Latest Morning Briefing Stories
Which Providers Get 10% Reimbursement Cuts?
Toby Douglas did not bring good tidings. Yesterday, the director of the Department of Health Care Services outlined the recently approved 10% cuts for California providers of Medi-Cal services.
“This is really hard,” Douglas said. “These are extremely painful reductions.”
The California Hospital Association on Tuesday filed a lawsuit in federal court in Los Angeles seeking to halt the implementation of Medi-Cal rate cuts approved last week by CMS.
Austerity Won’t Help Physician Shortage, Experts Predict
Cutbacks in Medicare and Medicaid could make it more difficult to deal with a physician shortage in California that threatens to become more severe as millions of newly insured people join the reformed health care system. California groups are lobbying to streamline and subsidize the training of new primary care doctors.
Access at Issue in Medi-Cal Cuts
You would think providers would be up in arms over having their Medi-Cal reimbursement rates cut — once again.
After all, California had one of the lowest Medicaid provider rates in the nation, even before this recent 10% reduction. But according to Carol Havens, president of the California Academy of Family Physicians, the rate reduction really affects patients, not doctors.
“Providers now, at the current level of reimbursement, have to make a decision about how many Medi-Cal patients they will see,” Havens said. “Since it actually costs them money to see Medi-Cal patients, they have to limit the numbers in their practice. So now, in a practical sense, these cuts will put an increased burden on that decision, and they’ll likely see fewer Medi-Cal patients.”
State Laying Foundation for Duals Conversion
The state’s Department of Health Care Services released a series of draft papers this week, outlining some of the concerns and aims of its planned conversion program, which will eventually offer managed care choices to dual eligibles — those Californians who are eligible to receive both Medi-Cal and Medicare benefits.
The latest paper, released yesterday and expected to be posted on the DHCS website today, looks at the possible scope of that transition and finds it could include many more than the 150,000 people originally estimated for the conversion program.
“There are 370,000 duals in Los Angeles County alone,” according to Peter Harbage of Harbage Consulting, who worked on the papers. “There are another 250,000 in the next four largest counties. The paper opens the conversation on that point, as well as on other key issues.”
State Appeals Ruling on Disability Funding
In May, a federal judge issued an injunction to halt the state’s freeze on funding for programs for the developmentally disabled.
Yesterday, California attorneys were back in court, this time at the 9th Circuit U.S. Court of Appeals in Pasadena, to ask that the May decision be overturned.
Craig Cannizzo, who argued the case on behalf of individuals with developmental disabilities, said this case has far-reaching implications because the state did not get permission from CMS for the rate freeze.
Legislative Hearing Looks at Rural Health
The list of rural health issues is a long one, according to Steve Barrow of the California State Rural Health Association. But it can be summed up by one statistic, he said.
“In the rural areas, we have 30% of the state’s Medi-Cal patients, and we have 10% of the state’s population,” Barrow said.
Barrow was one of the presenters at a recent bipartisan legislative hearing on rural health issues, presided over by Assembly members Alyson Huber (D-El Dorado Hills) and Linda Halderman (R-Fresno).
Pitfalls and Promise of Converting California’s Dual Eligibles
The state would like to move “dual eligibles” — Californians who receive both Medicare and Medi-Cal benefits — into managed care plans. State officials say the move would save money and improve care, but it’s a big and complicated task.
L.A. Care Health Plan’s Elaine Batchlor Talks About Efforts To Improve Safety-Net Care
Elaine Batchlor, chief medical officer at L.A. Care Health Plan, spoke with California Healthline about the challenges facing safety-net health programs and the opportunities to address such challenges through innovation.
Date Set, Plaintiffs Get Support in High Court Medi-Cal Case
First up on the Supreme Court’s docket this fall is a California case determining whether Medi-Cal beneficiaries and providers have the right to sue the government. The ruling — no matter which side it favors — is expected to have far-reaching implications.
Will ‘Most Important Study in Decades’ Matter for Reform?
Although Medicaid is set to be the backbone of the Affordable Care Act’s health coverage expansion, the program is beset by criticism from conservatives. Health policy experts hope that a once-in-a-generation study will strengthen the case for preserving the program.