STATE SAYS IT WILL COMPLY WITH MEDI-CAL COURT
ORDER - WILL RESTORE MEDI-CAL PROVIDER RATES THIS MONTH
BUT SOME MEDI-CAL PROVIDERS STRUGGLING TO
KEEP THEIR DOORS OPEN CAN'T BE PAID AT ALL UNTIL BUDGET IS PASSED AS
STATE BUDGET CRISIS CONTINUES WITH NO END IN SIGHT - CDCAN TOWNHALL
ON BUDGET DELAY SEPTEMBER 8TH MONDAY 1-2:45 PM FEATURING SECRETARY
KIM BELSHE AND OTHERS
SACRAMENTO (CDCAN) - With the California budget crisis
continuing with no end in sight, the Department of Health Care
Services, which oversees the State's federal Medicaid program
(called "Medi-Cal") filed papers yesterday (September
4) with US District Court Judge Christina S. Snyder saying it will
comply with her court order to restore the 10% Medi-Cal provider
rate cut for most fee for service providers by today (September 5)
and dental providers by September 9th. [see CDCAN Report August 19,
2008 for more details on lawsuit at
www.cdcan.us
and for copy of the order itself]
That means that from those dates, Medi-Cal providers covered by
Judge Synder's August 18th temporary court order (injunction) will
be paid the full Medi-Cal reimbursement rate as it was before the
10% reduction took effect on July 1, 2008.
Over 1.6 million children and adults with disabilities (including
developmental), the blind, and seniors are part of the massive Medi-Cal
program which serves over 6.5 million children and adults in
California.
State Medi-Cal officials indicated that once the Medi-Cal provider
rates are fully restored, it will then begin the process of paying
providers the 10% that was reduced from their reimbursements since
August 18th, the date the court order was issued. State
officials said that process of repaying providers could take several
months.
Dennis Dworman, regional general manager for Electronic Data Systems
(EDS) which processes and pays Medi-Cal provider claims, said in his
court declaration that “EDS believes that by September 5,
2008, the system will be modified to stop the ten percent reduction
with respect to all claims processed on or after that date with a
date of service on or after August 18, 2008” for physicians,
pharmacies, optometrists, and adult day care health centers.
Michael Kaufman, of Delta Dental, which processes and pays dental
claims in the Medi-Cal program, told the court in his declaration
that the 10% Medi-Cal provider reduction for dentists is expected to
be stopped by close of business on September 9, 2008.
Budget Delay Prevents Many Medi-Cal Providers From Receiving
Any Payments
Ironically some of those Medi-Cal providers, including Adult Day
Health Centers, won't get any payments at all until a State budget
is passed and signed into law - or unless there is emergency
funding legislation passed to authorize payments.
Those providers, including those funded by regional centers, and
programs under other departments including independent living
centers, providers who serve people who are blind, seniors and
others, are struggling to keep their doors open because the State
cannot make further payments to them until a State budget is
passed and signed into law. Medi-Cal doctors, In-Home
Supportive Services (IHSS) workers, and SSI/SSP recipients
however are being paid.
The State budget delay impact on community organizations, health
facilities and providers has reached a major crisis point of
meeting payroll, keeping their doors and programs open that have
impact on tens of thousands of children and adults with
disabilities, mental health needs, seniors, the blind and others.
Regional centers, who fund community-based organizations and
providers - including those funded by Medi-Cal, for over 230,000
children and adults with developmental disabilities (including
autism, down syndrome) are being impacting, with one, Westside
Regional Center sending out a notice Thursday (September 4th)
saying it will run out of money next week.
Judge Synder's August 18th Order Seen As "Major
Victory" For Medi-Cal Recipients and Providers
Judge Synder's temporary order, issued on August 18th,
that blocked the 10% Medi-Cal provider rate reduction was seen by
advocates as a major victory for Medi-Cal recipients and providers.
The judge's order impacts the Medi-Cal rate reductions for
Medi-Cal "fee for service" providers including
doctors, dentists, pharmacists, adult day-care centers and other
providers who provide services to people in the Medi-Cal program.
That August 18th order excludes some hospitals who do not
contract with the State and do not provide emergency care.
The case number is
CV
08-3315 CAS (MANx). (see CDCAN website for copy of the 22
page temporary injunction at www.cdcan.us
The August 18th temporary order (injunction) by the district
court judge was made because she believed there was a likely
possibility the lawsuit would win. The case has not yet gone
to trial. Two other similar cases were filed this past
year: one filed by Medi-Cal providers in State court which is
still pending, and another filed by Medi-Cal pharmacies against
the State, which was dismissed.
A "contempt hearing" was held on Thursday, August 28th
before Judge Synder because attorneys for the Medicaid Defense
Fund felt that the State was not complying with the August 18th
court order. The Judge subsequently ordered the State to
comply, but that it would be required to restore rates as of
August 18, 2008 (the date of the court order), instead of when the
rate cut went into effect on July 1, 2008, which advocates,
including the attorneys who filed the lawsuit, had hoped.
Medi-Cal Officials Dispute Who Is Covered by Court Order
State Medi-Cal officials, in their papers that they filed
with the Judge on September 4, 2008, claimed that the court
order (injunction) covers doctors, pharmacies,
optometrists, and adult day health centers, but not other
Medi-Cal providers.
Attorney Lynn Carman with the Medicaid Defense Fund disputes
that claim, which will be the subject of another court hearing
before Judge Synder on September 15th. He also said that
he believes the State had no intention of complying with the
August 18th court order until the contempt hearing was held
before the Judge last week.
Suit Filed By Medicaid Defense Fund For Medi-Cal
Recipients
The federal lawsuit was filed in the US District Court of the
Central District of California (in Los Angeles) by the Medicaid
Defense Fund for a number of persons who receive Medi-Cal services
and supports and advocacy organizations including the Independent
Living Center of Southern California, and also the Gray Panthers and
others.
The lawsuit was filed against Sandra Shewry, director of
the California Department of Health Care Services, which oversees
the Medi-Cal program. That department is under the
California Health and Human Services Agency, overseen by Secretary
Kim Belshe. The judge's order, while temporary, is still a
major setback for the Schwarzenegger Administration.
Medi-Cal Cut Proposed Last January by Governor and
Approved by Legislature
Governor Arnold Schwarzenegger last January, as part of his
emergency budget proposals, proposed a permanent 10% rate reduction
for most Medi-Cal providers, in order to help bridge the enormous
budget deficit.
He also proposed at that time other cuts to Medi-Cal, including the
permanent elimination of 11 Medi-Cal "optional benefits" -
called "optional" because the federal government does not
require the states to provide them. However many of those
benefits include services, such as dental and podiatry that are
considered by advocates as essential basic services for people with
disabilities, seniors and others on Medi-Cal.
The Legislature, controlled by Democrats, meeting in special session
in February, approved the Medi-Cal provider rate cuts, but held off
- and then later rejected, the cuts regarding Medi-Cal
"optional benefits".
At the same time in February, the Legislature also approved making
permanent cuts (called "cost containment measures") to
regional centers that fund community-based services to over 230,000
children and adults with developmental disabilities, and cut to the
State cost of living money owed to SSI/SSP (Supplemental Security
Income/State Supplemental Payment) from June 1, 2008 to October 1,
2008 (the Legislature's different budget proposals, including one
approved by Democrats, extends that cut to State cost of living to
SSI/SSP through May 31, 2010).
Court Order Complicates Budget Crisis
The court order complicates an already difficult budget crisis for
the State which faces a $17.2 billion shortfall (includes $2 billion
for reserve).
However all the different budget proposals being considered,
including those by the Democrats in their budget plan voted on
August 17th and August 29th, budget compromise by the Governor on
August 20th, and the Senate Republican budget compromise released last
week, all proposed restoring Medi-Cal provider rates. Each of
the plans however differed on how and when the rate reductions would
be restored, which impacts how much money the State saves in the
current budget year.
With the Judge's latest order - and compliance by the State, all the
different proposed budgets will need to be adjusted to reflect that,
which will make the budget hole even larger to fill.
CDCAN TOWNHALL TELEMEETING
SEPTEMBER 8TH MONDAY 1 to
2:45 PM
Toll Free Number: 1-800-839
9416
Passcode:
5585287
INVITED
GUESTS:
Kim Belshe, Secretary of the California Health and Human
Services Agency (CONFIRMED)
and directors
or chief deputy director from various state departments,
including Department of Developmental Services, Aging, Health Care
Services (Medi-Cal) have been invited - though have not yet
responded to the invite (all of them have appeared several times
on previous CDCAN Townhall Telemeetings - the invite was sent this
afternoon)
TOWNHALL
TELEMEETING BACKGROUND:
These townhall telemeetings, accessed by toll free lines,
are open to anyone and are held to bnring policymaking and
information to where people live - especially people with
disabilities, mental health needs, seniors, the blind, their
families, community organizations and workers who provide supports
and services - many who cannot travel to Saramento or may not be
connected to day to day information on what is happening.
FOCUS
OF THIS TOWNHALL TELEMEETING:
We are facing - due to the budget delay - a major crisis - and
State agencies and others should be responding now as they would
if this was a natural disaster or emergency - since the outcome of
people being harmed will be the same if nothing is done, or if
people and agencies do not respond properly, appropriately,
efficiently and effectively - and most of all, respond when it is
needed.
This
CDCAN Townhall Telemeeting will focus strictly on the the impact
of the budget delay - what people with disabilities, mental health
needs, seniors, and others (including providers, community
organizations and workers who provide supports and services)
should do, who to contact if health and safety issues, what are
state and local agencies doing or will do in response to the
impact of the budget delay, and next steps if budget delay
continues. Providers and other organizations are facing
closure or reductions in services that have or will have soon
major and devastating impact - even before any more actual budget
cuts are passed or take effect.
(Note: townhall will not focus on how to resolve the budget crisis
itself - but what are state agencies and other public agencies
doing to respond to the crisis caused by the delay, what is the
impact, what are community organizations and providers doing - who
should people contact if there are health and safety issues or
needs caused as a direct result of the budget delay)
If you have information about the impact of the budget delay - or
would like to be on the response panel (anyone who calls in can
ask a question or make a comment however), please send
READ
LATEST MARTY OMOTO COMMENTARY "TROPIC THUNDER: WORDS IN MOVIES
MATTER, BUT WORDS AND ACTION IN SACRAMENTO MATTER TOO" -
available on the CDCAN website at www.cdcan.us
DISABILITY
RIGHTS NEWS REPORT