The on-again, off-again access for Sacramento Medi-Cal patients to UC Davis Medical Center and its affiliated clinics is open once more for some patients, in light of a new agreement between UC Davis Health and the insurer Health Net.
The health system and the insurer struck a deal that will allow as many as 5,000 people enrolled in Health Net’s Medi-Cal plan in Sacramento County to receive primary care and other medical services through UC Davis Health, according to an announcement by the university. The deal comes about three years after UC Davis and Health Net canceled a previous primary care contract covering Medi-Cal enrollees.
UC Davis Health is the university’s academic health system, which includes the medical and nursing schools, a 619-bed acute care teaching hospital and associated clinics with a total of 1,000 physicians.
Just over two months ago, UnitedHealthcare, the nation’s largest health insurer, said it would stop offering coverage to Medi-Cal patients in Sacramento. UnitedHealth covered only about 1 percent of Sacramento County’s 422,000 Medi-Cal patients, but it was the only insurer whose members had access to primary care at UC Davis.
Those patients will now be able to continue getting care with UC Davis Health by shifting their enrollment from Unitedhealth to Health Net, said UC Davis spokesman Charles Casey. The health system has sent letters to its patients advising them of their option to do so, he said.
“We’re pleased to bring expanded access to our Medi-Cal members,” Steven Sell, president of Health Net of California, said in a statement.
Lee Henderson, a 54-year-old Sacramento resident with high blood pressure and an adrenal condition, is one of those who should be able to make the switch. He’s among the patients who has gained and lost access to UC Davis doctors in recent years with shifting agreements between insurers and the health system.
He had been a Health Net member when the insurer and UC Davis terminated their contract in 2015, forcing him to stop seeing doctors at UC Davis and seek care at a local community clinic instead. A year ago, he was able to return to UC Davis after UnitedHealth entered the Sacramento Medi-Cal market. But this year, UnitedHealth’s decision to withdraw effective Oct. 31 threatened his care again.
“It’s just a merry-go-round,” Henderson said. “It’s such a shock to keep going through this over and over. I wonder if I will be able to get on the bandwagon, and how long it will last.”
Patient advocates say that UC Davis, with its broad and highly skilled network of doctors, is the best and most appropriate source of care for many patients, especially those with complex medical conditions.
The advocates are concerned that many patients won’t know how to get access to care at the health system following the Health Net deal.
“The contract is for ‘up to’ 5,000 patients,” said Amy Williams, a staff attorney with Legal Services of Northern California who has been working to help Sacramento Medi-Cal patients get primary care at UC Davis clinics. “We need to make sure that 5,000 patients are enrolled. UC Davis needs to publicize this change.”
The off-and-on access of Sacramento Medi-Cal patients to UC Davis stems from the health system’s dissatisfaction with reimbursement rates. Casey, the UC Davis spokesman, said that in 2017 UC Davis Health absorbed more than $93 million in unreimbursed costs serving Medi-Cal patients.
The university and Health Net have been in talks for several months — driven in the past few weeks by UnitedHealth’s intention to withdraw, Casey said. He declined to discuss the terms, saying only that “we were able to reach an equitable agreement.”
Medi-Cal, California’s version of the federal Medicaid program for low-income residents, serves 13.2 million people, about one-third of the state’s population. The vast majority of them — about 80 percent — are served by managed-care plans, in which the state pays insurers a fixed amount per enrollee to provide comprehensive care.
That contrasts with fee-for-service Medi-Cal, in which the state pays medical providers directly for services provided. Medi-Cal enrollees are generally required to sign up for managed care.
Henderson said he hopes the shift between insurers happens soon, so the new hearing aids he needs will be approved and paid for.