in 2009 must be restore. Here the email.
CDCAN DISABILITY RIGHTS REPORT
#199-2010 – OCTOBER 22, 2010 – FRIDAY
CALIFORNIA DISABILITY COMMUNITY ACTION NETWORK: Advocacy Without Borders: One Community – Accountability With Action - California Disability Community Action Network Disability Rights News goes out to over 55,000 people with disabilities, mental health needs, seniors, traumatic brain & other injuries, veterans with disabilities and mental health needs, their families, workers, community organizations, including those in Asian/Pacific Islander, Latino, African American communities, policy makers and others across California.
To reply to this report write: MARTY OMOTO at martyomoto@rcip.com WEBSITE: www.cdcan.us TWITTER: www.twitter.com - “MartyOmoto”
State Budget Crisis:
Federal Judge’s 33 Page Ruling on Medi-Cal Optional Benefits Case – Could Impact Over 1 Million People
State Says It Will Comply – Not Clear if Judge’s Order Only Covers Rural Health Clinics Or If Other Eliminated Benefits Not Specifically Mentioned In Judge’s Order Are Also Temporarily Restored
SACRAMENTO, CALIF (CDCAN) [Updated 10/22/2010 02:50 PM (Pacific Time)] - Attached to this report is the 33 page ruling by Federal District Court Judge Frank Damrell in the California Association of Rural Health Clinics, et al v. Maxwell-Jolly, et al. that says the State needs to obtain approval first from the federal government before it eliminates Medi-Cal optional benefits. It is not entirely clear from the Judge’s order if his ruling covers the other eliminated benefits (one of which – optometry – was previously reinstated by the State in July) or just the three specific benefits he listed in his order (podiatry, chiropractic services and adult dental).
His ruling however referred to the entire section of the California Welfare and Institutions Code that listed all of the eliminated benefits. [CDCAN Note: Maxwell-Jolly is the director of the Department of Health Care Services – the state agency that oversees California’s Medicaid – called “Medi-Cal” program]
Judge Damrell hwoever rejected the argument that the State could not eliminate the optional benefits – saying those benefits were in fact optional and not required by the federal government or that the elimination violated federal Medicaid laws in terms of reimbursements to rural health clinic providers – which was the main contention of their lawsuit.
The lawsuit was filed March 30, 2010 by Murphy, Austin, Adams, Schoenfeld LLP, a Sacramento based legal firm. Kathryn Doi is the attorney working on the case. [CDCAN Note: The 33 page decision is attached as a pdf file titled “20101020-FederalJudgesOrder-CaliforniaAssociationOfRuralHealthClincs.pdf” The file is a scanned as a document – not as an image, so people with sight impairments using screen readers should be able to read it. For earlier CDCAN Report on this issue with additional details, see CDCAN Report #198-2010]
As reported in CDCAN Report #198-2010, Judge Damrell on Wednesday (October 20) ruled that the State of California could not eliminate certain Medi-Cal optional benefits without approval by the federal government. The Judge wrote in his ruling that the State is enjoined (or stopped) “…further implementation of [California Welfare and Institutions Code Section] 14131.10 with respect to the subject adult dental, podiatry and chiropractic services until the State's SPA [Medicaid State Plan Amendment] is approved by CMS [federal Centers on Medicare and Medicaid Services].”
The Judge, in his October 20th ruling, noted that the Department of Health Care Services did submit an amendment to its Medicaid State Plan for approval by the federal government. Federal law says that the Centers on Medicare and Medicaid Services (CMS) may approve or disapprove of the proposed amendment – or it may request that the state provide more information before it makes a decision. If the federal Centers on Medicare and Medicaid Services fails to act upon the submitted proposed State plan amendment within 90 days, the amendment is considered approved. However, a request for more information from the federal government to the state stops the 90 day clock.
In his October 20th ruling, Judge Damrell wrote that
Judge Damrell in his ruling noted that while the Department of Health Care Services did submit the proposed state plan amendment on June 30, 2009 that eliminated the 9 Medi-Cal optional benefits, “…On October 22, 2009, CMS [Centers on Medicare and Medicaid Services] advised DHCS [Department of Health Care Services] that the proposed SPA [Medicaid state plan amendment] was not approvable as drafted and requested additional information…To date, no SPA [Medicaid state plan amendment] has yet been approved excluding coverage of any of the Medicaid benefits…”
State Says It Will Comply
The Department of Health Care Services, through a spokesman, indicated it would comply with the Judge’s ruling and begin reimbursements for those services to the clinics and noted that the Schwarzenegger Administration would be seeking approval from the federal government, for the elimination of those benefits. No official announcement has been posted on the department’s website yet on the court ruling.
As previously reported the Governor proposed and the Legislature approved in February 2009, as part of the 2009-2010 State Budget passed four months early, the permanent elimination of 9 Medi-Cal “optional benefits” for adults, with certain exceptions (including adults living in intermediate care facilities, nursing facilities and certain other exceptions). Medi-Cal optional benefits for children 21 years or younger were not impacted. The benefits are called “optional” because the federal government does not require the states to provide that specific service and several others as part of their Medicaid program.
Lawsuit Contended That State Needs To Receive Federal Approval First
The Judge’s ruling was a partial – and temporary – victory for the California Association of Rural Health Clinics – and thousands of people with disabilities, the blind, mental health needs and seniors who are Medi-Cal recipients and used or need the Medi-Cal optional benefits that were eliminated in 2009.
The California Association of Rural Health Clinics lawsuit alleged that the State was in violation of federal Medicaid laws, by eliminating the 9 optional benefits, and a second contention that any such elimination required first approval by the federal government (through an amendment to the State’s Medicaid Plan).
Judge Damrell rejected the argument that the State could not eliminate the optional benefits – saying those benefits were in fact optional and not required by the federal government or that the elimination violated federal Medicaid laws in terms of reimbursements to rural health clinic providers – which was the main contention of their lawsuit.
The Judge however agreed with the rural clinics contention that before a optional benefit could be eliminated, the State first had to receive approval from the federal government – which means, if and when the federal government gives approval, then those benefits could be eliminated.
A different lawsuit to block the elimination of the 9 Medi-Cal optional benefits for adults was filed in federal court in August 2009 by the Novato-based Medicaid Defense Fund headed by 82 year old attorney Lynn Carman, but was unsuccessful. That lawsuit was centered on the State’s compliance of the provisions of the federal American Recovery and Reinvestment Act (ARRA). The Medicaid Defense Fund was successful in 2008 in stopping many of the cuts to Medi-Cal providers, which the US Supreme Court is now considering an appeal by the State to take up the case.
What the Judge’s October 20th Ruling Means
· At least temporarily until the State receives approval for the elimination of the optional benefits – those benefits, or at least the ones mentioned in the Judge’s order (see below) are restored – and that Medi-Cal rural community clinics at least would be reimbursed for those services.
· It was not clear if other Medi-Cal providers would be covered under the Judge’s ruling or if the other Medi-Cal optional benefits that were eliminated in 2009 are also temporarily restored – at least temporarily. The Judge’s order however references the entire section that lists all 9 eliminated optional benefits.
· It is not clear yet how long it will take for the federal government to give its approval – and what (if any) transition would take place between that approval and the restoration of the eliminated benefits (meaning would there be a specific future date when the optional benefits – once approval is received from the federal government – would again be eliminated with no provider reimbursement).
· It is not clear how the 21 non-profit regional centers who coordinate services and supports to over 240,000 children and adults with developmental disabilities will be impacted by the federal district court Judge’s ruling. The regional centers, under the 2009-2010 State Budget, are supposed to provide those lost optional benefit services through a person’s “individual program plan” or IPP.
· CDCAN NOTE: To find out if the Judge’s order includes the other eliminated benefits and if it includes other Medi-Cal providers, CDCAN suggests that you contact your own legislator (Assembly and State Senator) and ask them to find out for you.
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