California's Medi-Cal program for poor grows to 12 million - AND - Primary Care Physician Supply Not Keeping Up With Medi-Cal Demand

Tue Feb 24 18:33:28 PST 2015

February 15, 2015

California's Medi-Cal program for poor grows to 12 million

The Sacramento Bee

BY JUDY LINASSOCIATED PRESS
SACRAMENTO, CALIF. 
Since California embraced the federal health care overhaul, the state's Medicaid program for the poor has added more than 2.7 million people, a surprisingly high number that has left the state to grapple with making sure there are enough doctors to care for all of them.
Medi-Cal, the $95 billion joint federal-state program, covers 12 million people — nearly one in every three residents — for their doctor visits, hospital care, pregnancy-related services, as well as some nursing home care, making California the largest health care purchaser in the state.
The figure accounts for 17 percent of the nation's Medicaid enrollment, even though California has 12 percent of the U.S. population.
Lawmakers and advocates say the safety net program has grown so big, so fast that without major fixes, California won't be able to provide quality health care for its poor.
"Medi-Cal is turning into an empty promise with an insurance card," said Molly Weedn, a spokesman for We Care for California, a coalition of doctors, hospitals, health plans and labor unions pushing for higher payment rates. Democratic Sen. Ed Hernandez of La Puente and Assemblyman Rob Bonta of Alameda plan to introduce legislation Wednesday to raise rates.
Even though the federal government has injected billions into California, doctors and hospitals say the state continues to pay much less than private insurance or Medicare for medical services. That's meant fewer primary care doctors and specialists are willing to treat Medi-Cal patients.
According to the California HealthCare Foundation, a health care philanthropy based in Oakland, 76 percent of primary physicians accept new patients through private insurance, but only 57 percent accept new Medi-Cal patients.
The result is that more Medi-Cal patients are ending up in emergency rooms, which is more expensive and doesn't provide ongoing care for serious diseases and illnesses, according to We Care for California.
Dr. Marc Futernick, who directs emergency services at California Hospital in downtown Los Angeles, said one Medi-Cal patient with advanced colon cancer came into his emergency room four times in five weeks because he was unable to see an oncologist or get the chemotherapy treatments he needed.
"It's much worse than just a couple years ago," Futernick said.
As Democratic legislative leaders look for ways to spend more on social services, Gov. Jerry Brown and Republican lawmakers fret about the state's ability to pay for its commitments. Medi-Cal costs grew 4.3 percent from $17.8 billion last year to $18.6 billion this year, or 16 percent of the state's general fund. The program also faces spiraling costs for seniors and specialty drugs.
While the federal government will pay 100 percent of the costs for newly eligible Medi-Cal recipients until 2016, it will be phasing down to a 90 percent share in 2020. The Brown administration projects it will cost $1.7 billion more for the state to cover the 10 percent.
One way the Brown administration has proposed controlling costs is to limit Medi-Cal enrollment to certain times of the year, similar to open enrollment for private health plans.
Sen. Richard Pan, D-Sacramento, a doctor who has called for Medi-Cal reform, said it would be shortsighted if the state doesn't increase provider payments to save money in the long run. He said the state needs to improve coordination of care, set and measure performance standards for contracting health plans and better manage chronic illnesses to reduce hospitalization rates.
"How can we not afford this?" he asked.
Chris Perrone, director of health reform at the California HealthCare Foundation, said the state's enrollment success stems from its decision to make it easier for low-income people to enroll. For example, the state negotiated a waiver from the federal government to start covering low-income childless adults in a transitional program as early as 2010.
The expansion has helped Richard Olivares, a 33-year-old homeless man in Sacramento. He gained access to a cardiologist for heart spasms and a psychiatrist for schizophrenia, anxiety and anger management issues. Medi-Cal also covered a recent jaw surgery from a fight.
"It's really been a blessing because I have a heart problem and every time I get sick, I'm able to go and see a doctor," he said.
When Medi-Cal expanded last year under President Barack Obama's health reform plan, the state struggled to enroll people fast enough and counties reported being hobbled by a new web-based enrollment system that didn't always work. California's backlog reached as high as 900,000, prompting threats from the federal government and triggering a lawsuit from patients and health care advocates.
Under the expansion, a person can make up to $16,105 or 138 percent of the federal poverty level to qualify for Medi-Cal, or $32,913 for a family of four.
The state Department of Health Care Services, which oversees Medi-Cal, said the backlog has been "virtually cleared." The department declined multiple interview requests to The Associated Press to explain its plan for handling the caseload, which is expected to grow as more immigrants in the country without documentation will be eligible for state-funded health coverage under Obama's executive order not to seek deportation.
A report released Thursday by the nonpartisan Legislative Analyst's Office warned that Brown's budget lacked funding for the immigration policy change.

February 9, 2015

Primary Care Physician Supply Not Keeping Up With Medi-Cal Demand

California Healthline

The supply of primary care physicians in California has not kept pace with increasing enrollment in Medi-Cal, the state's Medicaid program, the San Jose Mercury News reports.

Background

According to the Mercury News, about 2.7 million additional state residents have enrolled in Medi-Cal since the program was expanded under the Affordable Care Act in January 2014. Further, state health officials project that a total of more than 12.2 million residents will be on the program's rolls by the middle of next year.

Meanwhile, there are 84,628 fee-for-service doctors participating in Medi-Cal -- more than half of whom are specialists, according to the California Department of Health Care Services, which oversees the Medi-Cal program.

Delays in Care

A recent report by the California HealthCare Foundation found that while access to specialists meets federal guidelines, the ratio of PCPs to Medi-Cal beneficiaries was about 35 to 49 physicians per 100,000 beneficiaries -- far below federal guideline of 60 to 80 PCPs per 100,000 beneficiaries. CHCF publishes California Healthline.

The shortage of PCPs participating in Medi-Cal has caused delays in care, and experts expect the situation to worsen, in part because of the program's low reimbursement rates.

The PCP shortage also is causing a surge in the number of Medi-Cal beneficiaries that seek treatment at emergency departments, the Mercury News reports. According to data from the Office of Statewide Health Planning and Development, "treat and release" ED visits by Medi-Cal patients increased by 30% between the first three quarters of 2013 and the same period in 2014.

Reaction

Steven Harrison, a PCP and director of a residency program at the Natividad Medical Center in Salinas, said, "We had a shortage of [PCPs] before this flood [of Medi-Cal beneficiaries] came about. Now we have a dire shortage."

Del Morris, president of the California Academy of Family Physicians, said, "California did a good job of getting people signed up, but they basically stuck their heads in the sand and assumed that California physicians would just jump right on board and want to take more Medi-Cal patients." He added, "It's unacceptable to say, 'We are not ready for you yet, you'll just have to suffer with your disease.'"

Meanwhile, some health officials say that delays in care and increased ED patient volume are expected parts of expanding Medi-Cal.

Bill Barcellona, vice president of the California Association of Physician Groups, said, "There's a lot of talk about physician shortages in California, and I don't buy it," adding, "We have plenty of doctors -- in fact, we have an oversupply of specialists in many areas, like the coastal areas" (Seipel, San Jose Mercury News, 2/7).

Bryan Sloane
Deputy Editor, CAL/AAEM News Service

Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service

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