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 take care of practically 50,000 low-income residents receiving therapy for extreme psychological sickness.
The Division of Well being Care Providers, which administers Medi-Cal, the state’s Medicaid program, says Sacramento and Solano counties should take over managing and offering specialty psychological well being take care of 1000’s of Medi-Cal sufferers enrolled in Kaiser Permanente plans. It insists on shifting the duty as a result of California’s remaining 56 counties already function this fashion. State officers argue the swap would simplify the state’s disjointed psychological well being system and is required to implement a bigger transformation of Medi-Cal, an initiative often 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. However the two counties are rebuffing the switch, arguing that with out extra funding they’ll’t adequately take care of a serious inflow of Medi-Cal sufferers with extreme psychological well being circumstances, comparable to schizophrenia or bipolar dysfunction. Medi-Cal officers, in the meantime, are threatening steep penalties or probably terminating psychological well being contracts with these counties.
Native officers warn that if the state follows by way of with its plan, about 39,000 sufferers in Sacramento County and about 8,000 in Solano County may see their care disrupted and, for example, could also be pressured to discover a new psychiatrist.
“For somebody who has schizophrenia or one other critical psychological well being dysfunction, it has taken a very long time to construct a trusted relationship with their supplier, and now they will see that care disrupted or need to discover a completely different supplier,” stated Debbie Vaughn, assistant county administrator for Solano County. “There can be dangers of individuals going into disaster.”
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 taking part in rooster with their lives,” he stated.
Beneath state regulation, counties are accountable for administering and delivering specialty care to Medi-Cal sufferers with extreme psychological sickness. Medi-Cal managed-care insurers are accountable for offering therapy for gentle or reasonable psychological well being circumstances, comparable to nervousness or low-level despair.
However underneath 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 take care of the well being care large’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 take care of Medi-Cal sufferers with extreme psychological sickness and that county behavioral well being companies could be those placing sufferers in peril 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 interact on this course of locations Medi-Cal members liable to dropping entry to important Medi-Cal entitlement companies,” stated Tony Cava, a spokesperson for the Division of Well being Care Providers. “DHCS can have no selection however to take motion if the counties proceed to refuse to satisfy their obligations.”
The state is contemplating sanctions or terminating the counties’ contracts, however Cava stated that “contract termination will not be DHCS’ most popular strategy.” He declined to elaborate, including solely that the company would “establish options to proceed protection” for Kaiser Permanente sufferers.
He stated transferring sufferers to the counties will present “a extra constant and seamless well being system by lowering complexity and growing 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 underneath the settlement in Sacramento and Solano, the state has been paying Kaiser Permanente from its normal fund to serve a portion of the insurer’s general Medi-Cal enrollees’ psychological well being wants.
Beneath the shift, California would cease distributing general-fund cash to the counties. As an alternative, counties would obtain a larger share of current gross sales tax and car license price revenues put aside by a 2011 association. However Kaiser Permanente’s specialty psychological well being sufferers, the counties argue, weren’t underneath 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 a further $11.6 million a 12 months to Sacramento and $7.7 million a 12 months to Solano, which might draw down further federal funding. That cash could be siphoned from income different counties depend on for behavioral well being therapy.
“The insult to harm is that this takes cash from different counties,” stated Michelle Doty Cabrera, government director of the County Behavioral Well being Administrators Affiliation, “and throughout California we’re seeing a larger demand for companies, particularly after the pandemic.”
Sacramento County needs $36 million extra every year to cowl a 16% improve in sufferers, or 4,836 folks. Solano County seeks practically $17 million extra every year for growing 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 on the seams,” stated Le Ondra Clark Harvey, CEO of the California Council of Group Behavioral Well being Companies, which represents native psychological well being suppliers.
State officers imagine that each counties have an enough variety of psychological well being suppliers, with the small exception of Sacramento County’s want for 2 to a few further psychiatrists to serve youngsters.
Kaiser Permanente informed KHN that it didn’t ask to maneuver sufferers out of its community of care and that it informed the state it wished to proceed serving them. But it in the end agreed to switch care to the counties.
“Whereas we had expressed our desire to proceed to supply specialty care to this susceptible inhabitants,” stated spokesperson Gerri Ginsburg, “we respect the state’s long-term targets.”
This story was produced by KHN, which publishes California Healthline, an editorially impartial service of the California Well being Care Basis.
KHN (Kaiser Well being Information) is a nationwide newsroom that produces in-depth journalism about well being points. Along with Coverage Evaluation and Polling, KHN is likely one of the three main working packages at KFF (Kaiser Household Basis). KFF is an endowed nonprofit group offering data on well being points to the nation.
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