MEDI-CAL: Enrollment Drop Hurts Safety-Net Clinics, Study Says

      The majority of primary care clinics, which serve as the foundation for the state's medical safety net for low-income residents, have experienced a decline in the number of Medi-Cal patients they serve, according to a new study, "Medicaid Managed Care's Impact on Safety-Net Clinics in California," published in the Jan./Feb. issue of Health Affairs. Researchers from the University of California-San Francisco analyzed the operations of safety-net primary care clinics statewide that treated a total of 1,600,000 patients and almost 500,000 Medi-Cal patients between 1995-1997. While the percentage of Medi-Cal beneficiaries who received care through managed care increased from 21% in January 1996 to 37% in January 1998, the total number of Medi-Cal enrollees actually declined 10% during that same time period. In addition, the number of Medi-Cal patients using the safety-net clinics during that time decreased 14.6%. Although health officials have expressed concern that the growing number of Medi- Cal patients using the managed care system would jeopardize the safety-net system, the study found that the decrease in Medi-Cal enrollees, not managed care participation, is the biggest challenge facing the safety-net clinics. Researchers noted that safety-net clinics retained their market share of Medi-Cal beneficiaries. Dr. Andrew Bindman, the study's principal investigator, indicated that cost control measures implemented under Medi-Cal managed care also pose a financial challenge to clinics that receive less money for provider services. Bindman concluded, "If the safety-net clinic system is to remain intact there needs to be a mechanism to quickly replace the funds that it is losing from a diminishing pool of Medi-Cal patients" (UCSF release, 1/10).