While Medi-Cal faces tough fiscal challenges, current recipients give the state health program for low-income Californians high marks in general.
In a survey released Thursday, about 90 percent of enrollees described the program as "very good" or "pretty good" and 69 percent said it offered access to high quality care.
The survey, commissioned by the California HealthCare Foundation in Oakland, was released as Medi-Cal, the state's Medicaid program that insures 7.5 million residents, is bracing for a potential influx of as many as 3 million more in 2014 - if the federal health legislation is upheld by the U.S. Supreme Court.
At the same time, the state budget crisis has already forced the elimination or reduction of benefits with the threat of more cuts on the way. Although the federal government will help support the expansion in the short term, in the long term the funding situation remains murky.
"If the coverage expansions in the Affordable Care Act are implemented as enacted, then Medi-Cal will go through some historic changes," said Chris Perrone, deputy director of the California HealthCare Foundation's health reform and public programs initiative.
The survey, considered the largest of its kind, was conducted in late 2011 and early 2012 of nearly 1,100 Medi-Cal recipients under 65. It did not include people covered by both Medi-Cal and Medicare.
Some discontent
The response was generally positive, but the survey found enrollees with disabilities or health problems who had less favorable experiences with Medi-Cal. Nearly half of those who described themselves as in fair or poor health said they had trouble getting an appointment to see a specialist.
Whether in good or poor health, adults with Medi-Cal were more than twice as likely to say they have visited the emergency room in the past year as compared with those with other types of coverage. They were also twice as likely to report problems getting appointment with primary care physicians or specialists.
Only 57 percent of California physicians are accepting new Medi-Cal patients, compared with about 90 percent of doctors accepting new patients with private insurance. The Medi-Cal payment rates could get even lower if proposed state cuts currently enjoined by the courts go through.
The federal health legislation would raise rates - for primary care physicians, not specialists - but the boost would last just two years. The ongoing state budget crisis casts doubt on whether California could continue those higher rates. Already, the state has had to make major cuts to the program, including the elimination of adult dental benefits and other services.
"There have been a lot of attacks on Medi-Cal and Medicaid as part of the political debate with some political leaders saying it's no better than being uninsured and it's a flawed foundation on which to build health reform," said Anthony Wright, executive director of Health Access, a consumer advocacy group.
Wright said that's not the case. "The survey does show that even with all the problems, it's an incredibly valuable program for millions of Californians," he said.
Help for the family
Jolina Barsanti of Oakland is grateful the program covers her two young children as well as her husband, a full-time graduate student. While she has health insurance through her job at a San Francisco design firm, her employer's dependent coverage is too expensive.
But because of her income, the family has to pay $1,249 in medical expenses before the Medi-Cal coverage kicks in. Between rent, the cost of day care and other expenses, Barsanti said it's difficult to afford care.
The family is not alone. The survey found that, despite the common perception that Medi-Cal offers free coverage, nearly a third of enrollees said they delayed medical care in the past year due to costs.
"The biggest hurdle is having that share of cost. It really hinders us from seeking medical help," Barsanti said. "The share of cost is too high for just one income. I don't know how they calculate those figures, but something needs to change."
Report online
The report "Medi-Cal at a Crossroads; What Enrollees Say About the Program" can be found at www.chcf.org.
For videos of recipients reflecting on their experiences with Medi-Cal: links.sfgate.com/ZLKP
This article appeared on page C - 2 of the San Francisco Chronicle
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