Calif. Medicaid reimbursement cuts take effect in Sept.

By DrBicuspid Staff

August 15, 2013 -- California will cut Medi-Cal dental reimbursement rates by 10% in September after an appellate court's recent decision that upheld the reductions. Medi-Cal is the state's Medicaid program.

The decision to cut dental reimbursements will impact roughly half of all children in California, as more than 5 million children will be enrolled in Medi-Cal by the end of 2013, according to the Children's Partnership advocacy group.

Notably, most other children's health services were exempted from the dental reimbursement cuts because of perceived provider shortages, the group said.

"This action has grave consequences for children and their access to dental care," according to a statement sent to DrBicuspid.com.

California ranks as one of the 10 worst states in terms of Medicaid-enrolled children getting dental care. Dental disease is currently the No. 1 chronic health problem among children in California.

California has one of the lowest Medicaid reimbursement rates in the nation. Low reimbursement rates are one of the main reasons dentists do not accept children on Medicaid. According to a recent survey, 97% of dentists who do not participate in Medi-Cal reported low reimbursement rates to be their number one reason for not participating, the group said.

The group recently released a study showing the difficulty parents of children enrolled in Medi-Cal often experience in accessing dental care for their children.

The cuts mean that families will face even greater hurdles getting care for their children, resulting in pain and suffering among children who go without necessary care, expensive emergency room visits for preventable dental problems, and missed school and work due to dental problems, according to the group.

In May, the U.S. Ninth Circuit Court of Appeals denied a petition filed by the California Dental Association (CDA) and a coalition of healthcare organizations designed to stop the reimbursement cuts, which were authorized by the Legislature and signed into law by Gov. Jerry Brown in June 2011.

In November 2011, the California Dental Association, the California Medical Association, the California Pharmacists Association, and the National Association of Chain Drug Stores sued the California Department of Healthcare Services and the U.S. Department of Health and Human Services to stop the proposed cutbacks after the Centers for Medicare and Medicaid Services approved them.

The cuts will not only affect Medi-Cal reimbursements to dentists, physicians, pharmacists, and other providers going forward, but will also allow the state to recoup payments made since that law was blocked by the court injunctions. The cuts could generate $50.1 million in general fund savings in the current fiscal year and $458.8 million in 2014, according to state officials.


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