State Grossly Overstated Number of Doctors Treating Medi-Cal Patients

Tuesday, July 22, 2014

There are around 4,500 more doctors allegedly tending to Medi-Cal patients than there are licensed doctors in the state, according to obviously dubious statistics provided by California Department of Health Care Services (DHCS), the agency that oversees the program.

After using the department's official number of 109,000 Medi-Cal doctors in a story, the California Health Report was informed that the state only had 104,422 licensed physicians as of 2013. And not all of the licensed doctors accept Medi-Cal patients. Oops.

Upon review, the list of doctors treating low-income patients in the state version of Medicaid was found to have duplications and names of retired and deceased doctors. Molly Weed, a spokeswoman for the California Medical Association told Health Report reporter Hannah Guzik, “They don’t have any idea how many physicians are actually accepting new Medi-Cal patients.”

That would be bad news under any circumstances, but is particularly appalling since the rollout of the Affordable Care Act has increased the number of Medi-Cal patients dramatically. One of the law's largest impacts is the extension of health insurance to millions of low-income people who have none, at virtually no cost to them.

California originally expected 1.3 million people to benefit, but, so far, 2.2 million have signed up. The overall savings to the state—from having a healthier population and by keeping people out of emergency rooms for primary care—is expected to be substantial.

DHCS revisited its list of Medi-Cal doctors and came up with 82,605 physicians, a 25% decrease. The list is important because a healthy supply of doctors is used in arguments by the state to justify cuts in reimbursement rates to doctors.

The doctor supply will be critical in the coming months as the state hacks away at the backlog of Medi-Cal applicants that swamped the system when Obamacare too effect this year. As of March, 900,000 applicants were waiting to be processed. The federal  Centers for Medicare and Medicaid Services (CMS) sent letters to California and five other states that they had better start doing something about that fast, about the same time DHCS said it had gotten the backlog down to 600,000.

The department, blaming the crush on new applicants and computer problems, said it will get the backlog down to 350,000 in August.

The DHCS works on its backlog and the doctor’s list, the state continues to operate the much larger Covered California―the state’s version of Obamacare―without any idea how many doctors are really in its networks.

All anyone knows for sure is that the insurance companies are maintaining much smaller networks of doctors for Covered California patients than those without the government subsidies and higher rates. People are still shocked and amazed to find that they have reasonably priced insurance with good coverage, but can’t find a doctor or hospital to treat them.

The state promised Covered California lists like those one finds at insurance company websites, but were tardy in producing them. Once finally posted on the web, the lists were found to be wildly inaccurate and were quickly taken down. Doctors, their medical groups and insurance companies continue to fight over who has to treat Covered California patients and it doesn’t appear their will be any progress before next year―if then.

–Ken Broder


To Learn More:

State Agency Running Medi-Cal Didn’t Know How Many Docs Took its Insurance (by Hannah Guzik, California Health Report)

Obamacare: California Details Plan to Cut Medi-Cal Backlog to 350,000 (by Eryn Brown, Los Angeles Times)

Directories of Doctors Who Treat the Poor Are Inaccurate, Hurting Access (by Hannah Guzik, California Health Report)

State Mails Quarter-Million Medi-Cal Enrollees Bogus Info about Losing Their Doctors (by Ken Broder, AllGov California)

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