From Supreme Court to Appeals Court

Yesterday’s decision by the U.S. Supreme Court had a ripple effect in California, influencing a number of lawsuits in the state over health care cuts.

Four lawsuits have been filed over the 10% Medi-Cal provider rate cuts, and in all four cases, a federal judge has issued a temporary injunction blocking those cuts. In another court case, an injunction halted 20% trigger cuts to Californians receiving In-Home Supportive Services.

All of those cases were waiting to see what the Supreme Court would decide in Douglas v. Independent Living Center of Southern California. Yesterday’s decision to send that case back to the Ninth Circuit Court of Appeals was a huge victory for patient rights’ groups, according to Melinda Bird, a Disability Rights California attorney.

“We’re thrilled. Absolutely thrilled,” Bird said. “What this means for the IHSS case is that all of our claims remain alive and active.”

Bird said that DRC is in active settlement negotiations with the Department of Health Care Services over the IHSS trigger cuts.

DHCS officials could not be reached for comment Wednesday.

Part of the reasoning behind the Supreme Court decision, Bird said, is that CMS had already approved the cuts in yesterday’s case, so there was no constitutional judgment to make. And that will be significant in California, she said.

“[The] Douglas [case] makes CMS approval more important than it has been in the past,” Bird said.

That makes the case of the 10% Medi-Cal provider rate cuts a little more interesting, she said, since a federal judge already enjoined the cuts, despite CMS approval. In the IHSS case, Bird added, California has not yet requested approval for the cuts.

“I think what we’ll be looking at, going forward, is this,” Bird said. “What is the significance of CMS approval in interpreting federal law?”

San Diego physician Steven Green, president of the California Academy of Family Physicians, said physicians are pleased with the ruling.

“In California, the Medi-Cal program is underfunded by most people’s standards, so even when physicians are taking Medi-Cal patients at the current rates, it is really difficult to keep their doors open,” Green said. “When you take 10% right out of the bottom line, then they’re no longer able to do that.”

The result of a 10% Medi-Cal provider rate cut, Green said, would be even fewer physicians treating low-income patients. That access problem would likely mean overcrowding in emergency departments, he said, and people putting off care until their health problems become dangerous — and expensive — health traumas.

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Capitol Desk Health Care Costs Medi-Cal