In a tentative victory for California O&P patients and professionals, Governor Arnold Schwarzenegger has restored O&P benefits to the 2010-2011 reimbursement schedule of Medi-Cal, the state’s version of Medicaid. The annual “May Revise” version of the budget, released on May 18, reversed an initial legislative decision to cut O&P as an “optional benefit” from the budget that would have gone into effect on July 1.
According to The California Orthotics & Prosthetics Association (COPA), the May Revise contained cost-savings that allowed for the preservation of O&P and some other benefits by including some of the following cost controls and increases:
Limits on Services and Utilization Controls Totaling $90.2 Million
- Elimination of certain over-the-counter drugs, such as acetaminophen and cough and cold medicine, and nutritional supplements, for a total savings of $13.0 million.
- Establishing a maximum annual benefit cap of $1,510 on hearing aids, $1,604 on durable medical equipment, $1,659 on incontinence supplies, $6,435 on urological supplies, and $391 on wound care supplies, for a total savings of $3.8 million.
- Limiting non-life-saving prescriptions to six per year, for a total savings of $4.2 million.
According to COPA, the proposed limits are consistent with the aggregate utilization of these services at the ninetieth percentile of Medi-Cal enrollees.
Increase Cost Sharing Totaling $218.8 Million
- $5 copayments on physician/clinic/dental/pharmacy, $3 for lower-cost preferred drugs, and $5 for other drugs, for a total savings of $118.2 million.
- $50 copayments on emergency room visits, for a total savings of $41.5 million.
- $100 per day copayments and $200 maximums for hospital stays, for a total savings of $59.1 million.
COPA described itself as “ecstatic” about the development, offering “major kudos” to its members, patients, and national partners who helped answer the group’s call to action over the past several months. The group added, however, that California’s budget deficit is still nearly $20 billion.
“We all must remain vigilant and committed to ensure that O&P stays off the chopping block!” COPA said in a May 18 press release. “The real difficult budget negotiations have begun among Governor Schwarzenegger and the legislative leadership now that the May Revise has been published. Other benefits that are being eliminated in the May Revise will be looking to cut services like O&P in order to justify saving that keep their programs alive…. Now is certainly not the time to take a victory lap for O&P, but this is for sure a positive step in the right direction. Please stay tuned as this continues to unfold!
To view California’s complete May Revise budget, click here.
