Study Questions Medi-Cal Access Again

The California Healthcare Foundation published a study late Wednesday questioning the relative effectiveness of the Medi-Cal program, concluding that its enrollees experience significant gaps in access to healthcare services compared to those who are enrolled in employee-sponsored healthcare plans. 

However, demographic differences among the two groups may explain away some of the gaps, according to the study.

Conducted by researchers at UCLA, the study did tend toward confirming a recent scathing audit of Medi-Cal by the state of California regarding a lack of access to individual providers and services. The results of the study were based on the 2012-13 California Health Interview Survey, a series of questions that UCLA researchers pose to thousands of residents statewide about their health status and access to insurance.

Medi-Cal has become an enormous program in recent years, particularly under the aegis of the Affordable Care Act, which to date has expanded Medicaid eligibility in 30 states, including California. There are currently about 12.2 million Californians enrolled in Medi-Cal, or about 30% of the state’s overall population. About three-quarters of those are in managed care plans.

The study compared 45 different areas of healthcare access between Medi-Cal enrollees and those whose coverage comes through their employers. It concluded there were “significant” gaps between Medi-Cal and commercial health plan enrollees in 29 different areas of care delivery. However, the study’s authors concluded that socioeconomic differences and contrasts in healthcare needs between Medi-Cal and commercial health plan enrollees are significant as well. For example, 61% of commercial health plan enrollees say they are in good or excellent health, compared to 31% of Medi-Cal enrollees.

When such differences are controlled for, gaps occur in only nine different areas. Among them:

• Eighteen percent of Medi-Cal enrollees say they do not have a usual source of care other than a hospital emergency room, which is at least 50% greater than those in commercial plans and more than twice as great depending on the kind of plan commercial enrollees are enrolled in

• 22 percent of Medi-Cal enrollees say they have not visited a physician in the past year, about 50% higher than commercial enrollees

• 12 percent of Medi-Cal enrollees said they delayed care due to cost concerns, about 20% higher than commercial enrollees

• Nine percent of Medi-Cal enrollees said they encountered doctors who would not accept their coverage, more than quadruple the rate of commercial enrollees

• 24 percent of children enrolled in Medi-Cal had visited a hospital ER in the past year, compared to about 13% of children enrolled in their parent’s employer-sponsored health plan

• 17 percent of children enrolled in Medi-Cal had height-to-weight ratios implying they were obese, more than 50% higher than those kids in commercial health plansThere were also significant access issues reported by Medi-Cal enrollees who had a condition that limited their ability to work. Nine percent said they had difficulties finding a specialist (compared to 3% of all Medi-Cal enrollees), and 20% delayed care due to cost concerns, 2.5 times the rate of those Medi-Cal enrollees who are able to work.

Anthony Wright, executive director of the advocacy group Health Access California and a member of the Payers & Providers editorial board, said he was not surprised by the study’s findings.

“We’re seeing both anecdotal and quantitative data showing that there is an access issue in Medi-Cal that needs to be resolved,” he said. “It is becoming a more and more important part of our healthcare system, and what was urgent before is now critical to address given the recent expansions in coverage.”

The study did note that children enrolled in Medi-Cal experienced fewer gaps in obtaining care than their counterparts in commercial plans. And in many instances, Medi-Cal managed care plans performed nearly as well as commercial insurance.

A companion to the UCLA study conducted by the Urban Institute concluded that provider access in California was similar to Medicaid enrollees in other parts of the country.

The Urban Institute study did note that concerns about affordability of care was significantly higher in California than in other states. According to its data, more than a third of Medi-Cal enrollees had unmet care needs due to cost concerns, compared to about 23% of Medicaid enrollees in other states. 

But when it comes to Medi-Cal managed care enrollees, the Urban Institute concluded their access to care was similar to that of Medicaid enrollees outside of California.

Nevertheless, the UCLA study concluded that “access to care is worse for Californians disproportionately represented in Medi-Cal, including those who are in poor health, have a disability, are low-income or of a race other than non-Latino white. State policymakers must take extra steps to ensure that Medi-Cal enrollees realize equal access to care.”

The study did note that California has one of the lowest rates of payments to providers participating in the Medicaid program in the entire country. Although Wright noted that increasing payments would likely address some of the issues, he did not see it as a cure-all. “Having additional accountability would also help,” he said.

Health Access has sponsored two pieces of legislation requiring state regulators to more regularly audit health plans participating in the Medi-Cal program regarding care access and quality provided to enrollees, and comply plans to update their provider directories weekly in order to ensure their accuracy. 

The first bill, SB 964, was signed into law last year. The second bill, SB 137, was unanimously passed by the Senate last month but has not gone to the Assembly for a vote.