Metropolitan News-Enterprise


Friday, December 14, 2012


Page 3


Ninth Circuit Upholds State Cuts in Payments to Medi-Cal Providers


From Staff and Wire Service Reports


The Ninth U.S. Circuit Court of Appeals yesterday upheld California’s right to cut payments made to Medi-Cal providers by 10 percent, a victory that Gov. Jerry Brown’s administration says will save the state more than $330 million a year.

The court overturned a preliminary injunction that has blocked the state from making the cuts that were approved by the U.S. Department of Health and Human Services.

U.S. District Judge Christina A. Snyder of the Central District of California had held that the plaintiffs were likely to prevail on their claims that the cuts violated the Supremacy Clause of the U.S. Constitution and that the procedure used by HHS in approving them violated the Administrative Procedure Act, and that some of the plaintiffs were likely to show that they had been deprived of their property without just compensation.

But Ninth Circuit Senior Judge Stephen A. Trott, joined by Senior Judge Andrew J. Kleinfeld and Judge M. Margaret McKeown, said Snyder’s ruling was insufficiently deferential to the judgment of Secretary Kathleen Sebelius on a matter committed to her discretion, and that the Takings Clause did not apply because Medicaid is a voluntary program that confers no property rights on providers.

Doctors, pharmacists and other health providers who had sued to try to block the cuts immediately urged the state to reconsider reducing the payments made under the insurance program for the poor and disabled. The groups say they are evaluating their legal options for an appeal.

State lawmakers authorized cuts last year to save money, but a district court blocked the move. At the time it was passed, AB 97 was projected to save $660 million, with half the savings going to the state’s general fund. Brown’s finance officials say the state could see an additional one-time savings of at least $124 million in the general fund if the cut is applied retroactively to June 2011.

“Today’s decision allows California to continue providing quality care for people on Medi-Cal while saving the state millions of dollars in unnecessary costs,” said Brown’s spokesman Gareth Lacy.

Dr. Paul Phinney, president of the California Medical Association, which represents 35,000 doctors, said the cuts will tragically hurt the access to care for millions of patients.

The association says ongoing cuts to Medi-Cal have left doctors with little option but to stop taking qualified patients because the reimbursements do not meet the cost of overhead and supplies to treat them.

“Our hope is that state officials and Gov. Brown can look at the situation and decide not to move forward with these cuts,” Phinney said in a statement. “It was a tough budget decision that was made when the state was in a much more dire fiscal situation than it is now.”

Health providers also voiced concern that the cuts will impact roughly 900,000 kids who are being moved next year from the children’s health insurance program known as Healthy Families into Medi-Cal.

In addition, millions of new patients are expected to be eligible for Medi-Cal under federal health reform. The program currently serves 7.7 million Californians.

The case is Managed Pharmacy Care v. Sebelius, 12-55068.


Copyright 2012, Metropolitan News Company