California Healthline Daily Edition

Summaries of health policy coverage from major news organizations

Ruling Could Worsen Shortage of Specialists Participating in Medi-Cal

A shortage of medical specialists willing to treat Medi-Cal beneficiaries could worsen under a federal ruling that allows California to cut reimbursements by 10%, the Los Angeles Times reports.

Medi-Cal is California's Medicaid program (Gorman, Los Angeles Times, 12/15/12).

Background on Ruling

In October 2011, CMS approved the state's plan to reduce certain Medi-Cal payments by 10%. State officials have projected that the cuts will save $623 million.

In December 2012, the 9th Circuit Court of Appeals ruled that HHS Secretary Kathleen Sebelius has authority to decide whether California and other states can reduce Medicaid rates while still adhering to program regulations.

The three-judge panel wrote, "Congress explicitly granted the Secretary authority to determine whether a state's Medicaid plan complies with federal law."

Critics of the ruling say that California already provides one of the lowest Medicaid reimbursement rates in the U.S.

The California Medical Association said that it hopes the state will decide against making the reimbursement cut, adding that the state now is expecting more revenue than when it planned the cuts in 2011.

However, a spokesperson for Gov. Jerry Brown (D) suggested that the governor is not likely to rescind the cuts (California Healthline, 12/14/12).

Possible Effect on Specialists

According to the Times, many private specialists in the state already are unwilling to treat Medi-Cal beneficiaries because of low reimbursement rates.

Mark Dressner -- a Long Beach physician and president-elect of the California Academy of Family Physicians -- said, "Specialists are paid so poorly that they don't want to take Medi-Cal patients," adding that CAFP is "really disappointed" in the recent ruling and "concerned what it's going to do for patient access."

In Los Angeles County, low access to specialists has overwhelmed the public health system, according to the Times. The issue has created costly inefficiencies and caused appointment delays that have lasted as long as a year-and-a-half (Los Angeles Times, 12/15/12). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.