An appellate court ruled today that a California law improperly stopped funding certain medical services, including dental care, which health clinics had provided to Medicaid patients.
Federal law requires states participating in Medicaid to reimburse clinics serving poor populations for a range of medical services to underserved communities, including dental care, optometry, podiatry, chiropractic care, and speech therapy, the 9th U.S. Circuit Court of Appeals ruled, according to an Associated Press story.
The appellate court said only Congress can change the terms of Medicaid coverage, which are now written to reflect the services covered by Medicare.
Because Medicare "unambiguously defines the Clinics' services to include services performed by dentists, podiatrists, optometrists, and chiropractors, in addition to services provided by doctors of medicine and osteopathy," eliminating those services for Medi-Cal recipients "would do violence" to the program, Judge Dorothy Nelson said.
The appellate court reverses a trial court's finding.
Anthony Wright, executive director of the nonprofit advocacy group Health Access California, was pleased with the ruling.
“These were short sighted and cruel cuts that were penny wise and pound foolish,” he told DrBicuspid.com. “Most of the savings from these cuts evaporated when people turned to emergency rooms for care. This creates legal pressure to fully restore these benefits and is important for California consumers and our health system.”
Legislators cut $135 million in 10 optional Medi-Cal benefits in 2009, but the majority of the cuts were to the state's Denti-Cal program, which accounted for $110 million, Wright noted.
The state had cut coverage for optional Medi-Cal benefits, including Denti-Cal and podiatry services, in response to budget shortages. Such care was optional because it was not provided by medical doctors, the state said.
Community clinics then sued, claiming the state didn't follow the administrative process correctly with the federal government to initiate the cuts. A judge issued an injunction against the cuts in October 2010.
In May 2011, the U.S. Centers for Medicare and Medicaid Services approved California's request for the cuts, backdated to July 2009. The state Department of Health Care Services, which oversees Medi-Cal, then asked clinics to repay the money it paid to clinics for dental services between October 2010 and May 2011.
Today's ruling stems from a lawsuit brought by the California Association of Rural Health Clinics and the Avenal Community Health Center in Kings County. The case was one of several challenges that healthcare providers and patients have brought over California's Medi-Cal cuts.
Last month, California legislators and Gov. Jerry Brown approved a budget that restores some dental benefits for adult beneficiaries of Medi-Cal.
Some $77 million has been slated for dental coverage beginning next year; that coverage will include preventive care, restorations, and full dentures, but does not include partial dentures.
The restoration of benefits, which still needs final budget approval, would begin in May 2014, according to the California Dental Association (CDA). Endodontic services may be included on a case-by-case basis, the CDA said, but full coverage details are not yet available.
