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First case of Supreme Court's new term has San Diego connection

Case will determine whether patients, providers can legally advocate for themselves

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On Monday the U.S. Supreme Court hears oral arguments in the Douglas v. Independent Living Center of Southern California ("Independent Living Center") case. The Supreme Court's ruling could have huge implications for the more than 10 million patients in California that are currently enrolled in Medi-Cal (California's Medicaid program), as well as for the physicians that voluntarily treat those patients. The California Medical Association (CMA) and Theodore Mazer, M.D., a San Diego-area ear, nose, and throat doctor, are parties in the case.

The issue addressed by Douglas v. Independent Living Center is whether Medicaid recipients and providers can sue a state for failing to pay the rates required by the Medicaid Act, which states that government-insured and privately insured patients have equal access to medical care.

As the Supreme Court hears the case, a number of state plan amendments (SPAs) submitted by the State of California sit with the Centers for Medicaid and Medicare Services (CMS). The SPAs each propose significant cuts to Medi-Cal. The SPAs would, among other things, cut physician reimbursement, limit the number of times a patient can see a physician per year, and implement mandatory patient co-pays.

"The state plan amendments submitted by California to CMS would severely reduce Medi-Cal patients' access to medical care," Francisco J. Silva, general counsel and vice president of CMA said. "The proposed cuts would mean that a primary care physician would only be reimbursed $11 for a Medi-Cal patient visit. Physicians have to pay their staffs and keep their doors open, and these rates would just not allow for them to do that and accept Medi-Cal patients."

Medi-Cal provides essential healthcare services to the poorest and most vulnerable Californians. Through Medi-Cal, physicians, dentists, pharmacists, adult day healthcare providers, clinics, and hospitals provide healthcare services to low-income seniors, families, children, and people with disabilities. By providing these primary and preventive care services, the state ensures these Californians have access to healthcare, while at the same time saving money by lowering the chances they will be forced to seek more costly healthcare, such as emergency rooms or hospital admissions.

"The issue before the U.S. Supreme Court is crucial to the future of how patient advocacy will unfold," said Dr. Mazer. "If patients can't fight for themselves, and if, as physicians, we can't either, then who is left to stand up for the group of people that needs our help the most?"

Dr. Mazer treated Medi-Cal enrollees for over 20 years until the state began seeking reimbursement cuts. Eighteen months ago, he stopped accepting new Medi-Cal patients. He is an individual party in the lawsuit.

"It's unfortunate that the state has made us choose between accepting new Medi-Cal patients and keeping our practices viable," Dr. Mazer added.

In 2008, a coalition of healthcare providers, including CMA, sued the state of California to stop a 10% cut in Medi-Cal reimbursements. A federal appeals court ruled that Medi-Cal providers have standing to challenge the state's rate cut and upheld the merits of the 2008 preliminary injunction that forced the state to immediately reverse the cut. The U.S. Supreme is considering this case and others with respect to whether providers and patients have legal standing to enforce the federal Medicaid law. A number of amicus briefs have been filed in support of respondents in the case, including:

Brief for Members of Congress

Brief for the National Association of Chain Drug Stores et al.

Brief for the Chamber of Commerce of the United States of America

Brief for the American Medical Association et al.

Brief for the American Health Care Association et al.

Brief for the American Civil Liberties Union et al.

Brief for AARP et al.

Brief for Former HSS Officials

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