California Community Clinics File Lawsuit Against State Over Budget Cuts to Critical Medi-Cal Benefits
Published: 2009-05-30 16:02:23
Author: California Primary Care Association | April 30, 2009
SACRAMENTO, Calif., Apr 30, 2009 (BUSINESS WIRE) -- The California Primary Care Association today announced that it is filing a lawsuit against the state of California to prevent the elimination of certain critical Medi-Cal benefits currently being provided by California's Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs).
In February, the Governor and State Legislature enacted a budget that eliminated the provision of nine Medi-Cal "optional benefits," including adult dental, psychology, chiropractic, acupuncture, speech therapy, incontinence creams and washes, audiology, optometry, and podiatry services. The elimination of these benefits will be effective July 1, 2009.
The lawsuit seeks a writ of mandatepreventing the State from eliminating Medi-Cal adult dental, chiropractic, optometry, podiatry, and psychology services when provided by an FQHC or RHC. Because these services are included in the definition of FQHC and RHC services under state and federal law, FQHC and RHC services are mandatory and not "optional" Medicaid benefits. The suit was submitted jointly by the California Primary Care Association and two of its member health centers, Clinicas Del Camino Real, Incorporated in Ventura, and Southern Trinity Health Services in Trinity.
Filed in the State Superior Court of Sacramento County, the lawsuit contends that the State of California has mischaracterized certain core FQHC/RHC services as optional benefits, and that the State must continue to reimburse FQHCs/RHCs for core services provided to Medi-Cal beneficiaries. The suit maintains that FQHC services are a mandatory Medicaid benefit; that Californiarecognizes FQHC services as a Medi-Cal covered benefit; that federal and state law both define FQHC services in terms of the types of providers who render services rather than the types of services that are rendered; and that, consistent with federal law, California's definition includes the services of dentists, chiropractors, optometrists, podiatrists and psychologists as FQHC core providers.
"California's Welfare and Institutions Code and State Plan clearly protect reimbursement for FQHC services that are provided by 'core' providers, as defined both federally and by the state," said Carmela Castellano-Garcia, president and CEO of the California Primary Care Association. "The legal definition of 'physician' includes dentists, chiropractors, optometrists, podiatrists and psychologists, and therefore means that their services are indeed not optional for FQHCs. Despite the state's effort to eliminate Medi-Cal optional benefits, the fact remains that the key state and federal statutes defining the FQHC reimbursement structure remain intact and were not altered by the budget bill.
"Not only that, but because FQHCs have a unique billing process with the State, one under which they are entitled to receive a flat rate per patient visit regardless of the type of service provided, we are questioning whether clinics were even included in the Administration's cost estimates for eliminating the optional benefits. The Department of Health Care Services has not been able to substantiate their claims that FQHCs were included in their impact analysis."
Medi-Cal FQHC services, including those mischaracterized by the state as optional, allow California community clinics and health centers to serve and receive reimbursement for approximately 1.2 million patient encounters each year. Medi-Cal adult dental alone translates to $56 million a year and comprises approximately 40 percent of the budget from which FQHCs operate their full dental programs.
"The state's action to eliminate Denti-Cal could have devastating consequences to patients who weren't even directly targeted by the cut, meaning the non-adult Medi-Cal populations such as children and the developmentally disabled," said Roberto Juarez, CEO of Clinicas Del Camino Real, Inc. "My health center will do whatever it can to continue to serve everybody who comes through our doors. However, these cuts will likely mean the closure of at least two of our five dental practices."
"Eliminating reimbursement for these services could be catastrophic in my area, as my clinic is now in danger of full closure and is the only health care facility and ambulance service providerwithin 1250 square miles," said Cathy Larsen, executive director of Southern Trinity Health Services. "As one of the plaintiffs in this lawsuit, we are confident that the court will take action to protect the rights of FQHCs like mine, whose mission is to provide a medical home to our state's low-income, underserved and uninsured populations."
The plaintiffs in this lawsuit will seek to have the matter heard and resolved prior to July 1, 2009, the date on which the State has indicated it will stop reimbursing FQHCs and RHCs for the benefits at issue.
About CPCA
California Primary Care Association (CPCA) is the statewide leader and recognized voice representing the interests of California community clinics and health centers and their patients. CPCA represents more than 800 not-for-profit community clinics and health centers (CCHCs) who provide comprehensive, quality health care services, particularly for low-income, uninsured and underserved Californians, who might otherwise not have access to health care.
About Clinicas Del Camino Real, Inc.
Clinicas Del Camino Real, Inc. is a not-for-profit Federally Qualified Health Center dedicated to providing quality, comprehensive and preventative health careservices to Ventura County's community. It is the explicit mission of Clinicas to save lives and restore good health to the underserved population of the county at rates that are consistent with an individual's ability to pay. Clinicas is committed to providing bilingual and bicultural services on a personal and humane basis in an effort to reach members of the community who are traditionally underserved.
About Southern Trinity Health Services
Southern Trinity Health Services is a not-for-profit Federally Qualified Health Center dedicated to improving the quality of life in southern Trinity and southeastern Humboldt Counties by providing access to quality, comprehensive, innovative, and integrated primary health care and emergency medical services regardless of ability to pay.
SOURCE: California Primary Care Association
CPCA
Chris Patterson,
916-440-8170
or
Clinicas Del Camino Real
Roberto Juarez,805-659-1740
or
Southern Trinity Health Services
Cathy Larsen,707-574-6616
MarketWatch
Published: 2009-05-30 16:02:23
Author: California Primary Care Association | April 30, 2009
SACRAMENTO, Calif., Apr 30, 2009 (BUSINESS WIRE) -- The California Primary Care Association today announced that it is filing a lawsuit against the state of California to prevent the elimination of certain critical Medi-Cal benefits currently being provided by California's Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs).
In February, the Governor and State Legislature enacted a budget that eliminated the provision of nine Medi-Cal "optional benefits," including adult dental, psychology, chiropractic, acupuncture, speech therapy, incontinence creams and washes, audiology, optometry, and podiatry services. The elimination of these benefits will be effective July 1, 2009.
The lawsuit seeks a writ of mandatepreventing the State from eliminating Medi-Cal adult dental, chiropractic, optometry, podiatry, and psychology services when provided by an FQHC or RHC. Because these services are included in the definition of FQHC and RHC services under state and federal law, FQHC and RHC services are mandatory and not "optional" Medicaid benefits. The suit was submitted jointly by the California Primary Care Association and two of its member health centers, Clinicas Del Camino Real, Incorporated in Ventura, and Southern Trinity Health Services in Trinity.
Filed in the State Superior Court of Sacramento County, the lawsuit contends that the State of California has mischaracterized certain core FQHC/RHC services as optional benefits, and that the State must continue to reimburse FQHCs/RHCs for core services provided to Medi-Cal beneficiaries. The suit maintains that FQHC services are a mandatory Medicaid benefit; that Californiarecognizes FQHC services as a Medi-Cal covered benefit; that federal and state law both define FQHC services in terms of the types of providers who render services rather than the types of services that are rendered; and that, consistent with federal law, California's definition includes the services of dentists, chiropractors, optometrists, podiatrists and psychologists as FQHC core providers.
"California's Welfare and Institutions Code and State Plan clearly protect reimbursement for FQHC services that are provided by 'core' providers, as defined both federally and by the state," said Carmela Castellano-Garcia, president and CEO of the California Primary Care Association. "The legal definition of 'physician' includes dentists, chiropractors, optometrists, podiatrists and psychologists, and therefore means that their services are indeed not optional for FQHCs. Despite the state's effort to eliminate Medi-Cal optional benefits, the fact remains that the key state and federal statutes defining the FQHC reimbursement structure remain intact and were not altered by the budget bill.
"Not only that, but because FQHCs have a unique billing process with the State, one under which they are entitled to receive a flat rate per patient visit regardless of the type of service provided, we are questioning whether clinics were even included in the Administration's cost estimates for eliminating the optional benefits. The Department of Health Care Services has not been able to substantiate their claims that FQHCs were included in their impact analysis."
Medi-Cal FQHC services, including those mischaracterized by the state as optional, allow California community clinics and health centers to serve and receive reimbursement for approximately 1.2 million patient encounters each year. Medi-Cal adult dental alone translates to $56 million a year and comprises approximately 40 percent of the budget from which FQHCs operate their full dental programs.
"The state's action to eliminate Denti-Cal could have devastating consequences to patients who weren't even directly targeted by the cut, meaning the non-adult Medi-Cal populations such as children and the developmentally disabled," said Roberto Juarez, CEO of Clinicas Del Camino Real, Inc. "My health center will do whatever it can to continue to serve everybody who comes through our doors. However, these cuts will likely mean the closure of at least two of our five dental practices."
"Eliminating reimbursement for these services could be catastrophic in my area, as my clinic is now in danger of full closure and is the only health care facility and ambulance service providerwithin 1250 square miles," said Cathy Larsen, executive director of Southern Trinity Health Services. "As one of the plaintiffs in this lawsuit, we are confident that the court will take action to protect the rights of FQHCs like mine, whose mission is to provide a medical home to our state's low-income, underserved and uninsured populations."
The plaintiffs in this lawsuit will seek to have the matter heard and resolved prior to July 1, 2009, the date on which the State has indicated it will stop reimbursing FQHCs and RHCs for the benefits at issue.
About CPCA
California Primary Care Association (CPCA) is the statewide leader and recognized voice representing the interests of California community clinics and health centers and their patients. CPCA represents more than 800 not-for-profit community clinics and health centers (CCHCs) who provide comprehensive, quality health care services, particularly for low-income, uninsured and underserved Californians, who might otherwise not have access to health care.
About Clinicas Del Camino Real, Inc.
Clinicas Del Camino Real, Inc. is a not-for-profit Federally Qualified Health Center dedicated to providing quality, comprehensive and preventative health careservices to Ventura County's community. It is the explicit mission of Clinicas to save lives and restore good health to the underserved population of the county at rates that are consistent with an individual's ability to pay. Clinicas is committed to providing bilingual and bicultural services on a personal and humane basis in an effort to reach members of the community who are traditionally underserved.
About Southern Trinity Health Services
Southern Trinity Health Services is a not-for-profit Federally Qualified Health Center dedicated to improving the quality of life in southern Trinity and southeastern Humboldt Counties by providing access to quality, comprehensive, innovative, and integrated primary health care and emergency medical services regardless of ability to pay.
SOURCE: California Primary Care Association
CPCA
Chris Patterson,
916-440-8170
or
Clinicas Del Camino Real
Roberto Juarez,
805-659-1740
or
Southern Trinity Health Services
Cathy Larsen,
707-574-6616
MarketWatch