Is San Diego County getting its fair share of Medi-Cal reimbursements?

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Article by Paul Sisson  |  Read full article in the San Diego Union-Tribune

After an initial discussion with medical providers in San Diego County, Supervisor Terra Lawson-Remer says she is convinced that the region is leaving Medi-Cal reimbursement on the table, and that’s money that could be used to improve the reimbursement rates that fund care for nearly 1 million San Diego County residents.

On Tuesday, the supervisor will ask her colleagues to take a slate of actions geared toward making improved Medi-Cal reimbursements a board priority. Medical providers have long been reluctant to participate in the government’s health plan for needy residents citing rates that do not cover the cost of doing business. According to the American Hospital Association, reimbursements covered only 88 cents of every dollar spent on caring for patients in 2020.

The supervisor said last week that conversations with county staff and the heads of local health care providers have led her to believe that “what we’re receiving and spending per-capita doesn’t align with what we see in other counties.”

Medi-Cal, called Medicaid everywhere but California, matches local funds with federal dollars, and Lawson-Remer said that many feel that there may be more effective strategies that could be employed to draw more matching funds to the region.

“I don’t think any of us are under any illusion that we’re getting cheated; it has to do with the failure of local government and my predecessors for not creating a strategy locally for how we structure our Medi-Cal reimbursement to ensure that we’re maximizing our federal share,” Lawson-Remer said.’

Chris Howard, chief executive officer of Sharp HealthCare, said that several people involved with the local Medi-Cal effort believe that there are ways to increase local reimbursements through the matching process.

“You know, California has not increased Medi-Cal base rates for 12 years, and that’s just not sustainable,” Howard said. “Sharp HealthCare, for instance, is paid 70 cents on the dollar for every service we provide to a Medi-Cal patient, and it creates this terrible shell game of trying to find other ways to make up reimbursement.”

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