KHN Morning Briefing

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Appeals Court Strikes Down Calif.’s Lowered Medi-Cal Payments For Hospital Outpatients

The state cut its Medicaid reimbursements to hospitals by 10 percent for services that didn't require an overnight stay and eventually got approval from the Obama administration. The federal appeals court said the government can adopt such measures only if it shows that access to care is not affected.

Los Angeles Times: U.S. Appeals Court Says Medi-Cal Cut To Hospitals Was Illegal
A U.S. appeals court decided Monday that the federal government wrongly approved California’s request to temporarily cut Medi-Cal reimbursement by 10% during the recession for hospital outpatient care. The ruling by a three-judge panel of the U.S. 9th Circuit Court of Appeals said the federal government can approve such cuts only if evidence shows that the recipients of aid will have access to the same services as the general population. ... If the ruling stands, the state and the federal government will have to pay back California hospitals hundreds of millions of dollars, said Robert Leventhal, who represented more than 50 California hospitals in the challenge. (Dolan, 8/7)

San Francisco Chronicle: SF Court Reverses Approval On Lowered Medi-Cal Outpatient Rates
The court case concerned rates for treatment of Medi-Cal patients who do not require an overnight hospital stay. In July 2008, the state reduced Medi-Cal rates for those outpatient services by 10 percent for a specific eight-month period in 2008-09, then raised them back to their earlier levels eight months later after the federal government withheld approval. In 2011, California lowered all of its Medi-Cal rates by 10 percent to balance its budget, and also sought and received approval from President Barack Obama’s health care agency for the earlier eight-month reduction. (Egelko, 8/7)

San Jose Mercury News: Paying Doctors More - Now Will They Treat More Poor Californians?
Yes, while debate over the future of Obamacare waxes and wanes in Congress, California doctors are happily preparing for their first state pay increase in Medi-Cal in 17 years. ... Even so, civil rights groups and some California labor unions are suing the state to pay doctors significantly more -- the latest in a long history of legal actions that blame meager Medi-Cal reimbursement rates for delays in patient care. ... Here’s what you need to know about how physicians may respond -- and how it could impact the ability of 13 million Californians to see the doctors they need, when they need them. (Levin, 8/7)

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