Patients and providers case ascends to supreme court

The United States Supreme Court will hear a case to determine whether Medicaid recipients and providers can sue a state government for failing to pay rates required by the federal Medicaid Act. The Act requires that government-insured and privately-insured patients have equal access to medical care. The Supreme Court’s ruling in the case of Douglas vs. Independent Living Center of Southern California could have huge implications for the more than 7 million Californians currently enrolled in the state's Medicaid progam, as well as for the program's physicians. The California Medical Association (CMA) is a party in the case. A number of state-plan amendments (SPAs) submitted by the State of California sit with the Centers for Medicaid & Medicare Services (CMS). The SPAs each propose significant cuts to Medi-Cal, which is California’s Medicaid program. The SPAs would, among other things, cut physician reimbursement, limit the number of times a patient can see a physician per year, and implement mandatory patient co-pays. “The state plan amendments submitted by California to CMS would severely reduce Medi-Cal patients' access to medical care,” Francisco J. Silva, general counsel and vice president of the California Medical Association said. “The proposed cuts would mean that a primary-care physician would only be reimbursed $11 for a Medi-Cal patient visit. Physicians have to pay their staffs and keep their doors open, and these rates would just not allow for them to do that and accept Medi-Cal patients.” It is through Medi-Cal that physicians, dentists, pharmacists, adult day-care providers, clinics and hospitals provide health-care services to low-income seniors, families, children, and people with disabilities. With preventive-care services, the intent is to lower the incidents of patients being forced to seek costly emergency-room care or hospital stays. “The issue before the U.S. Supreme Court is crucial to the future of how patient advocacy will unfold,” said San Diego physician Theodore Mazer, M.D. “If patients can’t fight for themselves, and as physicians, we can’t either, then who is left to stand up for the group of people that needs our help the most?” Mazer, an ear, nose and throat doctor, said that he treated Medi-Cal enrollees for over 20 years, until the state began seeking reimbursement cuts. Eighteen months ago, he stopped accepting new Medi-Cal patients, and is an individual party in the lawsuit. “It’s unfortunate that the State has made us choose between accepting new Medi-Cal patients and keeping our practices viable,” he asserted.