Dan Walters

Opinion: Medi-Cal’s expansion hits a snag

The Supreme Court will soon decide whether residents of states that refused to implement Obamacare are entitled to federal insurance subsidies.

Whatever it decides, the court’s decree will not affect California because no state was more eager to embrace the iconic program.

Previously, California had one of the nation’s highest proportions of medically uninsured residents, with an estimated 7 million Californians – the working poor, mostly – lacking coverage.

Gov. Jerry Brown’s administration estimates that in the last 18 months, 5 million Californians have obtained health insurance via Obamacare, although not all new enrollees were previously uninsured.

Some purchased coverage directly through a state insurance exchange called Covered California and some got it from employers. But the most dramatic surge has been enrolling 4 million more in Medi-Cal, the state’s version of Medicaid, the national health care program for the poor.

Obamacare expanded Medi-Cal eligibility with federal money to pick up some, but not all, of the increased costs, and enrollment has already soared to 12.2 million – nearly a third of the state’s population – with a large application backlog.

That stunning number is stark evidence of California’s ever-widening economic divide.

California has nearly twice as many enrollees as the next largest state, New York, and 17.2 percent of all Medicaid enrollment in the nation.

The expansion has not only added billions of dollars to the state budget, but placed an immense strain on agencies that oversee the program and an even more obvious strain on the medical provider system.

Many poor Californians have obtained insurance coverage only to face great difficulty finding doctors and other providers, fueling demands by medical groups to raise reimbursement rates that were slashed during years of state budget distress.

The Legislature’s dominant Democrats placed money in their version of the budget to raise rates over opposition from Brown’s budget advisers.

The budget deal announced Tuesday doesn’t include provider rate hikes, but they could re-emerge in a special legislative session that Brown called on health issues.

Coincidentally, State Auditor Elaine Howle issued a report Tuesday that sharply criticizes the administration for failing to ensure that the provider networks of Medi-Cal’s managed care contractors are accurate.

Howle’s staff found that many of the provider directories are inaccurate and the Department of Health Care Services “has not consistently monitored health plans to ensure they meet Medi-Cal beneficiaries’ medical needs.”

It validates the complaints about chronic medical provider shortages – a problem that may require either a lot more money or allowing nurses, chiropractors, pharmacists, naturopathic doctors or other non-physicians to become basic care providers.