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CenCal Health Briefs Santa Barbara County Providers on Affordable Care Act

Seminar covers details of the new health-care law, including an expansion of Medi-Cal and creation of the Covered California insurance exchange

CenCal Health has been hosting seminars on the new health-care reform laws for local providers, and discussed the Medi-Cal expansion and the Covered California insurance exchange on Thursday in Santa Barbara.

The Patient Protection and Affordable Care Act, also known as Obamacare, has two major parts in California: the expansion of Medi-Cal (subsidized care for low-income patients), and the creation of a state insurance marketplace, the Covered California exchange.

CenCal Health is the administrator for Medi-Cal on the Central Coast, and the expansion plans have been going smoothly so far, CEO Bob Freeman said.

Administrators from CenCal Health and Santa Barbara County briefed providers at Thursday's seminar. 

County health centers are already signing people up for Medi-Cal and identifying patients who were part of the Medically-Indigent Adult programs or were uninsured.

Those patients are now being admitted to the MIA program until Dec. 31, when it’s being eliminated, and then will automatically be enrolled in Medi-Cal come Jan. 1, when the expansion kicks in, said Elizabeth Snyder, deputy director of primary care for the Public Health Department.

More people will be eligible for Medi-Cal starting next year when the income ceiling rises, and the county is hoping most people who get insurance keep using the primary-care physician they do now, Snyder said.

A big concern for providers is the lack of funding for the residually uninsured and undocumented patients, who frequent the county health centers and local hospitals.

Covered California, one of 14 state exchanges, offers private insurance plans with varying levels of government subsidies. It has open enrollment now through March 31, so various health-care organizations and insurance brokers are getting trained and certified to be application counselors.

The Santa Barbara County Department of Social Services has counselors available now, and the Public Health Department, Santa Barbara Neighborhood Clinics and American Indian Health Services will have application counselors available starting in November.

The application process was originally estimated to take 30 minutes per person, but has increased to 90 minutes. Some people need two appointments to decide what insurance company to join and then which of the four plan levels to buy, Snyder said.

Only Anthem Blue Cross and Blue Shield have plans for Santa Barbara County on the exchange. If people want coverage by Jan. 1, they have to apply by Dec. 15.

One of the major problems with the state site has been the lack of a providers list, so consumers can’t check which doctors, clinics and hospitals are included in the health plans. It’s a problem for providers seeking answers, too.

It was clear from Thursday’s seminar that many providers aren’t sure about their own contracts with insurance companies, and whether they will be accepting patients with Covered California insurance plans.

CenCal Health can’t help with that, since it is not allowed to give contract advice and doesn’t know what every individual agreement includes, Freeman noted.

One person brought up the example of Sansum Clinic, which is not signed up to be a provider for any exchange plans even though the organization wants be included.

“That was news to us,” Sansum Clinic CEO Dr. Kurt Ransohoff told Noozhawk earlier this month. “We had operated under the assumption we would be in the network.”

Sansum's primary- and specialty-care services handle 61,000 patient visits monthly, and neither type of provider is included in the exchange’s insurance plans.

That means, if nothing changes, people who buy any kind of plan through the state exchange won’t be able to use their insurance to see doctors at Sansum Clinic next year.

The insurance companies are creating “narrower” networks of providers to try and make the insurance plans more affordable to consumers, Freeman said. As an impact, they seem to be offering lower reimbursements to providers – including doctors and clinics – but saying there are fewer providers in the pool, so a larger volume to make up the difference.

Noozhawk staff writer Giana Magnoli can be reached at .(JavaScript must be enabled to view this email address). Follow Noozhawk on Twitter: @noozhawk, @NoozhawkNews and @NoozhawkBiz. Connect with Noozhawk on Facebook.

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