Clinics sue California over dental cuts

Apr 30, 2009

A coalition of health clinics announced Thursday it is filing a lawsuit against the state of California to prevent it from cutting adult dental Medicaid (Denti-Cal) and other benefits.

In February, the state enacted a tentative budget that would eliminate nine Medicaid benefits that it determined were not mandated by the federal government. The cuts will become permanent as of July 1, 2009, unless the sate Legislature and Gov. Arnold Schwarzenegger reverse the decision when they revisit the budget this month. With estimates of the state's deficit larger now than in February, the reversal is unlikely, according to the California Primary Care Association.

Besides dental benefits, adult Medicaid recipients are scheduled to lose coverage for psychology, chiropractic, acupuncture, speech therapy, incontinence creams and washes, audiology, optometry, and podiatry services.

California Primary Care Association is seeking a writ of mandate preventing the state from eliminating Denti-Cal, chiropractic, optometry, podiatry, and psychology services when provided by Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs).

Because these services are included in the definition of FQHC and RHC services under state and federal law, FQHC and RHC services are mandatory and not "optional" Medicaid benefits, the association argues. The suit was submitted jointly by the California Primary Care Association and two of its member health centers, Clinicas Del Camino Real in Ventura and Southern Trinity Health Services in Trinity.

The lawsuit argues that federal and state law both define FQHC services in terms of the types of providers who render services rather than the types of services that are rendered; and that, consistent with federal law, California's definition includes the services of dentists, chiropractors, optometrists, podiatrists, and psychologists as FQHC core providers.

"California's Welfare and Institutions Code and State Plan clearly protect reimbursement for FQHC services that are provided by 'core' providers, as defined both federally and by the state," said Carmela Castellano-Garcia, president and CEO of the California Primary Care Association. "The legal definition of 'physician' includes dentists, chiropractors, optometrists, podiatrists, and psychologists, and therefore means that their services are indeed not optional for FQHCs."

In addition, because FQHCs have a unique billing process with the state -- one under which they are entitled to receive a flat rate per patient visit regardless of the type of service provided -- "we are questioning whether clinics were even included in the administration's cost estimates for eliminating the optional benefits. The Department of Health Care Services has not been able to substantiate their claims that FQHCs were included in their impact analysis," she noted.

Medi-Cal FQHC services, including those characterized by the state as "optional," allow California community clinics and health centers to serve and receive reimbursement for approximately 1.2 million patient encounters each year. Denti-Cal adult dental alone accounts for $56 million a year and comprises approximately 40% of the budget from which FQHCs operate their full dental programs.

"The state's action to eliminate Denti-Cal could have devastating consequences to patients who weren't even directly targeted by the cut, meaning the nonadult Medi-Cal populations such as children and the developmentally disabled," said Roberto Juarez, CEO of Clinicas Del Camino Real. "My health center will do whatever it can to continue to serve everybody who comes through our doors. However, these cuts will likely mean the closure of at least two of our five dental practices."