Tag Archives: Medi-Cal

Legislative Recap on Health: #Health4All; Out-of-Pocket Costs; Medi-Cal, Etc.

The Senate and Assembly adjourned Thursday, one day ahead of the June 5th deadline to pass all bills out of the first legislative chamber. The good news is that most key bills of interest to health care consumers have passed out of the house of origin, while one bill, opposed by public health groups, was defeated. Bills moving forward deal with limits and protections against unfair out-of-pocket costs; efforts at improving Medi-Cal; and most notably a significant expansion of access to coverage for all regardless of immigration status.

These bills now head to the second half of the legislative process. For details on each bill, see our weekly bill matrix:

http://www.health-access.org/i…

Below the fold, full reports on:

* SB 4 To Take Historic Steps to #Health4All & Cover the Remaining Uninsured

* Patient Protection Bills To Limit Out-of-Pocket Costs

* Additional legislation on transparency, Medi-Cal, tobacco control, and more

SB4, THE FRAMEWORK FOR #HEALTH4ALL REGARDLESS OF IMMIGRATION STATUS

The most-watched health bill was SB4, the first bill to pass a state legislative body that would explicitly expand coverage regardless of immigration status. The California Senate passed SB4 on a historic and bipartisan vote, 28-11, with all Democratic senators and 2 Republican senators voting in support. This bill, which continues California’s path to #Health4All, moves on to the Assembly Health Committee for consideration.

With last week’s amendments in the Senate Appropriations Committee, SB 4 would:

* Expand Medi-Cal eligibility to all children regardless of immigration status, as an entitlement;

* Expand coverage for undocumented adults as budget allocations will allow (to be decided each year in the budget, and that enrollment will be capped if funding runs out).

* By way of a Section 1332 waiver (a formal request to the federal government), SB 4 would allow all Californians to purchase coverage through Covered California using their own money.

Senator Ricardo Lara, author of SB 4, called the vote “historic” and one that Senators will remember long after their term is over. “We are talking about our friends, our families, our neighbors. Illness doesn’t care about our immigration status,” said Lara, describing the bill as still “realistic, balanced, and fiscally prudent.”

Several Senators rose to speak during the floor debate. From the opposing side, GOP Senators Jeff Stone, Janet Nguyen, and Bob Huff raised concerns about cost, arguing that expanding Medi-Cal was a “false promise” until the program addresses access issues. Several Democratic Senators responded to that argument, including Senator Richard Pan who stated, “We certainly need to make fixes to Medi-Cal, but certainly being on Medi-Cal is better than being uninsured.” Senator Isadore Hall derided “excuses,” Senator Ben Hueso wanted focus on the issue at hand: “We have a solution on the table, and we should move it forward.” Senator Hernandez rebutted concerns about cost: “The most inefficient way to provide health care is through the emergency room-we all pay for it.”

The most noteworthy speech was by GOP Senator Andy Vidak announcing his support for the bill while also raising the need to address Medi-Cal access issues and federal immigration reform. He and another Central Valley Republican, Senator Anthony Cannella, were the two GOP Senators to vote for the bill. Senator Nguyen abstained, with the rest of the caucus voting no.

This issue is currently pending in Budget Conference Committee as a $40 million item in the Senate’s budget proposal. The next week or two will make a big difference in whether enrollment under SB4 would start in the budget year 2015-16.

BILLS LIMITING OUT-OF-POCKET COSTS

Four Health Access-sponsored consumer protection bills to prevent unfair out-of-pocket costs passed out of their “house of origin” this week and are heading to the second half and second legislative chamber in the weeks ahead. The remaining sponsored bill, AB 248 (Hernandez) on large employer junk insurance is further along in the process, having passed out of the Assembly several weeks ago.

* Requiring Accurate Provider Directories: SB 137 (Hernandez) would set standards for provider directories and establish more oversight on accuracy so people know whether their doctor and hospital are in network when they shop for coverage, change coverage, or try to use their coverage. SB 137 passed out of the Senate with bipartisan support. The final vote was 33-0.

* Preventing Surprise Bills: AB 533 (Bonta), which would protect patients from “surprise” bills from out-of-network doctors when they did the right thing by going to an in-network hospital, imaging center, or other facility, passed out of the Assembly with a vote of 74-1.

* Limiting Prescription Drug Cost Sharing: AB 339 (Gordon), which would prevent discrimination against consumers with health conditions by setting standards for cost sharing on prescription drugs passed out of the Assembly with a vote of 48-29.

* Capping Individual Out-of-Pocket Costs: AB 1305 (Bonta) on limitations on cost sharing in family coverage passed out of the Assembly with a vote of 78-0. This bill ensures that the ACA individual out-of-pocket maximum (now $6,600) will apply to individual patients-even if they are in a family plan (which has an overall family out-of-pocket max of $13,200).

* Prohibit Subminimum Coverage: AB 248 (Hernandez), which would prohibit sale of subminimum coverage by insurers to large employers passed out of the Assembly several weeks ago with a vote of 51-27 and will next be heard in Senate Health.

TRANSPARENCY

SB546 (Leno) would advance transparency in our health system by extending rate review to large group health coverage. This bill, which requires justification of above-average rate increases, passed out of the Senate with a vote of 23-16.

Other transparency bills faltered earlier this year, including SB 26 (Hernandez), which sought to create a health care cost and quality database, was held in Senate Appropriations Committee amid questions on how to finance it. Earlier in the process, AB 463 by Assemblyman Chiu to facilitate more disclosure on prescription drug costs was stalled in Assembly Health Committee. These efforts will likely be revisited in future years.

MEDI-CAL

Several bills designed to improve the Medi-Cal program, which now covers almost 12 million Californians, advanced out of their house of origin.

* SB 33 (Hernandez), which would limit estate recovery in Medi-Cal to the federally required minimum of long-term care services and eliminate recovery from the estate of a surviving spouse of a deceased beneficiary, passed out of the Senate with a vote of 33-0.

* AB 1231 (Wood), which would facilitate practical access to Medi-Cal specialty care through coverage of nonmedical transportation, also passed out with a vote of 76-0.

* AB 635 (Atkins), which would require the Department of Health Care Services to seek federal funding to establish a program to provide and reimburse for certified medical interpretation services to Medi-Cal beneficiaries with limited English proficiency, passed out of the Senate with a vote of 72-2.

* AB 366 (Bonta), which would require the Department of Health Care Services (DHCS) to report to the Legislature on Medi-Cal access passed out of the Assembly with a vote of 77-0.  Originally introduced as a measure to restore Medi-Cal provider reimbursement rates and bring them up to Medicare levels in future years, this bill came out of the Appropriations Committee’s suspense hearing significantly scaled back in scope. A companion measure SB 243 (Hernandez) was held in Appropriations during the suspense hearing and is not moving forward.

TOBACCO CONTROL

A handful of bills aimed at the negative health impacts of tobacco use passed, including SB 151 (Hernandez) to raise the smoking age from 18 to 21. SB 140 (Leno), which would revise the definition of tobacco products to include e-cigarettes, thus subjecting such products to the same regulations as other tobacco products, passed out of the Senate with a vote of 25-12.  Public health groups, including the Heart Association, Lung Association, and Health Access supported that measure and opposed the related bill SB 24 (Hill), which did not classify e-cigarettes as tobacco. Research suggests that e-cigarettes have much the same negative effect as cigarettes. SB 24 (Hill) failed passage.  

OTHER KEY CONSUMER BILLS

A full matrix of the latest on all active bills supported by Health Access and other health and consumer advocates is available online (here). That list includes ACA implementation legislation like SB 43 (Hernandez), which would extend the sunset date on essential health benefits standards from 2016 to 2018 and incorporate recent changes in federal guidance regarding habilitative care (services that help you keep, learn, or improve skills and functioning for daily living); AB 1117 (Garcia) would help bring more resources to Medi-Cal to improve immunization rates for 2-year-olds and AB 1299 (Ridley-Thomas) seeks to improve the delivery of mental health services for foster youth.

WHAT’S NEXT?

Now that these bills have passed the critical house of origin deadline, they will next be heard in the “other house,” meaning if the bill was introduced in the Assembly, it will be heard in the Senate, and if the bill was introduced in the Senate, it will be heard in the Assembly. Committee hearings will resume on June 8th. Policy committees have until July 17th to meet and report bills out of committee.

This blog entry is cross-posted at http://blog.health-access.org. It was written by Sawait Hezchias-Seyoum, Health Care Policy Advocate, Health Access. Stay tuned for tools and talking points to bring these bills to the finish line.  

State Budget Preview: Medi-Cal, #Health4All, other health investments needed

The annual state budget process, which began in January, comes into focus later this week when the Governor releases the May Revision of his proposed 2015-16 budget. Health and community advocates are urging the Governor and the Legislature to include funding for critical health programs in upcoming budget negotiations. These investments continue the Affordable Care Act’s momentum by removing barriers to coverage, ensuring those covered in Medi-Cal get access to care along with important benefits, and extending coverage to the remaining uninsured.

The deadline for the Legislature to pass and the Governor to sign a budget is June 15. The Governor’s May Revision sets the stage for a short month of negotiations, shaped by information about how much of a surplus is available given the state revenues that came in during April tax time, and constitutional formulas that limit the use of these funds.

Recent Budget Subcommittee Hearings: Since introducing the budget in January, the legislature’s budget subcommittees have reviewed the Governor’s proposed budget along with budget requests from advocates. In recent days, the Senate and Assembly Budget Subcommittees on Health and Human Services completed their reviews of the Governor’s proposed budget, along with a range of urgent and needed health investments that were not included in the Governor’s proposed budget, from expanding coverage without regard to immigration status to limiting estate recovery in Medi-Cal to restoring Medi-Cal benefits. The subcommittees left most of these items open for further discussions pending the May Revision. Many consumer and community organizations including Health Access California were on hand to strongly support these critical investments.

Immigrant Health Care. Although the Affordable Care Act made health coverage possible for millions of Californians, it excludes undocumented immigrants currently living and working in any state. If and when the President’s executive order on immigration is upheld in court, those newly eligible for deferred action will have access to Medi-Cal. Advocates are proposing to expand that access to all Californians income eligible for Medi-Cal, without regard for immigration status, as proposed in SB 4 (Lara). The cost would be a small fraction of last year’s proposal, amounting to only 2 more cents for every dollar spent on Medi-Cal, but would make a world of difference for not just immigrant families, but for our health system and society.

Estate Recovery. Advocates are also seeking that California limit Medi-Cal estate recovery to costs associated with long term care services and supports, consistent with minimum federal requirements. Last year, the Governor vetoed a bill to limit Medi-Cal estate recovery, arguing the policy change should be considered in the budget instead. Health Access will continue to vigorously advocate for this policy change so that older low-income Californians don’t have to make a trade-off between seeking health care coverage and keeping their family home.

Restore Medi-Cal Benefits Eliminated in the 2009-10 Budget. Major cuts were made during the budget crisis that have yet to be restored, including Medi-Cal rates and benefits, and consumer advocates including Health Access request undoing those cuts. In this part week, the budget subcommittees heard a proposal to restore non-federally mandated yet critical Medi-Cal benefits that were eliminated for budgetary, not policy reasons, in response to the state fiscal crisis. They include, among other things: acupuncture, audiology, chiropractic, podiatry, speech therapy, and full restoration of adult dental coverage. Partial restoration of adult dental was done in the 2013-14 budget, which gives Medi-Cal beneficiaries access to preventative care, restorations, and full dentures. However, important services such as gum treatment and partial dentures or implants are still not covered in Medi-Cal. According to a recent study published in Health Affairs, California emergency departments experienced a spike in visits for dental issues after comprehensive dental benefits for adults were cut from Medi-Cal. The study further found that the lack of adult dental benefits shifts dental care needs to costly emergency departments where dental issues are not adequately addressed.

Medi-Cal Provider Rates. Many providers and consumer groups have sought to rescind the 10 percent Medi-Cal provider rate cut, which will encourage more providers to participate in Medi-Cal and help increase access for Medi-Cal beneficiaries. In fact, California’s Medi-Cal provider reimbursement rates are among the lowest in the nation, making access to doctors, specialists, and beneficiaries harder for some of the 12 million Californians with Medi-Cal coverage.

What’s Next: The Governor is expected to release his May Revision of the budget later this week. The budget subcommittees will then hold hearings to review the May Revision the following week (May 18-22), and the Budget Conference Committee will convene at the end of the month to hash out differences between actions taken by the two houses. A final budget must be passed by June 15th. Stay tuned for updates!

California Governor Jerry Brown Wants to Steal My Home

Due to the expansion of Medi-Cal under ObamaCare, my wife and I am now covered by that program.  But because both of us are over 55, Jerry can steal our house after we die to cover Medi-Cal’s expense of paying for our healthcare.  A 1993 law gives states the option to take back all the money spent by Medi-Cal for the healthcare of recipients over 55 by billing the estate after the recipient (and spouse) die.  Because California is taking advantage of this option, Medi-Cal for older people is effectively a long term loan.  

SB 1124, a bill to fix the problem, has made its way through most of the legislature.  If it passes, which is expected this week, Jerry has threatened to veto it to protect the state from the financial ruin of losing the $15 million it expects to collect by stealing the homes of other older Medi-Cal recipients who die over the next year.  That $15 million is 1/100 of 1% of the state’s budget!  At the end of this diary, I will ask you to contact Jerry Brown’s office and tell him to sign, not veto, SB 1124.  But first, a few important details.

My wife and I signed up for Medi-Cal late last year with coverage to start on January 1 of this year.  It was not until several months later that I read online that in California Medi-Cal is a long term loan program.  Even if we remain healthy, the state will deduct the monthly fee for the managed care program that administers Medi-Cal.  I even found a PDF of a brochure produced by the California Department of Healthcare Services (DHCS) that explained the details of how “estate recovery” works.  I prefer the term legal theft to the Orwellian “estate recovery.”

At no point in the process of signing up were we notified that it was perfectly legal to steal our home from our children after we both die.  When I called the Medi-Cal customer service line to ask about how to resign from Medi-Cal, they told me I was wrong and that the state could not and would not bill my estate.  Mentioning the DHCS brochure I had in my possession made no difference in that assertion by the customer service rep and his supervisor.

In April, California Senator Ed Hernandez, chair of the Senate Health Committee, introduced SB 1124, which limits so-called “estate recovery” to that which is mandated by Federal law, which is long-term care.  The bill also prohibits collection from the estate of a surviving spouse of a Medi-Cal beneficiary. I started an on-line petition in support of the bill and, with the help of Moveon and the Courage Campaign, have gotten almost 1500 people to sign the petition.  

Nearly every person I have ever talked to about Medi-Cal “estate recovery” is just as shocked as I am.  Some of the things they have said and/or written to me about “estate recovery” include “unconscionable,” “unfair,” “appalling,” and an “ill-conceived asset-stripping scheme.”  

Some of the people who signed the petition have told me their stories.  Here are some:

One woman is delaying gall bladder surgery rather than sign up for Medi-Cal.  She turned 55 earlier this year, is on disability and cannot work, and will pay off her home mortgage later this year.  Because her income is too low for the subsidies for private insurance that middle income people get, she is hoping to pay full price for health insurance when the open enrollment period for Obamacare begins in November.  

Others tell me that the process of signing up takes a long time, is cumbersome, and, like me, that nobody told them about “estate recovery” when they did sign up.  And, like me, they found out about it later through their own research.  There have even been cases where the family and beneficiaries first find out about Medi-Cal “estate recovery” after the recipient dies.

Another woman explained that she had chosen to move back into her father’s home when he became very ill so she could take care of him.  His healthcare was covered by Medi-Cal.  She was able to work in addition to caring for him but put all her extra money into paying taxes, maintenance, and upkeep for the house.  She has no money saved, but had assumed that she would be able to continue to live in the house after he dies.  There is a hardship exemption, but it will not apply because she can work.  Thousands of her dollars will be lost when he dies and the state steals his home that she will no longer inherit.  

Most ridiculous of all, a 62 year old man, who is an unemployed librarian with an MA in library science, broke his finger.  It is all discolored from the injury.  Rather than sign up for Medi-Cal so his finger could be taken care of by a doctor, he splinted it with a popsicle stick.  He does not want to lose his house.

So far, SB 1124 has gotten overwhelming support in the California legislature.  In the Senate, it passed the Health Committee 7-1, Senate Appropriations 6-1, and the full Senate 30-5.  It has also passed the Assembly Health Committee 18-0 and Assembly Appropriations 12-0.  The next step is a vote by the entire Assembly which is also expected to approve the bill as well.  As I said previously, the governor’s staff have said that they are recommending that SB 1124 be vetoed.

To overcome the opposition of the governor and his staff, I need you to act NOW by contacting Jerry Brown’s office and state your support for SB 1124.  Here is the contact information (mail, phone, fax, email):

Governor Jerry Brown

c/o State Capitol, Suite 1173

Sacramento, CA 95814

Phone: (916) 445-2841

Fax: (916) 558-3160

Email Jerry Brown

Please act right away.  

And please sign my petition in support of SB1124 at:

Online petition

Originally published in beyondchron.org

Medi-Cal, California Budget Woes, and the ACA

The unfortunate facts are what they are: California’s fiscal hardships are just as bad as you thought, possibly worse. According to a new report released this week, the cost of Medi-Cal in particular has put a real strain on California’s budget.

From coverage of the report this week:

Tops on the list of concerns in the report is the high cost of Medicaid, the federal program providing health care for the poor or disabled and administered here in California via the state program Medi-Cal. Funding for the health care services, and rules about eligibility and spending, are shared between states and the feds.

“The rapid growth in Medicaid spending has pushed aside other types of state spending,” says the report.  “Both the states and the federal government need to find ways to contain and control Medicaid costs.”

Regarding Medi-Cal, the question remains what will happen to the program–and how it will impact the budge–under the new Affordable Care Act, which a Daily News report indicates will provide health care (in part through Medi-Cal) to over 2 million residents in Los Angeles alone.

One pharmacist argues this week that the ACA will provide more competition to insurance companies, which could benefit health care providers and provide incentives for offering better care–competition could mean higher reimbursements.

From the article:

As a local pharmacy owner, […]the cash price of prescription drugs is not “stunningly less” than the insurance price. Insurance companies have been squeezing reimbursements to ALL healthcare providers (including pharmacies) over many years now, and have funneled money away from providers (who take care of patients) in order to boost corporate profits. […] those who have health insurance are ALREADY paying for the uninsured through the outrageous and ever increasing premiums that we pay. Being a business owner who provides generous benefits to my employees, I can attest to this fact first-hand. And the insurance companies, unchecked by real competition (that a government supported exchange would otherwise provide) keep raising their premiums at will.

Study: Less is Not More in Medicaid Managed Care

With state budgets in bad shape, many legislatures are turning to cutting state programs in desperate attempt to stem the tide of deficits. Among these plans is the move to shift Medicaid patients to a managed care program, which is happening in states such as Texas and Florida. Many see this as a way to save millions of dollars for state budgets, but this plan will only cost more in the long run.

According to a report from Bloomberg (emphasis ours):

Bloomberg Government health-care policy analyst Christopher Flavelle looked at managed-care plans in the five most populous states, including New York and California. His Bloomberg Government Study found large managed-care plans provided health care that was significantly and consistently worse than the national median.

For patients, the outcome may mean poorer health care. For states, the outcome may be higher costs when patients return to the system with more serious conditions.

Some states are starting to penalize the private managed-care providers because they perform poorly. The managed-care providers face the choice of doing a better job, or betting that states will continue to tolerate poor results.

This is not the first evidence that managed care systems are not a good solution for Medicaid, nor will it be the last. The only question remaining is whether states will listen, and take steps to course correct.

Managed care is bad for patients, and is also bad news for health care providers such as hospitals, doctors, and pharmacies. Many pharmacies under managed care will be forced to make the choice between remaining open and barely turning a profit, turning away longtime Medicaid patients they can no longer afford to service, or shutting their doors altogether. This is unacceptable.

Join Pharmacy Choice and Access Now, and fight back against managed care for Medicaid!

Medi-Cal Cuts Hurt California’s Most Vulnerable

California is in the midst of another budget crisis, and Governor Brown is looking to take $1.8 billion from the state’s Medicaid program, known as Medi-Cal, to help make up the shortfall. As part of the cuts to the Medi-Cal program, the governor’s plan includes cutting funding for hospitals and nursing homes. For many members of California’s most vulnerable and frail populations, this will mean more cuts to health care services that they rely on and loss of access to life-saving medications.

According to a local news report:

For many of those who rely on Medi-Cal to live as normal a life as possible, the proposed cuts will have major consequences.  Eva Crump turns 86 next month and says it’s scary for her to think about more cuts to her Medi-Cal benefits… A diabetic with a recently diagnosed heart condition, Crump relies on Medi-Cal to get the medicine she needs to live an independent life. “There are so many of us that need these facilities to get out and be taken care of without having to go into a bed and care home or something of that type”, Crump says, “its just like a God-send to have it available.”

Medicaid cuts at the state level are hurting seniors nationwide, with many of these types of budget cuts resulting in loss of access to some of their most vital health care services. In additional to hospitals, nursing homes, and senior care centers feeling the impact of state budget slashes, community pharmacies are often forced into an impossible predicament when reimbursement rates are lowered. Do they turn away valued and loyal customers, many of whom rely on their pharmacist as one of their primary health care providers? Or do they shut their doors, unable to stay in business and still service their Medicaid-dependent clientele?

One thing is clear: in situations like the one in California, there are no winners. Medi-Cal recipients like Eva Crump are hurting, health care providers are hurting, and community pharmacies are hurting. Surely there are other ways to solve a state’s budget woes than to cut access to vital services for the most vulnerable populations?

To find out more about Medicaid cuts and how they will impact seniors, community pharmacy access, and more, visit Pharmacy Choice and Access Now.

It’s the Time to Protect Healthy Families

By Wendy Lazarus, Founder, The Children’s Partnership

As we head into that time of year when our young people are graduating from high-school

and college, many commencement speeches will acknowledge the sacrifices many parents make to ensure their children succeed. Imagine how much more difficult that becomes when a child requires medical care and his or her parents are unable to access a doctor or health care coverage. As legislative leaders and the Governor wrestle over budget decisions to decide the fate of children who rely on Healthy Families, our state’s moms and dads deserve someone to stand up for them.

In a recent Capitol Weekly piece, I described the details of how health care for nearly a million California kids hangs in the balance as the Legislature completes its budget deliberations, which includes the Governor’s proposal to close the doors of the Healthy Families Program. The Legislature has an opportunity to pass what the Assembly and Senate Budget Subcommittees did: keep all kids, except those required by the ACA to move to the Medi-Cal program, in the Healthy Families Program. By any measure, Healthy Families is highly successful. California children who are newly enrolled in Healthy Families have been shown to have a nearly 63% improvement in performance and paying attention in class. Studies also show Healthy Families has substantially improved kids’ access to needed health care and produced meaningful improvements in their physical, mental, and social well-being.

The Governor plans to transfer nearly one million children in Healthy Families into California’s already overstretched Medi-Cal program over a brief nine-month period, starting in October 2012. Not only does it leave the Medi-Cal program inadequate time to prepare to receive so many new kids and get them set up properly in a new health care program, but families are already facing difficulties finding a doctor or dentist who will take their kids under Medi-Cal. So Medi-Cal needs more time to shore up the network of doctors for the children it already serves before stretching its capacity to add almost 900,000 more children. This is not the time to move nearly a million children from Healthy Families.

Instead of this overreach that could undermine the progress made in promoting healthy kids, a common sense, alternative approach is recommended by over 40 organizations. We recommend a more gradual shift, moving 200,000 Healthy Families kids into Medi-Cal-those kids who, based on the new federal health reform law, will be enrolled in Medi-Cal with their families by January 2014.

Last week, Governor Brown released a May revision to his budget proposal that ignored recommendations for an incremental approach. These huge disruptions to health care programs for nearly a million children do not even produce significant budget savings, so why put these children at risk? Any parent sending their graduates off to their future knows that being a parent is a tough job, 365 days a year. Today’s parents should not face a lack of access to health care for their children. The Governor and Legislators should protect the children covered in Healthy Families AND help parents and the families that rely on them to have healthier–and more secure– lives.

Wendy Lazarus, Founder & Co-President of The Children’s Partnership, has been an advocate for children, nationally and in California, for more than three decades.

Supreme Court Hears Medi-Cal

High Court to consider massive cuts to services and reimbursement rates.

by Brian Leubitz

The United States Supreme Court opened up its 2011-2012 term, and oh yeah, they’re talking California:

The Supreme Court began a new term Monday by refereeing a major healthcare dispute to decide whether cash-strapped states like California can cut their Medicaid payments to doctors and hospitals who serve low-income patients.

*** **** ***

Lawyers for California and the Obama administration urged the court to rule that Medicaid is a “voluntary” effort to provide medical care for the poor and that disputes over funding should be resolved by healthcare officials in Sacramento and Washington, not by federal judges in San Francisco.

*** **** ***

But Justices Ruth Bader Ginsburg and Elena Kagan spoke up for the medical providers who sued. They said California was seeking to cut its reimbursements even before the state had cleared the move with federal Medicaid officials in Washington. Ginsburg said there is no effective way to enforce the Medicaid Act if patients and providers cannot go to court when spending is slashed. (LA Times)

And really, that is kind of the point, right?  The poor have a very difficult time complaining about the cuts, and they have a smaller financial interest than the medical industry.  I don’t think this is necessarily the best way to go about a health care system, but denying the providers access to the courts means that there will be no challenges at all.

Sure, we need single payer or something that will actually work, but we need to be sure that we don’t close the courthouse door in the interim.

Where is the outrage?

For years, we’ve heard from political ideologues and ambitious district attorneys about how much waste, fraud and abuse there is in state programs like Medi-Cal. Whenever there is a case in which a low-income recipient is charged or convicted, the right-wing cheering section is quick to applaud and point to the case as proof of rampant fraud.

But where was the applause when Attorney General Kamala Harris recently announced a $241 million settlement in a case of Medi-Cal fraud by Quest Diagnostics, the state’s largest provider of medical laboratory testing?  

The settlement resulted from allegations that Quest systematically overcharged the state’s Medi-Cal program for more than 15 years and gave illegal kickbacks in the form of discounted or free testing to doctors, hospitals and clinics that referred Medi-Cal patients and other business to the labs. Here’s what AG Harris said:

“In a time of shrinking budgets, this historic settlement affirms that Medi-Cal exists to help the state’s neediest families rather than to illicitly line private pockets. Medi-Cal providers and others who try to cheat the state through false claims and illegal kickbacks should know that my office is watching and will prosecute.

Where is the outrage from these right-wing politicians and ambitious district attorneys at this massive theft of taxpayer dollars? Why can’t these hypocrites muster the same fervor for going after big white-collar firms that score lucrative government contracts, whose taxpayer rip-offs dwarf the meager amounts possibly scammed by a few low-income elderly and disabled Californians?

I Wouldn’t Be In A Rush To Defend The Medi-Cal Cuts Either

In something the state’s attorneys are calling a misunderstanding, federal judges have accused the state of lying to the court. That’s something of no-no under State Bar ethics rules.

The court said health officials, through their lawyers, had lied about why the state waited more than a year to make its current arguments in the case. Brown’s office said the court’s comments were “based on a misunderstanding” that the state’s lawyers will try to clear up in the next few days.

In July, the court ruled that the state had violated federal law with 2008 legislation that cut by 10 percent the rates it paid to doctors, dentists, pharmacists, clinics and adult day health care centers serving 7.1 million poor people in the Medi-Cal program. The ruling required the state to reimburse health care providers hundreds of millions of dollars that the state cut from their fees from July 2008 to March 2009, when a new law took effect setting rates at 1 to 5 percent below July 2008 levels. The court said state health officials and legislators were simply trying to save money and did not study how the cuts would affect Medi-Cal patients, as federal law requires. (Sf Chronicle)

This may seem like ancient news in internet time, especially considering the law lowering Medi-Cal payments is no longer in effect. However, the federal courts can still require reimbursement to the doctors that got the lower rate. Of course, the problem with these cuts wasn’t just the pay rates, it was the fact that many doctors got scared off of ever providing Medi-Cal services.  The cost of filling out the forms isn’t much less than the reimbursement rates for some services, so why bother at all? And even with the slightly higher rates restored, the incident makes it abundantly clear how it’s going to be every year. Why deal with that risk, when you can always go work for a pittance for Blue Shield’s coverage.

Medi-Cal is straining at the seams, and the more we deny it, the more waste we will see. Not only waste of money, but of human resources and human lives.