Rural Medi-Cal Beneficiaries Have Difficulty Accessing Specialty Care
Rural Medi-Cal beneficiaries have had a harder time accessing medical care since being shifted into managed care plans last fall, the CHCF Center for Health Reporting/San Francisco Chronicle reports. The center is supported by a grant from the California HealthCare Foundation, which publishes California Healthline.
Medi-Cal is California's Medicaid program (Wiener, CHCF Center for Health Reporting/San Francisco Chronicle, 9/23).
In November 2013, the state began transitioning Medi-Cal beneficiaries in rural areas from fee-for-service care arrangements to managed care plans. The move shifted 28 rural counties to the financial model the state is using throughout the rest of the state (Gorn, California Healthline, 11/7/13).
Medi-Cal managed care reimbursements for office visits are 65% lower than private insurer payments, according to a July Government Accountability Office report. In addition, the managed care plans pay 10% less than traditional fee-for-service Medi-Cal coverage.
Details of Access Issues
Following the shift to managed care plans and the expansion of Medi-Cal under the Affordable Care Act, some rural counties are reporting that program beneficiaries have had trouble accessing medical treatment.
For example, Mimi Hall -- public health director in Plumas County, where 3,700 residents are enrolled in Medi-Cal -- said that some medical equipment providers, pharmacists and specialists in the area have stopped treating new Medicaid patients or dropped out of the program altogether because of low reimbursements and other issues. As a result, some beneficiaries must travel to San Francisco -- 230 miles away -- if they need specialty care, according to the Center for Health Reporting/Chronicle.
In Placer County, Jeff Brown, director of the local Health and Human Services Department, said the system for referring patients to specialists is "woefully inadequate."
Marcie Caywood, deputy director of Calaveras County's child health and disability prevention program, said, "You can insure people all day long, and it doesn't equate to access."
Insurers say that they are complying with the state's requirements but noted that low Medi-Cal reimbursements make it more difficult to ensure specialists' participation in the program.
Patrick Johnston, CEO of the California Association of Health Plans, called the low payouts a "fundamental problem."
Anthem Blue Cross spokesperson Darrel Ng said, "We do our best to find primary care physicians and specialists," but the insurer "can't force providers to provide these services if they choose not to."
DHCS officials said the state collects data on managed care plans to ensure that beneficiaries have access to providers.
Javier Portela, an administrator at the state Department of Health Care Services, said the department has not seen an increase in complaints or "any access issues or concerns" from individuals who were shifted into managed care plans. Portela added that DHCS would not address "anecdotal comments from the counties," according to the Center for Health Reporting/Chronicle (CHCF Center for Health Reporting/San Francisco Chronicle, 9/23).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.