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Old 05-30-2011, 02:07 PM
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Jeanfromfillmore Jeanfromfillmore is offline
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Default State wants to reduce Medi-Cal costs

California has basically eliminated First Five and is turning those funds over to Medi-Cal. Remember every anchor baby is entitled to Medi-Cal along with all the other entitlements California slathers on all those "how just come here to feed their families." Now remember that the $576 in medical, which they hope will be lowered to $487 per member per month is in addition to the $1,000 per month spent on education for each anchor baby. Add that to the WIC, Section 8 Housing, free child care, food stamps, cash allotments, free appliances, reduced utilities and free legal assistance. There are plenty more given in Federal Grants, the numbers are astounding. But you will always find the truth hidden behind "Thousands of low-income, chronically ill elderly and disabled Inland patients" because hiding behind such a group give you the ability to promote your own "cause".



State wants to reduce Medi-Cal costs for thousands of Inland patients
Thousands of low-income, chronically ill elderly and disabled Inland patients used to deciding how to resolve their own medical needs soon must pick between two local organizations that will manage their care for them in their government-subsidized health program.
On June 1, managed care organizations will begin keeping track of about 366,000 Medi-Cal patients in 16 counties identified as a medically needy group that is expensive to treat. Medi-Cal is California's Medicaid program.
Until now, many Medi-Cal patients found their own doctors. Or they waited until they became seriously ill before going to hospital emergency departments for treatment.
State officials, doctors and patient advocacy groups think managed health care for many of California's sickliest people could improve their access to doctors and clinics, better control their illnesses, prevent costly hospital stays and save money.
Earlier this year, the state started asking Medi-Cal patients to pick a managed care organization that will handle their health care needs. The conversion includes nearly 43,000 Medi-Cal patients in Riverside and San Bernardino counties.
Managed care enrollment is to be staggered according to patients' birthday months. It will last through May 2012.
Medi-Cal spokesman Anthony Cava said costs for the group moving into managed care average about $576 per member per month. The managed care transition could lower costs to an average of about $487 per member per month, he said.
Cava said he couldn't break down costs for Riverside and San Bernardino counties.
About 2,500 residents in Riverside and San Bernardino counties will be enrolled each month. They will choose between Inland Empire Health Plan, a local, nonprofit health organization better known as IEHP, and Long Beach-based Molina Healthcare, a private company.
Cava said it's too soon to know how many people already have enrolled.
SAVINGS ESTIMATE
The mandatory managed care program could save an estimated $365 million annually, he said. The change comes as California and the nation implement sweeping federal health care legislation passed in 2010. The managed care program is part of a deal the state and federal government struck to give California about $10 billion during the next five years to change health care delivery.
However, patients who typically wait until they become severely ill to get hospital emergency department treatment or look for their own doctors will relinquish much of their freedom of choice to a managed care organization. They will be allowed to select or keep family doctors as long as those doctors participate in IEHP or Molina plans.
"We want to maintain that relationship as much as possible," said IEHP CEO Dr. Brad Gilbert.
His organization includes 750 family doctors and 2,000 specialists. Gilbert said he expects roughly 35,000 people to join IEHP, which already manages health care for nearly 500,000 low-income residents in Riverside and San Bernardino counties.
Notices started going to people about three months ago, encouraging them to select managed care organizations and family doctors. For those who don't choose, plans and doctors will be selected based on their medical billing histories, Gilbert said. Unsatisfied patients will be permitted to change doctors every month until they find someone they like, he said.
Until now, he said, "there has been no (doctor) list, no process. We anticipate getting a significant number of phone calls. "We're going to have people upset with the change," Gilbert said.
GETTING EXEMPTIONS
Chronically ill patients such as Ed Bentivengo, of Lake Elsinore, could become exempt from participation, even though the state wants him in managed care.
Bentivengo, 49, has been seriously ill for several years with a condition that he asked remain confidential. Managed care, he said, "is catastrophic for me. It's just very disturbing."
Bentivengo, who is disabled, said doctors in La Jolla and San Clemente, who do not participate in Riverside County's managed care organizations, have kept him alive. He doesn't want to be forced to change doctors or prescriptions. "I'm in a state of consternation," Bentivengo said.
Gilbert said patients with complicated circumstances might qualify for medical exemptions. They and their doctors are required to complete forms explaining the need for exemption, he said.
"The meds are not a big problem," Gilbert said. "Most will go right through and the patient will not be affected."
The goal is to settle patients into a new system with little hassle, he said.
"We're concerned about it," Gilbert said. "We're doing the best we can for our part of it."
Gilbert believes most people's doctors are in IEHP's network. So, transition into managed care should be fairly simple, he said. IEHP has included new doctors based on calls from people with serious illnesses, such as HIV, who wanted to continue treatment with their providers, Gilbert said.
AVOIDING DISRUPTIONS
"We want to keep the core system as intact as we can," he said. "It doesn't do any good to disrupt their care."
Dr. Dev GnanaDev, medical director at Arrowhead Regional Medical Center in Colton, thinks managed care could help a lot of people get organized, preventive care that they've been missing to manage serious problems.
"This is the way to get them coordinated care," said GnanaDev, who is past president of the California Medical Association, a professional organization. "Many of these people don't have primary care docs. These are people who generate a lot of the Medi-Cal costs."
Usually, they arrive very ill at hospital emergency rooms because they don't get regular checkups, he said. Afterward, they fight to get limited follow-up appointments that specialists set aside for Medi-Cal patients.
Medi-Cal pays specialists less than $30 for patients they treat. As a result, specialists routinely restrict the number of Medi-Cal patients they see to limit losses. No organization advocates for them to get appointments or arrange follow-up care.
However, state law requires managed care organizations, including IEHP and Molina, and their doctors to respond to their patient telephone calls and appointment requests within specific timelines.
"That'll be a challenge," said Gilbert, adding that the Inland area has a shortage of family doctors. "We'll make it happen. We already make it happen."
http://www.pe.com/localnews/stories/...0.3c4fcce.html
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  #2  
Old 09-14-2011, 01:57 PM
Schipperke Schipperke is offline
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Default Loss of freedom of choice

Due to the reduced payments to Medi-Cal providers and the fact that any Medi-Cal provider must accept *all comers* many of the best family practice doctors are no longer accepting Medi-Cal patients. I can't blame them. If the State used some common sense and allowed doctors to designate a percentage of their practice to Medi-Cal patients, even as little as 10%, there would be no shortage of doctors available to Medi-Cal patients. The option the State of California has chosen is not a good one. All we have done is set up one more bureaucracy to throw good money after bad with negative results. By forcing a severely ill person into a system where they have no choices in their health care and are too weak and ill to fight for what they need is criminal. I should be surprised? The entire country is being run down a criminal path step by step.... Today's Republican party is composed of the most selfish, uncaring people I have ever seen short of a communist state. Save money at the cost of more freedoms? Not if I can stop it.
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Old 09-14-2011, 03:03 PM
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Ayatollahgondola Ayatollahgondola is offline
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Quote:
Originally Posted by Schipperke View Post
Due to the reduced payments to Medi-Cal providers and the fact that any Medi-Cal provider must accept *all comers* many of the best family practice doctors are no longer accepting Medi-Cal patients. I can't blame them. If the State used some common sense and allowed doctors to designate a percentage of their practice to Medi-Cal patients, even as little as 10%, there would be no shortage of doctors available to Medi-Cal patients. The option the State of California has chosen is not a good one. All we have done is set up one more bureaucracy to throw good money after bad with negative results. By forcing a severely ill person into a system where they have no choices in their health care and are too weak and ill to fight for what they need is criminal. I should be surprised? The entire country is being run down a criminal path step by step.... Today's Republican party is composed of the most selfish, uncaring people I have ever seen short of a communist state. Save money at the cost of more freedoms? Not if I can stop it.
While I can agree on most of what you said, I'm a bit confused as to why only the republicans would be the demons here.

And welcome to SOS skipper


Last edited by Ayatollahgondola; 09-14-2011 at 03:05 PM.
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Old 09-15-2011, 07:04 AM
Patriotic Army Mom Patriotic Army Mom is offline
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I'd debate that, but words are not my strength.
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Old 09-16-2011, 03:55 AM
Rim05 Rim05 is offline
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While I can agree on most of what you said, I'm a bit confused as to why only the republicans would be the demons here.
It is not actually ONLY Reps, but they are so dissapointed that they lost the 08 election that they have said the will MAKE this President a one term President. In my words, AT THE COST OF ANY THING THAT IS GOOD , EVEN AT THE COST OF HARM TO OUR COUNTRY.
My, how patriotic, talk about 'throw the baby out with the bath water'.
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Old 09-16-2011, 07:52 AM
Patriotic Army Mom Patriotic Army Mom is offline
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I would have to say our country has been harmed badly for the last couple of years. Our military has been hand cuffed and I'm so glad my son after 5 tours over there, does not have to go back for awhile.
mr. o would rather they all get done in!
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Old 09-17-2011, 10:15 AM
Rim05 Rim05 is offline
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mr. o would rather they all get done in!
I must remind you that mr. b did not mind the danger he was seneing them into.
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Old 09-17-2011, 07:11 PM
Patriotic Army Mom Patriotic Army Mom is offline
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Yes, and my son gladly served 5 or 6 tours over there. I was very proud of all of them. They know things we will never be told. Wait till our own country has a leader like Sadam. God willing that never happens. Many men and women signed up to go and fight it over there.
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Old 09-17-2011, 08:32 PM
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Jeanfromfillmore Jeanfromfillmore is offline
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Originally Posted by Rim05 View Post
I must remind you that mr. b did not mind the danger he was seneing them into.
Rimo, Bush was bad, that's not in question. But, just because he was bad does not excuse how miserably Obama is and the damage he has caused and continues to cause.

Yes, there were those, from the beginning, who pledged to take Obama down, and those that voted for him felt an offense to that. But, the fact that he had no experience, absolutely NONE, was an insult to those who recognized he was not fit for the position; and time has proved them right. He wasted the first year on "his" healthcare while the country slid farther and farther down. It was an important time to attack our unemployment problems, but instead he was more concerned with what he thought would make "history for him!!!" We have an amateur in the White House, and comparing him to other who were bad at the job does not change that fact.
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Old 09-18-2011, 12:30 PM
Rim05 Rim05 is offline
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Jean, I probably should not have logged in today. I had a heated debate with a close friend this morning. After he left, I had to change from my long sleeve shirt to a short sleeve shirt.

He believes every dang thing the extreme right says. He even agrees with Parry (not a typo) that SS is a ponzi scheme. He would like his to be privitized, total block head.I will not get into it all, but he thinks it is all the medias fault. I ask where I should get my formation and he said I should read the laws. Typical Rep.
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