CDA, CMA proposal honors will of tobacco tax voters

Two weeks before the Proposition 56 tobacco tax went into effect in California, the California Dental Association and California Medical Association teamed up to ensure the additional $2 per pack smokers began paying on April 1 would be used as voters intended the dollars to be used — to increase access to care by boosting the level of payment for health care, services and treatment. CDA and CMA unveiled an alternative budget proposal on March 16 in response to Gov. Jerry Brown’s plan to divert $1.2 billion of Proposition 56 funds to cover general cost increases in the Medi-Cal budget, which would simply add more patients to the back of the line in the overburdened program.

As reported previously in CDA Update, the governor revealed his plan in the annual budget release in January, which is a starting point for negotiations with the Legislature. At that time, CDA vowed to work aggressively with its Proposition 56 coalition partners and legislators to prevent the proposed diversion of the new tobacco tax funds.

That work resulted in the fiscally prudent CDA-CMA proposal, which would provide supplemental payments that correspond with a provider’s level of participation in the Medi-Cal and Denti-Cal programs and directly incentivize additional care.

By tethering the supplemental reimbursements directly to the percentage of Medi-Cal or Denti-Cal patients served by physicians and dentists, the proposed plan will produce measurable results for patients, will be straightforward for the Department of Health Care Services to administer and can be implemented regardless of Medicaid funding decisions at the federal level.

The text of Proposition 56 calls for “increasing the level of payment for health care, services and treatment” for the 14 million Californians (more than half of all children and one-third of adults) who depend on the chronically underfunded Medi-Cal program for their medical and dental care needs. John Blake, DDS, executive director of Children’s Dental Health Clinic of Long Beach, recently addressed the importance of using Proposition 56 funds as intended to increase access to care.

“I know the challenges providers face in trying to meet the needs of patients enrolled in the Denti-Cal program, and the most valuable way to use this funding is to help ensure enrollees can access a provider in a timely manner,” he said. “(The CDA-CMA) proposal honors the will of the voters and the letter of the law for common sense investments in the Medi-Cal system that will result in vulnerable patients gaining timely access to care.”

Medi-Cal reimbursement rates for dentists and physicians remain among the lowest in the nation — lower than in Alaska, Mississippi, Texas and West Virginia — limiting their ability to serve Medi-Cal patients.

The majority of California counties have an insufficient number of Denti-Cal providers and 16 counties either have no Denti-Cal providers or none accepting new patients, according to the state auditor. California has seen a 16 percent decline in the number of Denti-Cal providers since 2008 due to low reimbursement rates and significant administrative burdens, while a large expansion of eligibility has resulted in a 75 percent increase in beneficiaries over the past three years.

As a result, patients continue to face significant barriers to care — including long delays for appointments, trouble finding specialists and having to travel long distances to receive care.

The governor will release a revised proposal in May after a reassessment of revenue projections before reaching a final budget agreement with the Legislature by the June 15 deadline. CDA will keep members informed about Proposition 56 funding and the final budget in the CDA Update and on cda.org.

To learn more about Proposition 56, read “CDA urges use of Proposition 56 funding as voters intended” in the February 2017 CDA Update.

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The 2017-18 state budget proposed by Gov. Jerry Brown calls for using tobacco tax-generated funds from Proposition 56 to offset the state’s current obligations to Medi-Cal rather than provide additional funding for provider reimbursement rates. This proposal disregards the will of the voters and the ballot measure’s provisions.