We Care for California coalition introduces legislation to increase Medi-Cal rates to Medicare levels Senate Health Committee Chair Ed Hernandez and Assembly Health Committee Chair Rob Bonta joined health care providers, medical students, patients and advocates on the steps of the Capitol on Wednesday to introduce AB 366 and SB 243, legislation that would not only restore a 10 percent cut to Medi-Cal reimbursement rates, but would also place reimbursement on par with Medicare, increasing payments rates for inpatient hospital services and most outpatient services. The proposals would also require the Department of Health Care Services to pay Medi-Cal managed care plans at the upper end of the rate range so as to ensure a more robust Medi-Cal provider network. “A Medi-Cal card needs to be more than an empty promise,” said Senator Hernandez. “Expanding access to health care coverage, as we have done under the Affordable Care Act (ACA), is a significant accomplishment. Unfortunately, millions of Californians in the Medi-Cal program lack that access because we pay providers an embarrassingly low rate.” In 2011, Medi-Cal payment rates to doctors, hospitals, dentists and other providers were cut by 10 percent as a way to balance the state’s budget. California now has one of the lowest payment rates in the country. At the same time, the Medi-Cal program now covers more than 12 million patients, one in three Californians, as a result of expanded eligibility under the ACA. “I believed then, and I believe now, that health care should be a right and not a privilege,” said Assemblymember Bonta. “Bills AB 366 and SB 243 are critical steps toward ensuring that the health care coverage millions have signed up for is meaningful and actually provides real access to quality health care.” “As physicians, we want to provide care to patients, and especially to the poorest and most vulnerable among us,” said Luther Cobb, M.D., California Medical Association president. “With primary care reimbursement rates as low as they are, many physicians are forced to stop taking new Medi-Cal patients as they simply can’t keep their doors open. In areas like rural, northern California where I practice, that can mean patients have longer wait times or have to drive farther to get care.” A 2011 survey funded by the California HealthCare Foundation of over 1,500 Medi-Cal beneficiaries identified difficulties in finding coverage, with 34 percent of Medi-Cal beneficiaries saying it was difficult to find health care providers who accept their insurance, compared to 13 percent of people with other coverage. The survey found a higher percentage of adults with Medi-Cal say they have more difficulty getting appointments with specialists and primary care providers than adults with other health coverage (42 percent vs. 24 percent for specialists, and 26 percent vs. 15 percent for primary care providers). March 9, 2015 Medi-Cal, Medicare Medic-Cal Cuts, We Care for California, Legislative Advocacy, Medi-Cal 0 0 Comment Read More »
NEJM study shows primary care rate increase for Medicaid patients increased access to care A study published in the New England Journal of Medicine last week shows that the increase in Medicaid reimbursement for primary care providers, a key provision of the Affordable Care Act (ACA), resulted in a 7.7 percent increase in new patient appointment availability without longer wait times. The study, conducted by the University of Pennsylvania and the Urban Institute, used “secret shoppers” to call primary care doctors offices seeking new appointments in 10 states: Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania and Texas. Calls were made in two time periods, from November 2012 through March 2013 and May 2014 through July 2014. While the study did not examine California specifically, it did find that “states with the largest increases in availability tended to be those with the largest increases in reimbursements.” In California, the primary care rate increase more than doubled the rate these providers would have gotten without this key provision in the ACA. The study provides the first research-based evaluation of the association between the ACA’s two-year Medicaid fee increase — for which federal funding expired on December 31, 2014 — and access to care for Medicaid patients seeking new patient primary care appointments at physician offices. For Medicaid patients, the average appointment availability increased 7.7 percentage points, from 58.7 percent to 66.4 percent, between the two time periods. There was no change in wait times for appointments. Low Medicaid reimbursement rates across the country are becoming a hot topic as more and more consumers gain access to care under the ACA. Several court cases that force the issue of access to care for Medicaid patients have shown up in court. Last month a federal court judge ruled that the low Medicaid reimbursement rates in Florida deprived children of necessary care. Last week, the U.S. Supreme Court heard a case originally filed by providers in Idaho who were frustrated with their state’s Medicaid reimbursement rates. The Urban Institute estimated that provider rates are set to fall an average of 42.8 percent because Congress chose not renew the rate increase. A Kaiser Family Foundation survey found that 15 states will continue some sort of rate increase with state funds. Twenty-four states will return to payment levels before 2013; and it is unknown what the remaining 12 will do to provide access to care. In California, physicians are faced not only with the expiring ACA pay bump, but also a 10 percent provider reimbursement cut authorized by AB 97 in 2011. California’s abysmally low provider reimbursement rates, which have not been adjusted for increasing costs in two decades make it very difficult for physicians to accept new Medi-Cal patients—placing roadblocks for patient access to care. Even before the AB 97 cuts, California's Medi-Cal provider payment rates were some of the lowest in the nation. Low reimbursement rates have made it difficult for physicians to continue accepting new patient in the program. As a result, 56 percent of Medi-Cal patients report difficulty finding a doctor. California's Medi-Cal rates often do not even come close to the cost of providing care. Medi-Cal physicians are currently paid roughly $16 for a regular, primary care visit. For many practices, this is simply unsustainable. The California Medical Association (CMA) continues to fight with the “We Care for California” coalition for increased Medi-Cal reimbursements. The unprecedented coalition includes the largest statewide organizations representing physicians, dentists, hospitals and health care workers, as well as health plans, first responders, caregivers and other health providers. “With over 12 million people to be enrolled in Medi-Cal, it is more important than ever to ensure that the program is adequately equipped to handle new patients,” says CMA President Luther F. Cobb, M.D. “California pays some of the nation’s lowest Medicaid reimbursement rates and in order to properly serve the poorest and most vulnerable patients among us, at a minimum, a restoration of the provider cut made in 2011 needs to be restored.” February 4, 2015 Medi-Cal Affordable Care Act, ACA, Medi-Cal, We Care for California 0 0 Comment Read More »
Legislation introduced to restore Medi-Cal funding Today Assembly Budget Chair Nancy Skinner and Assembly Health Chair Richard Pan, M.D., introduced two bills, one that would restore the 10 percent Medi-Cal physician payment cut that went into effect this year and another that would extend the temporary Medi-Cal primary care rate increases called for under the Affordable Care Act (ACA). “I have sought to make the Medi-Cal program more cost-effective, transparent and accountable,” said Dr. Pan. “The legislation that we are introducing today continues this effort.” Medicaid rates in California are the lowest in the nation, while the state has arguably the highest practice costs anywhere in the country. With physicians paid just $18 a visit for primary care services, many patients are already having a tough time finding access to quality medical care. “Without adequate payment, Medi-Cal becomes an empty promise of coverage without actual access to care,” added Dr. Pan. “Getting a pizza delivered costs about the same as what California now reimburses doctors for Medi-Cal patient visits, it should be clear to everyone which service is worth more,” said Assemblymember Skinner. “California needs to fix reimbursement rates so we don't undermine the very program designed to cover millions of individuals and families in need of health care.” AB 1805 will improve health care access by bolstering provider participation in Medi-Cal, a program California expanded last year as the state moves forward in aggressively implementing the ACA. Specifically, AB 1805 will restore the 10 percent cut to Medi-Cal provider reimbursement rates that were enacted as part of the 2011 State Budget Act. AB 1759 extends through 2015 (and indefinitely beyond) the reimbursement increase for certain Medi-Cal primary care providers called for under the ACA and set to expire on December 31, 2014. “Patients in our communities are already having a difficult time finding access to care,” said Richard Thorp, M.D., California Medical Association (CMA) president. “The legislation being introduced today will help to ensure that patients have real access to care as millions of new patients are enrolled in Medi-Cal.” More than 8.5 million Californians receive their health care from the Medi-Cal program – one in every five patients in the state – and this number will rise drastically this year when over 2 million new patients enter the system under the ACA. The bill continues the work that CMA has already been engaged in since 2011 when the California Legislature passed and Governor Jerry Brown signed AB 97, which included a 10 percent reimbursement rate cut for physicians, dentists, pharmacists and other Medi-Cal providers. The cuts were enjoined for two years while the matter was being argued in a CMA-filed lawsuit. Despite earlier favorable rulings, a three judge panel of the 9th Circuit Court of Appeals cleared the way for implementation of these rate reductions in 2013. CMA requested a rehearing from the full Ninth Circuit Court of Appeals, which was denied. In September 2013, CMA filed a petition with the United States Supreme Court, asking it to review the appeals court ruling. The Court decided not to take this petition in January 2014. CMA is part of an unprecedented coalition of physicians, dentists, health care workers and hospitals that is working to stop the cuts. The coalition, called “We Care for California," includes the largest statewide organizations representing physicians, dentists, hospitals and health care workers, as well as health plans, first responders, caregivers and other health providers. February 20, 2014 Medi-Cal ACA, Insurance/Reimbursement, Medi-Cal, Medi-Cal Cuts, State Legislative Advocacy, Affordable Care Act, We Care for California 0 0 Comment Read More »
