Lawsuit Filed Over Medi-Cal Reimbursement for Assistive Speech Devices
A recent 20% cut in Medi-Cal reimbursement rates to providers of medical devices that facilitate language communication has resulted in a number of beneficiaries with severe speech impediments being illegally denied aid, according to a lawsuit filed Tuesday in federal court in Sacramento, the Sacramento Bee reports. People with conditions such as cerebral palsy, autism and other disabilities frequently need augmentative and alternative communication devices and speech generating devices to communicate, the lawsuit states. Prior to the rate cuts, Medi-Cal covered 100% of the cost of the devices. The lawsuit -- which seeks class-action status on behalf of all Medi-Cal beneficiaries who have been or will be approved for such devices and an injunction barring further implementation of the cut -- asserts that the makers of the equipment have stopped delivering devices to approved patients because the new reimbursement rates are "substantially below the amounts paid by other device funding sources in California, including Medicare, private insurance, Tricare and the Department of Veterans Affairs." The suit states that 300 Medi-Cal beneficiaries received the devices in 2003. By comparison, of the 25 people approved for the devices this year, none has received the equipment, according to the lawsuit. The suit alleges that the Department of Health Services and its director, Sandra Shewry, were "motivated solely by the desire to save money" and did not comply with mandatory provisions of the federal Medicaid Act before implementing the reimbursement rate cuts.
"For many people ... a specialized device is the only way they can communicate," Zachary Potter, an attorney who filed the suit on behalf of three children and their parents, said. Lewis Golinker, director of the New York-based Assistive Technology Law Center, said that the total cost of the devices -- which range in price from $100 to $7,500 -- to Medi-Cal is about $1 million per year. DHS spokesperson Lea Brooks on Wednesday said that the department has not reviewed the lawsuit and had no comment (Walsh, Sacramento Bee, 5/27).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.