In Brief: Health Net Wins Dual-Eligibles Contract; Campbell Warns Of Charity Care Bill

Health Net Wins Dual-Eligibles Contract

A subsidiary of the Woodland Hills-based insurer Health Net has received a contract from the Centers for Medicare & Medicaid Services and the California Department of Health Care Services to provide services to the dual-eligible populations in Los Angeles and San Diego Counties.

California is moving about 456,000 dual-eligibles – those both enrolled in Medicare and Medi-Cal – into managed care under a program known as Cal MediConnect as part of a demonstration project to confirm whether care for this population can be better coordinated at a lower cost. There are about 1.1 million dual-eligibles in California. Eight counties in the Bay Area and Southern California are participating in the demonstration project.

“We look forward to improving the quality of care and service for those who are most in need of a truly integrated care delivery system,” said Jay Gellert, Health Net's chief executive officer. “We believe that the rate setting methodology in this contract, which is based on the historical fee-for-service costs of providing care to this population, will provide the necessary resources to improve the delivery of care to these beneficiaries.”

Health Net Community Solutions is expected to begin coverage no later than April 1. No enrollment figures or dollar value for the contract were immediately available.

Campbell Claims Charity Care Bill Would Imperil Patient Access

A new study co-authored by former California Finance Director Tom Campbell warns that pending legislation could  lock out thousands of the state's residents from obtaining healthcare coverage if passed into law.

Of particular concern is Assembly Bill 975, which would exclude the writing off of medical bills as charity care, and require hospitals and multispeciality clinics to conduct community needs assessments under the guidance of the Office of Statewide Health Planning and Development. Such assessments would also have to be updated every two years. 

“Lawmakers may not be intentionally seeking to undermine health care reform, but new mandates in AB 975 or other similar legislation would result in less hospital capacity, the loss of health care jobs, and a loss of state tax revenues,” Campbell said.  “Instead of moving forward with greater access to care, cumbersome new regulations would be a giant step backward.”

Although the bill may be reconsidered by the Assembly later this year, it is currently in that body's inactive file, and no votes or hearings are currently scheduled, according to a state website that monitors the status of bills. 

Campbell's study was performed in conjunction with the Berkeley Research Group and was underwritten by the California Hospital Association.

“Our non-profit hospitals are preparing to meet the demands of more than 3 million people who will have new access to healthcare as a result of federal reform,” said CHA Chief Executive Officer C. Duane Dauner. “AB 975 or bills with similar mandates would create unrealistic requirements.”