Medi-Cal is California’s Medicaid health care program. This program pays for a variety of medical services for children and adults with limited income and resources. But the program, relied on by millions of Californians, has needlessly been placed in jeopardy.
Medi-Cal and Medicaid programs in states across the country are a partnership between state governments and the Federal government. By law, all Medicaid programs must maintain a level of equal access to care for patients that ensures there are an adequate number of doctors, pharmacists and other health care providers willing to serve Medi-Cal patients.
In a misguided attempt to balance the state budget in 2008, California enacted cuts up to 10 percent in reimbursement payments to doctors, dentists, pharmacists and other Medi-Cal providers. Health care providers, including some independent pharmacists, sued the State of California to stop these cuts. Lower courts agreed with the health care providers and granted an injunction to delay the reimbursement reduction. California appealed the lower court decision to the U.S. Supreme Court and earlier this month, the court heard oral arguments that will determine whether individuals will continue to have the right to sue states over changes to the Medicaid program.
Needless to say, the court’s decision will have widespread implications for the future of all Medicaid programs. If health care providers or advocates are no longer able to bring private suits to ensure that the Medicaid program is providing equal access to health care services, who will? Given the dire financial situations that many states are facing, it is likely that a court decision that abolishes the right to bring private suits will lead to a flurry of activity across the country to cut Medicaid services.
It is ironic that this may occur just as California intends to enroll three to five million Californians into the Medi-Cal program to comply with President Obama’s Affordable Care Act.
In 2011, California once again cut 10 percent in reimbursement payments to providers. The fact is that these cuts to Medi-Cal will make it extremely difficult, if not impossible, for many pharmacists, doctors, dentists and other providers to continue participate in the program. If Medi-Cal cannot provide adequate reimbursements to providers, access to patient care will suffer greatly and Medi-Cal could effectively be destroyed for the sake of short-term budget fix.
A recent California Pharmacists Association survey of its membership makes it clear that pharmacies are at their breaking point and will have no choice but to leave the Medi-Cal program. When presented with the facts that Medi-Cal would no longer cover the cost of the drug and pharmacist’s services, seven-in-ten (72%) said they would decline to fill Medi-Cal prescriptions, which is contrary to pharmacist’s longstanding record of service to these patients.
We remain hopeful that the Supreme Court will uphold the right of private parties to bring suits to ensure that the Medi-Cal program can continue to provide health care to the neediest residents. In the meantime, the state should seek ways to cut costs in the Medi-Cal program that will save money without compromising care. For example, Medi-Cal should stop mandating that pharmacies dispense brand-name drugs that cost hundreds of dollars when generic drugs are available at a much more cost-effective rate. This mandate causes many pharmacies to lose money when filling Medi-Cal prescriptions.
Provider cuts to pharmacy services may satisfy this year’s state budget, but the result will be an overall increase in costs as patients seek care from hospital emergency departments. Over the long term, these cuts will lead to higher chronic disease rates and utilization of more expensive health care services, resulting in much greater state financial resources as opposed to realizing any cost savings.