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The state cut its Medicaid reimbursements to hospitals by 10 percent for services that didn’t require an overnight stay and eventually got approval from the Obama administration. The federal appeals court said the government can adopt such measures only if it shows that access to care is not affected.
State data show that the most expensive 1 percent of patients in Medi-Cal account for 23 percent of the program’s spending. Ten percent of patients create 63 percent of total costs.
Civil rights advocates file suit against California, alleging that care provided by Medi-Cal is substandard and disproportionately hurts Latinos — by far the largest group of enrollees.
“Without the health insurance, kids aren’t going to get the immunizations and the checkups. There are going to be more lost days of school. More trips to the emergency room,” said Dr. Traci Acklin, who grew up in Fayette County, West Virginia. “It would be food or healthcare for a lot of these families.”
California would be left with a nearly $115 billion shortfall for the program.
Michael Kennedy, the director of the county’s mental health divisions, said the state will eventually pay the outstanding Medi-Cal funds. But he said the delay creates “cash flow problems for counties.” Meanwhile, Gov. Jerry Brown signed his budget, which directs money from a tobacco tax toward Medi-Cal, into law.
The expansion of Medi-Cal under the Affordable Care Act was supposed to relieve stress on ERs, but it hasn’t worked out quite as planned.
For a state that so fully embraced Medicaid expansion, California has a lot to lose.
Officials in Gov. Jerry Brown’s finance department say the priority this year is to maintain the existing Medi-Cal system.
Medical groups backed the Prop. 56 expecting the revenue to go to reimbursement rates, but they were disappointed with the final budget plan.