Newly Insured Californians Would Fall by More than 1 Million Under the Affordable Care Act Without the Requirement to Purchase Insurance

Compares the estimated number and percentage of currently uninsured Californians who will be insured by 2019 under the Affordable Care Act with the individual mandate and without. Highlights the need for the mandate to ensure affordable coverage

Achieving Equity by Building a Bridge From Eligible to Enrolled

Calls for multilingual outreach and enrollment efforts to enable Californians of color and those with limited English proficiency to benefit from the Health Benefit Exchange. Recommends targeting high-need groups and strengthening data collection

Cost Analysis and Policy Implications of a Pediatric Palliative Care Program

ContextIn 2010, California launched Partners for Children (PFC), a pediatric palliative care pilot program offering hospice-like services for children eligible for full-scope Medicaid delivered concurrently with curative care, regardless of the child's life expectancy.ObjectivesWe assessed the change from before PFC enrollment to the enrolled period in 1) health care costs per enrollee per month (PEPM), 2) costs by service type and diagnosis category, and 3) health care utilization (days of inpatient care and length of hospital stay).MethodsA pre-post analysis compared enrollees' health care costs and utilization up to 24 months before enrollment with their costs during participation in the pilot, from January 2010 through December 2012. Analyses were conducted using paid Medicaid claims and program enrollment data.ResultsThe average PEPM health care costs of program enrollees decreased by $3331 from before their participation in PFC to the enrolled period, driven by a reduction in inpatient costs of$4897 PEPM. PFC enrollees experienced a nearly 50% reduction in the average number of inpatient days per month, from 4.2 to 2.3. Average length of stay per hospitalization dropped from an average of 16.7 days before enrollment to 6.5 days while in the program.ConclusionThrough the provision of home-based therapeutic services, 24/7 access to medical advice, and enhanced, personally tailored care coordination, PFC demonstrated an effective way to reduce costs for children with life-limiting conditions by moving from costly inpatient care to more coordinated and less expensive outpatient care. PFC's home-based care strategy is a cost-effective model for pediatric palliative care elsewhere

Assuring Children’s Accessto Pediatric Subspecialty Care in California

This policy note explores disparities in access to pediatric subspecialty care in California by insurance coverage, geographic location, race/ethnicity, and language. Using the available literature and interviews with stakeholders, it identifies barriers to access, which include a potential shortage of trained pediatric subspecialists, gaps in care delivery, low reimbursement rates and payment levels, and lack of care integration. Innovative care delivery models for improving the capacity of pediatric subspecialty care, including expanded use of technology, team models of care, and standard care processes, are also examined.Among the recommendations proposed to ensure adequate access to pediatric subspecialty care: increase the number of pediatricians specializing in pediatric subspecialties; address payment and reimbursement issues that impede the access of children with special health care needs (CSHCN) to pediatric subspecialty care; increase the capacity of pediatric subspecialists by better utilizing physician extenders and general pediatricians; improve access to telehealth services for pediatric subspecialty providers; improve the availability of pediatric subspecialty services to underserved populations; improve communication between general pediatricians and providers; develop benchmarks and collect accurate data on workforce supply; and assess the standards of care available to CSHCN in California

Assuring Children’s Accessto Pediatric Subspecialty Care in California

This policy note explores disparities in access to pediatric subspecialty care in California by insurance coverage, geographic location, race/ethnicity, and language. Using the available literature and interviews with stakeholders, it identifies barriers to access, which include a potential shortage of trained pediatric subspecialists, gaps in care delivery, low reimbursement rates and payment levels, and lack of care integration. Innovative care delivery models for improving the capacity of pediatric subspecialty care, including expanded use of technology, team models of care, and standard care processes, are also examined.Among the recommendations proposed to ensure adequate access to pediatric subspecialty care: increase the number of pediatricians specializing in pediatric subspecialties; address payment and reimbursement issues that impede the access of children with special health care needs (CSHCN) to pediatric subspecialty care; increase the capacity of pediatric subspecialists by better utilizing physician extenders and general pediatricians; improve access to telehealth services for pediatric subspecialty providers; improve the availability of pediatric subspecialty services to underserved populations; improve communication between general pediatricians and providers; develop benchmarks and collect accurate data on workforce supply; and assess the standards of care available to CSHCN in California

Better Outcomes, Lower Costs: Palliative Care Program Reduces Stress, Costs of Care for Children With Life-Threatening Conditions

SUMMARY: This policy brief examines the Partners for Children (PFC) program—California’s public pediatric community-based palliative care benefit to children living with life-threatening conditions and their families. Preliminary analysis of administrative and survey data indicates that participation in the PFC program improves quality of life for the child and family. In addition, participation in the program resulted in a one-third reduction in the average number of days spent in the hospital. Shifting care from a hospital setting to in-home community-based care resulted in cost savings of $1,677 per child per month on average—an 11% decrease in spending on a traditionally high-cost population. As the three-year pilot program draws to an end, policymakers are considering the advisability of extending the program beyond the 11 counties that now participate. This policy brief provides recommendations that policymakers, families and advocates should consider to ensure sustainability and successful expansion of the program

CHART PACK: Health Insurance Coverage in California under the Affordable Care Act: Revision of the March 22, 2012 Presentation to the California Health Benefit Exchange Board

The California Simulation of Insurance Markets (CalSIM) model is designed to estimate the impact of various elements of the ACA on employer decisions to offer insurance coverage and individual decisions to obtain coverage in California

Newly Insured Californians Would Fall by More than 1 Million under the Affordable Care Act without the Requirement to Purchase Insurance

The Affordable Care Act (ACA) requirement that almost all Americans purchase some type of health insurance coverage has been controversial. This policy note examines the potential implications of eliminating the minimum coverage requirement (MCR), or "individual mandate." Based on analyses using the California Simulation of  Insurance Markets (CalSIM) model, the authors find that the ACA will reduce California’s eligible uninsured population from 4.63 to 2.72 million by 2019; a reduction of 1.91 million or 41% of the eligible uninsured. In contrast, without the MCR, the ACA will reduce the state’s eligible uninsured population from 4.63 to 3.76 million; a reduction of only 870,000 or 19% of the  eligible uninsured. Comparing the number of newly insured with and without the MCR shows that the number of newly insured will be 1.04 million lower in 2019 without the MCR. In addition, eliminating the MCR is likely to accelerate premium growth due to adverse selection. If this occurs, the ACA will reduce the state’s eligible uninsured from 4.63 to 4.02 million by 2019; a reduction of only 610,000 or 13% of the eligible uninsured. The number of newly  insured will be 1.30 million lower in 2019 without the MCR and with higher premiums due to adverse selection. Eliminating the MCR from the ACA would therefore substantially lower  the number of newly insured Californians by 2019 and undermine the goal of the law to substantially increase health insurance coverage for the uninsured