Contact:
Alliance for Patient Care -- Contact: Karen Nikos, CMA Media Relations, 916-551-2069; Peter Warren, 310-548-5329; Ron Lopp, 916-551-2042

SACRAMENTO -- The California Medical Assn. released a report today calling on the State Legislature to make Medi-Cal a budgeting priority in conjunction with a request by CMA and The Alliance for Patient Care, a broad coalition of health care advocates, to increase Medi-Cal reimbursement rates.

The white paper, "Separating the Neediest From Health Care," addresses the growing problem for Medi-Cal patients in finding care as escalating health care costs combine with declining reimbursements to leave fewer and fewer providers able to treat Medi-Cal patients. "Low provider reimbursement rates threaten access to these services and erode the building blocks that are essential for maintaining a healthy California," the report states. (The report is available here).

Alliance for Patient Care, a coalition representing physicians and other providers who care for the state’s most vulnerable patients, is seeking a 15% increase as part of the state budget revision, which will distribute additional revenue from higher than anticipated tax payments. The request will be made Monday at the Assembly Budget Committee Hearing.

In calling for the increase, coalition leaders said Medi-Cal rates have not been increased since 2000-01 and have failed to keep pace with inflation.

"The young, disabled, aged and the most vulnerable patients – one in six Californians under 65 -- depend on Medi-Cal for medical treatment. Yet we also know that fewer and fewer physicians and other providers can continue to operate their practices or businesses with rates that don’t even come close to covering the costs of care," said CMA CEO Jack Lewin, M.D. "We are balancing the budget on the backs of these patients and the physicians, nurses and other providers who want to care for them. This formula for treating the neediest is not sustainable unless reimbursements increase."

Indeed, the actual value of Medi-Cal reimbursements has fallen nearly 15% in the past five years compared to medical inflation and other cost indicators, (chart page 8). There has been just one general Medi-Cal physician rate increase in the past 20 years, the one in 2000-2001.

Medi-Cal is the main source of health care for 6.7 million Californians, yet it pays a fraction of what commercial insurers pay. A routine physician office visit, for example, is reimbursed at $24 – an amount barely above a copayment for patients whose health care is paid through a commercial insurance company.

The coalition has worked together for many years to advocate for Medi-Cal patients, seek more realistic reimbursement rates and win greater access to health care. While acknowledging that legislators face tough economic choices for this additional tax revenue, coalition members said stagnant Medi-Cal rates are transforming the program into charity care funded in part by the generosity of providers.

For instance, those who treat Denti-Cal patients (dental work under Medi-Cal) report that a simple repair of dentures, for example, creates a loss because the reimbursement is just $45 for a clinic out-of-pocket cost ranging from $50 to $125.

Leaders noted that the last general rate increase was voted only after 500 CMA physicians marched on the capitol in a "Shame On California" campaign. At the time, physicians pointed out that California ranked 47th of the 50 states in Medi-Cal spending.

At the time, physicians didn’t think California could fall any lower. Today, California ranks last in dollars spent per patient.

A recent study of Medi-Cal access in urban counties published in 2002 by the Medi-Cal Policy Institute found just 50% of primary care physicians, 55% of medical specialists and 52% of surgical specialists accepted Medi-Cal patients in their practices. Furthermore, a California Healthcare Foundation report found that there are only 46 primary care physicians for every 100,000 Medi-Cal patients. The federal standard is 60-80 primary care physicians per 100,000.

Low Medi-Cal rates already have forced many physicians to stop seeing new Medi-Cal patients or to leave the program completely. More than 60 percent of Medi-Cal recipients report difficulty finding a physician. A media report earlier this month featured a father’s two-week search to find an orthopedist who could treat his little girl’s broken arm under Medi-Cal after she fell from playground equipment in San Bernardino County.

Typically, patients who can’t find a physician often are forced to wait too long for treatment, and end up in far costlier emergency departments. In addition, a variety of other expenses would rise dramatically, if rates are not increased and less expensive programs for the treatment of chronic illness are replaced by more hospitalizations.

For instance, patients on kidney dialysis or various forms of home health care would be forced into hospitals if providers of these relatively economical services reduce or eliminate services to Medi-Cal patients. And, AIDS Project Los Angeles, a member of the coalition, reports that it has difficulty getting home health care workers who will accept the $11.56 per hour cap for those who take care of homebound AIDS patients.

The California Dialysis Council, a member of the Alliance for Patient Care coalition, says in the report: "Much more costly emergency hospitalization will be the fate of those patients fortunate enough to get it (dialysis); and early death will claim the rest."

The Alliance for Patient Care includes, in addition to the California Medical Association, AIDS Project Los Angeles; the American Academy of Pediatrics, California District; (ACOG)-American College of Obstetricians and Gynecologists, District IX; (ANCO)-Association of Northern California Oncologists; (CAFP)-California Academy of Family Physicians; (AAP-CA) American Academy of Pediatrics-California. District; (OPSC)-Osteopathic Physicians and Surgeons of California; California Association of Long Term Care Medicine; Primary Provider Management Company; Latino Coalition for a Healthy California; (WOEMA)-Western Occupational and Environmental Medical Association; (CAFP)-California Academy of Family Physicians; (AAP-CA) American Academy of Pediatrics-Calif. District; (OPSC)-Osteopathic Physicians and Surgeons of California, (CALTCM)-California Association of Long Term Care Medicine; (CADP)-California Association of Dental Plans; California Dental Association; (CAPG)-California Association of Physician Groups; (LTCPA)-Long Term Care Pharmacy Alliance; (PACE)-Program for All-Inclusive Care for the Elderly; SCAN Social HMO; Evercare-(subsidiary of United Healthcare); California Association for Adult Day Services; Molina Medical Group; (PPAC)-Planned Parenthood Affiliates of California; AIDS Healthcare Foundation; American Academy of Ophthalmology; American College of Emergency Physicians-California Chapter; Local Health Plans; Addus Healthcare, Inc.; AARP; California Association For Health Services at Home; California Foundation for Independent Living Centers; California Dialysis Council and DaVita Inc.; California Clinical Laboratory Association, California Children's Hospital Association; California Medical Transportation Assn.; Molina Healthcare of California; Planned Parenthood Affiliates; California Pharmacists Association (CPhA); California Dermatology Society; National Alliance for the Mentally Ill; National Association for the Mentally Ill; National Association of Chain Drug Stores; National Multiple Sclerosis Society California Action Network, and many others.