Wednesday, March 19, 2008


Department Of Managed Health Care Announces $500,000 Grant To Educate Health Care Consumers About Their Rights To Treatment, Prescription Drugs

(Los Angeles) – The California Department of Managed Health Care (DMHC) today announced a $500,000 grant to Health Consumer Alliance (HCA) to fund a marketing outreach project aimed at consumers who experience barriers to health care services through income, language or disabilities. The campaign will inform consumers about important health care rights, such as how to file a complaint about a health plan or access an independent medical review (IMR) of a treatment denial through the DMHC's HMO Help Center. It will assist consumers in nine California counties, which are home to more than 60 percent of low-income Californians in both urban and rural areas.

“One of the most fundamental rights is the ability to get a free-of-charge second opinion from the DMHC if they are denied a medical treatment or a medication,” said Cindy Ehnes, Director of the California Department of Managed Health Care. “This funding will help more Californians to know about the extensive health care rights and protections available to them under state law.”

The $500,000 campaign was made possible through funding supplied by Blue Shield of California, following a 2007 DMHC investigation into the health plan’s timely implementation of IMRs decided in favor of the patient, which also resulted in a $500,000 penalty assessed by the DMHC on the plan.  

Blue Shield is not the only health plan fined recently by the DMHC for not handling member complaints or handling IMRs. More than $5 million in fines have been assessed to health plans in the past two years.

The Blue Shield donation to HCA will allow the organization to conduct outreach and education to through community events, working with community-based organizations, providing information on grievance and appeal rights through their toll free telephone lines and production of a consumer brochure that will be translated into 12 languages.

The HCA is a unique collaboration of nine Health Consumer Centers covering thirteen counties, including Alameda, El Dorado, Fresno, Imperial, Kern, Los Angeles, Orange, Placer, Sacramento, San Diego, San Francisco, San Mateo and Yolo. HCA attorneys and consumer advocates provide direct assistance to over 14,000 consumers each year obtain essential health care.

It is sponsored by two prominent statewide advocacy organizations serving vulnerable populations, the National Health Law Program and the Western Center on Law and Poverty. HCA assists consumers file grievances and complaints about health plans across a broad spectrum of low-income consumers including children, families, persons with disabilities and individuals who are limited-English proficient.

In addition, the HCA will share information with the DMHC to identify issues and trends experienced by consumers to allow state regulators to be more proactive to work with health plans on issues before they become large-scale problems.

The California Department of Managed Health Care is the only stand-alone watchdog agency in the nation, touching the lives of nearly 21 million enrollees. The DMHC has assisted more than 800,000 Californians through its 24-hour Help Center by resolving HMO problems while educating consumers on health care rights and responsibilities, and working closely with health plans to ensure a solvent and stable managed health care system.