Central Valley Kids Face Hurdles Accessing Care After Contract Dispute

Doctors and health care advocates in the central San Joaquin Valley maintain that children whose Medi-Cal and Healthy Families benefits are administered by Blue Cross of California have had problems accessing care since Children's Hospital Central California terminated its contract with the health plan last year, the Fresno Bee reports.

Medi-Cal is California's Medicaid program, and Healthy Families is its version of the State Children's Health Insurance Program.

Children's officials said they lost $11 million on the contract with Blue Cross in 2006 and tried to negotiate higher reimbursement rates with the insurer for its Medi-Cal and Healthy Families plans. When an agreement was not reached, the hospital terminated the contract on Aug. 1, 2007.

Members of Blue Cross commercial plans and beneficiaries enrolled in traditional Medi-Cal were not affected by the move.

However, area physicians and health care advocates say the change was particularly hard on Medi-Cal and Healthy Families beneficiaries with limited English language skills and those who live in rural areas. Those beneficiaries often have had to travel farther to receive care, and some have had problems finding new health care providers.

Medi-Cal and Healthy Families beneficiaries enrolled in Blue Cross plans can still see specialists at Children's with a referral from their primary care physician, but such requests must be approved by the health plan (Anderson, Fresno Bee, 3/18).