In 2009, as the Great Recession bore down on California, lawmakers cut coverage of eyeglasses, podiatry, speech therapy and other benefits from the state’s low-income health program.
A decade later, California will restore many of the cuts, according to an agreement reached between Gov. Gavin Newsom and the state legislature. In addition to expanding the Medi-Cal program to cover young adults regardless of immigration status, the 2019-20 budget will reintroduce coverage for adults for optical services, podiatry, speech therapy and incontinence creams and washes.
Such benefits are optional under federal Medicaid rules and may be added at the discretion of each state. Most of the cuts in services applied to adults—but not children—enrolled in Medi-Cal.
As a result of a deal between lawmakers and Newsom, $17.4 million has been allotted for the 2019-20 fiscal year to reintroduce the coverage to those who have fee-for-service Medi-Cal coverage. The restored benefits will become effective Jan. 1, halfway through the fiscal year. They will be funded to the tune of $40.5 million annually moving forward, including about $26 million for optical benefits and $4.6 million for podiatry. The new allotments will be boosted further with federal Medicaid matching funds.
The benefit restoration fulfills a pledge lawmakers made in 2017 to bring back coverage by 2020.
The need among Medi-Cal enrollees is significant, particularly for eyeglasses. According to the California Optometric Association, about 2 million Medi-Cal enrollees between the ages of 21 and 64—nearly 15 percent of the program’s enrollees—need glasses or some other form of vision aid.
Anthony Wright, executive director of Health Access California, a Sacramento-based advocacy group, noted that the benefits play a significant role in helping to preserve the health of Medi-Cal enrollees.
“Take podiatry for example,” Wright said. “Those kinds of services are incredibly important for diabetic patients. They can prevent worse issues, including amputations down the line.”
According to a 2016 UCLA study, about 9 percent of California adults have been diagnosed with diabetes, and 46 percent are either prediabetic or have the disease and have yet to be diagnosed.
Nevertheless, Wright is frustrated that it took a decade for such benefits to be restored.
“These were benefits that were eliminated for no policy reason, because anything that was nailed down at the time was being cut,” he said. “It required 10 years of an economic recovery to get them back.”
Although the services are being restored, it remains a question as to whether providers such as optometrists and podiatrists will be willing to return to Medi-Cal’s provider networks.
Although many services provided through Denti-Cal, Medi-Cal’s dental program, have been restored in recent years and payments have been upped to providers, the rates still remain lower than that of commercial dental plans. As a result, Denti-Cal still struggles to get more dentists to participate, particularly in rural areas.
Nadereh Pourat, professor-in-residence at the UCLA Fielding School of Public Health, has closely observed the issues trying to get dentists to return to treating Medi-Cal patients. “If you increase the fees, participation may go up, but not dollar for dollar,” she said.
It is not clear if the budget allocation for the restored benefits includes an adjustment for a decade’s worth of inflation. Officials from the California Department of Health Care Services, which manages the Medi-Cal program, did not immediately respond to a request for comment.
Wright noted that the benefits being restored to the fee-for-service Medi-Cal program are often covered by the Medi-Cal managed care plans in order to better manage the health of their enrollee population. As a result, many providers are used to working with Medi-Cal patients and therefore may be fairly receptive to treating those outside of a health plan.
“There might be some (coverage) hiccups, but you can’t even start to work on these issues until the benefits are restored,” he said.