will be $13 billion dollars short to pay its bills this budget year. None-the-less, short-sighted decisions that restrict access to care and reduce the quality of that care for the must vulnerable children in the state will exacerbate the budget problem long-term, not solve it.
State budget development lasts six months or more. The process is similar to a high stakes tennis match—the Governor serves up his budget proposal and then steps off the court, leaving the Legislature to hit the ball back and forth for months. Signature game moves include the Republicans refusing to raise taxes and the Democrats rejecting significant cuts, at which point both walk off in disgust. The Governor returns to play in May when he serves up a revised budget proposal, intended to address realities of state tax revenues received by the April 15th filing deadline, as well as political realities uncovered in the legislators’ deadlocked rally. Only then does the match begin in earnest, as Legislators must play round-the-clock to create a legally mandated balanced budget. (The deadline is June 30th, but that is rarely met.) In the end, the Governor takes the ball out of play one last time, makes his own line item changes to the budget (within legal constraints), and signs the revenue and expenditure decisions that are the law of the land for that year.
AAP-CA picks up our racket from Day 1 of the process, and leaps the net as necessary to engage with both sides of play! For example, merging Healthy Families and Medi-Cal would result in administrative savings, and would enable current Healthy Families children to be eligible for the federal Vaccine for Children’s “free” vaccine program, reducing costs to providers and the state. But that proposal can only work if attention is paid to adequate reimbursement, eliminating red tape, and evaluating the transition in a thoughtful process that allows for adjustments when access and quality are at risk. AAP-CA was successful last year by working with both the Governor and the Legislature to slow down the transition in order to consider these issues. In short, it is through a nonpartisan, evidence-based approach—building on the credibility that pediatricians have as champions for children— that we are able to influence outcomes. We will continue to advocate this year for “budgeting with care for children”, even as cost imperatives are taken into account.
Special Alert: Feds approve adult provider cuts under Medi-Cal, but NOT pediatric reimbursement!
Today, the Centers for Medicare and Medicaid Services (CMS) at the federal level approved California’s request to cut physician and other provider reimbursement under
Medi-Cal for a wide range of services.
However, due to
concern about already limited access for pediatric services, reimbursement for providers of children’s
services will not be cut!
We are happy that the Department of Health Care Services in California (CA DHCS) and CMS have gotten
the clear message from AAP, both nationally and from your local CA AAP Chapters working together at the state level,
that pediatric access in Medi-Cal is already in crisis and could not withstand another physician reimbursement cut.
At the same time, it is hard for kids to be healthy if their parents are not, and these newly approved cuts to
physicians who care for adults under Medi-Cal are extremely troubling.
For more information see attached for the CA DHCS press release.
AAP-CA is a statewide coalition of AAP-CA Chapters 1, 2, 3 and 4 dedicated to promoting
the lives and health of children living in California and to supporting the viability of
primary care and sub-specialist pediatrician practices.
Your membership in your local AAP-CA Chapter makes statewide advocacy possible!
Special Alert: Governor Signs Autism Coverage First Steps, Minor Consent to STD Prevention & More
Closing in on tonight’s midnight deadline Governor Brown has signed several more of the AAP-CA’s top bills!!!!
AB 300 by Assemblymember Fiona Ma (D-San Francisco) – Safe Body Art Act.
AB 499 by Assemblymember Toni G. Atkins (D-San Diego) – Minors: medical care: consent.
AB 673 by Assemblymember John A. Pérez (D-Los Angeles) – Office of Multicultural Health: LGBT communities
SB 695 by Senator Loni Hancock (D-Berkeley) – Medi-Cal: county juvenile detention facilities.
SB 746 by Senator Ted Lieu (D-Torrance) –Tanning facilities.
SB 946 by Senator Darrell Steinberg (D-Sacramento) – Health care coverage: mental illness: PDD or autism.
Thanks to the many pediatricians who contacted your legislators and the Governor!
To stay current on AAP-CA statewide advocacy (and to be aware of options for you to directly advocate), follow me on twitter @krisecalvin.
For a complete list of AAP-CA bills, including their status and links to the bill text go to http://www.aap-ca.org/bills/
AAP-CA is a statewide coalition of AAP-CA Chapters 1, 2, 3 and 4 dedicated to promoting the lives and health of children living in California and to supporting the viability of primary care and sub-specialist pediatrician practices.
Special Alert: Governor Signs Access to Seizure Meds in Schools and 8 other AAP-CA Bills!!
AAP-CA strongly supports the availability of a school nurse in every California school and has advocated to achieve this goal. However, given the current shortage of school nurses, children with epilepsy need trained, non-nurses to administer seizure medication in schools. (SB 161-Huff)
The deadline for Governor Brown to act on bills this year is Monday, October 10th. To date, the Governor has signed 9 of the 16 AAP-CA supported bills that have been sent to his desk.
These include extension of CCS local programs and case-management through 2016, a ban on BPA in baby bottle and child food containers, expansion of booster seat requirements to age 8 or 4 feet nine inches in height per AAP policy, mandated insurance coverage for maternity/prenatal care, addition of SCID (“bubble boy syndrome”) to routine newborn screening, removal of onerous eligibility screens for food stamps to reduce hunger in CA children and families, and establishment of a “Read Across CA” week to promote literacy.
These represent significant victories in advocacy for California children and pediatricians. Individual pediatrician membership in their local AAP-CA Chapter provides the resources to make these successes happen—thank you!
To stay current on AAP-CA statewide advocacy (and to be aware of options for you to directly advocate), follow me on twitter @krisecalvin.
For a complete list of AAP-CA bills, including their status and links to the bill text go to http://www.aap-ca.org/bills/
AAP-CA is a statewide coalition of AAP-CA Chapters 1, 2, 3 and 4 dedicated to promoting the lives and health of children living in California and to supporting the viability of primary care and sub-specialist pediatrician practices.
AAP-CA Bills to Protect Children’s Health Signed by Governor! California Children’s Services Saved, SCID added to newborn screening!
Governor Brown has signed two important AAP-CA bills to protect and promote children’s health!
The California Children’s Services program for children with serious and chronic conditions (CCS) was scheduled to be rolled into the Medi-Cal Managed Care program at the end of this year for eligible children, which would have eliminated much of CCS as we know it. AAP-CA had grave concerns about access to pediatric subspecialists and quality of care if this were to occur. Enactment of AB 301, an AAP-CA sponsored bill, will protect important functions of local and statewide CCS through 2016. We thank our cosponsors in this effort, the California Children’s Hospitals and the Children’s Specialty Care Coalition. The California Medical Association also provided significant advocacy support.
In a second AAP-CA advocacy success for children’s health, Severe Combined Immunodeficiency (SCID), “bubble boy disease,” has been added to the list of genetic disorders identified in California’s newborn screening process. AB 395, sponsored by the March of Dimes and supported by AAP-CA, requires this screening, which has been demonstrated to be cost-effective and will save children’s lives and health care dollars.
Both bills were authored by Richard Pan, MD, FAAP, the only pediatrician in the California Legislature, and were strongly supported by advocacy from the four AAP-CA Chapters (Chapters 1, 2, 3 and 4) working together at the state level. AAP-CA thanks Dr. Pan for his leadership and the priority he has placed on children’s health issues.
These successes could not have happened without the many pediatricians that contacted their Legislators and the Governor. It is increasingly difficult to get substantive bills passed in California, given the budget and partisan politics, and your actions really matter!
Please go to http://www.aap-ca.org/bills for the status of the rest of the bills your AAP-CA Chapter is working on this session.
AAP-CA Supported Bills Successfully Pass the California Legislature! Please Contact Governor Brown Now to Urge His Signature!
The Legislative session ends this Friday, September 10, 2011. To date, 11 AAP-CA supported bills have successfully passed both Chambers of the California Legislature and are on their way to the Governor’s desk for consideration.
AAP-CA sent organizational letters to Governor Brown urging his signature on these bills, but your personal contact with his office can make the difference!
Possible Actions
Please take a moment and review the list of bills below. Each has a brief description.
FAX SUPPORTING ALL BILLS
If you agree that ALL these bills should be enacted, copy (cut and paste) the list in it’s entirety onto a blank page or your letterhead. Handwrite at the top that as an AAP-CA member you urge the Governor to sign all these important bills on behalf of children. Then SIGN and if it is a blank page write your name and address.
FAX to the Governor at 916-558-3160 (emails may not be opened in time) CALL SUPPORTING 1-2 BILLS OF IMPORTANCE TO YOU
Choose one or two bills from the list that you care about and CALL the Governor’s office at 916-445-2841.
Leave a voicemail if needed (they keep track of these) urging the Governor to sign your select bills.
If you wish to learn more about any of these bills go to http://www.aap-ca.org/bills/ and click on the bill number. A box will open where you can click to view the bill text or the AAP-CA support letter.
Priority Bill: AAP-CA Sponsored Bill AB 301
Our top priority bill this session is AB 301 authored by Assemblymember Richard Pan, MD, FAAP. This critically important measure protects the California Children Services (CCS) program by extending until 2016 a carve-out of CCS services from Medi-Cal Managed Care plans. Without this bill, chronically and acutely ill children are at risk of losing safeguards and expert case management that promote quality of care.
AAP-CA Supported Bills
AB 6
Repeals quarterly reporting and fingerprinting requirements for receiving food stamps, and imposes semiannual reporting. Will increase participation in the food stamp program and reduce child hunger.
AB 25
Establishes concussion evaluation and management requirements for student athletes, per AAP policy.
AB 200
Establishes the option for a Physical Education Reward Program in local school systems in order to increase student participation in quality physical activity.
AB 300
Imposes stricter sanitation and safety requirements for performing body art (tatoos) as well as a comprehensive registration and licensing process.
AB 499
Allows minors 12 years and older to be able to consent to and receive preventative treatment for sexually transmitted diseases including HPV and Hep B vaccines. AAP-CA strongly supports parental involvement in these decisions, but where that is not possible believes that youth should not face barriers to potentially life-saving care.
AB 581
Creates the infrastructure necessary for poorer communities to receive healthier food options.
AB 673
Adds to The Office of Multicultural Health responsibilities to promote and protect the health and welfare of LGBT communities in California
AB 1319
Establishes stricter control of the usage of the chemical bisphenol A in products meant for children and infants.
SB 36
Allows counties who participate in County Health Initiative Matching Fund program to provide healthcare coverage to qualified low-income children.
SB 161
Permits a parent or guardian of a pupil with epilepsy to request the pupils school to have one or more of its employees receive voluntary training, as specified, in order to administer prescribed emergency anti-seizure medication, as defined, in the event that the pupil suffers a seizure when a nurse is not available.
AAP-CA Supported Bills Successfully Pass the California Legislature! Please Contact Governor Brown Now to Urge His Signature!
The Legislative session ends this Friday, September 10, 2011. To date, 11 AAP-CA supported bills have successfully passed both Chambers of the California Legislature and are on their way to the Governor’s desk for consideration.
AAP-CA sent organizational letters to Governor Brown urging his signature on these bills, but your personal contact with his office can make the difference!
Possible Actions
Please take a moment and review the list of bills below. Each has a brief description.
FAX SUPPORTING ALL BILLS
If you agree that ALL these bills should be enacted, copy (cut and paste) the list in it’s entirety onto a blank page or your letterhead. Handwrite at the top that as an AAP-CA member you urge the Governor to sign all these important bills on behalf of children. Then SIGN and if it is a blank page write your name and address.
FAX to the Governor at 916-558-3160 (emails may not be opened in time) CALL SUPPORTING 1-2 BILLS OF IMPORTANCE TO YOU
Choose one or two bills from the list that you care about and CALL the Governor’s office at 916-445-2841.
Leave a voicemail if needed (they keep track of these) urging the Governor to sign your select bills.
If you wish to learn more about any of these bills go to http://www.aap-ca.org/bills/ and click on the bill number. A box will open where you can click to view the bill text or the AAP-CA support letter.
Priority Bill: AAP-CA Sponsored Bill AB 301
Our top priority bill this session is AB 301 authored by Assemblymember Richard Pan, MD, FAAP. This critically important measure protects the California Children Services (CCS) program by extending until 2016 a carve-out of CCS services from Medi-Cal Managed Care plans. Without this bill, chronically and acutely ill children are at risk of losing safeguards and expert case management that promote quality of care.
AAP-CA Supported Bills
AB 6
Repeals quarterly reporting and fingerprinting requirements for receiving food stamps, and imposes semiannual reporting. Will increase participation in the food stamp program and reduce child hunger.
AB 25
Establishes concussion evaluation and management requirements for student athletes, per AAP policy.
AB 200
Establishes the option for a Physical Education Reward Program in local school systems in order to increase student participation in quality physical activity.
AB 300
Imposes stricter sanitation and safety requirements for performing body art (tatoos) as well as a comprehensive registration and licensing process.
AB 499
Allows minors 12 years and older to be able to consent to and receive preventative treatment for sexually transmitted diseases including HPV and Hep B vaccines. AAP-CA strongly supports parental involvement in these decisions, but where that is not possible believes that youth should not face barriers to potentially life-saving care.
AB 581
Creates the infrastructure necessary for poorer communities to receive healthier food options.
AB 673
Adds to The Office of Multicultural Health responsibilities to promote and protect the health and welfare of LGBT communities in California
AB 1319
Establishes stricter control of the usage of the chemical bisphenol A in products meant for children and infants.
SB 36
Allows counties who participate in County Health Initiative Matching Fund program to provide healthcare coverage to qualified low-income children.
SB 161
Permits a parent or guardian of a pupil with epilepsy to request the pupils school to have one or more of its employees receive voluntary training, as specified, in order to administer prescribed emergency anti-seizure medication, as defined, in the event that the pupil suffers a seizure when a nurse is not available.
URGENT Special Edition CEO Blog
YOUR IMMEDIATE ACTION REQUESTED ON PROPOSED HEALTHY FAMILIES-MEDI-CAL SHIFT!
THE CALIFORNIA ASSEMBLY AND SENATE MAY VOTE AS EARLY AS TODAY ON THIS ISSUE. YOUR ACTION NOW CAN MAKE A DIFFERENCE— PLEASE CALL OR FAX YOUR LEGISLATORS NOW. URGE THEM TO REMOVE THIS SIGNIFICANT POLICY DECISION FROM THE BUDGET.
BACKGROUND: As part of his budget, Governor Brown proposed elimination of the Healthy Families Program (HF) and movement of those 870,000 children into Medi-Cal (MC), to be implemented in 2012.
The nature of the state budget process allows little time for thoughtful analysis or stakeholder engagement. The emphasis in the budget is only on how to make the numbers work, especially in a deficit year like this one.
Given the significance of this proposed restructuring of children’s health care, AAP-CA has asked legislators to take the HF-MC shift out of the budget process and move it into the legislative policy process, where it can be heard by policy committees. (Assessment of how this move will impact access and quality of care is critical!)
We also asked that if they move any children now from HF to MC that they pilot the process by shifting only children up to 133% of poverty, since those children will be moved anyway under federal health care reform.
The Assembly and Senate may consider the HF-MC budget proposal today. This is likely one of our last opportunities to impact the process!
YOUR ACTION NEEDED: PLEASE CONTACT YOUR TWO CALIFORNIA LEGISLATORS (ASSEMBLY AND SENATE) TODAY WITH THE FOLLOWING MESSAGE: AS A PEDIATRICIAN IN YOUR DISTRICT, I URGE YOU TO REQUIRE THAT THE GOVERNOR’S PROPOSAL TO ELIMINATE THE HEALTHY FAMILIES PROGRAM AND MOVE THOSE 870,000 CHILDREN INTO MEDI-CAL BE TAKEN OUT OF THE BUDGET AND HEARD IN POLICY COMMITTEE. THIS PROPOSED CHANGE IN DELIVERY OF HEALTH CARE IN CALIFORNIA TO OUR MOST VULNERABLE CHILDREN DESERVES POLICY REVIEW!
IF ANY CHILDREN ARE MOVED IN 2011-2012 FROM HEALTHY FAMILIES TO MEDI-CAL, THE POPULATION SHOULD BE LIMITED TO CHILDREN UP TO 133% OF POVERTY, WHO WILL BE SHIFTED FROM HEALTHY FAMILIES TO MED-CAL UNDER FEDERAL HEALTH CARE REFORM BY 2014. EVEN THIS POPULATION SHOULD NOT BE MOVED WITHOUT APPROPRIATE POLICY REVIEW AND ATTENTION TO THE POTENTIAL EFFECT OF THE MOVE ON ACCESS.
To identify your Assembly Member and Senator by zip code go to http://www.leginfo.ca.gov/yourleg.html Then go to the legislator’s webpage for their contact information. PLEASE FAX OR LEAVE A VOICEMAIL FOR YOUR LEGISLATORS THIS WEEKEND. DO NOT EMAIL. (They often do not get to emails promptly, and the message must get to them promptly.)
If you would like help with this process, please send your voting address (home or work) to kcalvin@aap.net and I will email back the contact information you need.
Thank you!
Kris
Governor Brown proposes eliminating the Healthy Families Program and moving 870,000 kids into Medi-Cal
In the “May revise” to his 2011-2012 state budget, today Governor Brown proposed eliminating the Healthy Families Program (HF) and increasing Medi-Cal eligibility income limits so that the 870,000 children currently in HF can be served by Medi-Cal. AAP-CA does not yet have a position on this proposal and is carefully evaluating it. Below are initial thoughts.
An early analysis of the pros and cons of the proposed HF-Medi-Cal shift yields as a plus that Medi-Cal is an entitlement, i.e., every child that meets the eligibility requirements for Medi-Cal must be served by the state. In contrast, Healthy Families is set up so that if the state does not have sufficient funding in any given year, waiting lists or even program elimination is possible. (Federal health care reform has fixed this problem in the short-term with maintenance of effort clauses that do not permit states to downsize or eliminate their SCHIP programs, including Healthy Families. None-the-less, entitlement status through Medi-Cal may offer longer-term stability and access.) A second issue is that once moved to Medi-Cal HF children will become eligible for free vaccines under Vaccines For Children (VFC). In contrast, HF vaccines purchases work like the commercial sector, with pediatricians fronting the cost and waiting for reimbursement. For some small and solo practices, this may be particularly important. There are other practices, however, that do not want to have to join VFC to serve these children. In the neutral category, the 2/3 federal match currently given by the federal government under HF would be maintained when the kids are moved to Medi-Cal according to the state. Copays and premiums, which are permitted for children in families over 150% of the federal poverty level, will remain the same for children that are shifted from HF to Medi-Cal.
Potential negatives of the shift include that currently HF contracts are said to average approximately $100 per child member per month to plans, while Medi-Cal reputedly averages $75 per child member per month. This is one reason the state seeks this change—it totals a savings of $30 million to the state. Some of the difference may be the vaccine costs, in which case the doctor may not receive less. Further, reimbursement for certain primary care codes in Medi-Cal will experience a two-year increase due to federal reform rules. That does not, however, address woefully inadequate reimbursement to specialists. We are also interested in how this might affect California children’s hospitals. A second potential negative is that Healthy Families, as a kids only program, has been responsive to AAP-CA policy questions and concerns, whereas Medi-Cal, a much larger bureaucracy which also serves relatively more expensive adults, has been tough to navigate and change. Red tape and a limited formulary have also been raised as Medi-Cal concerns.
YOUR ACTION NEEDED: Please watch your inbox for a survey on how you feel about the proposed Healthy Families elimination and shift of those children to Medi-Cal. Your input is essential in developing an AAP-CA position and working with the Department of Health Care Services.
AAP-CA joins American Diabetes Association in urging CA Supreme Court to permit trained non-nurses to administer insulin in schools
May 12, 2011 the California District of the American Academy of Pediatrics (AAP-CA) signed an amicus brief supporting the American Diabetes Association request to the California Supreme Court to overturn a lower court ruling supporting a statute that restricts insulin administration in schools to nurses only. The AAP-CA Board’s decision is consistent with the National AAP policy supporting the use of appropriately trained non-nurses to provide students with insulin in schools.
AAP-CA took this action at this time because we believe that the health and well-being of California children with diabetes would be better served if more individuals, with proper training, were available to administer insulin in schools, considering the severe shortage of school nurses in California. The AAP-CA is strongly supportive of school nurses and continues to advocate at the state level for their increased funding and availability.
Registration open for AAP-CA 33rd Annual Pediatric Seminars at Caesars Palace, Las Vegas November 17-20, 2011
AAP-CA hosts only one CME meeting each year as a joint effort of all four of the AAP-CA regional chapters. In its 33rd year, this meeting provides critical support for AAP-CA advocacy efforts; without the revenue it produces, our ability to speak in Sacramento on your behalf is severely compromised. The meeting is held in Las Vegas at Caesars Palace, with attendance running at 600 or more pediatricians from around the country and around the world, and features an always-stellar array of speakers.
Please consider making a weekend of it to get your CME credits and to have a good time— there are lots of people to meet if you go on your own, or bring your family. I attend this annual CME meeting in its entirety, and am always happy to join groups for informal sidebars about what matters to you most in advocacy— I hope to see you there!
YOUR ACTION MATTERS: For more information or to register for the AAP-CA 33rd Annual Pediatric Update held November 17-20th, 2011, at Caesars Palace in Las Vegas go to http://www.aap-ca.org/meetings/index.html
Thank you for your interest in AAP-CA activities!
Kris
To see older blog postings visit the blog archive page.
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