Sacramento was well-served last week by the Assembly Subcommittee on Health and Human Services, chaired by Assembly Member Holly J. Mitchell.  Her subcommittee put the California Department of Health Care Services (DHCS), specifically the director, Toby Douglas, on the spot when they were investigating several programs that the department had made decisions on that weren’t in the best interest of anyone but DHCS.

Douglas was forced to defend his decision to cut the Hearing Aid Benefit reimbursement by as much as 50% of current reimbursements levels, which would have limited the ability of children and adults to obtain hearing aids from providers in the state. The providers lined up and announced that they would no longer be able to service these individuals because the minimal reimbursement would force them to close their doors and go out of business.

The reimbursement levels have long been low and the level of required “free” follow-up high. Faced with this, DHCS has backed off until April and has promised to work with the providers to determine a fair and equitable reimbursement rate. (The reimbursement rate before the cuts occurred was capped at a max of approximately $825 while most hearing aids today sell for $2000-$4000. However, even at this low pre-cuts rate, many providers would have continued to service the public.)

The Healthy Families program, actually a program for children, was scrapped by Governor Brown last year in an attempt to save money. All the children in this program were to be folded into the MediCal system. As there are almost a million children who will be affected, the inclusion process has been divided into phases.

DHCS never set up a list of objectives to pursue during the first phase. The department collected outcome data after the first phase, then retroactively established goals to match the data to show the successful accomplishment of the program.

Assembly Member Richard Pan, M.D., and Douglas got into a debate over whether this is the correct way to collect data and set goals. The hearing also revealed DHCS’s lack of inclusion of pediatricians in the process. DHCS relied for insight on administrators who do not directly care for children.

While DHCS claimed to not have received many complaints from parents about the program shift, at the hearing it was revealed that DHCS specifically told families that complaints should not go to DHCS but to other agencies. Those agencies received a high level of complaints from parents.

The Subcommittee also learned that DHCS did not know how many providers for hearing services are associated with the MediCal program. Many professionals on the current provider lists are retired, have moved out of California, or are dead. Douglas insisted that the only way to “control” professional involvement was to make all MediCal recipients go on managed care plans. Perhaps DHCS should pick up the phone and call providers to see if anyone on the other end answers.

The Subcommittee demanded more transparency and better communication with shareholders such as the pediatricians.

Assembly Member Mitchell reiterated that the meeting was not for the purpose of pointing fingers and saying “Got’cha” but rather to address needs and make sure that the California public is being helped in the manner that has been promised. However, to all spectators, it was obvious that the legislative body “Got’cha.” And it is about time!