Calif. Physicians Go to Court Over Medicaid Cuts

The California Medical Association (CMA) and 11 other plaintiffs filed suit in U.S. District Court in Sacramento on November 7 to stop a 5 percent cut in Medicaid payments to physicians and other health care professionals from taking effect on January 1, 2004.

The plaintiffs cited the Social Security Act, which says that a state plan for Medicaid (called Medi-Cal in California) must assure that payments are “consistent with. . . economy and quality of care,” and are sufficient to enlist enough health care professionals so that services are available to Medicaid enrollees at a level equal to those available to the general public.

According to figures provided by the Medi-Cal Policy Institute, the availability of specialists to Medi-Cal enrollees is 50 percent less than for the general population. A recent study by the institute found that fewer than half of physicians in the state accepted any Medi-Cal patients in 2001. In a 2002 CMA survey, 40 percent of physicians said that if there were further cuts in payments, they would stop participating in Medi-Cal.

According to the filing, the 5 percent cut would mean that an internist or family physician would receive less than $23 for a typical office visit.

The 5 percent cut would reduce payments from the state’s general fund by $115 million. But the total loss in Medi-Cal funds would be $237 million because the federal government matches every $100 spent by the state with $106.

A press release from CMA announcing the suit and related legal documents are posted on the Web at www.cmanet.org/publicdoc.cfm/708/207/PRESS/280. ▪