Calif. Physicians Unsure of Timeline for Medi-Cal Pay Increases Under ACA

California physicians who treat Medi-Cal beneficiaries do not know when to expect a reimbursement increase established by an Affordable Care Act provision, according to the California Medical Association, Modern Physician reports.

Medi-Cal is California's Medicaid program.

Details of ACA Provision

The ACA measure increases payments for certain primary care services for Medi-Cal beneficiaries to the same level as Medicare reimbursements for two years. The provision would affect family physicians, internists and pediatricians, as well as members of related subspecialties.

According to the ACA, the payment increases were scheduled to take effect Jan. 1.

To implement the reimbursement hikes, states must submit a "State Plan Amendment" to the federal government for approval. States will be granted retroactive pay increases after their plans are approved.

States have until March 31 to submit plans. CMS has 90 days to respond to submissions.

Timeline in California

Lisa Folberg -- CMA vice president of medical and regulatory policy -- said, "We don't know how long it will take to implement" California's plan. She said that the state Department of Health Care Services told CMA that the pay increase likely would not happen "at least until summer."

Jeffrey Cain -- president of the American Academy of Family Physicians -- said that AAFP's understanding is that the "worst-case scenario" is for the process to take six months.

DHCS Response

DHCS said the delay in reimbursement increases is unlikely to cause physicians to stop accepting Medi-Cal patients.

In an email, DHCS officials wrote that implementing the ACA provision "is a priority project for" the agency, "and we are working quickly to update system requirements and obtain federal approval of the State Plan Amendment."

They added, "Since the payment increase will be retroactive to [Jan. 1], any delay in implementing the payment increase is not expected to impact a provider's willingness to continue serving Medi-Cal members."

10% Medi-Cal Pay Cut Pending

However, Medi-Cal physicians' reimbursements might decrease before they increase, Modern Physician reports (Robeznieks, Modern Physician, 1/14).

In October 2011, CMS approved the state's plan to reduce certain Medi-Cal payments by 10%. The cuts would be retroactive to June 1, 2011.

However, U.S. District Court Judge Christina Snyder in January 2012 tentatively blocked the cut, saying it could cause irreparable harm to patients.

The 9th Circuit Court of Appeals lifted the injunction in December 2012.

An attorney for a group of pharmacies said the decision is being appealed (California Healthline, 12/14/12).

Gov. Jerry Brown's (D) fiscal year 2013-2014 budget proposal assumes "savings of $431 million" from the rate cut, according to an email from DHCS.

Paul Phinney -- CMA president -- said that actions like the 10% cut "will assuredly force physicians out of the Medi-Cal program" (Modern Physician, 1/14).