Lee Kemper is the executive director of the county Medical Services Program (CMSP) governing board, a program providing health coverage for low-income, indigent adults in primarily rural California counties. Starting Jan. 1, the board launched Path2Health, expanding eligibility for no-cost health coverage to adults at 100 percent of the federal poverty level.
How is Path2Health different from CMSP?
We gave Path2Health a new brand, if you will, because of the fact that it is part of the Low Income Health Program and it’s part of the “Bridge to Reform” [federal Medicaid waiver]. And so we thought that it would make sense to give it its own identity to be part of our outreach to help people understand that this is a program made possible by the federal health reforms. And it’s different in that the eligibility criteria are broader than what we were able to do under CMSP, although the benefit package is essentially the same. Over time, what we expect is that most of the members who were in CMSP will flow into Path2Health, because most of the people that we serve are at an income group of about 100 percent of the federal poverty level and below. And that’s our focus of the Low Income Health Program, that segment of the population. And under federal health reform, January 2014, that group is eligible up to 133 percent of poverty. But for essentially financial reasons we could only go to 100 percent of poverty because we have to come up with the non-federal share of total expenditure, and that’s how much we could make work.
Now that the proposed budget is out, has the program been affected in any way?
Generally the money that supports CMSP comes from realignment (sales tax and vehicle license fees), and those dollars go directly to counties and to the governing board so they’re outside of the state budget. This goes back to 1991. Those monies are the non-federal share, and the federal money comes down directly.
Really what the state is doing is making changes to the MediCal program, or to certain welfare programs, or certain human service programs. And there may be some interaction with counties in those areas. In a global sense, as the reductions come down from MediCal as a major payer they have an impact on providers, which means their financial viability may be affected. That then affects their overall ability to serve the population, which then could have an impact on our population. But since we contract separately and pay separately for services provided to our members, including those who will be included in Path2Health, it’s a separate sort of dynamic.
What happens to people enrolled in Path2Health after the federal reform is enacted?
The people in Path2Health become eligible for Medicaid, or in California MediCal. So Path2Health is really designed as a two-year bridge, or a pilot project, to get us to federal health reform. Whether or not Path2Health as an organization or a benefit sort of plan continues past 2014 is really dependent on a variety of things. The federal government will be picking up 100 percent of the costs for this Medicaid population, so there is a possibility that Path2Health could continue into the future if the governing board I work for wants to, in essence, serve in a role to administer the benefits plan. But there are a variety of different alternatives, there’s a lot of policy development to happen over the next couple years.
What happens to the realignment funds?
Well, the state of California has stated in the past that they want to redirect those resources back to the state. But there will be residual indigent care responsibilities that the counties will have because there are certain federal rules that make people ineligible for coverage either under the Medicaid program or the Exchanges. Most notably the citizen identity and alien documentation requirements that are in the federal law. For example we will continue to serve people now under CMSP because they either don’t meet the income criteria for Path2Health, which is pretty key, or alternatively because they don’t meet the documentation of citizenship or alien status requirements. For a person to be on Path2Health they have to be what’s called “DRA”, the Deficit Reduction Act standard. If they don’t meet that, they are given an opportunity to complete the documentation, for example if they were born in the United States but don’t have any of the source documents to support that. But if they can’t find the information, they wouldn’t be covered. Similarly people who come into the United States illegally are not allowed to participate in any federal program, and people who come to the United States and have been here legally for less than five years are not eligible to access public benefits. So folks likes these wouldn’t be covered under federal health reform, which means there will be certain residual obligations counties will have for the indigent. So that becomes a part of the conversation about realignment and money and all that business.
Has the CMPS governing board had much interaction with the Exchange Board, as far as working on this Bridge to Reform?
Well the populations are a little different, so not per se. And that’s primarily because the Exchange Board is relatively newish. The population that they’re focused on is those who are not eligible for MediCal and above. So folks from 134 percent of poverty up to 400 percent of poverty.
So that’s sort of how the pieces fit together, though. You have a segment that will be covered by MediCal, then you have a segment that will be covered by the Exchange, then you have other people who will be covered by their employers, and then you have people who have incomes above the threshold of the Exchange and they’re on their own.