With Half of Calif. Kids Enrolled in Medi-Cal, Access Concerns Grow

Nearly 50% of California children are enrolled in Medi-Cal, raising concerns among lawmakers and child advocates that the program might be unable to adequately serve so many children, Kaiser Health News reports. Medi-Cal is California's Medicaid program.

Background

According to KHN, about 5.2 million young Californians -- up to age 20 -- are covered by Medi-Cal.

Nearly one million of such individuals were added to the program in the last two years. Specifically:

• About 750,000 children were added to the program when California terminated Healthy Families, the state's Children's Health Insurance Program; and
• An additional 232,000 joined after the Affordable Care Act's expansion of Medicaid.

Most of these children enrolled in Medi-Cal are covered by managed care plans.

Details of Concerns

Advocates say that adding so many children to Medi-Cal could decrease the likelihood that they receive timely care.

For example, an ongoing study funded by the California HealthCare Foundation has found that child Medi-Cal beneficiaries were five times more likely than children with private coverage to have gone to the emergency department for asthma care because their doctor was unable to see them. CHCF publishes California Healthline.

Meanwhile, other research indicates the Medi-Cal is performing inadequately in several measures, KHN reports. For instance, more than two-thirds of the state's managed care plans ranked below the national average for Medicaid plans in ensuring children received required vaccinations by age two, according to a state Department of Health Care Services report based on data from 2013 (Feder Ostrov, Kaiser Health News, 1/29).

In addition, California has one of the lowest Medicaid reimbursement rates in the U.S. (California Healthline, 1/2).

State Response

Anastasia Dodson, associate director of policy at DHCS, said the department regularly checks whether there are enough providers within Medi-Cal's managed care plan network.

Meanwhile, state officials have maintained that it is unnecessary to increase reimbursement rates in order to encourage more providers to treat Medi-Cal beneficiaries. Dodson said, "At this time, we feel the rates are sufficient" (Kaiser Health News, 1/29).