Press Room
For Immediate Release Media Contact: Molly Weedn
September 29, 2011 916-551-2069
Centers for Medicare & Medicaid Services Deadline to Rule on California’s State Plan Amendments Passes
State’s proposed cuts would significantly hinder access to care for Medi-Cal patients
Washington, D.C. - After months of meetings and informational briefings, the Centers for Medicare & Medicaid Services (CMS) stopped the clock on the 90 day deadline to rule on proposed state plan amendments, submitted by California this summer. On the deadline, September 28, 2011, CMS submitted an official request to the State of California for additional information.
“CMS has full authority to stop the 90 day clock and ask the state of California for underlying documentation to support the state plan amendments (SPAs) that were submitted,” California Medical Association General Counsel and Vice President, Francisco J. Silva said. “Whether or not that documentation is adequate or even exists, is yet to be seen.”
As part of the state’s 2011 budget, AB 97 was passed and signed into law by Governor Brown. The bill included a 10 percent reimbursement rate cut for physicians, a limited number of physician visits for patients (seven) and mandatory patient co payments.
“We certainly understand CMS’s need for additional information from California’s Department of Health Care Services (DHCS),” Silva added. “We’re not convinced however, that the state has the background information to share. They should have had that data ready to submit when the state plan amendments were sent to CMS, yet we have been told the information is not available to share. We don’t believe the state can demonstrate that access to care wouldn’t be impacted.”
Under the federal Medicaid Act, the state must demonstrate that Medicaid patients and privately insured patients have equal access to health care. DHCS has rejected repeated requests for the underlying data from the California Medical Association. Legally, the state must be able to show that access to care would remain equal for Medi-Cal and privately insured patients.
“If the state plan amendments are approved, primary care physicians will only be reimbursed $11 for a patient visit,” James G. Hinsdale, M.D., President of CMA said. “Physicians have business costs and staff to pay; It is unfortunate that the State is making physicians choose between accepting new Medi-Cal patients and keeping our practices viable.”
Through Medi-Cal, physicians, dentists, pharmacists, adult day health care providers, clinics and hospitals provide health care serves to low-income seniors, families, children and people with disabilities. By providing these primary and preventative care services, the state ensures these Californians have access to health care, rather than having to rely on costly alternatives such as emergency room visits and hospital admissions.
“In the eyes of the California Legislature and Governor Brown, these cuts may be a short term budget solution. But, we’re talking about the access to care for the patients that need it most, and these cuts will certainly mean additional hurdles,” Hinsdale said.
For Immediate Release Media Contact: Molly Weedn
September 28, 2011 916-551-2069
United States Supreme Court to Hear Oral Arguments in Douglas v. Independent Living Center of Southern California, et al.
Case will determine whether or not patients and providers can legally advocate for themselves
Washington, D.C. - On Monday, the United States Supreme Court will hear oral arguments in the Douglas v. Independent Living Center of Southern California ("Independent Living Center") case. The Supreme Court’s ruling could have huge implications for the more than 10 million patients in California that are currently enrolled in California’s Medicaid program, as well as for the physicians that voluntarily treat those patients. The California Medical Association is a party in the case.
The issue addressed by Douglas v. Independent Living Center is whether or not Medicaid recipients and providers can sue a state for failing to pay the rates required by the Medicaid Act, which states that government insured and privately insured patients have equal access to medical care.
As the Supreme Court hears the case, a number of state plan amendments (SPAs) submitted by the State of California sit with the Centers for Medicaid and Medicare Services (CMS). The SPAs each propose significant cuts to California’s Medicaid program, Medi-Cal. The SPAs would, among other things, cut physician reimbursement, limit the number of times a patient can see a physician per year and implement mandatory patient co-pays.
“The state plan amendments submitted by California to CMS would severely reduce Medi-Cal patients' access to medical care,” Francisco J. Silva, General Counsel and Vice President of the California Medical Association said. “The proposed cuts would mean that a primary care physician would only be reimbursed $11 for a Medi-Cal patient visit. Physicians have to pay their staffs and keep their doors open, and these rates would just not allow for them to do that and accept Medi-Cal Patients.”
Medi-Cal provides essential health care services to the poorest and most vulnerable Californians. Through Medi-Cal, physicians, dentists, pharmacists, adult day health care providers, clinics, and hospitals provide health care services to low-income seniors, families, children, and people with disabilities. By providing these primary and preventive care services, the state ensures these Californians have access to health care, while at the same time saving money by lowering the chances they will be forced to seek more costly health care, such as emergency rooms or hospital admissions.
“The issue before the US Supreme Court is crucial to the future of how patient advocacy will unfold,” said Theodore Mazer, M.D. “If patients can’t fight for themselves, and as physicians, we can’t either- then who is left to stand up for the group of people that needs our help the most?”
Mazer, a San Diego area ear, nose and throat doctor treated Medi-Cal enrollees for over 20 years until the state began seeking reimbursement cuts. Eighteen months ago, he stopped accepting new Medi-Cal patients. He is an individual party in the lawsuit.
“It’s unfortunate that the State has made us choose between accepting new Medi-Cal patients and keeping our practices viable,” Mazer added.
In 2008, a coalition of health care providers including CMA sued the state of California to stop a 10% cut in Medi-Cal reimbursements. A federal appeals court ruled that Medi-Cal providers have standing to challenge the state’s rate cut and upheld the merits of the 2008 preliminary injunction that forced the state to immediately reverse the cut. The U.S. Supreme is considering this case and others with respect to whether providers and patients have legal standing to enforce the federal Medicaid law. A number of amicus briefs have been filed in support of respondents in the case, including:
- Brief for Members of Congress
- Brief for the National Association of Chain Drug Stores et al.
- Brief for the Chamber of Commerce of the United States of America
- Brief for the American Medical Association et al.
- Brief for the American Health Care Association et al.
- Brief for the American Civil Liberties Union et al.
- Brief for AARP et al.
- Brief for Former HSS Officials
