Sacramento and Solano counties are in a standoff with the state more than mental well being coverage for a portion of Medicaid sufferers in these counties — a dispute that threatens to disrupt care for practically 50,000 low-earnings residents getting therapy for extreme mental illness.
The Division of Overall health Care Solutions, which administers Medi-Cal, the state’s Medicaid system, says Sacramento and Solano counties need to take more than managing and delivering specialty mental well being care for thousands of Medi-Cal sufferers enrolled in Kaiser Permanente plans. It insists on shifting the duty simply because California’s remaining 56 counties currently operate this way. State officials argue the switch would simplify the state’s disjointed mental well being method and is necessary to implement a bigger transformation of Medi-Cal, an initiative identified as CalAIM.
State well being officials gave counties till March 15 to accept Kaiser Permanente sufferers, so California can adequately transfer their specialty mental well being care to counties by July 1. But the two counties are rebuffing the transfer, arguing that without the need of much more funding they cannot adequately care for a key influx of Medi-Cal sufferers with extreme mental well being circumstances, such as schizophrenia or bipolar disorder. Medi-Cal officials, meanwhile, are threatening steep penalties or potentially terminating mental well being contracts with these counties.
Nearby officials warn that if the state follows by means of with its program, about 39,000 sufferers in Sacramento County and about eight,000 in Solano County could see their care disrupted and, for instance, may perhaps be forced to discover a new psychiatrist.
“For a person who has schizophrenia or a further severe mental well being disorder, it has taken a lengthy time to make a trusted partnership with their provider, and now they are going to see that care disrupted or have to discover a various provider,” stated Debbie Vaughn, assistant county administrator for Solano County. “There will be dangers of men and women going into crisis.”
Ryan Quist, director of behavioral well being solutions for Sacramento County, stated the counties require not only much more funding, but also much more time to transfer the patients’ care. “The state is playing chicken with their lives,” he stated.
Beneath state law, counties are accountable for administering and delivering specialty care to Medi-Cal sufferers with extreme mental illness. Medi-Cal managed-care insurers are accountable for delivering therapy for mild or moderate mental well being circumstances, such as anxiousness or low-level depression.
But beneath a decades-old arrangement among the state and the counties of Sacramento and Solano, California has been paying Kaiser Permanente to offer all mental well being care for the well being care giant’s Medi-Cal enrollees. Now the state is dissolving that arrangement, forcing roughly 7,000 specialty mental well being sufferers in these two counties to move out of Kaiser Permanente and into county-run mental well being plans.
State officials argue that the two counties are legally obligated to offer care for Medi-Cal sufferers with extreme mental illness and that county behavioral well being agencies would be the ones placing sufferers in danger if the counties continue refusing the shift. Medi-Cal sufferers enrolled in well being plans other than Kaiser Permanente get their specialized mental well being care straight from counties.
“Sacramento and Solano counties’ failure to engage in this method locations Medi-Cal members at threat of losing access to important Medi-Cal entitlement solutions,” stated Tony Cava, a spokesperson for the Division of Overall health Care Solutions. “DHCS will have no option but to take action if the counties continue to refuse to fulfill their obligations.”
The state is taking into consideration sanctions or terminating the counties’ contracts, but Cava stated that “contract termination is not DHCS’ preferred strategy.” He declined to elaborate, adding only that the agency would “determine options to continue coverage” for Kaiser Permanente sufferers.
He stated transferring sufferers to the counties will offer “a much more constant and seamless well being method by minimizing complexity and rising flexibility.”
Counties at present obtain a portion of state sales tax income and automobile license charges to fund specialty mental well being care, but beneath the agreement in Sacramento and Solano, the state has been paying Kaiser Permanente from its basic fund to serve a portion of the insurer’s all round Medi-Cal enrollees’ mental well being desires.
Beneath the shift, California would cease distributing basic-fund revenue to the counties. Rather, counties would obtain a higher share of current sales tax and automobile license charge revenues set aside by a 2011 arrangement. But Kaiser Permanente’s specialty mental well being sufferers, the counties argue, had been not beneath their purview at the time that agreement was reached, underscoring their legal argument that the state must cover the fees of their care.
The state is supplying an extra $11.six million a year to Sacramento and $7.7 million a year to Solano, which would draw down extra federal funding. That revenue would be siphoned from income other counties rely on for behavioral well being therapy.
“The insult to injury is this requires revenue from other counties,” stated Michelle Doty Cabrera, executive director of the County Behavioral Overall health Directors Association, “and across California we’re seeing a higher demand for solutions, specially just after the pandemic.”
Sacramento County desires $36 million much more every single year to cover a 16% boost in sufferers, or four,836 men and women. Solano County seeks practically $17 million much more every single year for rising its load by 50%, or two,091 sufferers.
Behavioral well being officials say counties are also struggling to recruit and retain mental well being pros prepared to serve Medi-Cal sufferers.
“Our method is currently bursting at the seams,” stated Le Ondra Clark Harvey, CEO of the California Council of Neighborhood Behavioral Overall health Agencies, which represents neighborhood mental well being providers.
State officials think that each counties have an sufficient quantity of mental well being providers, with the compact exception of Sacramento County’s require for two to 3 extra psychiatrists to serve children.
Kaiser Permanente told KHN that it did not ask to move sufferers out of its network of care and that it told the state it wanted to continue serving them. However it eventually agreed to transfer care to the counties.
“Even though we had expressed our preference to continue to offer specialty care to this vulnerable population,” stated spokesperson Gerri Ginsburg, “we respect the state’s lengthy-term objectives.”
This story was created by KHN, which publishes California Healthline, an editorially independent service of the California Overall health Care Foundation.
This post was reprinted from khn.org with permission from the Henry J. Kaiser Loved ones Foundation. Kaiser Overall health News, an editorially independent news service, is a system of the Kaiser Loved ones Foundation, a nonpartisan well being care policy investigation organization unaffiliated with Kaiser Permanente.
