California's Department of Health Care Services has issued an advisory letter asking clinics statewide to send back funds that the agency paid out for certain optional Medi-Cal benefits within the last year, California Watch reports. Medi-Cal is California's Medicaid program.
DHCS has not yet started to bill clinics (Jewett, California Watch, 10/19).
Background
In 2009, the Legislature attempted to reduce state spending by eliminating coverage for certain Medi-Cal benefits, including:
- Adult dental care;
- Chiropractic treatment; and
- Podiatric services.
The California Association of Rural Health Clinics and a community health center in Kings County sued DHCS and state officials over the cuts, alleging that the Medi-Cal changes conflict with federal law.
A court order reinstated the coverage in October 2010 (California Healthline, 10/22/10).
The state resumed payments for such services until May, when it received CMS approval to eliminate coverage of benefits considered optional under Medi-Cal. DHCS then determined it has the authority to recoup payments that were made during the court-mandated period, according to a letter from the Family Health Centers of San Diego.
Details of the State's Stance
Norman Williams, spokesperson for DHCS, said that during the court-order period, the agency warned health care providers that they might need to send back the money.
Williams did not provide an estimate for the total amount owed to the state or how many clinics would be affected, but he said DHCS has "a responsibility to protect the fiscal integrity of the Medi-Cal program."
Clinics' Response
Jennette Lawrence Shea -- director of government and community relations for Family Health Centers of San Diego -- said community clinics will be burdened by the state's request. She said the clinic provided about 5,300 dental visits from October to May and that it could have to pay back about $850,000.
Marty Lynch -- executive director of LifeLong Medical Care in Berkeley -- said his organization could owe about $400,000 in dental care services.
Lawrence Shea added that the San Diego clinic has met with lawmakers to discuss the issue (California Watch, 10/19).