By AMY SHIN
Health Plan of San Joaquin CEO
STOCKTON — For its 50th anniversary, we’re celebrating Medicaid and how a great vision, powered by enduring partnerships, across political divides and from national to local levels, can deliver on the promise of quality health care access. Medicaid (Medi-Cal in California) continues to be government service at its best.
After President Johnson signed it into law in 1965, state and the federal governments worked to turn this first blush of health care reform into a lifeline for people who otherwise lack coverage. Since that summer 50 years ago, nearly two-thirds of Americans have either benefited directly from Medicaid or have a family member or friend who has.
For a new century, Medicaid has been expanded to become one of the two prongs of President Obama’s Affordable Care Act (ACA), alongside state exchanges. Already, Medicaid 2.0, or Expanded Medi-Cal, is reaching out to serve young adults and more low-wage working families. Medi-Cal now covers one in three of all Californians and more than half of all California children.
Throughout its history, Medicaid has given states enormous flexibility in who they cover, what benefits they provide, how they deliver health care services, and ways to control fraud, waste and abuse. Through federal waivers, states can experiment with new approaches that often lead to changes adopted by the entire country. For example, today more than half of all people with Medicaid are enrolled in a managed care plan. In California alone managed care serves about 9.5 million people, or 76 percent of the 12.4 million Medi-Cal members.
Health Plan of San Joaquin (HPSJ) was established in 1995 by state statute and San Joaquin County ordinance as a community-based, not-for-profit health plan initiative. In 2015, it is the leading Medi-Cal managed care provider for San Joaquin and Stanislaus counties. With 315,000 members – a third of our growth over the last year-and-a half since ACA implementation – HPSJ is at the forefront of health care access and delivery. We are also realistic about our challenges.
We offer a broad network of providers. But, maintaining that network with enough health care providers will remain an ongoing challenge. So we continue to work closely with physicians to develop programs to ensure efficient, timely access to quality care, and we partner with local entities to support students interested in health careers – hopefully here in the Central Valley.
The ACA will continue supplementing state Medicaid programs through 2016, but then support will gradually start to decrease, perhaps leading to demands for more cost-sharing between plans and the state. As our membership continues to grow, we – and all California public health plans – will face pressures to do more with less. HPSJ continues to streamline our business systems and use technology more efficiently to serve both members and providers.
The Central Valley is one of the most diverse populations in the U.S. Connecting with these communities is not automatic. As a child, my own Korean American immigrant parents needed my help as an interpreter, seeking health care while uninsured. Reaching out to provide culturally appropriate health care and advance wellness through community partnerships is part of our founding vision, and remains a deep-seated quest for me and for each of our hardworking staff.
As the Central Valley Business Journal noted in its June 24 E-Edition, HPSJ – approaching our own 20th anniversary – earned a three-year accreditation for our Medicaid/HMO line of business from the National Committee for Quality Assurance (NCQA). The NCQA seal of approval recognizes HPSJ as “accredited for service and clinical quality that meet or exceed NCQA’s rigorous requirements for consumer protection and quality improvement.” We could not be more proud of the hard work by all HPSJ staff, commission leadership, and our entire provider network to attain this level of unique national recognition.
HPSJ is one of only 11 health plans in California with NCQA accreditation for a managed care Medicaid plan. We believe we’re part of a growing community-based, managed care movement that presents a way to serve Californians in the years ahead.
Medicaid will continue to surmount challenges and evolve. In San Joaquin and Stanislaus counties, we are not just along for the ride, HPSJ is in a partnership to lead the way.
Health Plan of San Joaquin