Perspectives
The Governor’s proposed 2008-9 budget would cut more than $2 billion in funding from Medi-Cal, the program that provides health care to low-income families in California. Different members of the Alliance for Patient Care offer their perspective below on the impact the cuts will have on the people and organizations their groups represent.
SENIORS
Lydia Missaelides, MHA, Executive Director, California Association for Adult Day Services:
“The additive impact of these proposed cuts in health care on our most vulnerable low income frail elders will put their very lives at risk. Adult day health care and Alzheimer’s day care centers are small, important programs designed to keep people living in their communities. They rely almost 100% on Medi-Cal funding. A 10 percent cut in the rate, plus five weeks of no cash flow will shut down a significant number of these programs, some permanently. Without the support of day services, most displaced individuals will end up in a nursing home, costing the state four times as much.
The short term savings the Governor proposes are, in fact, more costly than the system in place today. Seniors ousted from adult day care will be forced into nursing homes at four times the cost, end up in emergency rooms, or a family member will have to quit their job to care for them. California’s budget crisis should not throw fragile elders and their families into crisis.
And no matter how draconian this is on California families, it is hard to imagine a more devastating impact than the closure of centers caring for people with Alzheimer’s or other serious health problems. This brings shame to our state.”
The California Association for Adult Day Services (CAADS) is a non-profit statewide association supporting the development of adult day services as an alternative to institutional care. Ninety percent (90%) of the people served by ADHC programs are very low income Californians, including those who are medically frail, have Alzheimer’s disease or a similar dementia, are recovering from a stroke or a fall, or have chronic medical conditions that need monitoring and treatment by skilled health professionals.
***
Jack Christy, Director of Public Policy, Aging Services of California:
“The Governor’s budget proposals have severe consequences for our most vulnerable citizens. Delaying Medi-Cal payments supporting aged and disabled Californians in nursing homes by a month will create extreme hardships for thousands of Medi-Cal beneficiaries dependent on weekly payments for their care. The delay could also put struggling providers into bankruptcy, which would cause the dislocation of this frail population.”
Aging Services of California is the leading advocate for quality nonprofit senior living and care in the state. The public-interest association represents more than 400 nonprofit providers of aging services – including affordable housing, continuing care retirement communities, assisted living, skilled nursing, and home and community-based care – that collectively serve more than 100,000 seniors.
CHILDREN
Dr. Thomas Klitzner, President, Children’s Specialty Care Coalition
“We have grave concerns over today’s announcement of proposed budget cuts to Medi-Cal and CCS physician rates because it will further jeopardize access to health care services for California’s sickest children.
Access to waiting lists is not access to health care. We are hopeful we can continue to work with the Governor and the Legislature to find solutions that do not inflict harm on California’s most gravely ill, vulnerable children – children with cancer, congenital heart disease, cleft palates and cystic fibrosis.”
Children’s Specialty Care Coalition is a nonprofit association representing more than 1,000 pediatric specialists in California.
PEOPLE WITH DISABILITIES
Rick Chavez, CPO, President, California Orthotics and Prosthetics Association:
“Without at least rejecting the proposed Medi-Cal provider cut, vulnerable patients may continue to suffer from substantial and lasting disabilities. These patients, many of whom are amputees, will struggle to achieve proper use and maintenance of worn out and defective O&P devices, increasing the likelihood of chronic disability and injury.”
The California Orthotics & Prosthetics Association (COPA) is dedicated to patients suffering from such ailments as birth defects and limb loss by striving for fair provider reimbursement and ensuring competent and ethical treatment of patients.
PROVIDERS
Richard Frankenstein, M.D., President, California Medical Association:
“It is inconsistent to talk about expanding health care coverage for low-income families at the same time we are cutting the budget of the state’s health care program for low-income families. Cutting the budget for Medi-Cal will only exacerbate the problems the Governor’s health reform plan was designed to solve. Fewer Medi-Cal dollars will mean less access to doctors for low-income families, more patients in emergency rooms, and higher health care costs for everyone.”
The California Medical Association represents 35,000 California physicians
***
Dr. David Priver, San Diego OB-GYN, American College of Obstetrics and Gynecology District IX Fellow:
“At the current time in the state of California, obstetrical care hangs by a slender thread as providers barely recoup their costs in caring for Medi-Cal patients. A 10% reimbursement decrease will almost certainly result in providing care at a loss, something that cannot and will not be done. At this point, the thread will break and patients will no longer have access to prenatal care, a development which will lead to complications and, ultimately, much higher costs" the other day.
***
Carla Kakutani, President, California Academy of Family Physicians:
"Cutting $1.1 billion in state funds from Medi-Cal would be devastating to our patients and our members. The state’s most disadvantaged people will have trouble finding a clinic or physician to treat them and some of the state’s family physician training programs may have to close down. California is already in the midst of a primary care physician shortage crisis – our communities need more family physicians, not fewer. Investing in family medicine is one of the best health care investments California can make.”
The 7,000-member California Academy of Family Physicians champions the cause of family medicine physicians and their patients. Family physicians are trained to treat an entire family’s health care needs, and serve a broad base of patients in urban, suburban and rural areas, often in California’s most underserved areas.
***
Ronald Morton, M.D., President, California Academy of Eye Physicians and Surgeons:
“As a surgical physician specialty treating the most chronic eye diseases, ophthalmology has had a long history of advocating for increasing access to high quality medical care in the Medi-Cal program. Unfortunately, the proposed 10 percent provider cut to an ophthalmologist is counterintuitive in accomplishing that objective.”
The California Academy of Eye Physicians and Surgeons serves the total visual health care needs of Californians through public and professional education, membership services, and legislative advocacy.
***
Christopher Ohman, CEO and President of the California Association of Health Plans:
“The California Association of Health Plans’ members provide Medi-Cal coverage to nearly half of the state’s 6.6 million Medi-Cal beneficiaries, and we are very concerned that this big a rate cut will drive even more doctors and other medical providers out of the system and threaten access to care for those Californians who must rely on Medi-Cal for their health care coverage. A whopping 10 percent cut in the reimbursement rates for Medi-Cal managed care poses a huge threat to the health care of millions of Californians who have no place else to turn for coverage. While they would continue to be covered by Medi-Cal under the governor’s proposal, these Californians will face even greater obstacles than they already do to find physicians and other medical providers willing to accept these substantially lower Medi-Cal payments.”
The California Association of Health Plans is a statewide trade association representing 40 health plans that provide health coverage to more than 21 million Californians.
***
Beth Grivett, PA-C, Government Affairs Committee Chair, California Academy of Physician Assistants:
“Unfortunately, due to egregiously low Medi-Cal reimbursement rates, many providers have chosen to simply render services on a ‘pro bono’ basis. I’m afraid that with this newly proposed cut that our supervising physicians will simply stop seeing Medi-Cal patients all together.”
The California Academy of Physician Assistants has a long tradition of advocating for expanding access to health care by promoting regulatory and legislative changes that will enhance the ability of PAs to provide safe, cost-effective medical care to all Californians.
***
Dawn Benton, Executive Vice President & CEO, California Society of Health-System Pharmacists:
“Our pharmacists play a critical role in safely managing the drug regime of Medi-Cal patients. The thought of jeopardizing access to their inpatient care by way of Medi-Cal provider cuts is very tragic.”
The California Society of Health-System Pharmacists (CSHP), founded in 1962, represents nearly 4,000 pharmacists and associates who serve patients and the public through the promotion of wellness and rational drug therapy.
***
William F. Updyke, , DC, California Chiropractic Association President:
"Elimination of chiropractic care will only limit a patient’s choice of health care provider and force more patients into our already over-crowded, expensive emergency rooms."
Established in 1928, the California Chiropractic Association is a Sacramento-based statewide, nonprofit organization of chiropractic doctors and allied industries. CCA’s mission is Promoting high standards of professionalism and patient care through education, advocacy and accountability.
***
PUBLIC HEALTH PROGRAMS
Elliott Robinson, Director of the Monterey County Department of Social and Employment Services, Vice President of Administration of County Welfare Directors Association of California:
“Budgeting savings of over $184 million by increasing the Medi-Cal paperwork burden and assuming more than a hundred thousand people will lose health insurance because they are not able to stay on top of the process is bureaucracy at its worst. Reducing the number of front-line staff available to help low-income working families who do not get insurance from their job is even more short-sighted. These cuts will hit many families tending to the crops in the Salinas Valley particularly hard, where nearly one third of the residents in our South County cities rely on Medi-Cal for preventive, acute and chronic health care needs. Hard-working families deserve better than this.”
The County Welfare Directors Association of California (CWDA) is a non-profit association representing the human service directors from each of California's 58 counties. The Association's mission is to promote a human services system that encourages self-sufficiency of families and communities, and protects vulnerable children and adults from abuse and neglect.