Supreme Court Kicks Medi-Cal Rate Cuts Back Down to Ninth Circuit

The United States Supreme Court issued an opinion Wednesday regarding three California Medi-Cal Provider Cut cases that will send them all back to the Ninth Circuit Court of Appeals. 

The cases were filed by Medi-Cal providers, such as doctors and pharmacists, Medi-Cal recipients, and advocates to halt certain provider rate cuts that were included in the 2008-09 state budget. The question before the Supreme Court was whether Medi-Cal stakeholders (recipients and providers) have a right to sue the State of California under federal Medicaid law. The groups specifically sued under the Equal Access provision of Medicaid law, by which states must set Medicaid provider rates at levels that will draw enough providers into the system and ensure that services are available and accessible to residents in geographic areas. 
By sending the case back to the Ninth Circuit, the Supreme Court affirmed the groups’ right to sue under Medicaid Law. It is not clear when the Ninth Circuit will hear arguments in the cases again. 

Please also note that additional legal actions regarding Medi-Cal provider and service cuts since 2009 remain separate and active. The three cases heard by the Supreme Court areDouglas v. Independent Living Centers of Southern California, Douglas v. California Pharmacists Association, and Douglas v. Santa Rosa Memorial Hospital. The Supreme Court’s decision can be found here.

Behavioral Services Hearing Spawns New Mental Health Services Oversight Spot Bill

The Legislature held an unusual four committee, bicameral joint hearing to discuss the changing landscape for behavioral health care in California on Tuesday.

Titled “Restructuring the Behavioral Health System in California,” the hearing brought together the following Senate and Assembly policy and budget committees: 

• The Assembly Budget Subcommittee No. 1 on Health and Human Services, chaired by Assembly Member Holly Mitchell;
• The Assembly Health Committee, chaired by Assembly Member Bill Monning;
• The Senate Health Committee, chaired by Senator Ed Hernandez;
• The Senate Budget and Fiscal Review Subcommittee No. 3 on Health and Human Services, chaired by Senator Mark DeSaulnier.

Participants heard about the Brown Administration’s vision for reorganizing behavioral health services, including the dissolution of the Departments of Mental Health (DMH) and Alcohol and Drug Programs (DADP) and the reorganization of services among existing departments – mainly the Department of Health Care Services (DHCS) and the Department of Social Services (DSS). 

Stakeholders, including counties, provided input on the administrative difficulties that some have encountered during the transition, but also the efficiencies – such as the timely payment of Medi-Cal Specialty Managed Care claims – that have occurred. It is also important to note that 2011 realignment placed the provision and funding of community mental health services at the county level, and counties look forward to working with the Administration and Legislature to ensure proper accountability and oversight for these critical local programs. 

After the close of the hearing, Senate President pro Tem Darrell Steinberg announced that he would be introducing legislation, SB 1136, to address some of the mental health service delivery issues that were raised earlier in the day. CSAC will work with Senator Steinberg and the Legislature to ensure the smooth transition and preservation of mental health services at the local level.

Senate Budget Committee Hears Concerns About IHSS and Medi-Cal Managed Care Proposals

The Senate Budget and Fiscal Review Committee met yesterday to examine the Governor’s budget proposals pertaining to two huge shifts in Medi-Cal : Integrating In Home Support Services (IHSS) into Medi-Cal Managed Care and significantly expanding a pilot program from four counties to 10 that would automatically shift dually eligible Medi-Cal and Medicaid recipients into the same model. 

CSAC and other county affiliates testified that both proposals are massive in scope and have not been adequately researched to determine if the shift will reach predetermined savings targets or adversely affect the provision of health and home care services to vulnerable beneficiaries. Counties also do not have any clarity on our potential fiscal role in these scenarios, and the state has provided little direction on the vision for the final program. To see the joint letter CSAC submitted with other affiliates, click here. 

Senator Mark Leno, chair of the committee, also had questions about the extent of stakeholder – including county – involvement and whether consumers should be passively or actively enrolled into managed care. Numerous IHSS and dually eligibly consumers also testified at the day-long hearing.