Tuesday, June 20, 2017
Open Board of Directors Meeting
3200 Inland Empire Blvd.
First Floor Media room
Ontario, CA 91764
Present: Tom Brickley, Rachelle Bussell, Ken Coate, Brad Gilbert, Lowell King, Bill Lemann, P.T. McEwen, John Mirau, Dan Murphy, Roman Nava, Vikki Ostermann, Cid Pinedo, Brian Reider, Elizabeth Romero, Kristine Scott, Paul Shimoff, Hassan Webb and Ray Wolfe.
Guests: Adam Eventov, Nick Grooters, Grace Johnson, Boris Medzhibovsky, Marco Robles and Jennifer Shaw.
Announcements: 1) A majority of the members present voted last week to extend an invitation of membership to Cota Cole & Huber LLP.
M/S/P: Minutes from June 13, 2017
Rachelle Bussell introduced Dr. Bradley Gilbert, CEO, Inland Empire Health Plan (IEHP).
IEHP is a Knox-Keene licensed health plan and organized as a Joint Powers Agency of Riverside and San Bernardino Counties. IEHP is a public agency, not-for-profit health plan that became operational in 1996. They provide a mixed model HMO with Independent Physician Association (IPA) and direct physician contracting (carrying over 4,000 primary care physicians and specialists).
One of the key provisions of the ACA is the expansion of health coverage to low-income families through the Medi-Cal program. Prior to the passage of the ACA our high number of uninsured received no preventative care and their medical needs were accessed thru hospital emergency rooms, the most expensive form of health care. Many of these individuals are hardworking people in low-wage jobs (full and part time) that are not offered or can afford health insurance.
IEHP now serves more than 1.25 million members in our region (a 160% increase in membership). They maintain contracts with every hospital in the Inland Empire and offer programs in Medi-Cal, and IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan). There is a prevalence of chronic health conditions in adult Medi-Cal recipients and adult IEHP members are much more likely to have one or more chronic conditions that require ongoing treatment such as:
- Substance abuse
- Behavioral health problems
The Medi-Cal expansion in California has benefited 3.7 million adults who now have coverage. If Congress repeals the ACA, millions of Americans who get affordable health coverage (some 24 million) will lose it under the American Health Care Act (AHCA) within 10 years.
The annual IEHP economic impact in our region now totals $1.38 billion dollars to the two counties. Without a solid replacement plan our local economy will experience a major economic loss. IEHP annually pays the following:
- Doctors $455.7 million
- Facilities $443 million
- Pharmacies $182.1 million
The American Health Care Act (AHCA) was passed by the House in May 2017. According to the Congressional Budget Office (May 24, 2017) that scored the bill and amendments, there will be 23 million fewer insured by 2026 and $834 billion in Medicaid will be cut over 10 years. While the ACA raised taxes on the rich to subsidize health insurance for the poor, the repeal-and-replace bill would redistribute hundreds of billions of dollars in the opposite direction. It would deliver a sizable tax cut to the rich, while reducing government subsidies for Medicaid recipients and those buying coverage on the individual market.
The bill, in current form, would have the following impacts on Medicaid Expansion (MCE) – Medi-Cal Expansion in CA:
Reduced Federal Match Dollars (FMAP)
- Under the current ACA, the federal government provides states with a 90% match for MCE member costs in 2020 and beyond.
- The AHCA would reduce the federal match to 50% for all new MCE members (at the state’s option) starting in 2020-which will require the State to reduce benefits or eligibility.
6-Month Eligibility Review
- Under the current ACA, MCE eligibility is re-determined annually.
- The AHCA would require eligibility redetermination every six months, potentially leading to rapid disenrollment.
Rapid Reduction of MCE Members with Enhanced FMAP
- CA will see a large shift in MCE members moving from 90% federal reimbursement to 50% which will create a large funding deficit.
- By 2027, CA projects it will have less than 2,000 MCE Members with enhanced FMAP.
Vital Components of the ACA include collectively working with vested stakeholders to:
- Preserve the Medicaid expansion option and associated funding structure
- Maintain mental health and substance use treatment as essential health benefits
- Maintain presumptive eligibility
- Shield against uncompensated care costs
A Q & A period followed
Meeting adjourned at 8:30 a.m.