Health Care Providers Request Review of 10% Medi-Cal Cut
Medi-Cal is California's Medicaid program (Megerian, "PolitiCal," Los Angeles Times, 1/28).
The stateâs planned cut comes as it preparesÂ to expand Medi-Cal to individuals who earn up to 138% of the federal poverty level -- or $15,415 annually -- under the Affordable Care Act (California Healthline, 1/28).
Background on 10% Cut
In October 2011, CMS approved the state's plan to reduce certain Medi-Cal payments by 10%. The state Department of Health Care Services has estimated that the cut will save the state $431 million.
According to DHCS, the cut would apply to:
- A number of providers and outpatient services, including clinics, dentists, laboratories, optometrists and pharmacists; and
- Freestanding nursing and adult subacute care facilities, as well as other nursing facilities.
Payment reductions would be retroactive to June 1, 2011.
In January 2012, U.S. District Court Judge Christina Snyder tentatively blocked the cut, saying it could cause irreparable harm to patients.
In December 2012, a three-judge panel of the 9th Circuit Court of Appeals overturned the decision, ruling that HHS Secretary Kathleen Sebelius has authority to decide whether California and other states can reduce Medicaid rates while still adhering to program regulations.
Details of Appeal by Health Care Providers
Health care providers are asking the full 9th Circuit court to review the case (Yamamura, "Capitol Alert," Sacramento Bee, 1/28).
Among the groups that contributed to the petition are the:
- California Dental Association;
- California Hospital Association;
- California Medical Association; and
- California Pharmacists Association (Robertson, Sacramento Business Journal, 1/28).
According to the petition, the December 2012 decision "upends 16 years of 9th Circuit precedent recognizing that federal Medicaid law does not allow California to set provider rates without documented consideration of providers' costs" ("Capitol Alert," Sacramento Bee, 1/28).
Paul Phinney -- president of CMA -- said that the cut no longer is necessary because the state's finances have improved since the reduction was proposed in 2011.
In a statement, he said, "We simply cannot continue to cut resources and expect successful implementation of health reform in California" ("PolitiCal," Los Angeles Times, 1/28).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.