1 00:00:02,240 --> 00:00:04,980 This is where health insurance leadership comes together. 2 00:00:05,279 --> 00:00:08,960 Becker's fourth annual spring payer issues roundtable brings 3 00:00:08,960 --> 00:00:10,500 together over 400 4 00:00:10,639 --> 00:00:13,044 payer and health plan executives and more than 5 00:00:13,044 --> 00:00:16,504 100 speakers to Chicago April. 6 00:00:16,885 --> 00:00:19,765 This year's event includes keynote conversations with the 7 00:00:19,765 --> 00:00:23,044 industry's top leaders and former president George w 8 00:00:23,044 --> 00:00:25,605 Bush. For the full agenda and event details, 9 00:00:25,605 --> 00:00:27,809 visit beckershospitalreview.com 10 00:00:27,890 --> 00:00:29,250 and click on the events tab in the 11 00:00:29,250 --> 00:00:31,489 upper right. We're looking forward to hosting you 12 00:00:31,489 --> 00:00:32,549 here in Chicago. 13 00:00:33,969 --> 00:00:36,289 Hello, everyone. This is Jacob Emerson with the 14 00:00:36,289 --> 00:00:39,329 Becker's Payer Issues podcast. Thrilled today to be 15 00:00:39,329 --> 00:00:41,729 joined by Jennifer Shermer, who's the vice president 16 00:00:41,729 --> 00:00:44,375 of growth and community engagement and the interim 17 00:00:44,375 --> 00:00:46,935 vice president of dual program integration at Blue 18 00:00:46,935 --> 00:00:49,655 Shield of California's Promise Health Plan. Jen, thanks 19 00:00:49,655 --> 00:00:51,174 so much for taking the time to be 20 00:00:51,174 --> 00:00:53,495 with me on the podcast today. Hi, Jacob. 21 00:00:53,495 --> 00:00:55,895 Thanks so much for having me. Absolutely. And 22 00:00:55,895 --> 00:00:57,655 before we dive into everything we wanna talk 23 00:00:57,655 --> 00:00:59,159 with you about, a lot of big changes 24 00:00:59,399 --> 00:01:01,640 happening in the Medicaid space. Can you first 25 00:01:01,640 --> 00:01:03,079 tell us, Jen, a little bit more about 26 00:01:03,079 --> 00:01:05,479 yourself, your background in health care, and what 27 00:01:05,479 --> 00:01:07,159 it is that you do today at Blue 28 00:01:07,159 --> 00:01:07,659 Shield? 29 00:01:08,359 --> 00:01:09,180 Yeah. Absolutely. 30 00:01:09,959 --> 00:01:12,299 I began my career in health care 31 00:01:12,704 --> 00:01:15,104 about twenty eight years ago as a customer 32 00:01:15,104 --> 00:01:16,164 service representative. 33 00:01:17,185 --> 00:01:19,984 And throughout my career since that time, I've 34 00:01:19,984 --> 00:01:20,484 had 35 00:01:20,944 --> 00:01:21,444 positions, 36 00:01:22,224 --> 00:01:22,965 that range 37 00:01:23,504 --> 00:01:26,864 in provider network management where I've negotiated provider 38 00:01:26,864 --> 00:01:29,100 contracts for all provider types, 39 00:01:29,640 --> 00:01:32,060 as well as held various operational roles 40 00:01:32,680 --> 00:01:33,579 like claims, 41 00:01:33,880 --> 00:01:34,380 configuration, 42 00:01:34,840 --> 00:01:37,820 enrollment, and billing across all lines of business 43 00:01:38,280 --> 00:01:39,820 and within a few different, 44 00:01:40,200 --> 00:01:41,180 health care organizations 45 00:01:41,480 --> 00:01:42,219 in California. 46 00:01:42,884 --> 00:01:44,965 And while I have supported all lines of 47 00:01:44,965 --> 00:01:48,185 business, I found my most fulfilling experiences 48 00:01:48,564 --> 00:01:50,984 were those that involved the Medicaid program, 49 00:01:51,604 --> 00:01:53,685 which is known as the Medi Cal program 50 00:01:53,685 --> 00:01:54,664 here in California. 51 00:01:55,819 --> 00:01:59,099 And I joined, Blue Shield of California Promise 52 00:01:59,099 --> 00:02:00,959 Health Plan in 2020, 53 00:02:01,099 --> 00:02:02,799 right at the onset of COVID. 54 00:02:03,579 --> 00:02:04,060 And, 55 00:02:04,459 --> 00:02:05,759 it was for an opportunity 56 00:02:06,060 --> 00:02:07,759 that was going to exclusively 57 00:02:08,139 --> 00:02:10,239 focus on the Medi Cal line of business. 58 00:02:10,780 --> 00:02:11,854 And I was hired, 59 00:02:12,254 --> 00:02:12,754 initially 60 00:02:13,134 --> 00:02:15,775 serving as the senior director of Medi Cal 61 00:02:15,775 --> 00:02:16,275 operations 62 00:02:16,655 --> 00:02:17,555 before transitioning 63 00:02:18,334 --> 00:02:20,905 into my current position in January 64 00:02:20,905 --> 00:02:21,955 2023. 65 00:02:22,735 --> 00:02:25,370 And in my current role here, I have 66 00:02:25,590 --> 00:02:28,889 the exciting privilege to lead an incredible team 67 00:02:29,509 --> 00:02:31,530 responsible for customer service, 68 00:02:32,229 --> 00:02:33,370 provider engagement, 69 00:02:33,989 --> 00:02:36,650 the duals special needs program integration, 70 00:02:37,509 --> 00:02:39,449 and our business development teams. 71 00:02:40,094 --> 00:02:41,075 And every day, 72 00:02:41,694 --> 00:02:43,935 I have the privilege to work alongside such 73 00:02:43,935 --> 00:02:45,955 talented professionals who are 74 00:02:46,415 --> 00:02:48,275 extremely passionate and dedicated 75 00:02:48,655 --> 00:02:50,435 about elevating member experiences, 76 00:02:51,534 --> 00:02:54,435 strengthening our relationships with our healthcare providers, 77 00:02:54,814 --> 00:02:55,314 and 78 00:02:55,750 --> 00:02:58,250 driving the strategic growth of our health plan. 79 00:02:59,349 --> 00:03:02,310 Wonderful. Well, appreciate that overview there, Jen. And 80 00:03:02,310 --> 00:03:04,310 let's just dive right into what we're here 81 00:03:04,310 --> 00:03:07,050 today to talk about, which is HR one, 82 00:03:07,590 --> 00:03:09,909 one of the most impactful changes to the 83 00:03:09,909 --> 00:03:12,985 Medicaid program since the program's inception, I think, 84 00:03:12,985 --> 00:03:13,805 fair to say. 85 00:03:14,264 --> 00:03:16,025 And we've been talking with insurers all over 86 00:03:16,025 --> 00:03:18,185 the country about how how they're preparing for 87 00:03:18,185 --> 00:03:20,444 these major changes coming down the pipeline, 88 00:03:21,224 --> 00:03:23,384 some of the biggest going into effect in 89 00:03:23,384 --> 00:03:25,004 in the coming next year. 90 00:03:25,784 --> 00:03:27,449 So so before we dive into all that 91 00:03:27,449 --> 00:03:29,610 and how how you're thinking about this at 92 00:03:29,610 --> 00:03:32,090 Blue Shield and the Promise health plan, can 93 00:03:32,090 --> 00:03:34,409 you first fill in our listeners who might 94 00:03:34,409 --> 00:03:35,870 not be too familiar on, 95 00:03:36,250 --> 00:03:38,169 what what's what's an overview of the impact 96 00:03:38,169 --> 00:03:41,594 of HR one on your Medicaid members, And 97 00:03:41,594 --> 00:03:43,194 what sort of the timeline that we're looking 98 00:03:43,194 --> 00:03:44,875 at in terms of all the changes to 99 00:03:44,875 --> 00:03:45,375 coverage, 100 00:03:45,995 --> 00:03:48,014 that are that are coming down the pipe? 101 00:03:48,955 --> 00:03:50,875 Yeah. Sure. I'm happy to. And I'll start 102 00:03:50,875 --> 00:03:52,555 with just a brief overview of kind of 103 00:03:52,555 --> 00:03:53,789 what HR one is. 104 00:03:54,989 --> 00:03:57,969 And HR one is short for House Resolution 105 00:03:58,030 --> 00:04:00,430 Bill one, also known as the one big 106 00:04:00,430 --> 00:04:01,409 beautiful bill. 107 00:04:01,789 --> 00:04:04,430 And it was signed into law last year 108 00:04:04,430 --> 00:04:05,650 on the July 4, 109 00:04:06,349 --> 00:04:08,689 and it was the first major bill 110 00:04:09,614 --> 00:04:12,354 signed into law under this new federal administration. 111 00:04:13,294 --> 00:04:15,854 And simply put, at a high level, HR 112 00:04:15,854 --> 00:04:18,514 one changed federal budget laws, 113 00:04:19,454 --> 00:04:19,954 including 114 00:04:20,415 --> 00:04:23,939 large cross cutting changes affecting health care, taxes, 115 00:04:24,580 --> 00:04:25,480 social programs, 116 00:04:25,939 --> 00:04:27,160 and state budgets. 117 00:04:28,420 --> 00:04:30,500 Medicaid or Medi Cal, again, as we call 118 00:04:30,500 --> 00:04:31,480 it here in California, 119 00:04:32,899 --> 00:04:35,220 is a public health insurance program in The 120 00:04:35,220 --> 00:04:36,120 United States 121 00:04:36,660 --> 00:04:40,214 that provides medical and long term coverage for 122 00:04:40,214 --> 00:04:40,714 people 123 00:04:41,254 --> 00:04:43,995 with low incomes and limited resources. 124 00:04:44,854 --> 00:04:46,954 And from a federal program perspective, 125 00:04:47,334 --> 00:04:50,694 Medicaid accounts for about nine to 10% of 126 00:04:50,694 --> 00:04:53,034 the federal spend, making it the third 127 00:04:53,574 --> 00:04:54,954 largest federal program. 128 00:04:56,089 --> 00:04:58,410 And H. R. One made the largest changes 129 00:04:58,410 --> 00:05:00,649 to the Medicaid program that we've seen in 130 00:05:00,649 --> 00:05:01,149 decades. 131 00:05:01,850 --> 00:05:03,149 It's affecting eligibility, 132 00:05:03,769 --> 00:05:05,470 coverage, and financing. 133 00:05:06,329 --> 00:05:08,444 And the federal changes to the Medicaid 134 00:05:09,384 --> 00:05:10,365 program have direct 135 00:05:10,745 --> 00:05:13,165 material effects on states because 136 00:05:13,625 --> 00:05:15,004 Medicaid is a joint 137 00:05:15,465 --> 00:05:17,245 federal and state program 138 00:05:17,705 --> 00:05:20,525 that states administer and also help finance. 139 00:05:21,639 --> 00:05:24,300 So changes to the federal budget laws directly 140 00:05:24,439 --> 00:05:28,060 affect state budgets and states' Medicaid operations. 141 00:05:29,160 --> 00:05:30,699 And here in California, 142 00:05:31,560 --> 00:05:32,779 the Medicaid program, 143 00:05:33,399 --> 00:05:34,379 or Medi Cal, 144 00:05:34,759 --> 00:05:38,314 has been impacted by both federal and state 145 00:05:38,314 --> 00:05:39,214 policy changes 146 00:05:39,754 --> 00:05:40,654 that impact, 147 00:05:41,194 --> 00:05:43,214 who remains eligible for coverage, 148 00:05:44,074 --> 00:05:47,055 how easy people can stay enrolled, 149 00:05:47,754 --> 00:05:50,095 and continue to have access to care, 150 00:05:50,555 --> 00:05:52,310 across communities in California. 151 00:05:53,649 --> 00:05:56,209 Understood. I appreciate that that overview of the 152 00:05:56,209 --> 00:05:57,829 law of the new law, Jen. 153 00:05:58,930 --> 00:05:59,430 Specifically 154 00:05:59,810 --> 00:06:00,629 for Californians, 155 00:06:01,169 --> 00:06:03,910 for your for your Promise health plan members, 156 00:06:04,105 --> 00:06:05,805 what is this looking like for them? 157 00:06:06,345 --> 00:06:08,824 And, ultimately, how are you preparing internally, to 158 00:06:08,824 --> 00:06:10,524 adapt to to some of the changes? 159 00:06:11,464 --> 00:06:13,145 Yeah. So some of the changes to the 160 00:06:13,145 --> 00:06:16,105 program have already gone into effect, and others 161 00:06:16,105 --> 00:06:18,829 are close on the horizon. So I'll start 162 00:06:18,829 --> 00:06:19,649 with an example 163 00:06:20,029 --> 00:06:21,889 of a state policy change 164 00:06:22,269 --> 00:06:24,589 that has already gone into effect, and then 165 00:06:24,589 --> 00:06:25,889 we can talk about, 166 00:06:26,509 --> 00:06:27,009 examples, 167 00:06:27,469 --> 00:06:29,250 on the federal policy side. 168 00:06:30,029 --> 00:06:30,769 So beginning, 169 00:06:33,014 --> 00:06:34,235 first of this year, 170 00:06:34,855 --> 00:06:38,375 California froze new enrollments into full scope medical 171 00:06:38,375 --> 00:06:39,355 for undocumented 172 00:06:39,814 --> 00:06:41,995 adults age 19 and older. 173 00:06:42,455 --> 00:06:46,134 And full scope means comprehensive medical coverage, such 174 00:06:46,134 --> 00:06:49,569 as primary care, specialty care, and prescription drugs, 175 00:06:50,029 --> 00:06:53,169 not just emergency services and prenatal services. 176 00:06:53,709 --> 00:06:56,370 And you may recall back in 2024, 177 00:06:56,430 --> 00:06:58,370 California became the first state 178 00:06:58,925 --> 00:07:01,985 to provide Medi Cal to all income eligible 179 00:07:02,045 --> 00:07:03,745 residents regardless of their 180 00:07:04,045 --> 00:07:05,024 immigration status. 181 00:07:05,884 --> 00:07:08,764 So the new policy change to freeze enrollments 182 00:07:08,764 --> 00:07:10,144 for undocumented adults 183 00:07:10,764 --> 00:07:13,904 is driven by budgetary and fiscal constraints, meaning 184 00:07:14,285 --> 00:07:17,500 it's a response to state budget deficit 185 00:07:18,120 --> 00:07:21,180 and rising state only Medi Cal costs. 186 00:07:22,519 --> 00:07:26,120 And also starting on 01/01/2026, 187 00:07:26,120 --> 00:07:28,060 the Medi Cal asset limit 188 00:07:28,599 --> 00:07:29,500 was reinstated. 189 00:07:30,735 --> 00:07:33,074 This means that when determining eligibility, 190 00:07:34,014 --> 00:07:36,654 Medi Cal will now check to verify what 191 00:07:36,654 --> 00:07:37,634 people own, 192 00:07:38,095 --> 00:07:39,634 not just their income. 193 00:07:40,334 --> 00:07:42,814 So some of your listeners may remember that 194 00:07:42,814 --> 00:07:43,944 in January 195 00:07:43,944 --> 00:07:44,835 2024, 196 00:07:45,149 --> 00:07:46,610 California fully eliminated 197 00:07:46,990 --> 00:07:48,610 the Medi Cal asset test. 198 00:07:49,230 --> 00:07:50,930 And now after two years, 199 00:07:51,790 --> 00:07:53,569 California has brought that back. 200 00:07:54,189 --> 00:07:55,410 And then an example 201 00:07:55,790 --> 00:07:56,269 of, 202 00:07:56,670 --> 00:07:59,470 kind of federal policy changes that will soon 203 00:07:59,470 --> 00:08:00,129 go into 204 00:08:01,185 --> 00:08:02,004 effect include, 205 00:08:02,785 --> 00:08:04,464 starting in October, 206 00:08:04,464 --> 00:08:06,564 so 10/01/2026, 207 00:08:07,024 --> 00:08:09,285 there will be changes to who is considered 208 00:08:09,425 --> 00:08:11,125 a qualified immigrant 209 00:08:12,145 --> 00:08:15,685 for federally funded medical. So HR one narrows 210 00:08:16,459 --> 00:08:16,959 noncitizen 211 00:08:17,419 --> 00:08:19,680 eligibility for federally funded Medi 212 00:08:20,139 --> 00:08:23,040 Cal, and this change means that many lawfully 213 00:08:23,419 --> 00:08:26,779 residing immigrants who are currently eligible for full 214 00:08:26,779 --> 00:08:29,600 scope Medi Cal will no longer be eligible. 215 00:08:30,464 --> 00:08:33,504 They will only be eligible for restricted scope 216 00:08:33,504 --> 00:08:34,004 medical, 217 00:08:34,384 --> 00:08:37,924 which covers emergency and pregnancy related services. 218 00:08:38,784 --> 00:08:41,204 And this policy change affects refugees, 219 00:08:41,825 --> 00:08:42,325 asylees, 220 00:08:42,865 --> 00:08:43,337 and victims of human trafficking, to name a 221 00:08:43,337 --> 00:08:44,084 few. So another federal policy change 222 00:08:57,730 --> 00:08:58,230 requirements 223 00:08:59,045 --> 00:09:01,365 and moving from an annual to a six 224 00:09:01,365 --> 00:09:04,345 month renewal requirement for certain adult groups, 225 00:09:04,884 --> 00:09:07,215 which go into effect January 226 00:09:07,215 --> 00:09:08,184 2027. 227 00:09:08,965 --> 00:09:11,684 So under the new federal work and community 228 00:09:11,684 --> 00:09:12,825 engagement requirements, 229 00:09:13,730 --> 00:09:16,850 certain groups of adults age 19 to 64 230 00:09:16,850 --> 00:09:19,809 must show evidence that one of five requirements 231 00:09:19,809 --> 00:09:20,550 are met. 232 00:09:21,090 --> 00:09:23,269 And those can range from, 233 00:09:23,889 --> 00:09:26,790 being employed at least eighty hours per month 234 00:09:27,090 --> 00:09:29,884 and meet a certain monthly income threshold, threshold, 235 00:09:31,016 --> 00:09:33,544 or they have performed eighty hours of community 236 00:09:33,544 --> 00:09:34,205 service per month. 237 00:09:34,745 --> 00:09:36,044 And there's a couple other, 238 00:09:36,585 --> 00:09:39,065 elements that they can meet the criteria for 239 00:09:39,065 --> 00:09:42,264 that. But I do wanna stress that the 240 00:09:42,264 --> 00:09:43,884 new work and community engagement 241 00:09:44,424 --> 00:09:48,059 requirement only applies to certain adults age 19 242 00:09:48,059 --> 00:09:49,120 to 64. 243 00:09:49,580 --> 00:09:51,500 And this group is referred to as the 244 00:09:51,500 --> 00:09:53,360 new adult group in California. 245 00:09:54,059 --> 00:09:57,120 It was formally known as the Medicaid expansion 246 00:09:57,419 --> 00:09:58,320 adult population 247 00:09:58,700 --> 00:10:00,480 under the Affordable Care Act. 248 00:10:01,154 --> 00:10:03,654 So these are the individuals and the adults 249 00:10:03,714 --> 00:10:04,934 with no dependents 250 00:10:05,634 --> 00:10:09,394 whose annual income is below a 138% 251 00:10:09,394 --> 00:10:12,115 of the federal poverty level, which is about 252 00:10:12,115 --> 00:10:14,294 $21,600. 253 00:10:15,059 --> 00:10:15,559 And, 254 00:10:16,179 --> 00:10:18,980 as part of this program, there are adult 255 00:10:18,980 --> 00:10:20,759 populations who are exempt 256 00:10:21,299 --> 00:10:23,879 from the work and community engagement requirements. 257 00:10:24,580 --> 00:10:26,840 And those folks would include individuals 258 00:10:27,220 --> 00:10:29,975 who are pregnant or up to twelve months 259 00:10:29,975 --> 00:10:30,475 postpartum, 260 00:10:31,575 --> 00:10:34,455 foster youth and former foster youth under the 261 00:10:34,455 --> 00:10:36,875 age of 26, and several more. 262 00:10:38,054 --> 00:10:40,295 And a final point I wanna mention is 263 00:10:40,295 --> 00:10:41,195 that eligibility 264 00:10:41,575 --> 00:10:42,075 redeterminations 265 00:10:43,009 --> 00:10:45,490 will increase from once a year to every 266 00:10:45,490 --> 00:10:46,389 six months 267 00:10:47,009 --> 00:10:49,570 for that new adult group who is subject 268 00:10:49,570 --> 00:10:52,389 to the new work and community engagement requirements. 269 00:10:53,090 --> 00:10:56,049 And we're still waiting for additional federal and 270 00:10:56,049 --> 00:10:56,870 state guidance 271 00:10:57,455 --> 00:10:59,695 on how medical members will show that they've 272 00:10:59,695 --> 00:11:03,154 met the work and community engagement requirements 273 00:11:03,774 --> 00:11:06,595 and what the renewal process changes will be. 274 00:11:07,054 --> 00:11:08,434 So more to come on that. 275 00:11:08,909 --> 00:11:10,669 I mean, it really is mind boggling, though, 276 00:11:10,669 --> 00:11:12,509 when you when you detail all that, Jen. 277 00:11:12,509 --> 00:11:14,029 And I know that's just a quick overview 278 00:11:14,029 --> 00:11:16,669 of all the changes happening that are coming, 279 00:11:16,669 --> 00:11:17,409 have happened, 280 00:11:18,190 --> 00:11:20,990 from from a immigrant perspective, from the work 281 00:11:20,990 --> 00:11:24,134 requirements perspective, so many details there, and then 282 00:11:24,134 --> 00:11:27,355 still waiting on guidance for eligibility redeterminations. 283 00:11:28,214 --> 00:11:30,934 So I wonder, internally, how has this changed 284 00:11:30,934 --> 00:11:32,714 your day to day, your role, 285 00:11:33,095 --> 00:11:35,574 within the Promise Health Plan? How how as 286 00:11:35,574 --> 00:11:37,334 a company are you preparing for all of 287 00:11:37,334 --> 00:11:38,954 this? And then, of course, communicating 288 00:11:39,389 --> 00:11:41,389 all of this to what is already a 289 00:11:41,389 --> 00:11:42,929 very vulnerable population. 290 00:11:44,110 --> 00:11:46,110 Yeah. And I think you're absolutely right. They 291 00:11:46,110 --> 00:11:48,830 are significant changes, and I think it's also 292 00:11:48,830 --> 00:11:51,330 important to note that all of these changes 293 00:11:51,644 --> 00:11:52,384 are significant 294 00:11:52,685 --> 00:11:54,625 undertakings for all of the states. 295 00:11:55,325 --> 00:11:56,685 If you think about what they have to 296 00:11:56,685 --> 00:11:57,425 set up, 297 00:11:57,805 --> 00:11:59,264 in terms of in infrastructure 298 00:12:00,125 --> 00:12:02,605 so they can track these work hours, these 299 00:12:02,605 --> 00:12:03,105 exemptions, 300 00:12:04,139 --> 00:12:07,279 and the new biannual renewal process. So, 301 00:12:07,899 --> 00:12:09,259 it it is a lot. It's a it's 302 00:12:09,259 --> 00:12:10,799 a heavy burden on the states. 303 00:12:11,419 --> 00:12:14,000 But with respect to how Blue Shield Promise 304 00:12:14,220 --> 00:12:16,159 is responding to these changes, 305 00:12:17,264 --> 00:12:19,924 and how we are our members are impacted. 306 00:12:20,625 --> 00:12:21,184 I just, 307 00:12:21,664 --> 00:12:24,084 wanna remind the listeners that in, 308 00:12:24,784 --> 00:12:27,204 in California, the Medi Cal program covers 309 00:12:27,824 --> 00:12:28,324 approximately 310 00:12:28,625 --> 00:12:30,404 14,700,000 311 00:12:30,625 --> 00:12:31,125 individuals. 312 00:12:32,149 --> 00:12:34,149 To put that into perspective, that's one in 313 00:12:34,149 --> 00:12:35,049 three Californians 314 00:12:35,429 --> 00:12:36,250 are currently 315 00:12:36,709 --> 00:12:39,049 receiving Medi Cal services and benefits. 316 00:12:39,829 --> 00:12:42,409 And the California Department of Healthcare Services 317 00:12:43,269 --> 00:12:44,549 anticipates the new federal provisions will increase administrative 318 00:12:44,549 --> 00:12:45,690 workload and the rate of procedural and 319 00:12:54,475 --> 00:12:57,054 administrative coverage for administrative reasons, 320 00:12:57,514 --> 00:12:58,975 not because they are ineligible. 321 00:13:00,100 --> 00:13:02,679 And those new changes are expected to impact 322 00:13:02,740 --> 00:13:03,879 up to 2,000,000 323 00:13:04,179 --> 00:13:07,000 medical members, which is about 14% 324 00:13:07,460 --> 00:13:09,799 of that medical population here in California. 325 00:13:10,820 --> 00:13:13,894 For Blue Shield Promise, we know these changes 326 00:13:13,955 --> 00:13:16,514 will have a significant impact on our members 327 00:13:16,514 --> 00:13:17,175 and communities 328 00:13:17,955 --> 00:13:19,815 and providers that we serve. 329 00:13:20,754 --> 00:13:23,955 Today, we're currently providing Medi Cal services to 330 00:13:23,955 --> 00:13:26,115 roughly 550,000 331 00:13:26,115 --> 00:13:26,615 members 332 00:13:27,139 --> 00:13:29,639 in Los Angeles and San Diego Counties, 333 00:13:30,340 --> 00:13:32,360 which are two of the most populous 334 00:13:32,820 --> 00:13:36,279 culturally and linguistically diverse counties in California. 335 00:13:37,460 --> 00:13:39,299 The good news is that we have been 336 00:13:39,299 --> 00:13:41,240 preparing for these program changes, 337 00:13:41,985 --> 00:13:44,865 and our experience positions us well to support 338 00:13:44,865 --> 00:13:46,965 our members for for what's ahead. 339 00:13:47,985 --> 00:13:49,125 Some of the specific 340 00:13:49,664 --> 00:13:52,085 programs and initiatives that promise, 341 00:13:53,345 --> 00:13:55,924 that promise is embarking on to support 342 00:13:56,330 --> 00:13:57,950 our members through these changes 343 00:13:58,649 --> 00:14:01,049 are really around three key areas. The first 344 00:14:01,049 --> 00:14:03,789 one is high touch support and outreach. 345 00:14:04,490 --> 00:14:08,350 The second is around innovation and technology solutions. 346 00:14:09,129 --> 00:14:10,529 And the third is stakeholder connections and collaboration. 347 00:14:10,529 --> 00:14:11,870 And we have several programs that 348 00:14:13,424 --> 00:14:15,125 And we have several programs 349 00:14:15,824 --> 00:14:18,384 that deliver high catch support and outreach to 350 00:14:18,384 --> 00:14:19,125 our members, 351 00:14:19,664 --> 00:14:22,464 including our growth and retention call center and 352 00:14:22,464 --> 00:14:23,924 community resource centers. 353 00:14:24,625 --> 00:14:27,444 Both programs are staffed by bilingual, 354 00:14:27,824 --> 00:14:30,960 bi cultural specialists who are experts in medical 355 00:14:30,960 --> 00:14:31,460 eligibility 356 00:14:31,840 --> 00:14:32,500 and enrollment, 357 00:14:33,120 --> 00:14:36,000 and many have similar lived experiences to our 358 00:14:36,000 --> 00:14:36,500 members. 359 00:14:36,960 --> 00:14:39,679 And they can quickly make connections and build 360 00:14:39,679 --> 00:14:42,100 trust and confidence. They know how to navigate 361 00:14:42,399 --> 00:14:43,460 around the system, 362 00:14:43,924 --> 00:14:45,684 and they know how to navigate within their 363 00:14:45,684 --> 00:14:46,504 own communities. 364 00:14:47,684 --> 00:14:50,024 We are also leveraging digital platforms 365 00:14:50,404 --> 00:14:52,745 and culturally relevant media channels 366 00:14:53,284 --> 00:14:56,245 to get information to our members, community leaders, 367 00:14:56,245 --> 00:14:58,884 and others who serve as trusted advisers to 368 00:14:58,884 --> 00:15:00,240 our members and communities. 369 00:15:00,700 --> 00:15:03,100 Promise has teams that are out in, 370 00:15:03,580 --> 00:15:06,320 in the community. We are at community events. 371 00:15:06,779 --> 00:15:08,320 We're on college campuses, 372 00:15:09,259 --> 00:15:11,120 at low income housing complexes, 373 00:15:11,740 --> 00:15:14,904 and other community places conducting outreach and offering 374 00:15:14,904 --> 00:15:15,404 enrollment 375 00:15:15,945 --> 00:15:17,245 and renewal assistance, 376 00:15:17,785 --> 00:15:18,924 wherever we can. 377 00:15:19,384 --> 00:15:22,264 We've got our provider engagement team who visits 378 00:15:22,264 --> 00:15:22,764 providers 379 00:15:23,225 --> 00:15:26,045 nearly every day, offering them information, 380 00:15:26,424 --> 00:15:26,924 training, 381 00:15:27,579 --> 00:15:30,379 and resources to help their patients navigate the 382 00:15:30,379 --> 00:15:32,320 medical enrollment and renewal processes. 383 00:15:33,500 --> 00:15:33,899 And, 384 00:15:34,620 --> 00:15:36,860 we we are making sure that at every 385 00:15:36,860 --> 00:15:39,019 touch point a member has with Blue Shield 386 00:15:39,019 --> 00:15:39,465 Promise, 387 00:15:40,184 --> 00:15:43,165 they are being reminded to update their contact 388 00:15:43,225 --> 00:15:43,725 information, 389 00:15:44,985 --> 00:15:45,485 recertify, 390 00:15:45,945 --> 00:15:48,425 and reach out to us for help with 391 00:15:48,425 --> 00:15:50,985 the medical renewal process. We understand it can 392 00:15:50,985 --> 00:15:52,445 be challenging and frustrating, 393 00:15:53,144 --> 00:15:54,665 but we are here to help them and 394 00:15:54,665 --> 00:15:55,080 support 395 00:15:55,960 --> 00:15:57,639 them. And, Jen, let me you know, you 396 00:15:57,639 --> 00:15:59,080 you said something really, 397 00:15:59,639 --> 00:16:00,379 really interesting 398 00:16:00,759 --> 00:16:02,279 at the start of your your last answer 399 00:16:02,279 --> 00:16:04,759 there about how more people are gonna be 400 00:16:04,759 --> 00:16:07,639 losing coverage because of administrative issues and not 401 00:16:07,639 --> 00:16:09,019 because they're actually ineligible 402 00:16:09,639 --> 00:16:12,475 for Medicaid, which is really unfortunate. And I 403 00:16:12,475 --> 00:16:13,375 I I wonder 404 00:16:14,154 --> 00:16:16,174 from from the human and from the emotional 405 00:16:16,475 --> 00:16:18,394 perspective of all of this, what are you 406 00:16:18,394 --> 00:16:20,894 hearing on the ground level from your members, 407 00:16:21,355 --> 00:16:24,075 in terms of their understanding of what's going 408 00:16:24,075 --> 00:16:26,589 on, how coverage needs to be maintained. 409 00:16:27,129 --> 00:16:30,190 Maybe they be are gonna be become ineligible. 410 00:16:30,970 --> 00:16:33,370 What what are you hearing, from members directly 411 00:16:33,370 --> 00:16:34,350 about all of this? 412 00:16:35,049 --> 00:16:36,809 Well, I think we can all agree that 413 00:16:36,809 --> 00:16:38,669 health care is already complicated, 414 00:16:39,835 --> 00:16:42,795 and these recent policy changes are adding yet 415 00:16:42,795 --> 00:16:45,695 another layer of complexity for patients and families. 416 00:16:46,795 --> 00:16:50,475 Our members, providers, and community partners have expressed 417 00:16:50,475 --> 00:16:50,975 concerns 418 00:16:51,740 --> 00:16:53,519 and are worried about 419 00:16:54,059 --> 00:16:56,320 understanding the different rule changes 420 00:16:56,940 --> 00:16:57,440 and, 421 00:16:58,139 --> 00:17:02,240 potentially losing their coverage over a paperwork mishap 422 00:17:02,379 --> 00:17:03,759 as opposed to eligibility. 423 00:17:05,035 --> 00:17:07,674 And they're also concerned about potential disruptions in 424 00:17:07,674 --> 00:17:08,174 care. 425 00:17:09,195 --> 00:17:12,234 And for our members who face barriers, these 426 00:17:12,234 --> 00:17:15,755 changes make an already complicated system feel even 427 00:17:15,755 --> 00:17:16,815 harder to navigate. 428 00:17:17,419 --> 00:17:19,419 And that's why we are focused on reaching 429 00:17:19,419 --> 00:17:22,079 our members where they are, helping them understand 430 00:17:22,220 --> 00:17:25,099 what's changing, and providing them with hands on 431 00:17:25,099 --> 00:17:27,519 support so they can keep their medical coverage. 432 00:17:28,700 --> 00:17:30,220 And, Jen, let me let me also touch 433 00:17:30,220 --> 00:17:32,059 on you know, as as we mentioned at 434 00:17:32,059 --> 00:17:34,065 the start of the conversation today, 435 00:17:34,444 --> 00:17:37,164 you're interim VP of duals program integration at 436 00:17:37,164 --> 00:17:38,944 at the Promise Health Plan as well. 437 00:17:39,644 --> 00:17:41,244 How are you approaching your role to best 438 00:17:41,244 --> 00:17:44,044 integrate Medicare and Medi Cal offerings right now? 439 00:17:44,044 --> 00:17:46,544 Does that fit into what we're talking about, 440 00:17:47,069 --> 00:17:48,909 with HR one? And and do you have 441 00:17:48,909 --> 00:17:51,630 any best possible approaches you'd share in terms 442 00:17:51,630 --> 00:17:52,369 of coordination, 443 00:17:52,750 --> 00:17:53,250 accessibility, 444 00:17:54,109 --> 00:17:54,929 more affordable 445 00:17:55,230 --> 00:17:56,289 offerings overall? 446 00:17:57,710 --> 00:18:00,785 Yeah. So our approach is ultimately to create 447 00:18:00,785 --> 00:18:02,244 an environment where coordination, 448 00:18:02,545 --> 00:18:04,244 access, and affordability 449 00:18:04,545 --> 00:18:05,365 are sustainable 450 00:18:05,664 --> 00:18:08,325 and practical for dual eligible members. 451 00:18:08,865 --> 00:18:10,404 And we are working to ensure, 452 00:18:10,865 --> 00:18:12,884 that Medicare and Medi Cal 453 00:18:13,200 --> 00:18:13,940 is seamless 454 00:18:14,640 --> 00:18:16,339 for our members and providers. 455 00:18:16,799 --> 00:18:18,659 And we're really focused on streamlining 456 00:18:19,039 --> 00:18:20,819 our operations and workflows 457 00:18:21,200 --> 00:18:23,059 so teams are working together 458 00:18:23,679 --> 00:18:25,539 and providing unified support. 459 00:18:26,404 --> 00:18:29,625 We're making coverage easier to understand and access 460 00:18:29,684 --> 00:18:31,065 with clear communication 461 00:18:32,005 --> 00:18:33,944 and a no wrong door approach 462 00:18:34,724 --> 00:18:36,904 to servicing every one of our members. 463 00:18:38,164 --> 00:18:40,644 We are looking at reducing out of pocket 464 00:18:40,644 --> 00:18:41,144 costs, 465 00:18:42,230 --> 00:18:46,009 aligning payments, and ensuring members stay covered through 466 00:18:46,230 --> 00:18:47,289 their life changes. 467 00:18:48,309 --> 00:18:51,750 Looking at supporting clear, consistent rules at state 468 00:18:51,750 --> 00:18:52,809 and federal levels 469 00:18:53,429 --> 00:18:56,345 to simplify enrollment and keep coverage. So really 470 00:18:56,404 --> 00:18:58,825 looking to strengthen policy advocacy 471 00:18:59,605 --> 00:19:00,085 and, 472 00:19:00,644 --> 00:19:02,484 and making sure that we've got support in 473 00:19:02,484 --> 00:19:04,345 that in that area as well. 474 00:19:05,444 --> 00:19:07,865 Wonderful. Well well, Jen, before we go today, 475 00:19:07,970 --> 00:19:09,890 you've got a lot of other colleagues from 476 00:19:09,890 --> 00:19:12,710 around the country listening and facing similar challenges, 477 00:19:13,089 --> 00:19:14,869 trying to figure out and navigating 478 00:19:15,329 --> 00:19:16,950 all these same policy changes. 479 00:19:17,329 --> 00:19:19,089 What else would you share with them, or 480 00:19:19,089 --> 00:19:21,329 is there any bits of advice you'd offer, 481 00:19:21,570 --> 00:19:23,349 as you as you navigate similarly? 482 00:19:24,605 --> 00:19:26,625 Yeah. So I I would close, 483 00:19:27,085 --> 00:19:29,424 just with a couple final thoughts. First, 484 00:19:29,805 --> 00:19:32,845 for individuals who live in California, one of 485 00:19:32,845 --> 00:19:35,485 the best ways to stay informed about the 486 00:19:35,485 --> 00:19:37,099 Medi Cal program changes 487 00:19:37,559 --> 00:19:39,740 is through the Department of Health Care Services 488 00:19:39,960 --> 00:19:40,460 coverage 489 00:19:40,759 --> 00:19:41,819 ambassador program. 490 00:19:42,599 --> 00:19:45,579 And the coverage ambassador program was launched 491 00:19:45,960 --> 00:19:48,200 at the end of the COVID nineteen public 492 00:19:48,200 --> 00:19:50,619 health emergency to help Medi Cal members 493 00:19:51,305 --> 00:19:51,805 understand, 494 00:19:52,585 --> 00:19:55,005 enroll, and keep their Medi Cal coverage. 495 00:19:55,545 --> 00:19:58,204 And anyone can become a coverage ambassador. 496 00:19:58,744 --> 00:20:01,565 There is no cost or certification requirement, 497 00:20:01,944 --> 00:20:04,424 and the program is voluntary and unpaid. So 498 00:20:04,424 --> 00:20:05,890 you can sign up to to be a 499 00:20:05,890 --> 00:20:08,549 coverage ambassador at the DHCS website. 500 00:20:09,250 --> 00:20:11,910 And once you enroll, you will receive updates, 501 00:20:11,970 --> 00:20:13,990 toolkits, and outreach materials 502 00:20:14,609 --> 00:20:17,009 to help you and others stay informed about 503 00:20:17,009 --> 00:20:19,109 Medi Cal renewals and policy changes. 504 00:20:19,615 --> 00:20:21,134 So you don't have to be a member. 505 00:20:21,134 --> 00:20:24,015 You can be a community partner. You can 506 00:20:24,015 --> 00:20:24,835 be a provider. 507 00:20:25,375 --> 00:20:27,775 You could be a member. But anybody, any 508 00:20:27,775 --> 00:20:30,575 health plan representative that wants to stay up 509 00:20:30,575 --> 00:20:31,234 to speed, 510 00:20:31,934 --> 00:20:32,279 that's 511 00:20:33,000 --> 00:20:35,640 in California, that is the best way to 512 00:20:35,640 --> 00:20:36,460 stay current 513 00:20:37,000 --> 00:20:38,940 with what's happening with all of the changes. 514 00:20:39,960 --> 00:20:42,680 Second, if you haven't already, I'd encourage you 515 00:20:42,680 --> 00:20:45,320 to connect with community organizations that are serving 516 00:20:45,320 --> 00:20:46,005 your members. 517 00:20:46,644 --> 00:20:50,184 Identify those community leaders who are trusted messengers, 518 00:20:50,884 --> 00:20:53,285 and work with your provider network to outreach 519 00:20:53,285 --> 00:20:55,924 to members early and often about the changes 520 00:20:55,924 --> 00:20:57,144 in the Medicaid program. 521 00:20:57,924 --> 00:20:59,384 And if you have the resources, 522 00:21:00,484 --> 00:21:03,769 invest in high touch support services through navigators 523 00:21:04,549 --> 00:21:07,450 and community health workers, technology solutions, 524 00:21:08,230 --> 00:21:09,049 and multilingual 525 00:21:09,429 --> 00:21:10,649 communications channels 526 00:21:11,109 --> 00:21:14,409 to engage members. It really shouldn't be in 527 00:21:14,914 --> 00:21:17,494 in either or. You know, in an ideal 528 00:21:17,554 --> 00:21:19,815 state, it should be a complimentary approach 529 00:21:20,434 --> 00:21:21,894 and not a trade off. 530 00:21:22,994 --> 00:21:25,394 And finally, I would just remind us all 531 00:21:25,394 --> 00:21:26,534 that we've navigated 532 00:21:26,835 --> 00:21:28,694 hard moments in Medicaid before, 533 00:21:29,394 --> 00:21:30,539 and our resilience, 534 00:21:31,420 --> 00:21:32,880 ingenuity, and dedication 535 00:21:33,180 --> 00:21:35,519 to the people we serve carries us forward. 536 00:21:35,660 --> 00:21:37,680 Medicaid is complex and challenging, 537 00:21:38,380 --> 00:21:40,700 but this work is in our DNA, and 538 00:21:40,700 --> 00:21:43,119 we rise to the challenge every time. 539 00:21:43,964 --> 00:21:46,044 Wonderful. I think that's a great last place 540 00:21:46,044 --> 00:21:48,044 to leave things. So, Jen, I wanna thank 541 00:21:48,044 --> 00:21:49,884 you for taking the time to be with 542 00:21:49,884 --> 00:21:51,804 us here on the podcast and for sharing 543 00:21:51,804 --> 00:21:54,204 your insights with our listeners. We really appreciate 544 00:21:54,204 --> 00:21:54,704 it. 545 00:21:55,164 --> 00:21:57,424 Absolutely. Thanks again for having me. 546 00:21:57,726 --> 00:21:59,726 Anytime. And and to our listeners, if you'd 547 00:21:59,726 --> 00:22:01,645 like to listen to more podcasts from Becker's 548 00:22:01,645 --> 00:22:04,945 HealthCare, you can visit beckershospitalreview.com.