HASC hosted more than 45 hospital representatives in a meeting with Healthy Way LA, the low-income health plan established under the Medicaid 1115 waiver. The meeting sought to update private non-contracted hospitals in Los Angeles County on program changes as the program approaches its 17th month of operation.

Since going live in July 2011, HWLA has enrolled more than 200,000 of the total estimated 500,000 people who qualify for the program. In addition, participating enrollment sites were expanded beyond the initial six county-designated sites. A listing of participating health clinics can be found in the HWLA Provider Directory located at www.ladhs.org/wps/portal/HWLA.

Healthy Way LA also addressed hospital concerns regarding HWLA recipients failing to self-declare their plan status when visiting a private hospital emergency room.  Emergency room visits are reimbursed at 30 percent of Medi-Cal per standard terms of condition.  Other concerns raised at the meeting were delays associated with obtaining HWLA authorization for inpatient admission. These delays are further complicated by the perception of inadequate staffing at the HWLA call center, and the need to repeatedly resubmit documentation. HWLA acknowledged that repatriation of HWLA members into the DHS system is a significant problem due to capacity limitations. However, HWLA believes DHS facilities will create additional capacity as InterQual is deployed at all DHS hospitals by February 2013.

In order to work through the operational challenges, HWLA representatives and private hospitals agreed to establish a workgroup that will be charged with trying to resolve communication, operational and claims processing delays as this program will sunset Dec. 31, 2013. HWLA recipients will then transition to Medi-Cal under the health care coverage expansion program created by the Affordable Care Act effective January 1, 2014.

Contact: Jaime Garcia
(213) 538-0702, jgarcia@hasc.org