Another potential Medicaid nightmare


Gov. Arnold Schwarzenegger this month issued a revised state budget for 2010-11 that proposes capping spending for DME, even power wheelchairs, to about $1,800 per Medi-Cal recipient per year.

“Part of it is, they haven’t been successful in cutting reimbursement rates, so they’re getting desperate,” said Bob Achermann, executive director of the California Association of Medical Product Suppliers (CAMPS). “The other part of it is, the governor is telling the legislature, ‘This is how bad it is; are you going to cut your way out of this? I don’t think so.’”

Medi-Cal reimbursement was cut 10% from July 2008 to March 2009 and then 1% from March 2009 on, but a group of providers, including HME providers, has sued to be exempted from the cut, and it looks like the courts are on their side, Achermann said.

The caps don’t make sense financially, Achermann and others argue. The governor estimates they would save only $3 million.

“Not a lot would change budget-wise,” he said. “We’re still $20 billion in the hole going forward.”

The caps don’t make sense rationally, either, they argue. How can the state cap spending for more costly DME like power wheelchairs?

“If a Medi-Cal recipient needs to replace a $5,000 wheelchair, they’re not going to just pay for the rest out-of-pocket,” he said. “Otherwise, they wouldn’t be on Medi-Cal. They're going to become bed-bound or end up back in a facility.”

Liz Beaulieu