When the state Senate Committee on Budget and Fiscal Review convened for the first time last week to discuss the governor’s budget proposal, concerns about health care funding kept popping up.
“I see the budget does not restore the provider rate cut in Medi-Cal,” said state Sen. Jeff Stone (R-Temecula) at the Jan. 22 hearing. Stone said the expansion of coverage to 2.2 million more Californians will only work if there are enough providers to see them.
“We have an expanding [Medi-Cal] population and I’m not sure we’re going to have physicians,” he said. “I see this as a potential medical catastrophe in the making.”
Keely Bosler, chief deputy director at the Department of Finance, said it’s up to the Department of Health Care Services to make sure the state meets its access requirements.
“This is an ongoing effort,” Bosler said. “DHCS does monitor access. And also the administration is putting together a new 1115 waiver with the federal government.”
Shawn Martin, managing principal analyst of Health and Human Services at the state’s Legislative Analyst’s Office, had a slightly different take.
“Over 70% of Medi-Cal beneficiaries will be enrolled in managed care plans,” Martin said, which are not directly affected by the state’s fee-for-service provider reimbursement rates, he said.
“We suggest the Legislature pivot,” Martin said, “in the direction of greater monitoring of access and quality of Medi-Cal managed care plans.”
State Sen. Bill Monning (D-Carmel) outlined a number of positives in the state budget proposal: “But if there are any shortcomings in this budget, it’s health and human services,” he said.
In particular, Monning was concerned about provider payments within developmental services.
“There has been no increase in rates to providers since 2006,” Monning said. “In my district, people are closing homes [serving the developmentally disabled] because they’re no longer able to run a business. The need is growing and provider rate is shrinking.”
State Sen. Richard Pan (D-Sacramento) pointed out the state auditor came out with recommendations on how to handle Denti-Cal access issues, but that is not addressed in the budget proposal.
Pan also said it’s well-known that employers end up paying more when Medi-Cal rates are low — but since the state is a major employer, it should be concerned about picking up the extra cost of basically subsidizing low Medi-Cal rates.
“The state is a major payer [of employer-based health care coverage],” Pan said. “So when Medi-Cal underpays, what pressure does that put on the rest of the system? And that includes pressure on the state for providing coverage for state employees.”
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