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Should some CCS conditions, such as the treatment of a broken bone, continue to be covered by CCS but no longer included in the CCS carve out (and thus be covered by managed care)?

Create specialty care centers.  The state could create a centralized place where special needs children can get care.  CCS children with chronic health conditions could be completely carved out from the existing fragmented system and put into systems of care with medical homes and specialty care centers.  

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The reimbursement system could be realigned so that the money follows the child to where care can best be delivered.  Providers or networks could bear some risk; however risk would have to be limited given the high cost nature of some of these children.  

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Case management and care coordination would be furnished by the specialty centers instead of the CCS offices, in much the same way as in managed care.  This could result in significant administrative savings for the state, counties, and providers which could be invested in improving access to care in the CCS program.

Improve funding coordination.  The alignment of state and county dollars in the programs should be revisited.  Funding fragmentation and a lack of clarity as to whether CCS is an entitlement has lead to gaps in care and provider payment delays.    State law limits county responsibility and treats the program as a benefit limited to the funds available.  However, historic practice has been to operate the program as an entitlement.   

Fiscal

There are savings that may be able to be achieved by new models that reduce administration and through changes to realign service and health care reimbursement.  However, CMS does not include administrative cost in waiver budget neutrality calculations, and if they were to be included the entire cost of administration for Medi-Cal would have to be included.  

It is highly unlikely that California will be able to both improve care quality and access for children with CCS conditions and remain budget neutral.  This is due in large part to depressed provider rates since the early 1980s.  As noted in the Governor’s health care reform proposal, a key component of reform has to include increases in Medi-Cal provider rates.  However, CCS could be included as an element of a global waiver, where budget neutrality is achieved through receiving “credit” for the state’s historically low reimbursement.  

2-E. Management of Dual Eligibles

It is complex and expensive to provide medical care to the nation’s approximately 7 million dual eligible individuals.  Dual eligibles often are elderly individuals who receive Medicaid on the basis of income and Medicare on the basis of age; however, about one-third of all dual eligibles

Health Management Associates/Harbage ConsultingPage 22

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