Medi-Cal caps: theeey’re baaack…

A budget is never done until signed. But it’s still surprising when a cut that many thought was rejected by both houses and soundly defeated comes back, even in a more limited form.

Both the Assembly and Senate rejected Governor’s proposal to institute a “hard cap” that would limit patients with Medi-Cal coverage to just 10 office visits per year, for a reduction of $392.9 million ($196.5 million GF).

The new proposal adopted by the Budget Conference Committee this afternoon goes as follows:

Due to a fiscal crisis, an alternative of a “soft cap” at 7 visits is proposed for a reduction of $89.7 million ($44.9 million GF). This “soft cap” would apply to Adults. Children (21 years and under), pregnant women, and residents in Long-Term Care facilities are exempt. The “soft cap” would apply to both Medi-Cal Fee-for-Service and Managed Care plans.

It affects outpatient primary care and specialty care provided under the direction of a Physician in the following settings: Hospital Outpatient Department; Outpatient Clinic; Federally Qualified Health Centers (FQHCs); Rural Health Centers; and Physician Offices.

All visits above 7 would be subject to Physician “self-certification” that they are medically required. The savings level assumes that 15 percent of the visits above 7 would not be certified. An October 1, 2011 implementation date is assumed.

Health Access California promotes quality, affordable health care for all Californians.

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