Sacramento doctors: County’s Medi-Cal system is failing its patients. The fix is simple

As primary care doctors in Sacramento, the vast majority of our patients receive health insurance through Medi-Cal, California’s Medicaid program. Nearly one-third of Sacramento residents — more than ever before — are now covered by Medi-Cal thanks to an expansion of eligibility in recent years.

In spite of this, the system in Sacramento is failing patients.

Sacramento is one of only two counties in California that allows multiple private, usually for-profit health insurance plans to contract with the state government to pay for health care services. In Sacramento, Medi-Cal beneficiaries are assigned to any one of five different private insurance plans. Other counties have fewer plans. San Francisco and Los Angeles each have two plans, and Yolo and San Mateo each have one.

The original goal of Sacramento’s approach was to improve quality, access and cost of care by providing an increased number of health plans for patients. In reality, Sacramento’s approach has failed.

One of our patients, experienced both the promise of Medi-Cal and shortcomings of Sacramento’s approach. Recently, she came to our clinic for a comprehensive primary care evaluation. She had recently been diagnosed with a type of skin cancer that would require months of specialized treatment with a dermatologist. As we do many times each day, we submitted a referral to her health insurance plan.

What should have been a routine step in her care became a circuitous detour of delayed treatment. For unclear reasons, and without her or our knowledge, she had been switched from one Medi-Cal insurance plan to another several weeks after we submitted her dermatology referral.

This new insurance plan contracted with a different network of specialist physicians, so a new referral was required. The insurance plan then referred her to a dermatologist who was unable to provide the specific treatment she required, so she needed to be referred to yet another dermatologist. Finally, four months after she first established care with us, she was seen by the appropriate dermatologist to initiate treatment.

For four months, treatment of her cancer was delayed because of the uncoordinated system of Sacramento’s Medi-Cal.

We both have dozens of patients like this who have struggled to access care and received substandard specialist follow-up due, in large part, to the number of Medi-Cal health plans in Sacramento County. Access to care and the quality of care for Medi-Cal beneficiaries in Sacramento is among the worst in the state, and several independent reports have directly attributed these problems to the Medi-Cal structure in Sacramento.

Counties with fewer health plans have higher quality care and greater patient satisfaction than Sacramento. While having more health plans may seem like a benefit to patients, in reality it creates a burdensome morass of conflicting formulas, physician networks and administrative contacts.

Our patients deserve better.

The state’s Department of Health Care Services is currently reviewing which plans to continue with for Medi-Cal. The department has indicated that it might limit the number of health plans in Sacramento to two or three, which would be a welcome change that could improve the care we provide to our patients.

Some have raised concerns that reducing the number of health plans would reduce access for patients. This is incorrect. The involvement of fewer health plans will increase access for patients because fewer patients will run into problems. The complexity of Sacramento County’s current system actually impedes the high quality care Medi-Cal providers strive to offer. A reduced number of plans will mean fewer bureaucratic, redundant and confusing processes for patients and providers.

This story was originally published December 7, 2021 at 6:00 AM.