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Low Medi-Cal, Insurance Payments Hamper Access to Specialists
Access to specialists could become a challenge as many California residents — especially Medi-Cal beneficiaries — gain health coverage under the Affordable Care Act, the Los Angeles Daily News reports. Medi-Cal is California’s Medicaid program.
The article was produced by the California HealthCare Foundation’s Center for Health Reporting. The center is supported by a grant from CHCF, which publishes California Healthline.
According to the state Department of Health Care Services, 8.5 million California residents currently are enrolled in Medi-Cal, and an additional one to two million residents are expected to become eligible this year under the ACA’s expansion of the program.
The American Medical Association says that between 85 and 105 specialists are needed for every 100,000 patients to sufficiently serve a population.
However, a 2010 report by CHCF report found that California had just 65 specialists per 100,000 Medi-Cal beneficiaries.
Details of Access Challenges
A Medi-Cal Managed Care Dashboard briefing, which CHCF released in December 2013, found that thousands of Medi-Cal beneficiaries were having trouble accessing care from specialists.
Experts say the number of specialists likely has declined since the report was conducted because of:
- Low reimbursement rates offered by plans sold through Covered California, the state’s insurance exchange; and
- A provision of Gov. Jerry Brown’s (D) fiscal year 2014-2015 budget proposal that retains a 10% cut to future Medi-Cal reimbursements.
DHCS officials say there are enough specialists to care for Medi-Cal beneficiaries, but they acknowledge that it is unclear whether the providers will be willing to accept new Medi-Cal patients (Udesky, Los Angeles Daily News, 3/4).
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