Skip to main content

1 in 3 Medi-Cal Enrollees Delay Care on Cost Concerns

 |  By cclark@healthleadersmedia.com  
   May 31, 2012

Medi-Cal, the largest Medicaid program in the nation with 7.5 million beneficiaries—and 10 million by 2014—may be a good program overall, but one in five patients don't think it provides access to high quality medical care and another 10% aren't sure.

Nearly half of Medi-Cal patients in fair or poor health (46%) say it is difficult to find a specialist for needed care, compared with 23% of patients in excellent health. And nearly one-third (31%) said they had delayed care in the last 12 months because of the cost. For example, 15% delayed filling a prescription, 18% care for a specific medical problem, and 17% delayed getting a test, treatment or follow-up care because of the cost.

More than half (56%) of respondents reported long wait times to sign up for the program and one in four said they disagreed with the statement that the workers at the county offices were friendly.

Those are some conclusions from a survey conducted by the California HealthCare Foundation, "Medi-Cal at a Crossroads: What Enrollees Say About the Program," released Thursday. The survey was conducted between December, 2011 and January, 2012, following a series of cuts to the program that were implemented in recent years.

The survey comes as disgruntled physicians who accept Medi-Cal brace themselves for more cuts to their reimbursement, and as an increasing number of doctors threaten to opt out of the program.

And it comes as most states across the country look to unload on Medicaid programs billions of dollars in cuts that must be made to balance legislative budgets. 

Across the country, "people see the Medi-Cal program as kind of a bellwether," says Christopher Perrone, deputy director of the foundation's Health Reform and Public Programs Initiative. "All states are struggling with how you control spending in this program, and California has chosen one path, with historically low provider payment rates, particularly for physicians. This is a report that shows what happens when you take that course of action."

"Almost every state has significant budget shortfalls that they're struggling with now, and which they're passing on to Medicaid," says Matt Salo, executive director of the National Association of Medicaid Directors in Washington, D.C. "They can either raise revenue, which means raising taxes, and which by and large isn't going to happen, or they reduce spending."

Illinois, for example, is trying to find $2.7 billion in Medicaid savings while Arkansas is looking at a 25% shortfall, he says. 

And California, he says, "has it as bad as anybody."

California pays physicians who take care of Medicaid patients about 56% of what it the same services would pay under the Medicare program. California ranks 47th out of 50th in states regarding Medi-Cal spending, according to a CHCF report from April, 2009.

In 2009, the state implemented $134 million in Medi-Cal program cuts, $115 million of which was for cuts in dental services. Other cuts reduced access to speech therapy, podiatric and audiology services, chiropractic and acupuncture care, optometric and optician and psychology services, Perrone says.

Currently, the state proposes to cut 10% more from payments to physicians, clinics, optometrists, therapists, laboratories, dental services, durable medical equipment and pharmacy; 10% cuts to freestanding nursing and adult sub-acute facilities and 10% payment reduction and rate freezes for nursing facility Part B services. They are pending court challenges from physician and hospital groups.

Historically, provider payment rates make California among the lowest, if not the lowest, in terms of physician compensation for care for Medi-Cal patients and at the bottom in terms of Medicaid program spending per beneficiary.

A statement issued with the CHCF report highlights its positive findings, for example, that 69% of the respondents say they are satisfied with the quality of their care and 78% believe the program covers the care people need.

Perrone says that's perhaps because the survey could have found much more negative responses than it did. "There's a lot of good news about the program at a time when Medi-Cal, and Medicaid nationally, are often disparaged.  It's important to recognize that the people enrolled really value and appreciate the program."

However, Perrone agrees that a legitimate way to interpret the report is to examine the flip side, of how many beneficiaries are unhappy with their Medi-Cal experience.

"It is important to see that even when you have three-quarters of people saying you need to enroll, it is important to say that one in four think it is not," he says.

The report is important especially in its roll to highlight challenges the program must overcome with regard to the enrollment process, which will serve a population in 2014 that is bigger than 43 states.

"If the Affordable Care Act is implemented in 2014 as enacted, and the expansions are implemented, California can expect two to three million more people to enroll in Medi-Cal, and that will require a wide array of pathways," Perrone said.

 

"This survey says that while most have good experiences with the enrollment systems now, many more people will prefer to enroll online and wait times at county offices are long. Those are clearly two opportunities for improvement."

Tagged Under:


Get the latest on healthcare leadership in your inbox.