California appeals court OKs Medi-Cal cuts; Medicaid pay raise for doctors met with dissatisfaction in Georgia; and two insurers sue Washington state over Medicaid allocation in this week's Medicaid Digest.
Court overturns Medi-Cal pay cut injunctions
A three-judge panel of the 9th Circuit U.S. Court of Appeals has unanimously overturned injunctions against the state of California in its effort to reduce reimbursements under its Medicaid program – called Medi-Cal – by 10 percent.
The cuts were proposed last year in a bill that eventually became law, as the state grappled with spiraling costs in Medi-Cal and a budget crisis that projects a $1.9 billion deficit next year. State officials have estimated that the reimbursement cuts could save the state as much as $50 million each month.
The cuts to providers and pharmacies have been broadly opposed by medical groups throughout the state, who have warned that reductions in Medi-Cal reimbursement could lead to fewer doctors willing to participate in the program and restrict access to care – all on the cusp of a broad expansion of Medicaid as spelled out in the Affordable Care Act.
In its ruling, the 9th Circuit judges said the injunctions preventing the state from making the cuts were invalid since they had received prior approval from the federal government. "Neither the State nor the federal government 'promised, explicitly or implicitly,' that provider reimbursement rates would never change," wrote Judge Stephen S. Trott in the ruling.
Georgia's Dept. of Community Health not happy with doc Medicaid payment raise
A federal policy that will require – and pay for – raising Medicaid reimbursement rates to be on par with Medicare reimbursements for family practitioners, internists, pediatricians and vaccinations was met with grumbling recently by members of the Georgia Department of Community Health board of directors.
But the opposition seemed to be more politically motivated by board members' opposition to federal health reform than to the pay raise, per se, reported Georgia Health News, even though the agency was only to vote on whether to adopt a public notice of the pay raise. "No one dislikes Obamacare as much as I do," said Rick Jackson, CEO of healthcare staffing agency Jackson Healthcare in the GHN report.
The additional money seeks to alleviate a serious issue across the country, with doctors dropping out of the Medicaid program due to low pay. A recent survey in Georgia indicated that half of the 1,400 doctors surveyed do not take Medicaid patients.
Two insurers sue state of Washington over Medicaid patient assignment
Molina and Community Health Plan of Washington (CHPW) have sued the state over its patient allocation formula, contending that that it will penalize them by assigning more patients to competing plans.
The health plans' lawsuit contends the state has breached their contracts via the reworked allocation formula that it wants to use beginning the first of the year and that the formula will give three other plans in the state – Amerigroup Washington, Coordinated Care Corp., and United Healthcare Community Plan – an unfair advantage.
But the state disagrees that it has changed a key provision of the contract, as the plaintiffs allege. Both Molina and CHPW have contracted with the state for a number of years to run Medicaid managed care programs. Allowing the three new health plans into the contract is a means for Washington to lay the groundwork for state Medicaid expansion under the Affordable Care Act, according to William Stephens, senior counsel in the Office of the Washington Attorney General.