Part III. Yes, there's more. (Hit delete now to avoid mind warp)
What I wrote about Secure Horizons wasn't quite right. Unfortunately, I have yet to sort out exactly where they are positioned in their hierarchy of corporate shills. From what I learned this morning at work, it sounds like SH is the parent, North American Med Management is the child organization--which is the reverse of what I thought. It was also not clear where the money comes from--which was Joe Noonan's original question. I checked several pieces of the mess this morning. Below are the current corrections.
Let's start with Medicare. If you qualify for Medicare you are offered a variety of options. The first is direct Medicare with Part A, and Part B. Part A is hospitalization, acute care, and routine medical visits. Part B is equipment and on-going services such as oxygen. The other option is to join a Medicare sponsored HMO. This is the point where Medicare or federal funds go directly to the private sector. Medicare will pay an HMO a fixed amount per enrollee, per month. Blue Cross, Kaiser, Secure Horizons, Aetna and numerous other insurance companies are contracted with Medicare to be an HMO's under this option. Another correction here is Blue Shield (which is a division of Blue Cross) is the current administrative contractor that manages Medicare in region nine. Authorization, verification and payments are handled by Cigna under a different contract.
The other arm of the federal program is Medicaid. While Medicare is not means tested and is available to everyone over sixty-five who has contributed to Social Security, Medicaid is specifically a means tested system that is distributed to the States in block grants and requires matching state monies. The States then can run the system directly or contract it out. California has several divisions of Medicaid, all part of Medi-Cal. The first division is for poor children, usually in single parent households and on welfare, or in any event with incomes below some fixed amount. There is transition in income levels where client contributes on a sliding scale to retain their Medi-Cal benefits. This helps working adults with children up to certain income level. Children are covered until age eighteen. Another division in Medi-Cal is specifically for poor and disabled adults. A third section is an strange program for disabilities and conditions that arise from genetic disorders and covers both poor adults and children.
After three years or over the age of eighteen, you can be moved off of Medi-Cal and turned over to Medicare as the primary, Medi-Cal as the secondary. This means that the state can dump cases on the Feds. The trick is to pick the best options of Medicare. At the moment that means choosing straight Medicare, and not their HMO contractors, and choosing Part A, but not Part B. This allows you to use Medicare for medical treatment, and Medi-Cal for equipment and services. Medi-Cal has a better coverage system than Medicare in terms of equipment and service.
Just because Medi-Cal is a state program, doesn't mean that all counties in the state offer the same system. The county agencies can receive block grants from the state and design their own system or simply match the money and run the services as straight Medi-Cal. So this means that some counties in the Bay Area for example offer better and more comprehensive Medi-Cal services than others. Alameda and San Francisco Counties are relatively good and match the State block grants and extend the minimums. On the other hand San Mateo county (just south of San Francisco) is terrible, despite the fact it has a much richer local tax base. This patchwork makes moving around within the state a risky proposition.
Chuck Grimes