California in Throes of Medi-Cal Woes

SACRAMENTO — After weeks of wrangling, the California
legislature has rejected a plan to place caps on Medi-Cal equipment
and supplies expenditures that would have forced recipients to dig
into empty pockets for such things as wheelchairs and enteral
nutrition.

Gov. Arnold Schwarzenegger proposed the cuts as part of his
revised 2010-11 budget, which attempts to plug the state’s $20
billion deficit. Under the plan, Medicaid spending for durable
medical equipment would cap at $1,800 annually per Medi-Cal
recipient.

“The governor [put] caps on various items — $1,800 on DME,
$3,600 for urological supplies, so much for wound care,” said Bob
Achermann, executive director of the California Association of
Medical Product Suppliers. “They say it represents the 90th
percentile of what the average beneficiary gets. Unfortunately, if
you’re out of that 90th percentile, you’re out of luck. Most of the
wheelchairs purchased would not be paid for entirely. It would
eliminate oral enteral nutrition.” There would be some exemptions
for children and pregnant women, Achermann said.

Under the proposal, the majority of Medi-Cal beneficiaries would
have been forced to accept whatever they could get or try to find
some money to pay the balance for what they really needed. In the
end, Achermann said, the caps would have saved only $3 million in a
Medicaid budget of $16 billion, and the idea “met with great
resistance in the legislature.”

Still, the budget situation in California is so dire that the
notion could resurface, Achermann said. Even though the legislature
rejected the idea, “it is not to say it couldn’t come back in some
shape or form.”

The deadline for a new budget is June 15, but the California
legislature hasn’t met a budget deadline in years.

“I can see a scenario where it goes until September,” Achermann
said.

However long budget discussions go — with the enormous
unresolved shortfall and legislators scrambling to close the gap
— Medi-Cal recipients won’t be safe until the budget is put
to bed, he said.