State Not Complying With Law for Annual Medi-Cal Pay Audits
California has not been complying with a law requiring the Medi-Cal director to review physicians' reimbursement rates annually and ensure that Medi-Cal beneficiaries have access to physician and dental services, the Sacramento Bee reports. Medi-Cal is California's Medicaid program.
Sandra Shewry -- director of the Department of Health Care Services, which administers Medi-Cal -- said the report has not been completed in the past 15 years. Shewry said the law is a holdover from when health care expenditures made up a smaller portion of the state budget.
The law, passed in 1976, is intended to keep physician reimbursement rates competitive with other insurance programs, as well as offer "reasonable access" to health services, the law states.
Last month, the Legislature approved a 10% cut to Medi-Cal physician reimbursements to help address an $8 billion budget deficit that the state faces through June 2009.
Assembly member Patty Berg (D-Eureka), a critic of the Medi-Cal cuts, said the deficit could increase to $10 billion.
Stan Rosenstein, director of Medi-Cal, said DHCS in recent years has compared Medi-Cal rates to Medicare rates, which are viewed as better benchmarks than the annual reviews.
According to the California Medical Association, physician reimbursements for Medi-Cal are the lowest of any state Medicaid program.
Ned Wigglesworth, a spokesperson for CMA, said about half of all state physicians do not participate in Medi-Cal because the reimbursement rates are inadequate.
San Francisco Mayor Gavin Newsom (D) has threatened a lawsuit to block the cuts from taking effect (Lin, Sacramento Bee, 3/28).
The "Legislature's Medi-Cal cuts are simply another budgetary shell game, shifting state health care expenditures onto already-hard-pressed local jurisdictions and onto private hospitals, which then boost costs to private insurers that in turn raise prices to consumers," a San Francisco Examiner editorial states.
In terms of Newsom's lawsuit, the editorial states, "More often than not, making budget policy in the courts is a bad idea," but adds that "we cannot see that Mayor Newsom has any other alternative except to fight as hard as he can [to] stop the state from playing its latest trick on the counties" (San Francisco Examiner, 3/27).