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Medi-Cal Cap Proposal
The initial Medi-Cal cap of 10 visits was defeated at the Leg Budget subcommittee level, but now there is a new Medi-Cal cap proposal on the state budget conference committee table (See Medi-Cal cap overview below).
The State Senate and Assembly Budget Committee’s have completed their subcommittee work and have sent the open items into the Legislature’s Budget Conference Committee process. The Budget Conference Committee is made up of five Assembly members (3 Democrats & 2 Republicans) and five Senators (3 Democrats & 2 Republicans): Conferees are Assembly Member Blumenfield, Chair; Senator Mark Leno, Vice Chair; Senator Lowenthal; Senator Negrete McLeod; Senator Huff; Senator Emmerson; Assembly Member Fuentes; Assembly Member Skinner; Assembly Member Harkey; and Assembly Member Neilsen.
Conference Cmte agendas and list of open items can be found at http://www.sen.ca.gov/budget/2011ConferenceInfo.html.
The Conference Committee’s job is to find common ground on the open items still on the table. The budget being crafted will cut around $12 billion out of the state’s $92 billion budget. There are many items within the proposed budget that will impact on healthcare in rural California. The Budget process is moving at a pace that is unprecedented and tracking all issues is problematic for all involved. The biggest issue at stake in the budget process is whether or not the Governor can get all 52 Democrats in the Assembly and 25 in the Senate to agree in putting the tax extension item on the June ballot. Not only does he need all Democrats to agree with him, but he will need two Republicans in each house to join the Democrats to reach the 2/3rds vote necessary to put the items on the ballot. If the tax extensions are not on the ballot or if they are on the ballot but the voters turn them down, the Governor and Legislature will have to find another $12 billion in cuts within the state budget to balance the budget.
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Additional Cuts to Medi-Cal
Both the Senate and Assembly previously rejected Governor’s proposal to institute “hard cap” of 10 office visits per year for certain Medi-Cal recipeints (that would have meant a reduction of $392.9 million ($196.5 million in State general funds). The Budget Conference Committee however will now likely approve a “soft cap” instead, at 7 visits is proposed for a reduction of $89.7 million ($44.9 million in State general funds)
The “soft cap” would apply to adults in the Medi-Cal program, with children (21 years and under), pregnant women, and residents in Long-Term Care facilities exempt.
The “soft cap” would apply to both Medi- Cal Fee-for-Service and Managed Care plans. It affects outpatient primary care and specialty care provided under the direction of a Physician in the following settings:
· Hospital Outpatient Department;
· Outpatient Clinic;
· Federally qualified Health Centers (FQHCs);
· Rural Health Clinics; and
· Physician Offices.
In addition the Budget Conference Committee will likely apply the 10% Medi-Cal provider rate reduction to more providers as follows, would would provide an additional $39.1 million (State general funds) in savings pertaining to Distinct-Part Nursing Facilities, Rural Swing Beds, Distinct Part Subacute and Pediatric Subacutes.
The Brown Administration says that without this technical adjustment the Budget Conference Committee needs to approve, these specific facilities would be receiving an average reimbursement increase of 4.31 percent for 2010-11 and 4.76 percent for 2011-12, while other Medi-Cal providers would be experiencing a 10 percent reduction. The intent of the Brown Administration was to also reduce these Facilities by 10%.
The Budget Conference Committee released this afternoon a 12 page addition (errata) to the original two part agenda that the conference committee worked on since it held its first hearing last week. The additional new items include a new adjustment or reductions of $50 million in State general funds to developmental services – including an additional $24 million reduction on top of the $150 million cut in State general fund spending that is currently not specified, but could be achieved by statewide standards to limit spending on regional center community-based services.
See attached.
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Please feel free to contact the CSRHA office and/or the CSRHA Policy Director, Steve Barrow with any questions at 916-453-0780.
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555 Capitol Mall, Ste 750, Sacramento, CA 95814
Telephone: (916) 453-0780| Fax: (916) 453-0783
E-mail: advocate@csrha.org |
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