As the governor's budget stands, physicians will have their Medi-Cal reimbursements cut by about 10 percent when the state's fiscal year begins on July 1, which may further reduce the number of providers who accept Medi-Cal patients. But there remains a slim hope that the final plan may not turn out that way.

The California Medical Association points out that the move will likely result in further reduced access for Medi-Cal patients as doctors drop from the program, stop accepting new Medi-Cal patients, or otherwise shift their attachment to the program. Approved by the legislature and signed by the governor in February, six budget bills addressed the state's estimated $16 billion 2008 budget shortfall partly by cutting about $2 billion over a year and a half, including about $544 million from the state Medi-Cal program--not including federal matching funds. The plan achieves other savings through a mixture of borrowing and accounting maneuvers.

In California, the governor presents an initial budget that he generally revises based on April tax revenues. The legislature has until June 15 to approve the budget, but often misses that deadline. However, the cuts in Medi-Cal will require serious measures to reverse. "It would take additional legislation or the trailer bills that go through with the budget to change what's already been enacted," says Tony Cava, a spokesperson for the state Department of Health Care Services. "The May revision might give a better indication of where the budget stands, but [without] a large improvement in the financial outlook, those cuts are scheduled to go into effect."

The CMA will still attempt to pressure legislators to soften the blow on physicians. "We're trying to just talk about [how] we're not saving ourselves any money here," says Ned Wigglesworth, a CMA spokesperson. "Because one, we're losing out on federal matching dollars; and two, because these costs are just going to get shifted on to people with insurance and are going to compromise the quality of healthcare in emergency rooms and some other specialties, given their location," he says. In March, the CMA began asking the state's county medical associations for help in raising awareness of the budget cuts' impact.

So far, the budget debate has centered on taxes, with Republicans generally lined up against new levies and Democrats pushing for them. Asked at a press conference how Democrats plan to overcome cuts in education that came with the six budget bills, state Senate Pro Tem Don Perata said, "Raise taxes. That clear enough? Raise taxes." Almost all Republican legislators have signed a Taxpayer Protection Pledge in which they promise to oppose all new taxes. While initially opposing new taxes to ease budget problems, Gov. Schwarzenegger has been softening his position.