Santa Clara County Steps Up: What You Need to Know About the New Managed Health Care Program

Santa Clara County is facing deep federal funding cuts. To tackle this, local leaders want to reduce how much taxpayer money supports the county’s large public hospital system. However, this approach raises concerns about whether the focus will shift from providing health services to maintaining the institution’s survival.

On May 20, the Board of Supervisors decided to replace most members of the Santa Clara Family Health Plan’s governing board with county employees. This move aims to streamline the Medi-Cal reimbursements for low-income families, foster youth, disabled individuals, and seniors. The plan is to simplify the Medi-Cal process and enhance funding by creating a single plan model, reducing inefficiencies and overlapping costs.

The leaders of the Family Health Plan strongly opposed this decision. CEO Christine Tomcala called the proposal “reprehensible” and claimed it disrespects the governing board, staff, and members. In a letter to supervisors, they labeled the shift a “hostile takeover.”

The Family Health Plan was set up in 1995 to offer coordinated care for those eligible for both Medicare and Medi-Cal. The initial goal was to provide a better healthcare experience. Yet, as County Executive James Williams noted, this program now acts as a barrier to funding necessary care.

Currently, around 300,000 residents are enrolled in the Family Health Plan, making it the largest in Santa Clara County. However, its separate governance resembles that of an insurance company, prioritizing cost containment over patient care.

Unlike the county’s general fund, which supports various needs, the Family Health Plan lacks a financial safety net. County officials argue this results in lower reimbursement rates for hospitals.

More control over the Family Health Plan could help the county advocate for better reimbursement rates. With federal Medicaid cuts looming from Congress and proposed reductions by California Governor Gavin Newsom, officials say changes are urgent.

To implement a unified Medi-Cal strategy, the state Department of Health Care Services must approve the county’s “single plan” request. If accepted, the Family Health Plan would become the sole provider for Medi-Cal and Medicare, removing Anthem from the mix. However, gaining approval may take years.

Currently, there are four plans managing Medi-Cal and Medicare: two private providers (Anthem and Kaiser Permanente) and two public ones (Valley Health Plan and Family Health Plan).

Williams highlighted the need for a streamlined strategy to ensure essential services remain stable. As Family Health Plan seeks legal action against the county’s takeover, a judge has already denied their request for a temporary restraining order, which the county sees as a victory.

Supervisor Susan Ellenberg reassured residents that these changes don’t affect patients directly, emphasizing that the goal is to improve care quality from trusted doctors and health professionals.

In light of recent struggles, it’s clear that balancing funding and patient care is crucial. Local health systems face complicated challenges, but understanding these dynamics can help residents stay informed and engaged with their healthcare options.

For further reading on healthcare funding and reforms, you can check out resources from the California Department of Health Care Services. Their insights into Medi-Cal and changes can provide a broader context to this ongoing conversation.

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health care, Santa Clara County