Low Reimbursement Rates May Hinder Medi-Cal Expansion July 12, 2012 Medi Cal Medi-Cal reimbursement rate, Medi-Cal Expansion 0 As California prepares to expand Medi-Cal coverage under the federal health reform law, physicians across the state are expressing concern that the program's reimbursement rates are inadequate. Background on the Medi-Cal Expansion The state currently has 7.7 million Medi-Cal beneficiaries, but enrollment in the program could increase by 30% in the next few years. California expects to enroll 1.5 million or more adults in Medi-Cal once federal health reform law provisions take effect in 2014. Meanwhile, about 900,000 California children will be transferred to the program following the elimination of the Healthy Families program. About Medi-Cal Reimbursements California has one of the lowest Medicaid reimbursement rates in the U.S., ranking 47th out of the 50 states. Meanwhile, state lawmakers last year approved an additional 10% Medi-Cal reimbursement cut for health care providers, but the cut is on hold while a lawsuit filed by physicians to block the cut is pending. When Dr. Jerold Kaplan made a home visit last year to a man with a foot wound, he billed Medi-Cal what he thought was a modest $90. His payment: $8.96. The Berkeley wound surgeon received a bit more for his home visit to a quadriplegic last year: $13.44. Medi-Cal told him it cut both payments in half because of late paperwork. But even at the full rate, he would have received no more than $27 for a house call, barely enough to cover gas. As a result of the low reimbursement rates, many California health care providers have stopped accepting Medi-Cal beneficiaries or have limited the number of Medi-Cal patients they see. Details of the Concerns Health care stakeholders have raised concerns that physicians, clinics, and hospitals that accept Medi-Cal beneficiaries will become overwhelmed when the program is expanded. William Lewis, a Los Gatos ear, nose, and throat doctor and former president of the Santa Clara County Medical Association, said that even if beneficiaries find a physician who accepts Medi-Cal, “they have to wait much longer for an appointment and as a result, they are going to the emergency room for routine care and that clogs up the ER.” He added, “That is clearly going to get worse if you’re adding people without adding doctors.” State Response Norman Williams, a spokesperson for the Department of Health Care Services, said California has nearly 80,000 physicians enrolled as Medi-Cal providers—a number that has held steady for the past five years. He noted that Medi-Cal reimbursements will increase in 2013 and 2014 to Medicare levels. Williams said the pay boost should help encourage doctors to treat Medi-Cal beneficiaries. Source: California Healthline, July 12, 2011. Comments are closed.
