DHCS 2011-12 Budget Actions
To help address California's budget concerns, the California Legislature passed Assembly Bill (AB) 97, which Governor Brown signed into law on March 24, 2011. AB 97 contains cost savings measures that impact the state's Medi-Cal program. Before implementing the measures, California must receive federal approval. To do so, the state requested amendments to the State Plan, which is California's contract with the federal government to operate the Medi-Cal program. It also sought a waiver, which gives the state permission to operate Medi-Cal differently than required under the State Plan. One proposal, the elimination of the Adult Day Health Care benefit, has been approved. The other requests are pending.
To support the state's proposals to reduce provider payments by up to 10 percent, DHCS is developing baseline access analyses and a monitoring plan for review by the Centers for Medicare and Medicaid Services (CMS). The analyses will examine the impact, both in size and scope, of the proposed payment reductions. The analyses and monitoring plan will be posted on the DHCS website following CMS approval of the SPA. Copies of the Department’s submissions to implement (AB) 97’s cost savings measures are linked below.
Provider Reductions
Utilization Controls
Copayments
ADHC Elimination
Assembly Bill 97
In the past few weeks, a federal district court judge in Los Angeles issued preliminary injunctions in four separate cases, each of which focuses on different services affected by AB 97 payment reductions: 1) California Hospital Association v. Douglas and Sebelius (Distinct Part/Nursing Facility rates); 2) Managed Pharmacy Care v. Douglas and Sebelius (pharmacy services); 3) California Medical Transportation Association v. Douglas and Sebelius (non-emergency medical transportation services); and 4) California Medical Association v. Douglas and Sebelius (physician, clinic, and other services).
In mid-January, DHCS filed Notices of Appeal in the first three cases. Also, the Ninth Circuit Court of Appeals immediately set an expedited briefing schedule for those three cases. Furthermore, on January 17, DHCS sent a letter and enclosed copies of the federal district court’s orders in these cases to the United States Supreme Court for consideration in its decision in Douglas v. Independent Living Center. The decision in the Supreme Court case is still pending.
Other Resources
California State Plan
Recent Amendments