May 18, 2010

Medi-Cal patients and the hospitals who serve them will be some of the hardest hit if Governor Arnold Schwarzenegger’s May revision to the state budget stands.

It calls for $750 million in savings from a Medi-Cal cost containment proposal. Some of those savings would come through increasing co-pays and premiums, establishing maximum annual benefit dollar caps on medical supplies, limiting the number of doctor visits to 10 per year and limiting the number of prescriptions, except for life-saving drugs, to six per month. Over-the-counter drugs and nutritional supplements would also no longer be paid for by Medi-Cal.

“The Governor’s revision is shifting costs to the county or low income residents who can’t afford the payments,” said Joy Alexiuo, the public information officer for the Santa Clara Valley Medical Center. A lot of the co-pays for Healthy Families and other programs are doubling, and although it may not seem like much, for those living on the poverty line it may mean the difference between going to the doctor and not.

“There will be low income children who won’t be able to get healthcare services because of premiums and co-pays,” Alexiou said. “We’ve worked really hard to cover every child in this county and this proposal takes us a huge step backward,” she said.

The Revised budget also calls for freezing hospital rates at the current level and to start charging a $50 co-payment on emergency room visits and a $100 daily copayment on hospital stays with a $200 maximum.  The California Hospital Association takes issue with these measures.

California hospitals lost $4.6 billion last year treating Medi-Cal patients, stated the California Hospital Association in a press release. “These individuals are already at the low end of the economic scale and do not have the financial resources to cover such unplanned expenses. As a result, hospitals will face greater losses when they treat Medi-Cal patients.”

The association states that California is close to the least-funded state in the nation in terms of funding Medicaid patients. 

Dan Robinson, Chief Administrative Officer of San Ramon-based Hill Physicians Medical Group, which represents 3,000 physicians, said that the Governor’s proposals might result in less willingness by some physicians to see Medi-Cal patients, but he doesn’t think it will impact a huge number of individuals.

Hill’s physicians serve Medi-Cal patients in Sacramento and Stockton and the company has recently entered the Medi-Cal market in San Francisco. Robinson says the company is expanding into Medi-Cal because the company believes it is the right thing to do. “We fully expect to continue to expand in San Francisco with our Medi-Cal [services]. The Governor’s budget does not change our resolve,” he said.

The governor released his May revision of the budget on May 14 and it is meant to address a $19.9 billion budget gap.

Other provisions affecting Medi-Cal recipients are the establishment of maximum annual benefits on items like hearing aids, which would be capped at $1,510, and durable medical equipment, which would be capped at $1,604.