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Medi-Cal Provider Rate Cuts Approved

Despite already having some of the lowest Medi-Cal reimbursements in the country, the feds recently approved an additional 10% cut to many providers’ Medi-Cal reimbursements (including physicians, dentists, clinics, pharmacies, and most nursing homes). Reimbursements could be as low as $11 after the cuts. The Medi-Cal program costs California $14 billion per year and serves 7.6 million of California’s low-income and disabled. The anticipated cuts are expected to save the state $623 million (that’s 62.3 Kardashian weddings!). DHCS plans to monitor how the cuts will affect access to care.

Nearly all other states have implemented copays, reduced benefits, and reimbursement cuts in an effort to save money, according to the Kaiser Family Foundation. The feds have yet to approve added copays ($5 for doctor’s appointments, $50 for emergency room visits, and $100/day for hospital stays) and limited doctor visits (seven visits per year) for Medi-Cal beneficiaries.

The following chart shows the number of states that have either implemented expansions or restrictions to Medicaid in FY 2011 and FY 2012 (planned).

The following chart shows the number of states that have either implemented provider rate changes for Medicaid between 2009-2011 or plan to do so in 2012.

The following chart shows the number of states that have implemented certain provider rate changes.

It is also important to note that along with 15 other states, California receives the lowest category of Federal Matching Assistance Percentage (50%) and along with 17 other states and Washington, DC, covers the highest upper limit of low-income (100% FPL+).

The cuts could severely limit access to care for Medi-Cal beneficiaries at a time when the uninsured rate is rising. It could also severely impact the implementation of Medi-Cal expansion in 2014 by spreading limited resources even thinner. Hopefully the Medi-Cal saga turns out better than Kim Kardashian’s $10 million/72-day marriage.

Read more from the LA Times.

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