California healthcare groups urge CMS to reject cuts to Medi-Cal program

WASHINGTON — The Alliance for Patient Care, a coalition of healthcare providers, health plans, patient advocates and others working together to protect access to care in California’s Medi-Cal (Medicaid) program, headed to Washington, D.C., to urge the Centers for Medicare and Medicaid Services and members of Congress to reject California’s proposed cut to the state’s Medi-Cal program, according to a statement issued Wednesday by the National Association of Chain Drug Stores.

In May, the coalition sent a letter to CMS urging the agency to reject a proposed plan submitted by the state of California, which would drastically cut Medi-Cal. The letter was submitted in response to the passage of Assembly Bill 97, which includes a 10% reduction in Medi-Cal payment rates to physicians, hospitals, nursing homes and other providers, patient co-payments ($50 per ER visit, $5 per physician visit, $100 per day in the hospital), and a limit of seven physician office visits per year. Gov. Edmund G. Brown, Jr., signed the legislation, which needs approval from CMS in order to take effect.

Because the California Medi-Cal rates are extremely low, many providers cannot afford to participate. For instance, half of all California physicians don’t participate in the program and thus, 56% of Medi-Cal patients report difficulty finding a physician. Kaiser State Health Facts lists California as the lowest reimbursed state in the nation. The coalition argues that co-payments and arbitrary limits on services will create additional barriers for patients seeking care and ultimately, they will be forced to delay care or use emergency rooms for basic health services.

Currently, Medi-Cal is the source of health care for 1-in-5 Californians (about 7 million). With the implementation of healthcare reform right around the corner, another 3 million uninsured soon will be added to the state’s Medi-Cal program.

Coalition participants who met with leaders in Washington include NACDS, the California Pharmacists Association and the California Association of Health Plans.

In 2008, a similar plan was submitted, proposing to cut the reimbursement of all Medi-Cal providers. Recognizing that this reduction would have threatened Medi-Cal beneficiaries’ access to healthcare services, CMS rejected the plan in November 2010.