CMA Urges Federal Officials To Review Medi-Cal Payment Rates

The California Medical Association has requested that CMS assess whether California pays health care providers enough to guarantee adequate access to care for Medi-Cal beneficiaries, California Watch reports. Medi-Cal is California's Medicaid program.

CMA also is involved in an effort urging federal officials to reject Gov. Jerry Brown's (D) proposed Medi-Cal cuts (Jewett, California Watch, 10/26).

Brown is seeking federal approval to cut Medi-Cal by $1.4 billion.


In late June, Brown signed a state budget package with changes to health and human services programs.

The budget aims to reduce state spending by:

  • $623 million by cutting health care providers' reimbursements for Medi-Cal by 10%;
  • $511 million by requiring Medi-Cal beneficiaries to pay $5 copayments for physician visits and $50 copays for emergency department visits; and
  • $41 million by imposing a soft cap of seven physician visits annually and placing a dollar limit on hearing aids for Medi-Cal beneficiaries.

Federal officials must approve the Medi-Cal adjustments and have asked California to provide data on the cuts' possible effects on access to care (California Healthline, 10/13).

Details of CMA's Request

CMA's request relies on federal law that says Medi-Cal should pay health care providers enough to ensure the same level of care is available to beneficiaries as individuals with private insurance.

A 2008 Kaiser Family Foundation analysis showed that California ranked last in the nation for Medi-Cal payment rates, spending about $3,367 per Medi-Cal beneficiary, compared with the nationwide average of $5,342.

CMA President James Hay said, "We believe that California's historically low rates have caught up with the state and are now having a significant and adverse impact on access to care."

Survey Shows Disparities in Access to Care

CMA, the California Association of Health Plans and the California Hospital Association released a survey that found 36% of Medi-Cal beneficiaries reported being turned down for treatment by a health care provider because he or she did not accept Medi-Cal, compared with 9% of individuals with private insurance.

The poll surveyed 763 Californians, 363 of whom were Medi-Cal beneficiaries.

State Response

Toby Douglas, director of the state Department of Health Care Services, said the agency is examining how it can implement the state's proposed Medi-Cal cuts while ensuring proper access to care.

He said the agency will implement cuts only "to the extent that our analysis shows that there will be sufficient access to care."

Douglas added that the recently released survey neither addressed how many individuals received care nor accounted for a shift to a managed care model under Medi-Cal (California Watch, 10/26).

James Roache PharmD
How this shift to Managed Medi-Cal plays out will be very interesting. A significant number of physicians who are not accepting Medi-Cal patients today (recall that only 15% of the physicians in CA care for 80% of the Medi-Cal patients) are a large portion of those participating in these managed care plans. When the plans accept the capitated funds to care for ALL of the beneficiaries, those funds will be less than the sum total of Medi-Cal's expense today for the same patients otherwise why would Medi-Cal do this? The plans will also incur all of the new administrative costs to provide the infrastructure for managing these new patients. It should then follow that the individual plan physician’s share of the new revenue for caring for 8 million new patients (increasing to 14+ million in 2014) will be doing so for far less money than what Medi-Cal would currently pay them today. When this is fully analysed, I am not certain the goal of access to quality/timely care will be attained.
Robert Forster
Is anybody recognizing that we are out of money and expansion of programs by either unit cost or access (utilization) will only exacerbate our fiscal situation in Ca? Toby has his hands full since solutions are not obvious. The legislature should not be legislating more entitlement benefits behind the electorate until dollars are available and comment by the people are made available. Legislation by ideology is inconsistent with finite resources.

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