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Doctors and pharmacists are suing California over the latest round of Medi-Cal budget cuts, saying the state has refused to show what impact the reductions would have on health care for low-income patients.

The state Department of Health Care Services must document that Medi-Cal cuts will not undermine access to care to receive federal approval. As part of the state budget this year, Gov. Jerry Brown and state lawmakers approved a 10 percent cut in reimbursements to Medi-Cal, mandatory co-pays and a soft cap on doctor visits.

The state told the Obama administration this summer it would show how the cuts maintain care for Medi-Cal patients consistent with federal law.

But state officials have refused to make public any such findings, rejecting a Public Records Act request filed by the California Medical Association and the California Pharmacists Association. DHCS rejected a similar request from The Bee in August.

"We strongly believe that the documents (the Centers for Medicare & Medicaid Services) are asking for simply do not exist," said Francisco J. Silva, general counsel for the CMA, in a statement. "Access to care for Medi-Cal patients will most certainly be impacted by the proposed cuts. The repeated refusal to share the information is a clear indication."

Doctors, pharmacists and patient advocates say that reducing Medi-Cal rates by 10 percent will discourage health providers from treating low-income patients. Medi-Cal is California's Medicaid program, and the state already ranks near the bottom among U.S. states in payments to Medicaid providers.

Director Toby Douglas said in an August interview that 10 percent reimbursement reductions were a "legislative goal," and that it is possible the cuts will be lower. Asked if it is possible to maintain adequate Medi-Cal access with 10 percent reductions, Douglas said, "We're in the midst of finalizing the analysis so at this point I can't comment on those kinds of questions."

DHCS said in its August rejection of The Bee's Records Act request that disclosing information would impair the state's ability "to engage in candid policy discussions" with federal officials.

Federal courts and Medicaid officials have previously rejected Medi-Cal cuts. The U.S. Supreme Court began hearing arguments today in one of the cases, Douglas v. Independent Living Center of Southern California, though the court is only examining whether outside groups can file suit to block Medicaid reductions.



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