Medi-Cal Psych Limits OK

California’s Medi-Cal program may limit payments for psychological counseling to two visits a month, a state court of appeals held Thursday.

Medi-Cal, which is California’s version of federal Medicaid providing health care to low income people, determined it would limit payments to federally-qualified health centers for psychological services.  The Mendocino Community Health Clinic, which provides outpatient clinic services, challenged the rule.

The Third District Court of Appeals rejected the challenge.

Based on 2003 revisions to state law, the state Department of Health notified Mendocino Clinics that they were not eligible for Medi-Cal payments for more than two visits per month per patient.

The clinics said that rule could not be applied to federally qualified centers, which are subject to a complex funding formula adopted by Medicaid.

The administrative law judge concluded that without a federal law specifically exempting federally qualified centers, the California clinics are subject to both federal and state limitations.

“We conclude that federal law does not prohibit application of California’s two-visit rule to psychology services,” according to Justice George Nicholson.

He was joined by Justices Ronald B. Robie and William J. Murray.

Case:  Mendocino Community Health Clinic v. State Dept. of Health Care Services, NO. C067826