Medi-Cal patients would pay more and have limited doctor visits under governor's proposal

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Contra Costa Times

Medi-Cal patients would have new mandatory co-pays and limits on their prescriptions and doctor visits.

Doctors and nursing homes would be hit with a 10 percent cut in Medi-Cal reimbursements.

And state funding for adult day health care would be eliminated, making it tougher for thousands of frail seniors to remain in their homes.

These are among the health care budget cuts Gov. Brown proposes that left many advocates reeling Monday, even as they acknowledged the state's dire financial condition.

"If we don't find additional revenues to prevent them, these cuts will harm the health of individual families, our health system on which we all rely, and our attempts at economic recovery," said Anthony Wright, executive director of Health Access California, a consumer advocacy group.

Brown wants to cut $1.7 billion from Medi-Cal, which provides health coverage to 7.7 million low-income Californians, or nearly one in five state residents.

Medi-Cal expenses have grown by 6 to 8 percent annually, exceeding inflation. To clamp down on such costs, Brown would:
• Limit doctor visits for Medi-Cal patients to 10 per year, and limit prescriptions to six per month, except for lifesaving drugs.
• Cap annual spending for health items such as hearing aids, incontinence supplies and wound care.
• Set mandatory co-pays for Medi-Cal patients of $5 per doctor's visit, $50 for emergency room
services, and $100 per day for a hospital stay up to a maximum of $200.

Service could be denied to patients unable to make the co-pay, as long as they are referred to a county indigent health program.

A hospital leader noted that California hospitals lost $4.8 billion treating Medi-Cal patients last year. C. Duane Dauner, president of the California Hospital Association, predicted growing losses if the co-payments are approved because he said most Medi-Cal patients will not be able to pay the increased cost-sharing, forcing hospitals to write-off that expense.

Courts have blocked the state's previous attempts to cut reimbursement rates for Medi-Cal providers, but the state has appealed to the U.S. Supreme Court and hopes to have a favorable ruling by July.

Medi-Cal now reimburses a primary care doctor about $21 to $24 for a routine visit, noted Dr. Tim Ganey, president of the Alameda-Contra Costa Medical Association. He predicted more doctors would stop seeing Medi-Cal patients if the 10 percent cut goes through.

"Right now, for quite a few physicians, it's almost like they subsidize seeing patients," Ganey said.

Operators of adult day health care services are gearing up for a fight.

The Mt. Diablo Center for Adult Day Health Care in Pleasant Hill would lose about 85 percent of its budget and would be forced to close, eliminating day programs for 120 frail and elderly people, said Executive Director Debbie Toth.

Toth predicted more seniors would be isolated in their homes, or end up in skilled nursing facilities or hospital emergency rooms.

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