Bills Introduced To Reverse, Study Effects of 10% Cut to Medi-Cal Providers

  ·  David Gorn, California Healthline   ·   Link to Article

An Assembly bill introduced yesterday would reverse the 10% cut in Medi-Cal provider rates approved by the Legislature in 2011.

A second Assembly bill, also introduced yesterday, would take a different tack on the reimbursement conundrum. It would order an independent analysis to determine the degree of impact rates have on access to care in California.

The bill to reinstitute pre-2011 Medi-Cal provider rates is AB 1805 by Assembly member Richard Pan (D-Sacramento). The independent analysis of rates' impact on access is AB 1759, also authored by Pan.

The provider rate reduction started going into effect in September last year after the law was held up in court for more than two years. California providers, who already faced some of the lowest Medicaid reimbursement rates in the country before the cuts were approved, will fall even further behind their counterparts in other parts of the country as the cuts are implemented. Medi-Cal is California's version of the federal Medicaid program.

In addition, some California providers will need to pay back two years' worth of "clawback" money by returning 10% of their Medi-Cal reimbursements from the past two years. Because the cuts were not immediately enacted pending outcome of court challenges, the state is now owed an additional 10% by some providers, according to court rulings.

All of that adds up to providers who don't want new Medi-Cal patients, Pan said.  

"The real problem is we have the second-lowest rate of physicians accepting Medi-Cal patients in the nation," Pan said. The low rate of taking on new patients has already started to create a serious access problem in California, he said.

"Even when Medi-Cal rates have dropped in the past, providers still see their [Medi-Cal] patients, because that's what providers do, they're not going to just drop patients," Pan said. "The problem is, they don't take up new ones -- and that creates the access problem."

Millions of additional Californians joining Medi-Cal because of Medicaid expansion associated with the Affordable Care Act creates a need for additional primary care and specialty providers but low reimbursement rates are a deterrent to providers.  

Patricia Samuelson, a family practice physician in Sacramento, said she wants to see Medi-Cal patients but can't afford to.

"The cut has resulted in rates that are already so low we can't afford to operate our offices. We just can't afford to see these patients," Samuelson said.

"The state's perspective that physicians will just continue to lose money is unrealistic," Samuelson said. "There are people right now leaving their Medi-Cal practices."

In the past, providers subsidized low reimbursement rates with grant money or with higher rates paid by employer-sponsored insurance. But health plans are squeezing those higher employer rates, Samuelson said, so that's becoming less effective.

"Right now, I am personally taking care of people who should be seeing someone else," Samuelson said. Because of the dearth of specialists who see Medi-Cal patients, she is the only alternative for many patients needing a specialist, she said.

"There are horrific access problems now," she said. "In the next few years, it will get worse."