ODs As Physicians

The Ninth Circuit Court of Appeals today ruled that a California law that eliminated Optometric and a variety of other “physician’s services” from coverage under Medi-Cal (Medicaid) is not enforceable. In a nutshell, they ruled that Congress was clear and unambiguous that these services must be provided, and that’s the end of the discussion. In a fascinating piece of the ruling, the Court stated, “It is clear then that the “physicians’

services” that the Clinics provide, and for which they must be reimbursed, include not only the services furnished by doctors of medicine and osteopathy, but also the services furnished by dentists, podiatrists, optometrists and chiropractors.”

Thus, among other things, the 9th Circuit has now unambiguously defined optometrists as “physicians” under Medicaid.

Summary: Reversing the district court’s summary judgment, the panel held that California legislation that eliminated coverage for certain healthcare services, including adult dental, podiatry, optometry, and chiropractic services, conflicted with the Medicaid Act and was therefore invalid.

D.W. NELSON, Senior Circuit Judge:

This case concerns a clash of competing interests: the mission of publicly-funded health clinics to provide a panoply of medical services to under-served communities on the one hand, and California’s persistent budget woes on the other. We must decide whether California legislation that eliminates coverage for certain healthcare services, including adult dental, podiatry, optometry and chiropractic services, conflicts with the Medicaid Act, 42 U.S.C. §§ 1396, et seq., and is therefore invalid. We hold that Medicaid prohibits the limitations adopted by the California legislature and,

accordingly, we reverse and remand.

Full case is found at http://www.metnews.com/sos.cgi?0713//10-17574