The State Still Doesn’t Know How Many Doctors Take Medi-Cal Patients, but It’s Not Enough

Wednesday, June 17, 2015

There is a difference between providing health insurance and providing health care, and when it comes to California’s poorest residents, the gap could be huge.  

The California State Auditor issued a scathing report (pdf) this week about the plight of Medi-Cal patients after passage of the Affordable Care Act (Obamacare) greatly expanded their numbers the past two years. Medi-Cal is the state version of Medicaid, which provides medical assistance to people with low incomes and limited resources.

The audit found that California’s Department of Health Care Services (DHCS) still can’t say how many doctors in the state accept Medi-Cal patients, despite requirements that insurance providers maintain adequate physician networks, and complaints from patients and their advocates that they have not.

“Health Care Services did not verify that the provider network data it received from the health plans were accurate,” the report said, and without that information, “cannot ensure that the health plans had adequate provider networks to serve Medi-Cal beneficiaries.”

But why guess? Certainly if people couldn’t find doctors they would have complained mightily about it to the ombudsman’s office established by the state. The auditor said that the office’s phone system was overwhelmed and rejected between 7,000 and 45,000 calls a month from patients. Only 30% to 50% of the lucky ones who got connected actually reached a person, accounting for another 12,500 ignored patients.

California added 3.7 million patients to Med-Cal to the 8.6 million enrolled in 2013. About half of them joined through the ACA. But while the state and federal governments were encouraging more people to sign up, Medi-Cal reimbursement rates to doctors that were whacked after the Great Recession were not restored.

The auditors looked at three health plans in three counties—Anthem Blue Cross in Fresno County, Partnership HealthPlan of California in Solano County and Health Net in Los Angeles County—as a representative sample. They found inaccurate information for 3% to 23% of the providers. The state is supposed to verify, by law, that Medi-Cal patients do not have to drive enormous distances for medical care, but couldn’t make that assurance for lack of reliable information.

Around 75% of Medi-Cal patients are in private managed care health plans. The state has 22 and DHCS is supposed to audit each of them every year. The auditor said the department only looked at 10 in 2013-2014.

The state Legislature asked for the auditor’s report last year after a study by the California Health Report found that half the primary-care doctors on lists given to low-income patients by insurance companies weren’t taking new patients or couldn’t be reached by phone for one reason or another.

Some listed doctors had died, some had moved and some had retired. But the problem extended far beyond bad communication between doctors and insurance companies. The state doesn’t pay doctors a whole lot to handle Medi-Cal patients and as a result many have reduced how many patients they see.

The auditor’s findings were similar.

It’s not like California was starting from a position of strength. A study conducted between 2011 and 2013 by the University of California, San Francisco, found that there were 35-49 physicians for everyone 100,000 Medi-Cal patients. That is far short of the federal standard of 68-102. The study was conducted before Obamacare increased the rolls.

–Ken Broder


To Learn More:

California State Auditor Blasts Medi-Cal Program for Inadequate Provider Networks (by Tracy Seipel, San Jose Mercury News)

Medi-Cal Patients May Not Have Adequate Access to Doctors, Audit Finds (by Soumya Karlamangla, Los Angeles Times)

State Auditor Finds Holes In Medi-Cal Plans (by Paul Sisson, San Diego Union-Tribune)

Medi-Cal Patients Can’t Find Doctors; State Needs Audit to Find out Why (by Ken Broder, AllGov California)

Medi-Cal Managed Care Audit (California State Auditor) (pdf)

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