Week 7- Reflections on SB 1004 stakeholder meeting and the Medicaid expansion

This week’s focus includes Medicare, Medicaid and the Affordable Care Act (ACA) as examples of public policy. This provides a prime opportunity to share my experiences participating in a stakeholder meeting for California Senate Bill 1004. As reviewed in previous posts, SB 1004 was passed in the 2014 congressional session. This bill provides a palliative service benefit for all individuals enrolled in the state Medicaid program.

This meeting was preempted by a conference call in which attendees heard from Senator Ed Hernandez who serves as the chair of the Senate Health Committee. The conference call provided stakeholders with the history and broad applicability of this bill. Stakeholders were then invited to join subject matter experts and members of the Department of Health Care Services (DHCS) for a discussion forum at the state Capitol.  While this was clearly a ‘working’ meeting, the dome of the California State Capitol looming across the street lent a heavy weight to the discussion.

The meeting was facilitated by Anastasia Dodson, the Associate Director for Policy at DHCS and Claudia Crist, Deputy Director Health Care Delivery Systems. The director of DHCS, Jennifer Kent, made opening remarks and participated in question and answer sessions. I was pleased to see that many contributors to the health care industry were also represented. The operations and executive officers of many health plans were involved as well as research experts in the field of palliative care. There were also several providers in attendance.

When questioned about the necessity of involving stakeholders in policy development the overarching theme was that this was a critical component to good policy. Stakeholders were asked to “inform” the policy. Ms. Dodson reiterated that policies should be developed in collaboration; they should build on what is currently working. This information is primarily obtained from those working in the field, or the stakeholders.

I had previously been under the impression that once a bill was passed the majority of the work was complete when in fact it appears the work is just beginning! Next steps include drafting documents for public review and holding a second stakeholder meeting to further operationalize the bill.

The passage of SB 1004 rides on the waves of the Medicaid expansion directed by the passage of the ACA in 2010. California is one of the 26 states that have chosen to implement the expansion as of 2012 (McDonough, 2014). According to Medicaid.gov (n.d.) the number of Californians enrolling in Medicaid has grown by 30% since 2013, to reach over 11 million people. The program was designed to reach as many low income individuals and families as possible. The Medicaid expansion coupled with SB 1004 lends itself to a workforce shortage, reimbursement concerns and complicated outcome measurements. The ACA has suffered a tumultuous start as has the Medicaid expansion programs. Regardless of where you land in the political realm it is clear that a cohesive, meticulous roll-out is required when discussing a benefit provided for 11 million people.

This makes the stakeholder process all the more essential. The public are welcomed to these meetings and to comment on the draft documents.  As Ms. Dodson elaborated, the policy should be fully ‘informed’ by the stakeholders to ensure its success. She remarked that we should get the policy right, right out of the gate.


California Department of Health Care Services (2015). Palliative Care and SB 1004 [PowerPoint Slides]. Retrieved from http://www.dhcs.ca.gov/provgovpart/Pages/Palliative-Care-Meeting-Material.aspx.

McDonough, J.E. (2014). Health system reform in the United States. International Journal of Health Policy and Management, 2(x), 1-4.

Medicaid.gov (n.d). California. Retrieved from http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-State/california.html

Miller, B.J. (2015). Palliative Care 101 [PowerPoint slides]. Retrieved from http://www.dhcs.ca.gov/provgovpart/Pages/Palliative-Care-Meeting-Material.aspx


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