California’s Medi-Cal program has expanded greatly over the past several years, now covering nearly 14 million people – one out of every three Californians.
Yet ensuring that these individuals actually have access to exams, screenings and other vital primary health care services is an ongoing challenge. A recent story in The Sacramento Bee (“Patients on Medi-Cal search for care beyond UC Davis,” Page 1A, Aug. 8), exemplifies the dilemma facing Medi-Cal patients and hospitals that provide higher levels of care.
Medi-Cal patients deserve access to timely health care services in the right setting. And no health care provider ever wants to turn a patient away. At the same time, doctors and hospitals must be paid enough to cover their costs and keep the doors open for everyone in the community.
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In most areas of California, including Sacramento County, the state has contracted its role of coordinating care for Medi-Cal beneficiaries to health plans. These plans, however, are not receiving adequate funding from the state. As a result, higher-cost providers such as academic medical centers are often eliminated from the insurer’s network.
California led the nation in expanding Medicaid. Having health care coverage, however, is not the same as having access to care. California consistently ranks near the bottom of national spending per Medicaid enrollee, about $5,300 compared to about $10,700 in North Dakota.
Medi-Cal payments to providers have not kept up with the cost of providing care. For instance, for a visit to a primary care physician, it’s about $16 – less than the cost of a haircut. As a result, Medi-Cal beneficiaries can’t get care because there aren’t enough providers in the health plan networks.
The solution to this problem is difficult to achieve. In this environment of limited resources and competing priorities, providers and health plans that serve Medi-Cal patients must be properly funded. Otherwise, it will be difficult to ever resolve this issue.
C. Duane Dauner is president/CEO of the California Hospital Association. He can be contacted at firstname.lastname@example.org.