Tuesday, January 3, 2012

No cuts to Medi-Cal provider rates for now

*This article was originally published by the Viễn Đông on 3 January 2012. It was reported by Vanessa White.


GARDEN GROVE, California—A recent court decision has helped save Pharamcist Thư-Hằng Trần's pharmacy, along with others across the state.
At least for now.
On 29 December 2011, the U.S. District Court, Central District of California, in Los Angeles (LA) granted an injunction-or stop- to plaintiffs opposing the 2011-2012 State budget trailer bill, Assembly Bill (AB) 97, which would have made 10 percent cuts to Medi-Cal provider rates statewide.
Pharmacist Trần told the Viễn Đông that providing the proper medication for her patients under AB 97, could have eventually led to her closing down her pharmacy, as she would not have received enough State funding to break even.
To keep her pharmacy open, she would have had to offer her patients less expensive, generic medications, rather than provide quality medication for them.
Since the summer 2011, the Viễn Đông has reported on proposed cuts to Medi-Cal, California’s version of the federal Medicaid program. It covers low-income families with children, seniors, foster children, pregnant women, and people with specific diseases including breast cancer and HIV/AIDS.
The State provides funding to Medi-Cal providers so they can offer less expensive, yet quality services to such individuals.
Passed in March 2011, AB 97 cuts were supposed to go into effect on 1 June 2011 as a way to help the State balance its budget, however the State had to wait for federal approval to enact them.
On 27 October 2011, the federal government approved over $623 million in cuts to Medi-Cal provider rates, spurring a lawsuit from plaintiffs, including the Medicaid Defense Fund which represented Pharmacist Trần's pharmacy, Tran Pharmacy.
AB 97 would have made cuts to more than just pharmacy services, including adult physicians and clinics, therapy, optometry, and dental. Nursing home nurses and adult sub-acute care nursing home facilities would have also experienced 10 percent reductions in provider payments, while acute care nursing facilities would have received 10 percent reductions in provider payments as well as a rate freeze.
However provider cuts would not have applied to child physician and clinic services, home health services, hospital based sub-acute care facilities, or outpatient hospital services.
“It affects everybody,” Pharmacist Trần said of AB 97, adding that many employees working at outpatient services experiencing the cuts would have lost their jobs as their employers would not have had enough money to pay them.
She continued, saying that the AB 97 injunction is similar to the 2008, 2009, and 2010 court decisions that also blocked cuts to Medi-Cal provider rates, originally passed by the California legislature for the 2007-2008 budget.
As a response to the U.S. District Court in LA block in 2008, California appealed the decision with the U.S. Supreme Court in 2009 and 2010, losing both times.
However, the AB 97 injunction case is different from those past cases because California did not have federal government support then as it does now.
Pharmacist Trần told the Viễn Đông that California will probably appeal the newest AB 97 injunction, which will only spur appeals from plaintiffs seeking to block cuts.
“It will go back and forth,” she said.
Though, the Ping-Pong-like drama could be stopped if a pending U.S. Supreme Court decision to be decided by June 2012 rules against plaintiffs.
Douglas vs. Independent Living Center of Southern California
In October 2011, the Viễn Đông reported on first U.S. Supreme Court case of its new 2011-2012 term, Douglas vs. Independent Living Center of Southern California.
The case focused on whether or not people receiving Medi-Cal, their providers, and their advocates can sue California and stop its cuts to Medi-Cal provider rates.
Pharmacist Trần was a plaintiff in the case and traveled to Washington D.C. to offer her presence as support.
“If you don’t have the right to sue, the court will not accept your case,” Pharmacist Trần told the Viễn Đông in October 2011, adding that this case will affect decisions regarding similar lawsuits in the future.
She continued, saying that if the plaintiffs win the case, there will be similar lawsuits against states throughout the country.
However, if the plaintiffs lose, doctors and patients may never be able to sue the government again.

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