Doctors Worried Over Pay Rates for Ventura County’s Medi-Cal Plan

Many Ventura County physicians say they might not participate in the county's restructured Medi-Cal plan because of concerns over low reimbursement rates, the Ventura County Star reports. Medi-Cal is California's Medicaid program.

Background

California recently directed counties to modify the state-run Medi-Cal system into locally administered managed care organizations.

Ventura County's local Medi-Cal program -- called the Gold Coast Health Plan -- is scheduled to debut on July 1 (Kisken, Ventura County Star, 4/11). The new plan will:

• Assign Medi-Cal beneficiaries to a medical home;
• Negotiate reimbursement contracts with health care providers; and
• Set benefit levels.

More than 100,000 low-income Ventura County residents are expected to receive coverage through the Gold Coast Health Plan (California Healthline, 9/27/10).

Reimbursement Details

The new system will pay primary care physicians a monthly rate for each Medi-Cal beneficiary under their care, even if they do not see the patient that month.

Gold Coast Health Plan administrators said payment terms are confidential. However, according to contract details obtained by the Star, primary care providers will receive $8.38 monthly for each Medi-Cal beneficiary.

Health care providers say that private insurance plans reimburse at an average rate of $12 to $15 per patient per month, with physicians also receiving copayments.

Few Private Doctors Participating

So far, 144 primary care physicians and 523 specialists have signed on to participate with Gold Coast Health Plan. Of the primary care physicians, about 90% belong to large safety-net health systems and the remaining 10% are private practitioners.

Gold Coast Health Plan administrators say they are working to recruit more physicians to the health care provider network. Administrators currently are in contract negotiations with Clinicas del Camino Real, a local group of safety-net clinics staffed by about 35 primary care doctors (Ventura County Star, 4/11).