ADVOCACY NEEDED

Fiscal Year 2008-09 Budget Cuts

Governor Schwarzenegger has proposed dramatic cuts for Medi-Cal services and programs in his budget for the coming fiscal year. These cuts would cause significant losses in health care services to the neediest patients in the state.

Budget deliberations are going on now in Sacramento. It is important that everyone contact their elected representatives to urge them NOT to make the cuts in Medi-Cal that the Governor has proposed.

Here are talking points to use when contacting your elected representatives to protest these cuts. These were developed by the California Primary Care Association. You may use the ones you think are most important when you call, write or e-mail your representatives.

CCHC stands for Clinics & Community Health Centers. Feel free to change this to the name of your clinic, organization or yourself.

Traditional Clinic Programs

· CCHCs strongly oppose the Governor’s proposed cuts to traditional clinic programs:

o Expanded Access To Primary Care (EAPC) - $4.5 million cut ; 63,000 more uncompensated patient visits;

o Seasonal/Agricultural/Migratory Workers (SAMW) - $690,000 reduction; 21,756 more uncompensated medical, dental and health education patient visits;

o Rural Health Services Development (RHSD)  - $820,000 reduction; 40,592 more uncompensated patient visits;

o Indian Health (IH) - $650,000 reduction; 73,469 more uncompensated medical, dental, and public health nursing patient visits

o Grant-in-Aid (GIA) - $60,000 reduction; 1,700 more uncompensated patient visits

· All told, Governor Schwarzenegger’s intended cuts amount to a $6.7 million reduction to clinic-specific programs that go toward providing care to our state’s uninsured and underserved populations.

· Governor Schwarzenegger’s cuts translate into hundreds of thousands of uncompensated patient-encounters for community clinics that are already financial strapped.

· The non-partisan Legislative Analyst’s Office (LAO) asserts that cutting EAPC and other safety net programs will lead to a shift in where patients go to receive their health care, most likely to costlier venues such as hospital emergency rooms.  

· The LAO also states that these cuts will result in an additional burden to already overcrowded emergency rooms that will ultimately diminish the net savings to the state.

· CCHCs urge the Legislature to fight the Governor on these cuts and protect these critical programs.

Medi-Cal Optional Benefits – Adult Dental

· CCHCs strongly oppose the Governor’s proposed cuts to optional benefits under Medi-Cal.

· The elimination of psychological services chiropractic care, incontinence creams and washes, acupuncture, audiology, optometry, opticians and optical labs, podiatry, speech therapy, and especially adult dental will have a devastating impact on CCHCs.

· Medi-Cal adults constitute almost 40% percent of clinic dental programs and generate about $56.5 million revenue each year.

· The Governor’s proposal eliminates clinics’ primary payer from which their entire dental programs function.

· Although clinics would still be able to secure Medi-Cal reimbursement for dental services provided to children, maintaining a dental practice without a payer source for the Medi-Cal eligible parents will be unsustainable.

· Under the Governor’s proposal, clinic dental programs statewide face the very real possible of having to shut down, or at the very least scale down the services they provide.

· CCHCs well understand the fiscal predicament that the Governor and Legislature are in with respect to the projected budget deficit, however cutting the optional benefits under Medi-Cal, could do significant harm to CCHCs and their patient population.

· Clinics urge Legislators to reject the Governor’s proposal to eliminate Medi-Cal Adult Dental.

Quarterly Status Report (QSR)

· CCHCs strongly oppose the Administration’s proposal to institute quarterly status reports (QSRs) for families in Medi-Cal.

· While seemingly bureaucratic in nature, establishing QSRs will mean the termination of thousands of individuals from the rolls of Medi-Cal.

· By requiring Medi-Cal adults and children to complete a detailed form about income and other personal information every quarter, this budget gimmick preys on our state’s most vulnerable, counting on the fact that many will neglect to return their status reports and will, in turn, be dropped from Medi-Cal coverage.

· Instituting the QSR means an entirely new uninsured population for already overloaded community clinics to serve.

Licensing Fees

· CCHCs strongly oppose any effort to increase Licensing and Certification fees.

· Over the past two fiscal years (2006-07 and 2007-08), clinics have been forced to endure a 2800% increase in L&C fees ($30 to $871 currently) yet have seen minimal improvement in the actual services provided to clinics.

· Given the Administration’s inability to provide any hard evidence as to the necessity of increasing clinic L&C fees yet again, as well as their inability to address concerns about their fee-setting methodology & workload calculations, the State Senate Budget Subcommittee 3 recently voted to decrease L&C fees to $600 (from its current $871) - as opposed to the proposed 55% increase in fees to $1350 in the Governor’s Budget.

· Clinics urge the Assembly Budget Subcommittee 1 members to do the same.

Restricted Medi-Cal for Legal Immigrants

· California’s community clinics and health centers strongly oppose the Governor’s proposed reduction to full-scope Medi-Cal benefits for adults and children who are Legal Permanent Residents (LPR) and immigrants who reside under the color of law (PRUCOL).

· The Governor’s proposal reduces current coverage to Restricted Medi-Cal for immigrants who are otherwise eligible except that they have been legally residing in the U.S. for less than five years.

· Restricted Medi-Cal covers only emergency services, pregnancy-related services, long-term care in a nursing facility, and breast and cervical cancer treatment.

· Cutting essential benefits, like preventative care, for this population will have deleterious impact on CCHCs. One community clinic in the Bay Area reported that 1,700 of its patients are LPR and account for more than $1.3 million in revenue.

· Currently, California is one of six states that provide full-scope Medi-Cal to LPR and PRUCOL populations. Limiting coverage is not only inhumane, but a poor financial decision. These individuals will continue to require health care, but will now turn to the emergency room for much costlier care.

Undocumented Immigrants and Restricted Medi-Cal

· CCHCs strongly oppose the Governor’s proposal to require LPRS/PRUCOL individuals to apply for Restricted Medi-Cal on a monthly basis

· In 2002 California paid an average annual Medicaid expenditure of $1,004 per Restricted Benefit Immigrant, as opposed to Florida that paid $5,237.

· California’s costs are less because pre-enrolled immigrants use services sparingly and in some cases they receive medical care at an earlier and less expensive disease stage.

1931(b) Rollback for Medi-Cal Applicant Families

· CCHCs strongly oppose the Governor’s proposal to roll back the eligibility requirements for 1931(b) Medi-Cal applicants

· The income level requirement for existing 1931(b) families is $1157 per month for a family of three and no limit exists for the number of hours a month a family member can work

· The Governor’s proposal decreases the income-level eligibility to $957 per month for a family of three and imposes a 100 hour per month cap on the number of hours a family member can work

· The increased administrative burden imposed on current Medi-Cal beneficiaries, such as mid-year or quarterly status reports, can result in current beneficiaries becoming Medi-Cal applicants subject to the new 1931(b) rollback limitations