DME / AT Are Not Optional!

A Call to Action:

The California Department of Health Care Services has proposed to cap benefits for several categories of "optional" services under Medi-Cal in the Governor's budget proposal now before the legislature. These caps will limit the maximum annual fiscal year reimbursement that Medi-Cal will pay for such things as hearing aids, wheelchairs, IV equipment, respiratory equipment, incontinence supplies and much more.

California's legislature must approve these caps as part of the budget process. Medi-Cal is the largest State funded program behind education and must therefore make substantial efforts to reduce cost and rein in expenditures.

Assembly and Senate members must be made aware of the counterproductive impact these caps will have on the state's budget and the dire effects they will have on the lives of people with disabilities. Cuts and limits that reduce the ability of disabled citizens to live and work in the community result is a demand for more costly institutional care, more emergency room visits and increased administrative costs for local governments, Medi-Cal, providers and beneficiaries.

The Department of Health Care Services (DHCS) has calculated the annual cap for each category at levels they believe will be sufficient for most beneficiaries (see below). However, the caps will reduce or entirely eliminate critical services for many beneficiaries who need them most. Those that use multiple products/services, require higher quantities of a single service or rely on more expensive items will be forced to go without. These caps could affect the health and safety of those who are forced to do without and may result in more expensive institutional care.

Now is the time to contact your legislators and tell them how these caps will affect you. Sharing your stories and letting those that will vote on these proposals know the real world consequences of their actions will make these cuts real to them. Take Action now to prevent these cuts and raise the caps to levels that are adequate to cover the needs of those most vulnerable to these reductions.

The proposed caps include:

Hearing Aids: Medi-Cal has covered hearing aids when supplied by a hearing aid dispenser through the prescription of an otolaryngologist, or attending physician. Effective July 1, 2009, and with certain exceptions, Medi-Cal no longer considers audiology services to be a covered benefit. This proposal will establish a cap of $1,510 per fiscal year.

Durable Medical Equipment: Examples of DME items include: ambulation devices, bathroom equipment, decubitus care equipment, hospital beds and accessories, patient lifts, traction and trapeze equipment, communication devices, IV equipment, oxygen and respiratory equipment, and wheelchairs and accessories. This proposal will establish a cap of $1,604 per fiscal year.

Select Medical Supplies: The select medical supplies include: incontinence supplies with a fiscal year cap of $1,659; urological supplies with a fiscal year cap of $6,435; and wound care supplies with a fiscal year cap of $391.

Similar to the elimination of certain optional benefits that DHCS implemented in FY 2009-10, certain Medi-Cal beneficiaries will be exempt from these reductions and certain benefits in these categories will not count against the cap.

Benefit Cap Exemptions:

1. Pregnancy-related benefits and benefits for the treatment of other conditions that might complicate the pregnancy if not treated;
2. Beneficiaries under the age of 21;
3. Beneficiaries residing in a long-term care nursing facility that is both: (A) A skilled nursing facility or intermediate care facility as defined in subdivisions (c) and (d) of Section 1250 of the Health and Safety Code, and (B) Licensed pursuant to subdivision (k) of Section 1250 of the Health and Safety Code;
4. DME items associated with compressed oxygen and respirators; and
5. Disposable medical supply items associated with tracheostomy, respiratory care; ostomy care; IV infusion; and diabetic testing; disposable gloves and miscellaneous medical supplies

Take Action Now!