Practice Management

CDA sues government over Medicaid cutbacks

By staff writers

November 22, 2011 -- The California Dental Association (CDA) has joined forces with the California Medical Association (CMA), the California Pharmacists Association (CPhA), and the National Association of Chain Drug Stores in a federal lawsuit against the California Department of Healthcare Services (DHCS) and the U.S. Department of Health and Human Services protesting proposed cutbacks to the state's Medicaid reimbursement system.

The suit, filed November 21 in the U.S. District Court for the Central District of California, is in response to the Centers for Medicare and Medicaid Services' (CMS) recent approval of a 10% reimbursement rate cut in California's Medicaid program, Medi-Cal.

"In late September, the CMS asked DHCS for more information that would substantiate its state plan amendments (SPAs) for cuts in the Medi-Cal program. Without receiving that information, CMS went ahead and approved the cuts before them," Francisco Silva, CMA general counsel and vice president, stated in a news release. "It is clear that CMS did not follow protocol and applied the wrong legal standard. The approval of the SPAs will have dramatic affects on access to healthcare for the poorest, most vulnerable Californians."

“More cuts to children's services are unconscionable.”
— Dan Davidson, DMD, CDA president

Earlier this year, in a budget-cutting move, Gov. Jerry Brown signed AB 97, which included a 10% Medi-cal reimbursement rate cut. The federal government approved the rate cuts on October 27. Federal approval was required before the state can implement its proposed cuts.

The cuts, which will save the state $623 million, would impact outpatient services for physicians, dentists, clinics, optometrists, medical equipment, laboratories, and pharmacies. California spends $14 billion annually on the Medi-Cal program.

Medi-Cal currently provides dental benefits to 6.9 million people through a contract with Delta Dental of California. In 2009, the state eliminated most adult Denti-Cal services except for pregnant women and some emergency situations.

While children's services are exempt from the newest round of Medi-Cal cuts, the exemption applies only to medical services, not dental, according to the CDA.

"While the rate cuts exempted children’s medical providers, including clinics due to existing access difficulties, rates paid to dentists are subject to the cuts," noted ChildrenNow in a November 22 letter to Toby Douglas, director of the DHCS, that was signed by nearly a dozen related healthcare organizations. "This action by the Administration continues to batter the already fragile safety net of Denti-Cal providers for millions of children who require adequate access to oral health care."

By law, the state is required to submit underlying documents to CMS clearly documenting that access to care for Medi-Cal patients would not be impacted by the state plan amendments. The lawsuit filed November 21 challenges the adequacy of the information provided by the state to support the cuts.

"CMS’ decision simply defies reason and logic," the lawsuit states. "It strains credulity to its breaking point to accept that a 10 percent cut to rates that have already caused significant gaps in access for Medi-Cal beneficiaries will not have any adverse impact on provider participation levels in Medi-Cal."

The plaintiffs believe this latest attack on the already inadequate Medi-Cal network of dental care will result in further hindrance of dentists' ability to provide appropriate care.

"The state's elimination of adult dental services in 2009 was devastating to low-income Californians," said Dan Davidson, DMD, president of the CDA. "More cuts to children's services are unconscionable."

The information that CMS relied on to approve the state's cuts do not measure whether and how patients' access to care would be impacted or otherwise take into consideration, as required by law, the costs to provide the care, according to the CDA. In fact, a recent poll and independent studies show that access to care is already unequal, making the recent cuts illegal by federal standards.

Because California Medi-Cal rates are already extremely low, many providers cannot afford to participate. Kaiser State Health Facts lists California as the lowest reimbursed state in the nation. The co-payments and arbitrary limits on services will create additional barriers for sick, vulnerable patients seeking care and, ultimately, they will be forced to delay care or use emergency rooms for basic health services, according to the CDA.

CMA, CPhA, and CDA successfully sued in the past to enjoin prior Medi-Cal cuts and expect to demonstrate once again that federal law, which ensures that Medi-Cal patients have equal access to healthcare, was not followed.

New Calif. Medicaid cuts may affect kids' dental services
Faced with a severe budget crisis, California virtually eliminated adult Medicaid dental benefits two years ago. Now children's dental services are being...
Report: California budget cuts taking toll on oral care
More than 450,000 Californians on Medi-Cal have had to either pay for or go without dental care since July as a result of state budget cuts, according...
Clinics sue California over dental cuts
A coalition of health clinics announced Thursday it is filing a lawsuit against the state of California to prevent it from cutting adult dental Medicaid...
Denti-Cal cuts would affect millions of lower-income Californians
More than 2.8 million Californians -- primarily poor, disabled, and elderly adults and their children -- stand to lose access to dental health services...
California dentists sue state government
The California Dental Association (CDA) has joined a lawsuit against the State of California that seeks to prevent a $1.3 billion cut in Medicaid...

Copyright © 2011

Last Updated kk 11/22/2011 1:34:06 PM

3 comments so far ...
11/22/2011 12:07:12 PM
Buckeye DDS
The correct abbreviation for the Centers for Medicare and Medicaid Services' is CMMS not CMS.
Please clarify, the article states that Medi-Cal is cutting fees by 10%, but later states "While children's services are exempt from the newest round of Medi-Cal cuts, the exemption applies to medical services, not dental, according to the CDA".  Are children's dental services being cut or not under this proposal?  California at one time had the most comprehensive Medicaid dental program in the country.  They used to cover fixed bridge work along with other services that were never covered in other states.  Now they are down to the lowest fees in America & virtually no adult dental coverage.  The LBJ Great Society seems to be working well in California!

11/22/2011 12:47:37 PM
Cant take in one dollar and spend two. I do not know how a country which is a capitalistic society can have certain segments that are socialistic, its too confusing and complicated. Obamacare is a socialistic system with capitalistic payments, just wont work!!! Medicare/medicaid are examples of this failure. Canada is a prime example as well. We need to decide the value of health in this country, and we need to have a vote of the people, through referendum, whether we want to add to the constitution if healthcare is a right or a privilege of a citizen of this country. Once we have the answer from the people, not corrupt politicians, we can then move forward as a country!

11/24/2011 9:12:49 PM
It is time to form a national health provider's union. Insurance companies can collude without
fear of antitrust action because they are immune by law. Furthermore, they have organizations which
help them to determine how much the professional can get screwed. The state and national societies
have been of no direct help because they are not immune to and fear antitrust action. Unions can legally deal with all these assaults on healthcare professionals. We are just sitting ducks, the wolves are the lawyers, congress and health departments each of which do not appreciate the value of our ever improving services.
The auto mechanic has a sign on the repair wall stating that his service is worth as much as $125/ hour.
The lawyers charge over $600/hour and they are protected by a congress and legislature which contains
more than 50% attorney-politicians. It's like running an ever non-rewarding gauntlet every day. Wisconsin Delta just cut its benefits to providers by about 10% unilaterally, but all these insurance company executives leave with multi-million dollar parachutes, of which we contribute about 40% of a UCR. Our professional associations are of no help because of anti-trust fears. I'd like to see a change I can believe in which is good for me NOW.  If you are interested in helping e-mail to [][/email] and let us get some really serious business started which will be in our favor for a change![:-]