SACRAMENTO, Calif. — Sacramento and Solano counties are in a standoff with the state over psychological well being protection for a portion of Medicaid sufferers in these counties — a dispute that threatens to disrupt look after almost 50,000 low-income residents receiving therapy for extreme psychological sickness.
The Department of Health Care Services, which administers Medi-Cal, the state’s Medicaid program, says Sacramento and Solano counties should take over managing and offering specialty psychological well being look after 1000’s of Medi-Cal sufferers enrolled in Kaiser Permanente plans. It insists on shifting the accountability as a result of California’s remaining 56 counties already function this manner. State officers argue the change would simplify the state’s disjointed psychological well being system and is required to implement a bigger transformation of Medi-Cal, an initiative generally known as CalAIM.
State well being officers gave counties till March 15 to just accept Kaiser Permanente sufferers, so California can correctly switch their specialty psychological well being care to counties by July 1. But the 2 counties are rebuffing the switch, arguing that with out extra funding they’ll’t adequately look after a serious inflow of Medi-Cal sufferers with extreme psychological well being situations, comparable to schizophrenia or bipolar dysfunction. Medi-Cal officers, in the meantime, are threatening steep penalties or doubtlessly terminating psychological well being contracts with these counties.
Local officers warn that if the state follows by with its plan, about 39,000 sufferers in Sacramento County and about 8,000 in Solano County might see their care disrupted and, as an example, could also be compelled to discover a new psychiatrist.
“For someone who has schizophrenia or another serious mental health disorder, it has taken a long time to build a trusted relationship with their provider, and now they are going to see that care disrupted or have to find a different provider,” stated Debbie Vaughn, assistant county administrator for Solano County. “There will be risks of people going into crisis.”
Ryan Quist, director of behavioral well being companies for Sacramento County, stated the counties needn’t solely extra funding, but additionally extra time to switch the sufferers’ care. “The state is playing chicken with their lives,” he stated.
Under state legislation, counties are accountable for administering and delivering specialty care to Medi-Cal sufferers with extreme psychological sickness. Medi-Cal managed-care insurers are chargeable for offering therapy for delicate or average psychological well being situations, comparable to anxiousness or low-level melancholy.
But below a decades-old association between the state and the counties of Sacramento and Solano, California has been paying Kaiser Permanente to supply all psychological well being look after the well being care big’s Medi-Cal enrollees. Now the state is dissolving that association, forcing roughly 7,000 specialty psychological well being sufferers in these two counties to maneuver out of Kaiser Permanente and into county-run psychological well being plans.
State officers argue that the 2 counties are legally obligated to supply look after Medi-Cal sufferers with extreme psychological sickness and that county behavioral well being businesses could be those placing sufferers at risk if the counties proceed refusing the shift. Medi-Cal sufferers enrolled in well being plans apart from Kaiser Permanente get their specialised psychological well being care instantly from counties.
“Sacramento and Solano counties’ failure to engage in this process places Medi-Cal members at risk of losing access to critical Medi-Cal entitlement services,” stated Tony Cava, a spokesperson for the Department of Health Care Services. “DHCS will have no choice but to take action if the counties continue to refuse to fulfill their obligations.”
The state is contemplating sanctions or terminating the counties’ contracts, however Cava stated that “contract termination is not DHCS’ preferred approach.” He declined to elaborate, including solely that the company would “identify solutions to continue coverage” for Kaiser Permanente sufferers.
He stated transferring sufferers to the counties will present “a more consistent and seamless health system by reducing complexity and increasing flexibility.”
Counties at present obtain a portion of state gross sales tax income and car license charges to fund specialty psychological well being care, however below the settlement in Sacramento and Solano, the state has been paying Kaiser Permanente from its basic fund to serve a portion of the insurer’s general Medi-Cal enrollees’ psychological well being wants.
Under the shift, California would cease distributing general-fund cash to the counties. Instead, counties would obtain a larger share of present gross sales tax and car license payment revenues put aside by a 2011 association. But Kaiser Permanente’s specialty psychological well being sufferers, the counties argue, weren’t below their purview on the time that settlement was reached, underscoring their authorized argument that the state ought to cowl the prices of their care.
The state is providing an extra $11.6 million a 12 months to Sacramento and $7.7 million a 12 months to Solano, which might draw down extra federal funding. That cash could be siphoned from income different counties depend on for behavioral well being therapy.
“The insult to injury is this takes money from other counties,” stated Michelle Doty Cabrera, government director of the County Behavioral Health Directors Association, “and across California we’re seeing a greater demand for services, especially after the pandemic.”
Sacramento County needs $36 million extra every year to cowl a 16% enhance in sufferers, or 4,836 folks. Solano County seeks almost $17 million extra every year for rising its load by 50%, or 2,091 sufferers.
Behavioral well being officers say counties are additionally struggling to recruit and retain psychological well being professionals keen to serve Medi-Cal sufferers.
“Our system is already bursting at the seams,” stated Le Ondra Clark Harvey, CEO of the California Council of Community Behavioral Health Agencies, which represents native psychological well being suppliers.
State officers imagine that each counties have an sufficient variety of psychological well being suppliers, with the small exception of Sacramento County’s want for 2 to 3 extra psychiatrists to serve children.
Kaiser Permanente advised KHN that it didn’t ask to maneuver sufferers out of its community of care and that it advised the state it needed to proceed serving them. Yet it finally agreed to switch care to the counties.
“While we had expressed our preference to continue to provide specialty care to this vulnerable population,” stated spokesperson Gerri Ginsburg, “we respect the state’s long-term objectives.”
This story was produced by KHN, which publishes California Healthline, an editorially impartial service of the California Health Care Foundation.
KHN (Kaiser Health News) is a nationwide newsroom that produces in-depth journalism about well being points. Together with Policy Analysis and Polling, KHN is likely one of the three main working applications at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit group offering data on well being points to the nation.
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