The Medi-Cal program in California is a public form of health insurance. There is a history of problems with the program, primarily with the reimbursement rate that doctors get for treating patients who use Medi-Cal. These problems are continuing, and new problems have formed.
Medi-Cal is part of the Medicaid program in the state of California. Just like with other state’s Medicaid programs, it is paid for in part by the federal government, and in part by the state government. It is a public form of health insurance that is used by people who are low-income, people who are disabled, and people who have specific kinds of serious diseases.
This program has a history of problems. In 2008 and 2009, the legislature of the state of California cut the reimbursement fees that it paid to hospitals, doctors, and other health care providers. In some cases, the cut to the reimbursement rate was as high as 10%.
At that time, the state of California was supposed to wait for the federal Medicaid agency to approve those cuts. Instead, the state went ahead and made the cuts, and put them into affect. When the federal Medicaid agency learned about this, it disapproved of the cuts. However, the state of California chose to keep the cuts in place.
In 2011, the state of California refused to release supporting evidence that the reimbursement cuts to Medi-Cal would not harm patient’s access to health care. This was after the California Medical Association, California Hospital Association, and California Pharmacists Association filed a Public Records Act request for that evidence.
In 2012, California Governor Jerry Brown decided to expand a pilot program that would result in putting high-needs patients who used Medi-Cal into managed care. It would also require them to start paying co-pays when they needed to see a doctor.
Now, the state of California is making even more cuts to the Medi-Cal program. According to the Contra Costa Medical Association:
“The California Legislature recently approved Governor Jerry Brown’s proposal to phase out the Healthy Families program entirely in 2013, forcing approximately 880,000 children into the Medi-Cal program instead. Fewer physicians are able to accept new Medi-Cal patients due to the inadequate reimbursement rates that generally do not cover the costs of the medical practice.”
The organization also notes that the Legislative Analyst’s Office estimates that only about 25% of physicians who are treating Healthy Families kids will be able to continue to provide care after the program is eliminated in 2013. This is specifically due to the cuts to the reimbursement rate imposed by the legislature.
The California Medical Association is opposed to the cuts to the Healthy Families program. They have proposed a compromise to restructure Healthy Families by moving children whose parents earn between 101% and 138% of the federal poverty level into Medi-Cal. The state will be required to do this anyway, as part of the federal health reform.
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