New Policy for Medi-Cal Beneficiaries Affects Access to Care in San Jose
Under a new policy at HCA's Regional Medical Center, more than half, or about 33,000, of the Medi-Cal beneficiaries who seek care at the facility must be transferred to another hospital that will accept fee-for-service Medi-Cal beneficiaries, the San Jose Mercury News reports.
Regional, which became a for-profit hospital in 1999, in November 2004 stopped accepting Medi-Cal beneficiaries not enrolled in managed care plans. According to the Mercury News, some observers have said that the "reverberations of Regional's Medi-Cal policies could eclipse the closure of its sister hospital [San Jose Medical Center] in hampering access to health care throughout the county."
Bill Gilbert, Regional's CEO, said the hospital lost $500 to $1,000 daily on treatment for each fee-for-service Medi-Cal beneficiary. Gilbert said the hospital lost between $27 million and $29 million dollars in 2004, making the new policy financially necessary.
Gilbert said, "We hope it's temporary. I want to serve all of the community. The trouble is, somebody's got to pay for it."
Fee-for-service Medi-Cal beneficiaries made up about 25% of Regional's inpatient population. Since the new policy has gone into effect, admissions to the labor and delivery unit have declined by 30%, primarily because pregnant women who qualify for emergency Medi-Cal are no longer accepted at Regional.
The San Jose City Council on Tuesday is expected to consider the hospital's planned $140 million expansion (Feder Ostrov, San Jose Mercury News, 1/24).