On Monday, CMS said that California cannot require Medi-Cal beneficiaries to take on copayments for physician visits and prescription drug purchases, the Sacramento Bee's "Capitol Alert" reports. Medi-Cal is California's Medicaid program (Yamamura, "Capitol Alert," Sacramento Bee, 2/6).
Background
The copay proposal was passed as part of last year's state budget. Gov. Jerry Brown (D) and state lawmakers said the requirement would save $511 million annually.
Under the proposal, Medi-Cal beneficiaries would have been required to pay:
- A maximum of $200 for hospital stays;
- $50 for an emergency department visit;
- $5 for visiting a physician or dentist visit; and
- $3 for certain prescription drugs (Lin, AP/San Francisco Chronicle, 2/6).
Details of CMS' Decision
CMS acting Administrator Marilyn Tavenner said that while she supports the "goal of promoting cost-effective use of health care services," federal law prohibits states from requiring copays for medical insurance programs that aid low-income residents (Lavelle, U-T San Diego, 2/6).
She added that federal officials were "unable to identify the legal and policy support" for the copays (Kleffman, San Jose Mercury News, 2/6).
State Response
H.D. Palmer -- a spokesperson for the state Department of Finance -- said that California will appeal the decision.
He said that if the decision is not reversed, the state would have to spend an additional $575 million in the next fiscal year (Megerian, "PolitiCal," Los Angeles Times, 2/6).