Experts Say Medi-Cal Expansion Could Worsen Health Provider Shortage
Health care stakeholders are concerned that there will not be enough health care providers to treat newly insured Medi-Cal beneficiaries after a program expansion under the Affordable Care Act, the San Francisco Chronicle reports (Bazar, San Francisco Chronicle, 3/2).
Medi-Cal is California's Medicaid program.
Under the ACA, the Medi-Cal expansion would affect individuals with incomes up to 138% of the federal poverty level, or $15,415 annually.
Brown's fiscal year 2013-2014 budget proposal earmarked $350 million to cover the increased enrollment.
Under the ACA, the federal government will fund the expansion for the first few years (California Healthline, 2/25).
Details of Concerns
Some health care stakeholders say that access to care for Medi-Cal beneficiaries is inadequate ahead of the program expansion.
Carmen Burgos of the not-for-profit Greater Bakersfield Legal Assistance program said, "We're not even talking about 2014. Good luck finding a doctor who takes Medi-Cal now."
Alex Briscoe -- director of the Health Care Services Agency in Alameda County -- said, "Patients often wait months to get access to care."
Studies have shown that California has one of the lowest reimbursement rates for Medi-Cal providers.
Andrew Calman -- associate clinical professor at UC-San Francisco and health care provider in San Francisco's Mission District -- said he loses money treating Medi-Cal beneficiaries, so he must limit the number he accepts.
He said, "[T]here is a limit to how much ... we can do and still have a viable practice," adding, "We have to pay our rent, we have to pay our salaries to our staff. We have to pay insurance" (San Francisco Chronicle, 3/2).
Reimbursements could decline further under a state plan approved by CMS to reduce certain Medi-Cal payments by 10%.
In December 2012, a three-judge panel of the 9th Circuit Court of Appeals ruled that the state is allowed to enact the rate cut. However, health care providers in January appealed the decision, requesting that the entire 9th Circuit review the case (California Healthline, 2/14).
Response From State
Norman Williams -- a spokesperson for the state Department of Health Care Services, which administers Medi-Cal -- said, "We do believe that the Medi-Cal provider network provides adequate access in California now." He added that the state is "adequately preparing for 2014 and the expansion."
Williams also said that a temporary reimbursement increase that will boost Medi-Cal rates to Medicare levels for certain primary care physicians "is a significant incentive that we anticipate will help attract new primary care physicians to the Medi-Cal provider network."The article was produced by the California HealthCare Foundation Center for Health Reporting. The center is supported by a grant from CHCF, which publishes California Healthline (San Francisco Chronicle, 3/2). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.