Medi-Cal Refund Cuts Invalidated by the 9th

     (CN) – California violated federal Medicaid law when it cut adult dental, podiatry, optometry and chiropractic services from its state program, the 9th Circuit ruled Friday.
     The budget crisis led California in 2009 to stop reimbursing health care services under the California Medical Assistance Program, or Medi-Cal, if it deemed them nonessential or “optional.”
     Though the California Association of Rural Health Clinics and others challenged the move in court, a federal judge in Sacramento rejected shot them down just before the Centers for Medicare and Medicaid Services (CMS) approved the cuts.
     After ruling that the clinics had a private right to sue, the District Court found the cost-saving scheme legal under the Medicaid law.
     A three-judge panel of the 9th Circuit reversed Friday, giving no deference to agency approval.
     Though the San Francisco-based panel agreed that the clinics have a right to sue, it had a different interpretation of the law’s language.
     “We hold that Medicaid imposes on participating states an obligation to cover ‘rural health clinic services’ and ‘Federally-qualified health center services,’ and Medicaid imports the Medicare definition of those terms,” Judge Dorothy Nelson wrote for the panel. “Thus, Medicare unambiguously defines the clinics’ services to include services performed by dentists, podiatrists, optometrists and chiropractors, in addition to services provided by doctors of medicine and osteopathy. Any alternate reading of the statute would do violence to Medicaid’s command that the terms ‘rural health clinic,’ ‘rural health clinic’ and ‘Federally-qualified health center services’ shall have the meanings given those terms in Medicare.”

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