GOVERNMENT

California lawsuit challenges Medicaid reimbursement cuts

The reductions are a serious threat to patient access, physician groups say.

By Joel B. Finkelstein, AMNews staff. Dec. 1, 2003.

Washington -- California physicians don't want to be the victims of their state's budget crisis. They have filed a lawsuit alleging that impending Medicaid cuts violate federal law.

The California Medicaid program, called Medi-Cal, is set to implement a 5% cut in reimbursement effective Jan. 1, 2004.

The lawsuit was brought by the California Medical Assn. and other physician groups in the state that say the cut will make an already bad situation worse. It cites the Social Security Act, which requires states to assure that Medicaid payments are adequate to enlist enough physicians and others to serve their beneficiaries.

"By reducing reimbursement for physicians, dentists and others, and greatly reducing funds for such equipment as wheelchairs, prosthetics and other medical necessities, the state is greatly injuring the most vulnerable Californians," said Jack Lewin, MD, the CMA's chief executive officer.

Physician Medicaid participation rates are already very low in California. According to research by the University of California, San Francisco, just over half of primary care physicians in urban counties serve Medi-Cal. But only half of those physicians provide the bulk of the services to these patients.

The 2001 study showed that there were 46 primary care physicians available per 100,000 Medi-Cal patients. Federal workforce standards require 60 to 80 physicians per 100,000 patients.

The state's push for Medicaid cuts is a sharp departure from just a few years ago. In August 2000, a 15% increase in Medi-Cal reimbursement to physicians and others was approved.

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