Health Advocates See Risks in Gov. Brown’s Proposed Medi-Cal Cuts

Some health advocates are voicing concern about provisions in Gov. Jerry Brown's (D) budget proposal that aim to cut spending on Medi-Cal, California's Medicaid program, California Watch reports.

Capping Services

To achieve the spending reductions, Brown's budget plan would limit Medi-Cal beneficiaries to 10 physician visits annually. The state expects the 10-visit cap to reduce state spending by $200 million per year.

However, health advocates questioned whether the expected spending reductions would be realized if the 10-visit cap spurs Medi-Cal beneficiaries to seek care at hospitals instead of physician offices.

Advocates also said the cap could pose risks for Medi-Cal beneficiaries who need frequent medical care, such as those who undergo chemotherapy or dialysis treatments. 

According to the Department of Health Care Services, the cap likely would affect 10% of Medi-Cal beneficiaries. DHCS estimates that those 10% generally account for about 40% of the 3.3 million annual physician or medical visits covered under Medi-Cal.

California's Legislative Analyst's Office recently recommended that the state pursue a Medi-Cal service cap that allows exemptions for certain medical conditions or procedures (Jewett, California Watch, 2/7).

Adding Copayments

In addition to the limits on physician visits, Brown's budget plan would impose mandatory copayments for Medi-Cal beneficiaries. The plan calls for:

• $5 copays for physician visits, clinic visits and prescriptions;
• $50 copays for emergency room visits; and
• $100 copays for each day of a hospital stay, up to a maximum of $200 total.

The governor estimates that the copayments could reduce state spending by more than $500 million for the next fiscal year.

However, Dev GnanaDev -- medical director at Arrowhead Regional Medical Center in Colton -- said many Medi-Cal beneficiaries might be unable to afford the higher copays for medical services, which could lead hospitals and physicians to face higher costs for uncompensated care (Koren, Redlands Daily Facts, 2/6).