May 2019 Volume LIV Number 3


State News

March 2012 Volume XLVIII Number 2

Update on California Medicaid Lawsuit

californiaCSPD Public Policy Advocate (and AAPD CDBP Chair) Dr. Paul Reggiardo provides the following update on pending California lawsuits seeking to block a 10 percent reduction in Medi-Cal payments to physicians, dentists, pharmacists, and other providers.

  • In March 2011, the California legislature passed, and the Governor signed, a budget bill which included a 10 percent reduction in Medi-Cal reimbursement for physicians, dentists, pharmacists and other providers. The federal government approved a Medicaid waiver permitting the rate cuts on Oct. 27, 2011, based on documentation provided to CMS by the California Department of Health Care Services (DHCS) that access to care for Medi-Cal patients would not be impacted by the move.

  • In making the announcement, the DHCS said the reductions would be retroactive to June 1. While the rate cut exempted hospitals and children's medical providers (on the basis that the state could not make the case that access to these entities would not be affected), it did not exempt children’s dental providers. The state indicated it would take several months before the reductions could be implemented and that it would develop a plan to recoup the 10 percent retroactively to June 1.

  • On Nov. 3, 2011, the California Hospital Association filed a lawsuit against the state and the federal Department of Health and Human Services (HHS) to block the reductions, citing violation of the equal access provisions of Medicaid law. A group of individual pharmacists filed a second suit shortly thereafter. Both seek a preliminary injunction to block implementation of the cuts until the cases can be fullyconsidered by the courts.

  • On Nov. 21, 2011, the California Dental Association (CDA) joined with the California Medical Association, the California Pharmacists Association, and the National Association of Chain Drug Stores in a separate lawsuit challenging the adequacy of the information provided by the state to support the rate cut approval. The lawsuit claims the CMS action in approving the rate cuts was arbitrary and capricious, and that the provider’s cost to deliver care was insufficiently considered. In addition, the suit alleges CMS did not follow procedural requirements in reviewing the state plan amendment and applied an incorrect legal standard. The lawsuit also alleges violation the equal access provisions of Medicaid law.

  • Subsequent to the filing of the lawsuits, the state agreed that a Temporary Restraining Order would not be necessary to preserve existing Medi-Cal rates until the December 19 hearings on the preliminary injunction.

  • On Jan. 31, 2012, the U.S. District Court for the Central Distric of California granted a preliminary injunction blocking the reimbursement cuts, stating "the state’s fiscal crisis does not outweigh the serious irreparable injury plaintiffs would suffer absent the issuance of and injunction."

  • CSPD is assisting CDA by identifying dental providers willing to provide a written declaration to the court on the impact of the proposed cuts to their delivery of services to Denti-Cal beneficiaries.

Reggiardo also provided a separate written declaration as CSPD’s Public Policy Advocate attesting to the inadequacy of the data submitted by the DHCS to CMS to justify approval of the rate reductions.

Wisconsin Dental Association’s Innovative Dental Academy for State Legislators

wisconsinIn January 2011, the Wisconsin Dental Association held its first ever WDA Dental Academy for state policymakers. Twentythree state legislators and 16 legislative staffers attended the event at a local hotel in the state’s capital city of Madison. The AAPD is highlighting this unique advocacy initiative so that other states may consider hosting a similar program. The purpose of the "Dental 101" seminar was to provide newly-elected lawmakers and staffers in key state government health and licensing agencies an understanding of basic dental issues and terminology. It also helped position the WDA and its 2,900 member dentists as advocates for quality oral health care policy and the authoritative source for dental care information in the state. The two-hour program allowed the WDA to brief policymakers on key issues:

  • WDA President Dr. Gene Shoemaker (Waukesha) welcomed attendees to the academy and closed the event with remarks about, "Charity: A Stop-Gap Effort to Prevent a Tragedy in Wisconsin" highlighting such programs as Give Kids A Smile and the WDA Foundation’s Donated Dental Services and Mission of Mercy programs.

  • WDA Government Services Director Mara Brooks presented on "Doctors of Oral Health" and the difference between Federally Qualified Health Centers and private sector dental care. Contract lobbyist Pete Christianson joined Brooks for a discussion of Wisconsin’s dental Medicaid program.

  • WDA Executive Director Mark Paget gave a brief overview of WDA Healthy Choices - a five-part, bipartisan legislative agenda for reducing barriers to care.

  • Northwest Region 5 Trustee Dr. David Clemens (Wisconsin Dells) helped the audience understand the uniqueness of the dental care delivery model.

  • WDA Past-President Dr. Kent Vandehaar (Chippewa Falls) provided highlights from the 2010 - 2020 Wisconsin dental work force study.

  • Marquette University School of Dentistry Dean Dr. William Lobb (Milwaukee) emphasized that last year the school’s six clinics provided $55 million in dental care to patients living in 66 of Wisconsin’s 72 counties.

  • WDA Legislative Committee member Dr. Paul Feit (Sturgeon Bay) told those assembled of his efforts as a new dentist to associate with and then establish his own private dental practice. He noted his more than $1 million in combined school and business debt and added, "I’m passionate about getting care to people and have to focus on community outreach efforts, because I can’t afford to do it within my practice."

dankapankeaward"To have such a good number of legislators and staffers take two hours out of their schedules in these early weeks of the new legislative session is a credit to all the grassroots WDA dentists who urged their elected officials to attend this event," noted Brooks. "Making these connections is just one more ‘piece of the puzzle’ that helps dentistry have a stronger voice on issues where government impacts dentists’ ability to deliver quality dental care to all Wisconsinites."

Every legislator who attended received an engraved, acrylic WDA "molar" to display in their offices as a thank you for showing an interest in the dental profession (pictured). The WDA website has additional information on this program at: subcategories/252-dental-academy-legislative-day/documents/1264-wdadental- academy.