California’s sickest children are experiencing unacceptably long wait times to see specialists and the situation is quickly worsening as a direct result of the 10% mid-term state budget cut to CCS (California Children’s Services) reimbursement rates.
Now it is up to the Governor and the Legislature to show leadership to protect California’s sickest children’s access to necessary medical care. They must recognize that this short-term budget savings – estimated at less than $20 million of the General Fund – is “penny-wise and pound-foolish” and these cuts will not save the state and taxpayers in the long run, but will cost infinitely more down the road as a result of children with serious and chronic conditions being denied timely access to necessary medical treatment.
The damage caused now cannot be reversed later. Unlike some budget items that can potentially wait for sunnier economic conditions, seriously sick children don’t have the luxury of time to wait for care.
Most Californians don’t know about CCS – California Children’s Services- the lifeline for children with conditions and diseases like cancer, diabetes, congenital heart disease, HIV, spinal cord injuries and birth defects. Unlike Medi-Cal, eligibility for CCS is based on a child’s medical condition, not on family income alone. While many children with CCS conditions are eligible for Medi-Cal, some are from middle-class families who could face financial ruin trying to cover the cost of their child’s care, which often exceeds private insurance coverage limits. Between 50 and 75 percent of the patients seen by pediatric sub-specialists in California depend on Medi-Cal, CCS or a combination of the two for their healthcare coverage.
When a local family’s daughter, Alexandra Stoffel, became suddenly unable to walk at the age of six, her parents learned that she had a large tumor on her spine. The prognosis was bleak. Alexandra needed immediate surgery and ongoing treatment that far exceeded her parents’ private insurance limits. A social worker connected them with the CCS program to help meet the coverage gap and now Alexandra, who requires a wheelchair, is an active, accomplished high school student with a bright and productive future. CCS saved her life and saved her family from financial devastation.
Even before the Legislature approved a 10% mid-term cut to CCS physician reimbursements in February, California’s rate for physician services had remained flat – increasing only once in more than twenty years – while medical delivery costs continue to rise. At the pre-cut levels, California’s reimbursement rates for Medi-Cal and CCS often did not cover the cost to provide care.
Before the 10% cut took effect, very sick children had been forced to wait months to see a pediatric specialist. And, in the short time since the cuts were approved, wait times are getting longer. The examples are many, but to illustrate – a pediatric subspecialist group in Orange County has lost two pediatric specialists, who care for children with diabetes, endocrine and metabolic disorders, since February and the group can no longer accept any new Medi-Cal or CCS patients for certain services.
The loss of one pediatric specialist translates to approximately 1,500 fewer patient appointment slots per year. Our member groups are being forced to cut staff, shrink programs and are unable to compete with other states in attracting new doctors. In recent months, pediatric specialty groups in other states have been actively recruiting California specialists to states with better practice environments. We are losing medical talent, and access to healthcare is shrinking.
We are hopeful that the legislative leadership and the Governor will restore the reimbursement rate for Medi-Cal and CCS in the final budget. When California’s sickest children are denied appropriate and timely care, they will cost the state more in preventable hospital visits and adult disability – not to mention the terrible cost to our collective conscience.