‘Medi-Cal Is No Cadillac Program’

As the quest continues for solutions to the Medi-Cal system’s current problems, the facts behind the budget overruns become clearer. In their article (Editorial Pages, March 9), “Medi-Cal Is No Cadillac Program,” Assemblyman Bruce Broznan (D-Fresno) and Sen. Alfred E. Alquist (D-San Jose) rebut the assertion by Administration officials that Medi-Cal is a “Cadillac” system. The California Chiropractic Assn. joins in the amazement at this “Cadillac” analogy and would like to share some additional facts for consideration.

The Administration uses the estimated $178-million shortfall in the Medi-Cal budget as justification for the controversial 10% across-the-board cut in provider payments. In addition, state health director Kenneth Kizer has indicated that chiropractic care and acupuncture services may have to be completely eliminated, inferring that such a move would provide substantial cost reductions.

As members of the Joint Medi-Cal Legislative Task Force, Broznan and Alquist found that chiropractic care and acupuncture account for only $1.5 million or 0.06% of the total program costs. This means that if these services were cut completely, the savings would still not amount to even 1% of the cost overrun.

If Medi-Cal is a “Cadillac,” who is driving? Certainly not the chiropractic profession. California is not the only state that provides chiropractic services for Medicaid recipients. The Health Care Financing Administration reports that more than half of the states provide chiropractic care under the Medicaid program (termed (Medi-Cal in our state).

In California the chiropractic doctor receives only $7.25 per Medi-Cal patient visit, with no reimbursement for X-rays or adjunctive therapies. This “Cadillac” drives the Medi-Cal patients away from chiropractic doctors to medical doctors where care averages 10 times more for typical low back injuries. The chiropractic office is limited to a maximum charge of $14.50 per month under Medi-Cal. Within one month, the medical office treating the same type of low back injury can run up a tab of $147, including exam, X-rays, prescriptions and physical therapy. The cost jumps by another $64.40 if the MD calls for an orthopedic or neurological consult. The comparative cost analysis suggests the source of fuel for the Medi-Cal “Cadillac.”

JERILYNN S. Kaibel DC

President

California Chiropractic Assn.

Sacramento