Health & Medicine

Sacramento County’s safety net is failing Medi-Cal and uninsured patients, report says

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Sacramento-based Sutter Health on August 25, 2018, opened two new California Pacific Medical Center campuses in San Francisco.
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Sacramento-based Sutter Health on August 25, 2018, opened two new California Pacific Medical Center campuses in San Francisco.

Sacramento County has “historically lagged” in providing health care services for its Medi-Cal recipients and its poor and uninsured populations, according to a new report by California Health Access.

Released this week, the report by the patient advocacy group found that Sacramento County struggles or fails to provide basic safety net services that other counties in the state provide – there is no public hospital, fewer primary care doctors take on new Medi-Cal patients, and navigating available health care plans is complex and confusing.

Sacramento County “certainly isn’t the worst” county in California when it comes to providing health care services to the poor and uninsured, said Health Access California executive director Anthony Wright

“But it is certainly is not the best, and for a sort of large sophisticated county like Sacramento, you’d expect it to have a more robust set of infrastructure and services,” he said.

More than 428,000 Sacramento County residents have Medi-Cal insurance as of last month, according to the California Health and Human Services agency.

“Residents with Medi-Cal coverage in Sacramento struggle to find a provider or access specialty care while the uninsured are left with even fewer options for both primary and specialty care,” the report read.

“The question the county now must ask is how Sacramento can go from laggard to leader in caring for its vulnerable populations.”

Key recommendations for the county in the report include:

  • Defending the safety net against federal repeals and rollbacks
  • Boosting programs for uninsured and medically indigent residents
  • Increasing oversight of and transitioning out of the Geographic Managed Care model – a model that allows Medi-Cal recipients to pick among many different health plans, which in turn contract clinics, hospitals and other providers
  • Encouraging UC Davis and other hospital chains such as Sutter and Dignity to contract more with Medi-Cal plans

In 2015, people on Medi-Cal could no longer get primary care services such as checkups and consultations at UC Davis Medical Center without paying out of pocket. The hospital had historically operated as a county hospital. That led to more emergency room visits by Medi-Cal patients, and increased pressure on community clinics as a stopgap.

Though UC Davis briefly began accepting one Medi-Cal coverage plan for primary care services in 2017, that access threatened to end again last year. The new contract with HealthNet – which serves only about a quarter of all Medi-Cal recepients in Sacramento County – was secured last October.

In this environment, with the Affordable Care Act providing more resources, community and student-run clinics have flourished, Wright said. But they can’t always provide specialty care like larger hospital, and they aren’t sufficient to cover the county’s growing need, he said.

“There is a downtown clinic, but if you’re in the further outskirts, your access may be threadbare or nonexistent,” Wright said.

As for transitioning out of the Geographic Managed Care, or GMC, model, Wright said Sacramento County should look to other systems more widely used in the state.

While the GMC model may seem like a better option because it allows patients to have more health care plan options, Wright said the system ends up “carving up” existing medical resources like hospitals, clinics and doctors, and ultimately limiting access.

And because patients are directly signing up for plans through nonprofits and private groups, rather than through the county, there is less accountability, he said.

“One of the issues here is, is there a greater role for Sacramento-focused consumers and stakeholders to be involved in?” Wright said.

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Alexandra Yoon-Hendricks covers Sacramento County and the cities and suburbs beyond the capital. She’s previously worked at The New York Times and NPR, and is a former Bee intern. She graduated from UC Berkeley, where she was the managing editor of The Daily Californian.
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