Dan Barsanti, left, a graduate student, is photographed with his wife Jolina and their two children, Vincenzo, 1, and Gianna, 4, at their home in Oakland, Calif., on Tuesday, May 29, 2012. Dan and his two children are on Medi-Cal, while his wife is not because she has other insurance through her employer. Dan sometimes delays seeing a neurologist for his headache problems because of the expense involved. The family pays out-of-pocket for its medical bills until it reaches $1,249. (Ray Chavez/Staff)
As California's Medi-Cal program readies for an influx of 2 million to 3 million people when national health reforms kick in, major challenges lie ahead, including finding enough specialists who will see participants.
The state's existing 7.5 million Medi-Cal recipients already have difficulty accessing specialists, according to a study by the California HealthCare Foundation.
And adults on Medi-Cal are twice as likely to visit the emergency room as people with other coverage, the study reveals. This may be an indication of greater difficulty in seeing primary care doctors.
Medi-Cal, the state's version of the federal Medicaid program for low-income people, is confronting challenges on two fronts.
Even as it copes with financial pressures and state budget cuts, it is gearing up for the major expansion in 2014 if the national health reform law is upheld by the Supreme Court.
Against this backdrop, the California HealthCare Foundation surveyed more than 1,000 enrollees about their experiences. The results highlight the opportunities and hurdles ahead.
"The overwhelming majority think that Medi-Cal is a good program," said Chris Perrone, the foundation's deputy director of health reform.
Ninety percent called Medi-Cal a "pretty good" or "very good" program, and 78 percent said it covers most of the medical care people need. More than two-thirds said Medi-Cal provides access to high-quality care.
But getting that care
is not always easy, the survey reveals.Thirty-four percent of adults said it is difficult to find a specialist who will accept Medi-Cal, and 23 percent said it is tough to find a primary care doctor.
Many providers refuse to see Medi-Cal patients because the program has one of the lowest reimbursement rates in the nation. California ranks 47th of 50 states, the study notes.
Some people worry that access will become more difficult with the influx of new enrollees in 2014. At that time, Medi-Cal eligibility will expand to include people with incomes up to 138 percent of the federal poverty level. That will bring many uninsured, childless adults into the program for the first time.
"This will close a huge, gaping hole in our safety net," said Anthony Wright, executive director of Health Access California, a consumer group.
The health reform law contains a temporary Medi-Cal reimbursement hike for primary care doctors to address the access issue. In 2013 and 2014, payment rates for such providers will rise to Medicare levels. That will mean a significant pay boost in California.
But it is unclear what happens after those two years end.
"Hopefully, Congress will see the importance of continuing
The temporary pay boost does not apply to specialists, making access to such care of particular concern, Perrone notes.
Adding to the uncertainty: State lawmakers have approved a 10 percent pay cut for Medi-Cal providers, an action on hold pending the outcome of a court challenge.
"We clearly see some of the problems; at the same time, it's important not to let the criticisms devalue the importance of Medicaid as a whole," Wright said. "Whatever the issues and challenges, it's far preferable to being uninsured."
Oakland resident Jolina Barsanti and her family will second that.
Jolina has private insurance through her employer, but Medi-Cal provides coverage for her husband, Dan, a graduate student, and their 4-year-old daughter and 1-year-old son.
Dan has problems with cluster headaches and needs to see a neurologist occasionally and take medication. But he sometimes postpones seeking care because of the cost. Because Jolina Barsanti works, the family must pay $1,249 out-of-pocket before much of their Medi-Cal coverage kicks in.
"If it's something that doesn't need urgent care, he does put it off," Jolina Barsanti said.
He is not alone. Although most Medi-Cal enrollees have only minimal cost-sharing, 31 percent of those surveyed said they have delayed seeking care in the past year because of the cost, including 17 percent who postponed a recommended test or treatment.
The Barsanti family also has experienced the effect of Medi-Cal cuts in 2009, including elimination of such benefits as optometry, adult dental care, podiatry, speech therapy and psychology.
Dan Barsanti now pays out-of-pocket for his appointments with eye specialists and to buy contact lenses.
"It's a good program, but I think it can be better," Jolina Barsanti said.
Consumer advocate Wright is optimistic about Medi-Cal's future. Health care reform will create opportunities to streamline enrollment and make other improvements, he said. But he also offers a note of caution.
"The budget cuts make this a lot harder because you're taking millions of dollars out of a stressed health care system at a time when we should be building it up."
Sandy Kleffman covers health. Contact her at 925-943-8249.
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