MEDI-CAL DENTAL BENEFITS RESTORED

Medi-Cal Dental Benefits for Adults

On April 29, California Department of Health Care Services received Medicare approval to restore certain optional adult dental benefits for members 21 years of age and older under the Medi-Cal program, effective May 1.  The partial restoration of dental services includes examinations and x-rays, dental cleanings with fluoride treatments, silver and tooth-colored fillings, and root canals and crowns on front teeth.  Complete dentures are also being restored.

For a complete list of services being restored, please see Provider Bulletin Volume 29, Number 14 (August 2013).  Dental providers will determine which medically necessary services will be provided, and the existing benefits for children will not change.  When the elimination of the optional Medi-Cal dental benefit for adults began in July 2009, due to the state’s severe budget issues, there were several exemptions that allowed some members to continue receiving services.  They included members who were residents of nursing homes and skilled nursing facilities, pregnant women, and some others.

This partial restoration of the benefit is not a component of the Affordable Care Act (ACA).  Most of the costs are for individuals who are already eligible for Medi-Cal.  Any ACA funding would be used for services to those who qualify for Medi-Cal only because of the ACA’s expanded eligibility.

If a member needs help finding a dentist, please see the Provider Referral Tool on the Denti-Cal website or call Denti-Cal at 1-800-322-6384.

Consumer Advisory Committee

ILSNC is requesting assistance in locating a consumer (must be receiving Medi-Cal and live in Shasta, Siskiyou, Lassen or Modoc counties) to be a consumer representative on the Consumer Advisory Committee with Partnership HealthPlan.  Partnership’s offices are near the airport in South Redding.  The meetings occur every other month.  This is a real need.  Professional advocates are invited to attend, but the real power lies in the hands of the consumer.  Please find a worthy representative.  They need not be a consumer of ours, but must be on Medi-Cal from one of the 4 counties.  Information can be obtained by contacting Kelley Sewell, Northern Region Member Services and Provider Relations Director. 

She can be reached at: 

Partnership HealthPlan of California

PO Box 492475

Redding, CA 96049

Phone:  (707) 420-7685 phone

E-mail:ksewell@partnershiphp.org

Our website: www.partnershiphp.org

The Disability Organizing Network (www.disabilityorganizing.net) is embarking on a quest to populate local Voting Advisory Committees throughout the state.  We cannot do much outside of our major population centers, but since Shasta & Tehama counties are combining their efforts, can we locate 1 or 2 disabled folks to serve on this committee?  This activity is coordinated by the Secretary of State’s office through each county and is active every other year.  2014 is an election year, so this is the year to ensure that various disabilities are represented on local boards.  For information, please contact  Cathy Darling Allen, Shasta County Clerk @  225-5166.

 

MEDI-CAL MANAGED CARE UPDATE

IF YOU LIVE IN SHASTA, SISKIYOU, LASSEN OR MODOC COUNTIES, THIS IS FOR YOU:

All persons living in the northern half of our service area who have Medi-Cal, Medi-Cal/Medicare, Healthy Families or Temporary Assistance for Needy Families for health insurance will receive their healthcare services as administered by Partnership Health Plans starting on September 1.

Work in Progress

PHC has a Member Services Department that is available Monday – Friday, 8:00 am – 5:00 pm. You can call them at (707) 863-4120 or (800) 863-4155. The Member Services Representatives are there to answer your questions about PHC and help you with any problems you may have related to your medical care.

You should call the Member Services Department if you:

  • Want to transfer to a new primary care provider.

  • Are getting a bill for medical care.

  • Need a new PHC ID card

  • Would like to file an appeal or complaint about PHC, your medical care, or your medical provider.

  • Have any questions about PHC or the services PHC provides.

  • Have a problem getting a medical appointment.

  • Have a problem getting a prescription filled.

  • Have paid for medication and/or a co-pay.

PHC_logo

Multi-lingual services and services for hearing, speech and visually impaired members are available through the PHC Member Services Department. For more information about these services, call our Member Services Department or refer to the appropriately titled sections of this website for additional information.

Additional information is available at the website for Partnership HealthPlan of California (http://www.partnershiphp.org/index.htm or http://www.partnershiphp.org/Members/MC_MbrExpan.htm)

Information from the California Department of Health Care Services can be found at: http://www.dhcs.ca.gov/provgovpart/pages/mmcdruralexpansion.aspx or http://www.dhcs.ca.gov/services/pages/healthyfamiliestransition.aspx

 

MEDI-CAL DENTAL COVERAGE PARTIALLY RESTORED

Legislative leaders and Gov. Jerry Brown (D) have  agreed on a budget plan that restores partial funding for dental services in Medi-Cal, California’s Medicaid program.

Oral HealthNorthern California legislators and dental providers have been at the forefront of a campaign over the past four years to get dental coverage for Medi-Cal adults restored. For many advocates and stakeholders, this week’s budget news was considered a partial victory. Although not the complete restoration of $131 million sought, the state plans to spend about $16.9 million this fiscal year and $77 million next year on dental coverage. The money will provide preventive care, dental restorations and full dentures for adult beneficiaries of Medi-Cal.

denticalRestoring adult coverage in Denti-Cal was considered a priority for California Senate President Pro Tempore Darrell Steinberg (D-Sacramento).

“Dental care is so essential to physical health and employability,” Steinberg said. “The current alternatives are gum disease and use of hospital emergency rooms at the expense of taxpayers, which is unacceptable.”

Lindsey Robinson, a pediatric dentist in Grass Valley and president of the California Dental Association, called the agreement “a significant achievement in the effort to restore all adult Denti-Cal services and a step in the right direction to address the oral health care crisis facing millions of Californians.”

by Mari Edlin, California Healthline Regional Correspondent

Read the rest of the article at http://www.californiahealthline.org/features/2013/medical-dental-coverage-partially-restored.aspx#ixzz2Wt8niGJz

STUDY: REPUBLICAN PLAN WOULD CHOP MEDICAID BY $1.7 TRILLION

By PHIL GALEWITZ, KAISER HEALTH NEWS
October 25, 2012

The House Republican plan to repeal President Barack Obama’s health law and turn Medicaid into a block grant program would save the federal government $1.7 trillion from 2013 to 2022, a 38-percent spending reduction,according to a report this week by the Urban Institute for the Kaiser Family Foundation.

 

It would also result in 31 million to 38 million fewer people getting  Medicaid coverage in 2022, according to the report. The entitlement program, which is jointly financed by the state and federal governments, now provides health coverage to about 62 million poor people, about half of whom are children.

THIS MIGHT HURT A LITTLE BIT

The block grant idea — paying a fixed sum to states — was formulated by Rep. Paul Ryan, Mitt Romney’s vice presidential running mate and chair of the House Budget committee, and passed by the Republican-controlled House of Representatives in 2011 and 2012. The strategy is part of the GOP plan to cut the nation’s $1 trillion federal deficit.

 

Romney backs a similar Medicaid block grant strategy that would cut $100 billion a year from Medicaid starting in 2013. Under Romney’s plan, federal payments to the states for Medicaid would grow at 1 percentage point a year above the Consumer Price Index. That would slow funding increases, but give states greater freedom in how they use the money, including the ability to cut eligibility or benefits to meet their budget needs. Today, the federal government sets minimum rules and guidelines and must approve any major changes to the program.

 

The Urban Institute analysis, which updates an analysis originally done in May 2011, said the House block grant plan would cut funding to hospitals by as much as $363.8 billion, and payments to nursing homes by $22.2 billion.

DISABLED FOLKS ARE LIABLE TO BE HURT THE MOST

Of the $1.7 trillion cut to Medicaid spending, $932 billion of the reductions come from repealing the Medicaid expansion in Obama’s health law and $810 billion is a result of spending cuts that are part of the block grant.

 

Under the health law, Medicaid would expand to cover as many as 17 million more people starting in 2014. States have the option to decide whether to expand eligibility, and several Republican-led states including Florida and Texas say they can’t afford the expansion.

 

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

 

To read the article source, click here:
http://www.disabilityscoop.com/2012/10/25/study-republican-chop-medicaid/16733/

Another source of information:  http://www.theatlantic.com/business/archive/2012/08/is-medicaid-doomed-how-ryans-plan-would-affect-americas-very-poorest/261070

100 Attend Town Hall on Healthcare

Monday evening, a full house of 100 people attended an exciting and inspiring town hall meeting describing the successful new strategy  employed by activists in Vermont from 2008 to the present day.   One of the strongest messages heard was that only through dogged determination and a strong commitment to promoting unity based on principles of inclusion can any progressive movement succeed.

It was truly empowering to learn that so many dedicated activists were so committed to the first principle of reform, which is universality.  Attempts were made by opponents to dilute the resulting legislation by proposing to not cover undocumented immigrants.  It could easily have been people with disabilities since most have Medi-Cal and are technically covered with one form of insurance.  Since most of us suffer at the expense of an inferior brand of health insurance, we urge y0u to join the single-payer movement.  You can make real contributions and receive an improved, truly universal 100% coverage “Improved Medicare for All” healthcare system as a result.  In Butte County, the Butte County Health Care Coalition would welcome your contribution of effort.

The 6 Principles of Real Healthcare Reform are:

  1. Universality

  2. Comprehensive, High-Quality Level of Care

  3. Affordable, Based on Ability to Pay

  4. Costs Must Be Contained

  5. Accountability

  6. Transparency

If you would like to be the beneficiary of such a wonderful improvement in your healthcare options, consider volunteering for the Butte County Health Care Coalition.  Additional information is available on their website at : http://www.buttesinglepayer.org

In our society there is a new opening for deep changes.  If you are tired and discouraged from getting the short end of the stick lately, we encourage you to get active.  In the 60’s, disabled activists gained important civil rights through participation in the social justice issues of the day.  Now is our time to gain new rights by joining with other activists.  What better place to start than by joining the other activists fighting for a fair and just healthcare system, one in which disabled citizens share with others in living a better quality of life.