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Santa Clara County takes over managed well being care program – NBC Bay Space

May 31, 2025
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Santa Clara County takes over managed well being care program – NBC Bay Space


Faceing the dramatic federal fund cuts, Santa Clara Clera County leaders need to scale back the of the mandatory taxpayers to help their mass public hospital system. That implies that in an establishment that the county created a long time in the past, which officers warn dangers to place their very own survival on well being providers.

The Board of Supervisors voted unanimously on Might 20 to remove the vast majority of the Authorities Board of Santa Clara Household Well being Plan in favor of occupying the seats with the county staff. It is among the varied steps that the County leaders are taking to maximise their refunds of public hospitals of the State’s Medi-Cal program for low-income households, parenting youth, folks with disabilities and older adults. The plan is to rationalize the medi-Cal reimbursements, identified on the federal degree as Medicaid, beneath a plan of plan solely to enhance reimbursement charges, remove inefficiencies and duplicate prices of AX.

The leaders of the Santa Clara Household Well being Plan left towards the concept final week.

“The proposal of the County Administration is frankly representable,” stated the CEO of Household Well being Plan Christine Tomcala to supervisors on the assembly. “It doesn’t respect our Board of Administrators, our employees and, most significantly, our members.”
The leaders of the Household Well being Plan to measure a “hostile acquisition” in a letter from Might 16 to supervisors.

Santa Clara County established the Household Well being Plan in 1995 to combine look after eligible folks for each Medicare and Medi-Cal. The target was to offer registered members a extra coordinated and particular person -centered care expertise. The county established the medical care program as a separate entity as a result of officers thought it might be too tough to deal with internally.

However since then this system has turn out to be a barrier for financing care, stated County Govt James Williams on the assembly final week.

Round 300,000 residents of the Santa Clara County are registered within the Household Well being Plan, which makes it the most important managed care plan within the county. Because of their authorities construction, county leaders say that the company works largely as a separate insurance coverage firm extra involved with value containment and surplus revenue.

The Household Well being Plan lacks monetary help such because the Basic Fund of the County, a dice financed by taxpayers for discretionary bills. County leaders stated this encourages this system to reimburse hospitals at decrease charges than most well-liked.

Having extra supervision concerning the Household Well being Plan will give essentially the most stated county about these charges, stated Williams. In the meantime, he warned the efforts of the Republicans in Congress to make the steep federal reductions of Medicaid, aggravated by reductions proposed by the governor of California Gavin Newsom, have pressed the timeline to make these modifications now.

The State Medical Care Companies Division must approve the request of the “Single Plan” of Santa Clara County. If accredited, the county would remove the anthem and make the household well being plan the one medi-cal/ Medicare supplier. However the utility might take a number of years.

Primarily there are 4 totally different well being plans that handle Mem-Cal and Medicare members. Two are personal insurance coverage suppliers: Anthem and Kaiser everlasting. Two are public: Valley Well being Plan and insurance coverage suppliers of the Household Well being Plan.

“There’s actually an pressing want for an environment friendly, unified and efficient medi-Cal technique that may mitigate these cumulative impacts and help the steadiness of those essential community providers,” Williams stated on the assembly.

The Household Well being Plan filed a lawsuit towards the County requesting a short lived restriction order towards acquisition, arguing that it’s unlawful because the Household Well being Plan is a separate entity. A decide denied that request.

“We’re happy that the Courtroom didn’t intervene to stop the Board of Supervisors will correctly train its coverage formulation authority to enhance the care administered in Santa Clara County, and that the Household Well being Plan subsequently requested the dismissal of the lawsuit the subsequent day,” stated County Lawyer Tony Lopy to San José Highlight.

The supervisor of District four, Susan Ellenberg, in feedback geared toward residents, stated that the actions that the Board took that day won’t have an effect on sufferers.

“(It’s) to easily finance the most effective out there look after you, of medical doctors and well being professionals you belief,” Ellenberg stated on the assembly.

This story was initially revealed by San Jose Highlight and written by Brandon Pho.



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