Canutillo High grad overcomes severe injuries, on track for career now
He was hit by a semitruck and suffered severe injuries.
Johnson, now age 20 and a 2023 graduate of Canutillo High School, basically had to relearn to walk, eat, basically how to live, his mother Ana said.
'It was like he had to be reborn,' Ana Johnson said.
But through a special needs program at Canutillo High School, Johnson is now on track for a full-time job and a rewarding future career as a pharmacy technician.
'It's a beacon of hope,' Cash Johnson said, in his soft-spoken, understated way.
Dina Thompson, a biotechnical science teacher at Canutillo High School, taught Johnson before and after he was hurt.
'It is a beautiful story of resilience, of faith and hard work, ' she said.
During the past year, Johnson has returned to Canutillo High, which he can do as a special needs student, and has participated in the national and international job training program Project Search.
Johnson has become the first Project Search student in the nation to earn a training license to become a pharmacy technician, his teachers said.
He will take a state test in May to become certified as a pharmacy tech.
Project Search at Canutillo High is affiliated with The Hospitals of Providence Transmountain Campus and Johnson went through a year's worth of training and education there.
After he passes his state certification test in May, he is hoping to go back to the hospital and work there full time.
Johnson said he likes dealing with numbers and organization, and those things make pharmacy work perfect for him.
Erin McNellis, the Project Search teacher at Canutillo High, said that Johnson has grown in amazing ways as a person over the past few years.
'He is responsible. He is much more mature,' McNellis said. 'He is ready to go out and get things done and go out and conquer the world.'
The Project Search Program follows the same calendar as the school year, McNellis said.
During the program, students go through three 10-week sessions in different parts of the hospital.
For Johnson, his program was tailored to meet his interest in the pharmacy.
Johnson said he has been fascinated by pharmacies since he was a young boy and now his dream of working at one is within sight.
He also credits Dr. Roberto Guevara, pharmacy director at the hospital, calling him an amazing teacher and mentor.
Cash's mother, Ana Johnson, said the Project Search program has been a godsend for her son and her family.
'Every single parent, we all worry when we have children,' Ana Johnson said. 'We worry about their future. Just imagine having a kid with disabilities. Your worry is twice.'
She said that the Project Search team at Canutillo High has been there for her son, but also for her when she needed encouragement or a hug, too.
'I am so grateful for Canutillo Independent School District for its special needs program,' Ana Johnson said. 'There will be more Cashes. More kids getting jobs through Project Search and why not, going to college too – going to college which is the plan for my son. Hopefully, he will do it.
'More than anything, it has been these beautiful ladies (here at Canutillo High),' Ana Johnson said. 'They have been there from day one. If it wasn't for them, he wouldn't be here (having this success).'
Brenda Matamoros is the transition specialist at Canutillo ISD.
She said that Johnson was part of the inaugural Project Search class at Canutillo High and will serve as a 'role model' for future students in the program.
'I believe he is a shining star for the rest of the students, for what Project Search is capable of, with hard work and determination,' Matamoros said.
Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
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Yahoo
13 hours ago
- Yahoo
Supplemental new drug application submitted to U.S. FDA for CAPLYTA® (lumateperone) with data demonstrating significant schizophrenia relapse prevention compared to placebo
Submission is based on long-term Phase 3 data demonstrating 63 percent reduction in risk of relapse in adults with schizophrenia compared to placebo CAPLYTA® is FDA approved to treat schizophrenia and is the first and only approved treatment for bipolar I and II depression as an adjunctive and monotherapy With the addition of CAPLYTA® to Johnson & Johnson's robust portfolio of therapies, the Company now offers the broadest range of treatment options for adults with schizophrenia TITUSVILLE, N.J., July 8, 2025 /PRNewswire/ -- Johnson & Johnson (NYSE:JNJ) announced today the submission of a supplemental New Drug Application (sNDA) to the U.S. Food and Drug Administration (FDA) based upon long-term data evaluating the safety and efficacy of CAPLYTA® (lumateperone) for the prevention of relapse in schizophrenia. CAPLYTA® is the newest addition to Johnson & Johnson's portfolio of schizophrenia therapies, which now offers the broadest range of oral and long-acting injectable treatment options to support each patient's individual treatment journey. "For people living with schizophrenia, relapses can be devastating as they disrupt lives, undo hard-earned treatment progress toward patients' goals, and increase the risk of hospitalization with each episode," said Christoph U. Correll, M.D., Clinical Professor of Psychiatry at the Zucker School of Medicine at Hofstra/Northwell, New York.a "CAPLYTA® substantially lowers the chance of relapse for patients compared to placebo, which is often a major source of anxiety and suffering for them and their families." The submission is supported by positive results from a Phase 3, double-blind, multicenter, placebo-controlled, randomized withdrawal trial, which on the primary endpoint found time to relapse during the 26-week double-blind treatment phase was significantly longer in patients receiving CAPLYTA® compared to those receiving placebo (p=0.0002). Treatment with CAPLYTA® was also associated with a 63 percent reduction in risk of relapse versus placebo (hazard ratio [95% CI] = 0.37, [0.22, 0.65]). The key secondary endpoint showed a significantly delayed time to all-cause discontinuation, including relapse, compared with placebo during the double-blind phase (p=0.0007). The safety profile of CAPLYTA® was consistent with the existing body of clinical data, and no new safety concerns were identified. The most commonly reported adverse event that was observed at a rate greater than or equal to 5% and twice the rate of placebo was headache.i Schizophrenia affects up to an estimated 2.8 million adults in the United States, yet it remains insufficiently treated, with approximately 40 percent of people not receiving When left untreated, this complex mental health disorder can lead to episodes of psychosis, hallucinations, or other disruptive behaviors, which can damage and interrupt the lives of those living with schizophrenia as well as their loved Relapses, or a recurrence of symptoms, are associated with significant functional decline, increased caregiver burden, and a greater likelihood of On average, an adult with schizophrenia experiences nine relapses in less than six "Relapse prevention is a critical goal for the long-term care and management of this debilitating disorder," said Bill Martin, Ph.D., Global Therapeutic Area Head, Neuroscience, Johnson & Johnson Innovative Medicine. "These Phase 3 results provide compelling evidence of meaningful relapse prevention, which is critical in preserving long-term patient stability, breaking the cycle of hospitalization, and helping to control symptom progression. We're committed to building on the decade of research reinforcing the robust efficacy, proven safety, and favorable tolerability of CAPLYTA® and providing additional data to support the long-term use of this medicine in neuropsychiatric disorders." While its exact mechanism of action is unknown, CAPLYTA® is characterized by high serotonin 5-HT2A receptor occupancy and lower amounts of dopamine D2 receptor occupancy at therapeutic doses. In short-term clinical studies, CAPLYTA® was similar to placebo in weight change, metabolic effects, and extrapyramidal symptoms, which are often cited as reasons for treatment discontinuation. The most commonly reported adverse events were somnolence/sedation, dizziness, nausea, and dry mouth. CAPLYTA® can be taken at any time of day with or without food and does not require titration, allowing adult patients to start treatment at the effective dose. CAPLYTA® is FDA approved for the treatment of schizophrenia, as well as depressive episodes associated with bipolar I or II disorder in adults, as monotherapy, and as adjunctive therapy with lithium or valproate. An sNDA for CAPLYTA® as an adjunctive treatment for adults with major depressive disorder (MDD) is currently under FDA review. If approved, CAPLYTA® has the potential to become a new standard of care to treat some of today's most prevalent and debilitating mental health disorders. Editor's note: a. Christoph U. Correll, M.D., has provided consulting, advisory, and speaking services to Johnson & Johnson. He has not been paid for any media work. About Schizophrenia Schizophrenia is a complex, chronic brain disorder that affects how people think, feel, speak, and act. It affects up to an estimated 2.8 million adults in the United States yet remains widely misunderstood and insufficiently Symptoms vary by person, but confusion and distortions in perceptions, emotions, and behavior are common. Evidence shows that the first three to five years after diagnosis – "the critical period" – from symptom onset are key for a patient's treatment, as this is when the condition progresses most rapidly.v,vi A comprehensive treatment plan, which may include medication, therapy, and psychosocial services, can be critical in delaying the time to relapse for adults with About Study 304This study was a multicenter, multi-national, double-blind, placebo-controlled, randomized withdrawal study of lumateperone for the prevention of symptomatic relapse in adult patients with schizophrenia. The approximately 47-week study included an 18-week open-label phase where patients with schizophrenia were treated with lumateperone 42 mg per day. Patients who met the stabilization criteria during the open-label period progressed to the double-blind treatment phase. These patients were randomized to continue on lumateperone 42 mg (N=114) or switched to placebo (N=114) for up to 26 weeks or until the time to relapse occurred. The primary endpoint was time to first symptom relapse and the key secondary endpoint was time to all cause discontinuation during the double-blind phase. About CAPLYTA® (lumateperone) CAPLYTA® 42 mg is an oral, once daily atypical antipsychotic approved in adults for the treatment of schizophrenia and depressive episodes associated with bipolar I or II disorder (bipolar depression), as monotherapy, and as adjunctive therapy with lithium or valproate. While the mechanism of action of CAPLYTA® is unknown, the efficacy of CAPLYTA® could be mediated through a combination of antagonist activity at central serotonin 5-HT2A receptors and postsynaptic antagonist activity at central dopamine D2 receptors. CAPLYTA® is under FDA review for potential approval as an adjunctive treatment for adults with major depressive disorder and is being studied for other neuropsychiatric and neurological disorders. CAPLYTA® is not FDA-approved for these disorders. CAPLYTA® (lumateperone) is indicated in adults for the treatment of schizophrenia and depressive episodes associated with bipolar I or II disorder (bipolar depression) as monotherapy and as adjunctive therapy with lithium or valproate. Important Safety Information Boxed Warnings: Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. CAPLYTA is not approved for the treatment of patients with dementia-related psychosis. Antidepressants increased the risk of suicidal thoughts and behaviors in pediatric and young adults in short-term studies. All antidepressant-treated patients should be closely monitored for clinical worsening, and for emergence of suicidal thoughts and behaviors. The safety and effectiveness of CAPLYTA have not been established in pediatric patients. Contraindications: CAPLYTA is contraindicated in patients with known hypersensitivity to lumateperone or any components of CAPLYTA. Reactions have included pruritus, rash (e.g., allergic dermatitis, papular rash, and generalized rash), and urticaria. Warnings & Precautions: Antipsychotic drugs have been reported to cause: Cerebrovascular Adverse Reactions in Elderly Patients with Dementia-Related Psychosis, including stroke and transient ischemic attack. See Boxed Warning above. Neuroleptic Malignant Syndrome (NMS), which is a potentially fatal reaction. Signs and symptoms include: high fever, stiff muscles, confusion, changes in breathing, heart rate, and blood pressure, elevated creatinine phosphokinase, myoglobinuria (and/or rhabdomyolysis), and acute renal failure. Patients who experience signs and symptoms of NMS should immediately contact their doctor or go to the emergency room. Tardive Dyskinesia, a syndrome of uncontrolled body movements in the face, tongue, or other body parts, which may increase with duration of treatment and total cumulative dose. TD may not go away, even if CAPLYTA is discontinued. It can also occur after CAPLYTA is discontinued. Metabolic Changes, including hyperglycemia, diabetes mellitus, dyslipidemia, and weight gain. Hyperglycemia, in some cases extreme and associated with ketoacidosis, hyperosmolar coma or death, has been reported in patients treated with antipsychotics. Measure weight and assess fasting plasma glucose and lipids when initiating CAPLYTA and monitor periodically during long-term treatment. Leukopenia, Neutropenia, and Agranulocytosis (including fatal cases). Complete blood counts should be performed in patients with pre-existing low white blood cell count (WBC) or history of leukopenia or neutropenia. CAPLYTA should be discontinued if clinically significant decline in WBC occurs in absence of other causative factors. Decreased Blood Pressure & Dizziness. Patients may feel lightheaded, dizzy or faint when they rise too quickly from a sitting or lying position (orthostatic hypotension). Heart rate and blood pressure should be monitored and patients should be warned with known cardiovascular or cerebrovascular disease. Orthostatic vital signs should be monitored in patients who are vulnerable to hypotension. Falls. CAPLYTA may cause sleepiness or dizziness and can slow thinking and motor skills, which may lead to falls and, consequently, fractures and other injuries. Patients should be assessed for risk when using CAPLYTA. Seizures. CAPLYTA should be used cautiously in patients with a history of seizures or with conditions that lower seizure threshold. Potential for Cognitive and Motor Impairment. Patients should use caution when operating machinery or motor vehicles until they know how CAPLYTA affects them. Body Temperature Dysregulation. CAPLYTA should be used with caution in patients who may experience conditions that may increase core body temperature such as strenuous exercise, extreme heat, dehydration, or concomitant anticholinergics. Dysphagia. CAPLYTA should be used with caution in patients at risk for aspiration. Drug Interactions: CAPLYTA should not be used with CYP3A4 inducers. Dose reduction is recommended for concomitant use with strong CYP3A4 inhibitors or moderate CYP3A4 inhibitors. Special Populations: Newborn infants exposed to antipsychotic drugs during the third trimester of pregnancy are at risk for extrapyramidal and/or withdrawal symptoms following delivery. Dose reduction is recommended for patients with moderate or severe hepatic impairment. Adverse Reactions: The most common adverse reactions in clinical trials with CAPLYTA vs. placebo were somnolence/sedation, dizziness, nausea, and dry mouth. CAPLYTA is available in 10.5 mg, 21 mg, and 42 mg capsules. Please click here to see full Prescribing Information including Boxed Warnings. About Johnson & Johnson At Johnson & Johnson, we believe health is everything. Our strength in healthcare innovation empowers us to build a world where complex diseases are prevented, treated, and cured, where treatments are smarter and less invasive, and solutions are personal. Through our expertise in Innovative Medicine and MedTech, we are uniquely positioned to innovate across the full spectrum of healthcare solutions today to deliver the breakthroughs of tomorrow and profoundly impact health for humanity. Learn more at or at Follow us at @JNJInnovMed. © Johnson & Johnson and its affiliates 2025. All rights reserved. Cautions Concerning Forward-Looking Statements This press release contains "forward-looking statements" as defined in the Private Securities Litigation Reform Act of 1995 regarding product development and the potential benefits and treatment impact of CAPLYTA®. The reader is cautioned not to rely on these forward-looking statements. These statements are based on current expectations of future events. If underlying assumptions prove inaccurate or known or unknown risks or uncertainties materialize, actual results could vary materially from the expectations and projections of Johnson & Johnson. Risks and uncertainties include, but are not limited to: challenges and uncertainties inherent in product research and development, including the uncertainty of clinical success and of obtaining regulatory approvals; uncertainty of commercial success; manufacturing difficulties and delays; competition, including technological advances, new products and patents attained by competitors; challenges to patents; product efficacy or safety concerns resulting in product recalls or regulatory action; changes in behavior and spending patterns of purchasers of health care products and services; changes to applicable laws and regulations, including global health care reforms; and trends toward health care cost containment. A further list and descriptions of these risks, uncertainties and other factors can be found in Johnson & Johnson's most recent Annual Report on Form 10-K, including in the sections captioned "Cautionary Note Regarding Forward-Looking Statements" and "Item 1A. Risk Factors," and in Johnson & Johnson's subsequent Quarterly Reports on Form 10-Q and other filings with the Securities and Exchange Commission. Copies of these filings are available online at or on request from Johnson & Johnson. Johnson & Johnson does not undertake to update any forward-looking statement as a result of new information or future events or developments. Footnotes i Intra-Cellular Therapies Announces Positive Topline Results in Phase 3 Trial Evaluating CAPLYTA for the Prevention of Relapse in Patients with Schizophrenia. GlobeNewswire, 05 Nov. 2024, ii "Schizophrenia Fact Sheet." Treatment Advocacy Center, 10 Mar. 2025, iii Alphs L, et al. Factors associated with relapse in schizophrenia despite adherence to long-acting injectable therapy. Int Clin Psychopharmacol. 2016;31(4)202-209. doi:10.1097/YIC.0000000000000125 iv Lafeuille MH, Gravel J, Lefebvre P, et al. Patterns of relapse and associated cost burden in schizophrenia patients receiving atypical antipsychotics. J Med Econ. 2013;16(11):1290-1299. doi: 10.3111/13696998.2013.841705 v Birchwood, M. "Early intervention and sustaining the management of vulnerability." The Australian and New Zealand journal of psychiatry vol. 34 Suppl (2000): S181-4. doi:10.1080/000486700241 vi Tandon, Rajiv et al. "The schizophrenia syndrome, circa 2024: What we know and how that informs its nature." Schizophrenia research vol. 264 (2024): 1-28. doi:10.1016/ View original content to download multimedia: SOURCE Johnson & Johnson
Los Angeles Times
6 days ago
- Los Angeles Times
Republican holdouts bristle at Trump pressure over megabill
WASHINGTON — Confident that passage of President Trump's signature legislation is all but assured, West Wing aides summoned holdouts in the House Republican caucus on Wednesday to deliver a blunt message: Follow the president's orders and get it done by Friday. It was a call to action after House Speaker Mike Johnson directed his caucus to converge back on Washington from home districts around the country, braving flight delays due to storms in the capital to rush back in time for a vote before Independence Day. But the vote is in doubt, and signs have emerged of cracks in a coalition otherwise firmly under Trump's control. 'The president of the United States didn't give us an assignment,' Rep. Derrick Van Orden, a Republican from Wisconsin, told reporters, using an expletive to suggest Trump was treating lawmakers like his minions. 'I'm a member of Congress. I represent almost 800,000 Wisconsinites. Is that clear?' Frustration within the Republican Party is coming from two disparate camps of a broad-tent coalition that have their own sets of grievances: fiscal hawks who believe the bill adds too much to the national debt, and GOP lawmakers representing districts that heavily rely on Medicaid. One GOP lawmaker who attended the White House meeting on Wednesday, Rep. David Valadao of California, represents a Central Valley district with one of the highest percentages of Medicaid enrollment in the nation. The president's megabill, which he calls the 'big beautiful bill,' levies historic cuts to the healthcare program that could result in up to 12 million Americans losing health coverage, according to the nonpartisan Congressional Budget Office, gutting $1 trillion in funding and introducing a work requirement for enrollees of 80 hours per month until they turn 65 years old. The proposed legislation also restricts state taxes on healthcare providers, known as the 'provider tax,' an essential tool for many states in their efforts to supplement Medicaid funding. Several Republican lawmakers fear that provision could have devastating effects on rural hospitals. A handful of Republican lawmakers from North Carolina have bristled at the president's pressure campaign, with Rep. Chuck Edwards telling Punchbowl News that the White House meeting 'didn't sway my opinion.' North Carolina Sen. Thom Tillis, a Republican, was one of three senators who voted against the bill on Tuesday, warning it would devastate his state. It still passed with a tie-breaking vote from Vice President JD Vance. The vote is shaping up to be narrow in the House, as well, where Johnson can only afford to lose three votes in order to pass the omnibus legislation. Earlier Wednesday, after taking meetings at the White House, members of the House Freedom Caucus, a bloc founded to promote fiscal responsibility, also met with Johnson. The speaker emerged with a message of tempered optimism. 'I feel very positive about the progress, we've had lots of great conversations,' Johnson told reporters Wednesday, 'but we can't make everyone 100% happy. It's impossible.' 'This is a deliberative body. It's a legislative process by definition — all of us have to give up on personal preferences,' he continued. 'I'm never going to ask anyone to compromise core principles, but preferences must be yielded for the greater good. And that's what I think people are recognizing and coming to grips with.' Trump says the legislation encompasses his entire domestic agenda, extending tax cuts passed during his first term in 2017 and beefing up funding for border security, mass deportations, and the Defense Department. Cuts to Medicaid, as well as to the Supplemental Nutrition Assistance Program, better known as SNAP, are intended to offset a fraction of the costs. But the CBO still estimates the legislation will add $3.3 trillion to the national debt over the next decade, and hundreds of billions to the deficit, with other nonprofit budget trackers forecasting even higher figures.
Miami Herald
30-06-2025
- Miami Herald
Insurer Blue Shield of California's new parent company alarms consumer advocates
Last year, regulators approved a request by Blue Shield of California, the state's third-largest health insurer, to restructure and establish a new parent corporation in Delaware. The Oakland-based nonprofit got the go-ahead from the Department of Managed Health Care, or DMHC, to create an entity called Ascendiun Inc., which is now the out-of-state corporate parent of Blue Shield. The insurer said that the restructuring would allow it to better serve its members "with less bureaucracy and faster results, while making health care more affordable." But the transaction has raised alarm among a former high-level Blue Shield executive and consumer advocates, who complain that it was carried out with no public oversight and could allow the insurer to transfer money to a Delaware parent company with few strings attached. The activists claim that some of that money could be used to boost its spending on charitable endeavors. The company has accrued a surplus of more than $4 billion over the decades as it benefited from its former tax-exempt status, according to a regulatory filing. "The move guts the ability of the DHMC to enforce Blue Shield's nonprofit obligations to the California public and gives Blue Shield's directors ... a virtually free hand to make use of Blue Shield's billions of dollars in charitable assets as they please," wrote Michael Johnson, the insurer's former director of public policy, in a recent letter to Mary Watanabe, director of the department, which was reviewed by The Times. Johnson is calling for the department to rescind its approval and unwind the restructuring. The department maintains that the insurer is not subject to charitable trust rules as a nonprofit mutual benefit corporation. In a statement, the department said it "maintains full regulatory authority and enforcement of all Blue Shield of California health plan operations," and reviewed the transaction to ensure that it will not harm the plan's financial viability. Blue Shield's restructuring is reviving a longstanding debate about whether one of the state's largest insurers is reinvesting enough of its profit to lower its rates, better serve low-income residents and provide coverage for underserved areas of the state. Controversy over the company's role as a nonprofit previously aired in 2015 as it sought approval from the department for its $1.2-billion purchase of Care1st, a Medicaid health plan. Blue Shield has disputed Johnson's claims, noting that the state has determined it is not subject to the rules governing charitable nonprofits. In the Jan. 8 announcement of its restructuring, Blue Shield also disclosed that it was forming a for-profit subsidiary called Stellarus that would provide services to other health plans, such as delivering drugs to patients more inexpensively than pharmacy benefit managers. Ascendiun is structured as a nonprofit and Blue Shield and the company's Medi-Cal insurer, Blue Shield of California Promise Health Plan - the former Care1st - also would continue as nonprofits, the insurer said at the time. "This structure is not uncommon among health plans, as many across the country - including other nonprofit Blue Cross and Blue Shield companies - have made similar corporate reorganizations to better serve their membership," the insurer said in its statement to The Times. A scathing audit Blue Shield was established in 1939 by the California Medical Assn. as the nation's first prepaid health plan to cover physician bills. It followed the creation of the first Blue Cross plan, in Texas, to pay for hospital bills. The California insurer did not pay federal taxes until a change in the law in 1986. And it was exempt from state taxes until the Franchise Tax Board revoked that status in August 2014 after a scathing audit that The Times first reported. The audit found that Blue Shield was operating similarly to a for-profit company, with executives instructed to "maximize profitability." The tax board also found that the insurer had stockpiled "extraordinarily high surpluses" even as it failed to offer enough public benefits, such as more affordable coverage. Blue Shield denied the accusations but ultimately relinquished its tax-exempt status, even as it has continued to pursue an appeal of an order requiring it to pay more than $100 million in back taxes. Johnson contends that the new corporate structure will allow Blue Shield to move its assets around in pursuit of its business goals with little oversight beyond maintaining required reserves - especially given its parent company's incorporation in Delaware, a business-friendly state where most Fortune 500 companies are registered. The DMHC strengthened reserve requirements in approving the deal and it now totals about $2.1 billion, according to a regulatory filing, which Johnson says would allow Blue Shield to transfer about $2.4 billion to Ascendiun. Charles Bell, a healthcare advocate who was involved in last decade's debate over Blue Shield's charitable obligations, is troubled by the decision to establish an out-of-state parent. "I think that the changes in corporate structure that were made are highly concerning, and it should have received a much higher level of public scrutiny and a lot more skepticism by the Department of Managed Health Care," said Bell, advocacy programs director for Consumers Union, the publisher of Consumer Reports. The department said in its response to The Times that it "may hold public meetings if a transaction meets certain requirements to qualify as a major transaction. Upon due consideration, the Department determined that the specific facts of this restructuring did not meet the criteria set out in law to hold a public meeting." A long history of restructuring Blue Cross and Blue Shield plans have a long history of restructuring, including Blue Cross of California. That insurer broke ground when in 1993 it spun off a recently established for-profit subsidiary, Wellpoint Health Networks. Blue Cross was later required to distribute $3.2 billion to a pair of new nonprofits, the California Endowment and the California Health Care Foundation, which are still operating. Less than a decade later, Blue Cross and Blue Shield plans in more than dozen other states had converted to for-profits, typically highly controversial proposals, given questions about what was to become of their billions of dollars of assets. More recently, the nonprofits have converted into mutual insurance holding companies. That allows them to maintain their nonprofit status while funding for-profit ventures, such as in technology, said Brendan Bridgeland, an attorney with the Center for Insurance Research in Cambridge, Mass. What is unusual about Blue Shield of California's restructuring, he said, is that the DMHC allowed it to establish an out-of-state parent company. "Once you reach the point where the subsidiary starts transferring money up to the parent and it gets reallocated, then it's going to be out of their control," Bridgeland said. Johnson's concerns are rooted in efforts last decade by healthcare advocates to have Blue Shield declared a charitable organization and to dig into its assets to improve patient care as a condition of its approval to acquire Care1st. Johnson worked at Blue Shield from 2003 until 2015, when he resigned to mount a public campaign to pressure the insurer over its nonprofit mission. Johnson has been involved in litigation with his former employer, which sued him in 2015 alleging he disclosed confidential information, including Blue Shield's communications with the Franchise Tax Board. In a settlement, he agreed to no longer retain or disseminate such documents. In seeking to retain its state tax-exemption during its audit by the board, which began in 2013, Blue Shield argued that should it dissolve, its assets could be distributed only to another nonprofit. Yet, the insurer told the DMHC, when the agency reviewed the proposed acquisition in 2015, that as a nonprofit mutual-benefit corporation it served only its enrollees and had no such obligations. Ultimately, the department decided that Blue Shield did not have the charitable obligations though it required the insurer, in approving the acquisition that year, to refrain from making "misleading or inconsistent" statements regarding the distribution of its assets if it ever were dissolved. "Through this process there have been inconsistencies in what Blue Shield has said. It was frustrating because we had to spend a lot of time and energy to make sure what was true," the department's then director, Shelley Rouillard, said at the time. A pledge to spend more on patient care The insurer pledged as part of the Care1st acquisition to spend $200 million over the next decade on several initiatives aimed at providing better patient care. Nevertheless, patient advocates criticized the DMHC's finding that Blue Shield did not have charitable obligations, saying the state lost the opportunity to regulate how the insurer spent its billions in assets - and then failed to impose tougher conditions on the insurer, such as limiting its ability to impose rate increases deemed unreasonable. In his March letter, Johnson called on the DMHC to require Blue Shield to spend annually at least 5% of its total assets on community benefits, which might go, for example, to grants to community clinics in underserved areas of the state. Blue Shield defended its charitable spending, noting that it caps its annual profit at 2% and allocates additional revenue to such services as delivering COVID vaccines at no cost to the state, and funding nonprofits that advance mental health. "Blue Shield … has consistently supported its members and California communities throughout the state," the company said. Johnson also contends newly public documents show Blue Shield has continued to argue before state tax authorities that it is a charitable trust. In the opening brief of its back taxes case in 2020, the insurer cites a state Supreme Court case that it said confirms "Blue Shield operates exclusively for the promotion of social welfare," his letter notes. Blue Shield told The Times that it has provided "consistent information to DMHC about its corporate restructuring" and that Johnson's letter provided "no new evidence" regarding Blue Shield's status as a "tax-paying not-for-profit mutual benefit corporation." Johnson and the DMHC traded additional letters last week, with Johnson questioning why the department had not reviewed the new tax appeal documents or why they had not reviewed Ascendiun's articles of incorporation or bylaws prior to approving the restructuring. Janet Rickershauser, a nonprofits lawyer at Hurwit & Associates, said that the bylaws are important to understanding the parent company's operations, including the relationship of the subsidiaries to each other and the holding parent company. In a letter sent June 23 to Johnson, Jonathon Williams, an assistant chief counsel at the DMHC, said the department concluded it was "not necessary or appropriate" to review the tax-appeal documents in its review of Blue Shield's application to restructure nor conduct a "full evaluation of Delaware's corporation statutory scheme." The department told The Times that it conducted a "comprehensive review" of the articles of incorporation of Blue Shield and its Medicaid Promise Health Plan as required by state law. Although it did not review Ascendiun's bylaws or articles of incorporation, the department said it retained its regulatory authority over Blue Shield. Blue Shield said it would not release it bylaws because they are "confidential company documents." However, Rickershauser said that "hiding the ball on the bylaws is preventing transparency into important aspects of how they're operating." Copyright (C) 2025, Tribune Content Agency, LLC. Portions copyrighted by the respective providers.
