Governor Brown is coming back from Washington, DC, from a series of meetings–with his fellow Governors, our U.S. Senators, our Congressional delegation, various Administration officials, and with President Obama.
With everything going on, I’m legitimately surprised that Governor Brown spent so much time lobbying the federal government to give him more authority to cut Medi-Cal.
In particular, one item he focused on was the federal government’s recent rejection of a request to allow the state to impose significant new cost-sharing on millions of low-income Californians. Last year’s budget included the provision to impose $5 co-pays for doctor visits and prescription drugs, and $50 for an emergency room visit (and $100 for a night in the hospital), all targeted at families making less than $900/month.
The problem with the request is not just that it would put a significant financial barrier between patients and needed care, making some Caliornians make poor choices for their health–including life-and-death decisions. It’s that it is illegal under federal law. The original Medicaid law only allows “nominal” cost sharing for low-income patients–and there’s no way that $50 for an emergency room visit, given the patient’s meager income, in nominal.
Thankfully, Health and Human Services Secretary Kathleen Sebelius, herself a former Kansas Governor, seemed to be clear with Governor Brown that he can’t do that–but suggested other changes might be doable.
Let’s be clear–the Obama Administration and its Centers for Medicaid and Medicare Services (CMS) has given significant flexibility to California and other states. For example, earlier this year, the Administration approved a major provider rate reduction by another 10%–despite the fact that California’s Medi-Cal rate is particularly low already. While CMS curtailed the worst of the proposals, it approved the vast majority of the provider rate cuts, over the objectice of the appeals courts. Previously to that, California was granted a major Medicaid waiver that brought the potential of a new influx of money. So California has gotten significant flexibility under its “waiver.”
It’s just troubling that Governor Brown is using his rare face time with President Obama on something so wrong, and illegal to boot.