Federal Appeals Court Approves Cuts to Medi-Cal Providers

(David Mason/Flickr)

(David Mason/Flickr)

A three-judge panel of the Ninth Circuit Court has upheld payment reductions to Medi-Cal doctors, pharmacists and other providers. The cuts have been tied up in courts for more than a year — and they’re not settled yet. Advocates say they expect to ask for a review of the decision by the full court.

Some history:

  • Medi-Cal cuts must be approved by the federal government.
  • The current reductions, proposed by the Brown Administration, were approved by the Centers for Medicare & Medicaid Services in October, 2011.
  • That approval was promptly challenged by the California Medical Association (and others) in federal court.
  • In January, a federal judge blocked the cuts.
  • The state appealed to the Ninth Circuit Court of Appeals — and that’s where we are today.

The Sacramento Bee quotes Lynn S. Carman, counsel for the Medicaid Defense Fund, saying that his side would take the case to the Supreme Court, if the Ninth Circuit’s full bench either does not take up the care or does not block the cuts.

Also from The Bee:

Circumstances have changed significantly since Gov. Jerry Brown and Democratic lawmakers agreed last year to cut Medi-Cal rates. Voters in November approved two statewide tax initiatives, generating several billion dollars annually for the budget, and President Barack Obama‘s health care overhaul has survived political and legal hurdles en route to wide implementation in 2014.

The Obama plan calls for increasing rates paid to Medi-Cal primary care physicians starting in January 2013 to the higher Medicare rate, presumably sparing them from state rate cuts.

But it also expands Medi-Cal to a new group of uninsured low-income residents, largely able-bodied adults without children, starting in 2014. Meanwhile, Brown officials are pushing hard to move 860,000 lower-middle-class children to Medi-Cal next year.

Providers and advocates for the poor, who have repeatedly filed suits blocking state Medi-Cal cuts, argue that lower payments will discourage health care professionals from serving Medi-Cal patients. They say that will hurt access to doctors, particularly from specialty fields, leaving Medi-Cal patients without care.

“Our hope is the state will reconsider,” said California Medical Association spokeswoman Molly Weedn. “The state implemented these cuts when it was in much more dire straits than it is now. This is going to hugely impact care, especially now that the Healthy Families transition is going to happen.”

Brown spokesman Gareth Lacy responded to the ruling in a statement: “The Court of Appeals ruled that trial courts cannot block California from making Medi-Cal cuts that were approved by the federal government. Today’s decision allows California to continue providing quality care for people on Medi-Cal while saving the state millions of dollars in unnecessary costs.”

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