Obama Administration Rejects California Request to Impose Mandatory Copays

On Monday, February 6, the Centers for Medicare and Medicaid Services (CMS) rejected California’s request to impose mandatory co-payments for Medi-Cal patients. The co-pays, which would have included physician office and clinic visits ($5), emergency room (ER) visits ($50), and inpatient hospital stays ($100 per day up to a $200 maximum), was another attempt by the state to balance to budget by slashing Medi-Cal.

“The Obama administration has made the right decision. By federal law and our own ethics, physicians must treat patients that come to the ER, regardless of ability to pay. Imposing a mandatory copayment would have done nothing to address costs or improve patient care. We are pleased that CMS understands that and has rejected the proposal,” James T. Hay, MD, president, California Medical Association, said.

Medi-Cal payment rates are grossly inequitable for emergency care as is, and the proposed copayments exceeded the limits allowed by federal law for Medicaid cost sharing. The copayments would have exceeded federal maximums, particularly for nonemergency use of the emergency department.

“These copayments would for all intents and purposes be uncollectable, and would have made it even harder for Medi-Cal patients to gain access to the care and medication they need,” Dr. Hay added.

Often, copayments discourage low-income families from filling prescriptions for themselves or their children because they can’t afford it. When patients fail to take their prescription medications correctly, or stop taking their medications altogether, this seriously undermines their quality of life, quality of care, healthcare outcomes and the value of healthcare dollars spent.

The rejection comes just days after Federal Judge Christina Snyder issued her final ruling in CMA et al v. Douglas. Her decision blocked the state from imposing a 10 percent reimbursement rate reduction to Medi-Cal physicians.