Doctors ask feds to review Medi-Cal rates


The CMA is relying on a federal law that says Medi-Cal should pay health providers enough to ensure care is available to program beneficiaries at the level of their privately insured peers.

The move relies on an obscure law that allows Medicaid authorities to impose conditions on or possibly cut off funding to states that run a noncompliant program. It also comes after the doctors group and others released the results of a survey [PDF] last week showing that Medi-Cal patients are four times more likely than privately insured patients to be turned down by a doctor who does not take their insurance.

"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," CMA President Dr. James T. Hay said in a statement.

The call for a federal review is the second front in a battle being waged by the CMA, which represents about 35,000 doctors. Doctors are part of a coalition of health providers lobbying federal authorities to reject California's proposed 10 percent Medi-Cal provider cut.

Toby Douglas, director of the state Department of Health Care Services, which administers the state's Medi-Cal program, said the agency is now examining how it can carry out the budget cuts approved by the governor and legislators while ensuring patient access to care.

"We will only implement reductions to the extent that our analysis shows that there will be sufficient access to care," Douglas said. "We're looking at the data, and if the data doesn't show we can make payment reductions, we're going to have to take other actions."

Officials from the Centers for Medicare & Medicaid Services are now considering a "state plan amendment" submitted by the Department of Health Care Services. The agency is expected to show that cutting Medi-Cal payment rates to 10 percent shy of 2008 levels would not hinder patient access to care.

Proposed budget cuts would mean that primary care doctors could get $11 for an office visit with a Medi-Cal patient.

"What the state is doing is making doctors choose between taking new Medi-Cal patients and keeping their businesses open," said Molly Weedn, spokeswoman for the CMA.

A 2008 review of Medicaid payment rates shows that California ranks last in the nation, spending about $3,367 per beneficiary. The nationwide average is $5,342, according to data compiled by the Kaiser Family Foundation.

The CMA and other groups delved into the impact of those payment rates in a survey of 763 Californians - including 363 who rely on Medi-Cal for treatment - that covered the perspectives of insured, uninsured and Medi-Cal patients.

The survey, which also was commissioned by the California Hospital Association and California Association of Health Plans, found that 36 percent of Medi-Cal enrollees reported that a doctor turned them down for service because he or she did not take Medi-Cal patients. In comparison, 9 percent of insured patients were rejected by doctors who didn't take their plan.

The CMA is relying on results of the survey to make its case in Washington, D.C., with regulators who determine whether states are in compliance with the equal access provision.

Douglas, of the Health Care Services Department, said he appreciates the groups' efforts to conduct a survey to carefully look at the matter. However, he said the survey did not address how many patients actually received care. Nor does it take into account recent changes in the Medi-Cal program that move away from a fragmented fee-for-service system and toward a managed care model.

The survey "points out one of the problems we've addressed and that we're fixing through managed care, which will drive better outcomes and quality for our beneficiaries," he said.

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