National Groups Oppose CA Request to Circumvent Cost-Sharing Protections

Cost-sharing in the private insurance model was intended to encourage consumers to use services prudently, however, the application of increased cost-sharing for those enrolled in Medicaid often simply forces low-income individuals to go without medically necessary care.  For that reason, federal legal protections were put in place to protect low-income people from being overburdened with cost-sharing charges.  The necessity of these long-standing legal protections is backed up by substantial research.

Recently, the state of California made an unprecedented request to HHS asking to waive some of those protections for Medicaid beneficiaries living in the “Golden State”.  Eleven national organizations, including CCF, voiced their strong concerns about California’s request to amend its existing Section 1115 “Bridge to Reform” Medicaid Waiver to allow broad authority to impose mandatory copayments on Medi-Cal beneficiaries with no out-of-pocket caps.

In an October 21st letter to HHS Secretary Sebelius, the groups wrote:

“Research has shown that making health care more expensive places a heavy burden on low-income families, and as a result they often delay or reduce the care they or their children need, leading to poor health outcomes. California would provide no exemptions for children at any income level, including children in deep poverty. Given that over 40 percent of California’s Medi-Cal enrollees are children, the impact of this proposal on children is deeply troubling.

Medicaid beneficiaries with chronic and/or disabling health conditions who use services frequently are at greatest risk. Limitations on cost-sharing are included in the Medicaid statute to ensure that a family or individual s lack of resources does not impose a barrier on access to care. These protections are especially important for those who are in poorer health and use services more frequently.”

In addition to Georgetown University Health Policy Institute’s Center for Children and Families, the letter was signed by the American Diabetes Association, American Heart Association/American Stroke Association, Children’s Defense Fund, National Association of Community Health Centers, National Association of Pediatric Nurse Practitioners, National Health Law Program, Planned Parenthood Federation of America, Easter Seals, First Focus, Georgetown University Center for Children and Families and March of Dimes.

Joan Alker
Joan Alker is the Executive Director of the Center for Children and Families