Testimony Presented by:
Lourdes A. Rivera, Staff Attorney
National Health Law Program
Hearing before the California Assembly Committee on Judiciary
Tuesday, April 6, 1999
Good morning. I am Lourdes Rivera, Staff Attorney at the National Health Law Program (NHeLP). Thank you for the opportunity to testify before you today. I also want to thank Assemblymembers Sheila Kuehl and Helen Thomson for introducing AB 525. NHeLP proudly sponsors and strongly supports this bill. NHeLP is a private, non-profit organization that has worked for the past 30 years to gain access to health care for low-income people. We are based in Los Angeles and have a long history of working collaboratively with California advocates throughout the state on issues of Medi-Cal, Medi-Cal managed care, reproductive health, children's health and indigent care.
A. AB 525 Ensures Access to Important Reproductive Health Services for Low-Income Women
The vast majority of women receiving Medi-Cal are in their childbearing years.(1) Moreover, low-income women on Medi-Cal are being targeted for Medi-Cal managed care enrollment.(2) Reproductive health services are a critical part of basic, primary care for all women, and for women in this age group in particular. It is imperative that reproductive health services not be fragmented from the rest of women's health care services. AB 525 will ensure that women, men and adolescents enrolled in regular Medi-Cal, Medi-Cal managed care and commercial plans, alike, have access to these important services.
B. AB 525 Empowers Consumers with Information
For example, AB 525 will ensure that managed care consumers receive the information that they need about the availability of reproductive health services in order for them to make their health care choices. Up front, clear information is needed at the time that individuals choose their health plans and providers as well as when they are seeking needed health care services. Individuals often assume that reproductive health services are going to be available. Without this information, health care consumers will not be aware that services are restricted until they are seeking care. This often is too late to make alternative arrangements.
C. AB 525 Ensures Choice of Providers
By requiring health plans whose providers restrict access to reproductive health services to contract with at least one other facility in the area that provides services, AB 525 ensures that health plans that serve both Medi-Cal and commercial managed care consumers provide accessible choices within their plan networks. While federal and state law requires that individuals maintain freedom-of-choice to access family planning services from any Medi-Cal family planning provider, beneficiaries not only need to be told of this right, they must have alternative providers in order to exercise this right. If these services are not easily accessible within the health plan network, women often will not be able to obtain these services. Low-income health care consumers, in particular, do not have the time, income, and transportation to seek needed services outside of their health plans or outside of their communities.
D. AB 525 Promotes Coordination of Care
Women's health services also can be needlessly fragmented if the comprehensive set of Medi-Cal covered services are not available within the health plan. For example, while a tubal ligation is available as an out-of-plan family planning service, labor and delivery, unless an emergency, is not. This means that a woman could not arrange with the necessary lead time a voluntary tubal ligation at labor and delivery, unless there were an available, geographically accessible hospital within the health plan network. AB 525 would ensure coordination and continuity of care for all of women's basic health services.
E. AB 525 Mirrors Effective Authority in Other States
AB 525 provides the Attorney General with the authority to oversee both nonprofit-to-nonprofit and nonprofit-to-for-profit mergers. This measure provides the community the means to voice concerns about services that are important to them and provides the AG flexibility to weigh the impacted community's needs. This ensures that communities are not left without adequate access to reproductive health, emergency, and indigent care services. Other states, such as Montana and Connecticut, give their Attorney Generals and other state officials similar authority to oversee hospital mergers and to impose conditions in order to preserve access to services that otherwise would be lost.
F. AB 525 Preserves Religious Freedom While Promoting Access
AB 525 also furthers the public interest of preserving access to services by targeting limited taxpayer resources by awarding state bonds and loan guarantees to health care facilities that will not discriminate and that will provide services or partner with others who will make these critically needed services available. AB 525 allows facilities to develop creative partnerships and does not force anyone to provide services to which there is any moral or religious objection. In sum, AB 525 contains important measures to ensure that reproductive, emergency, and indigent health services remain available and that reproductive health services are not marginalized. I look forward to working with you and others interested in preserving access in the near future.
1. UCLA Center for Health Policy Research & Women's Health Collaborative, Women at Risk in California: A Chartbook on Health Insurance and Coverage and Access to Care at 76 (Nov. 1998) (of non-elderly women (80%) receiving Medi-Cal, the vast majority are between the ages of 18 and 44).
2. Department of Health Servs., 1998 Managed Care Annual Statistical Report (March 1998), Table 2.3 (showing that most individuals between the ages of 15 and 45 who are in the mandatory enrollment Medi-Cal aid categories are female.).