Some Calif. Physicians Still Awaiting ACA’s Medi-Cal Pay Increases
Many California physicians who treat Medi-Cal beneficiaries have not yet received reimbursement increases established by an Affordable Care Act provision that were supposed to take effect in January 2013, HealthyCal reports.
Medi-Cal is California's Medicaid program (Guzik, HealthyCal, 3/31).
The ACA provision 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, 2013 (California Healthline, 1/15/13).
However, the California Department of Health Care Services did not begin issuing the increased reimbursements until November 2013.
DHCS spokesperson Anthony Cava said the agency was unprepared to begin issuing reimbursements in a timely fashion because of "payment and system issues that had to be resolved with CMS."
DHCS said it plans to reimburse physicians retroactively for the scheduled pay increase. According to HealthyCal, the state has issued more than $154 million in reimbursements since mid-March.
Physicians Not Receiving Funds
Despite DHCS' efforts to send physicians retroactive payments, many health care providers say they have not received such payments.
Much of the funding was sent to county-level managed-care plans that offer Medi-Cal services.
Officials with three managed-care plans say they have spent months determining how to distribute the funding, but insurers vary on their timelines for dispersing the funds to physicians. For example:
- A Health Net spokesperson said the insurer will begin distributing checks within the "next few weeks" with a deadline of late June;
- Gold Coast Health Plan said it plans to distribute checks this week; and
- L.A. Care Health Plan said it is working on resolving technical issues that have affected some of the payments and did not give a date as to when it would begin sending checks to physicians.
Molly Weedn, associate vice president of public affairs for the California Medical Association, said that many physicians have been operating under the assumption that they would be receiving their reimbursements much earlier.
She added that the delay could make it difficult for physicians to accept new Medi-Cal patients (HealthyCal, 3/31).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.