Co-pay is back. Last year, the Legislature passed and the governor signed a budget trailer bill that included Medi-Cal co-payments of $5 for some provider visits, up to $50 for emergency department visits and up to $100 for patients admitted to the hospital.
That move required a CMS waiver but in February, federal officials denied it. Now, with the May budget revision, a scaled-down version of co-payments is back on the table.
Yesterday, an Assembly budget subcommittee heard testimony on the subject and decided to hold co-pay approval for a later date.
Toby Douglas, director of the Department of Health Care Services, said the measure should be added to this year's budget trailer bill, in part because it's a lesser version of what the Legislature already passed.
"Given the enormity of the budget deficit, we have to make some revisions," Douglas said. "We were willing but unable to approve the proposal, so [this time around] we were able to come back with a more narrow approach."
Now the state is asking approval of a $15 co-pay for non-emergency use of emergency departments, and between $3 and $5 for prescription medication.
Douglas said any new co-pays would meet all federal standards and concerns. "We're making sure we're not doing it in a way that causes harm," Douglas said. "It will require a waiver, and some work."
Douglas did not submit new trailer bill language for the co-pays because a more robust set of co-payments passed the approval process last year.
Vanessa Cajina, legislative advocate for the Western Center on Law and Poverty, objected.
"It's primarily troubling that we haven't seen any language on the trailer bill yet," Cajina said. "It's hard to respond in an effective manner. But ideally, we would get rid of the ones that were passed in the trailer bill last year."
The amount of co-pays may seem small, but the impact is potentially great, according to Gary Passmore, vice president of the California Congress of Seniors.
"What you're really doing is creating a barrier to needed care," Passmore said. "It's just another way to reduce access, and we think this is reckless policy."
For Medi-Cal beneficiaries who may have multiple medications, multiple trips to providers and to hospital emergency departments, those small co-pays can add up quickly, said Brandon Tartaglia, legislative advocate for Disability Rights California. It's a population with no financial margin, Tartaglia said. "People on Medi-Cal cannot afford them," he said.
Subcommittee chair Holly Mitchell (D-Los Angeles) suggested pulling co-pays out of the DHCS request and leaving the issue open for further discussion later. That motion was passed on a 3-0 vote.
"It does seem to me we should codify what was proposed," Mitchell said.