Community Columns

Lakshmi Dhanvanthari: Medicaid at 50 – also part of health care reform

This week, for its 50th anniversary, let us celebrate 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 an example of government service at its best.

After President Lyndon 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 lacked coverage for the cost of their care. 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 Barack Obama’s Affordable Care Act, alongside state exchanges. Already, Medicaid 2.0, or Expanded Medi-Cal, is serving young adults and more low-wage working families. Medi-Cal now covers 1 in 3 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, and how they deliver services. States can experiment with new approaches that often lead to changes adopted throughout the U.S. 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 was established in 1995 by state statute and a county ordinance as a community-based, not-for-profit health plan initiative. In 2015, it is the leading Medi-Cal managed-care provider for Stanislaus and San Joaquin counties. With 315,000 members – a third of our growth 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 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 care 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.

The Central Valley has one of the most diverse populations in the U.S. Connecting with these communities is not automatic. I am a pediatrician with deep roots serving California families. Reaching out to provide culturally appropriate health care and advance wellness through community partnerships is part of HPSJ’s founding vision, and remains a deep-seated quest for me and all of our hardworking staff.

This June, approaching our own 20th anniversary, the National Committee for Quality Assurance awarded HPSJ a three-year accreditation for our Medicaid/HMO coverage. 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 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 Stanislaus County and beyond, we are not just along for the ride, HPSJ is in a partnership to lead the way.

Dr. Lakshmi Dhanvanthari is chief medical officer for Health Plan of San Joaquin and oversees HPSJ’s quality review and maintenance programs.

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