Medi-Cal facing expensive boom

July 12, 2012

Medi-Cal patient numbers will expand dramatically over the next few years while more and more California physicians are curtailing their services to recipients of the state’s health care program. (San Jose Mercury News)

Many doctors already view Medi-Cal reimbursements as inadequate; the state ranks 47th of 50, one of the lowest reimbursement rates in the U.S. Medi-Cal pays a physician $15-20 for an office visit; Medicare reimburses $50 for the same service, and a private insurer ponies up as much as $70.

Recently state legislators eliminated the Healthy Families program, which provided low-cost medical insurance for children and teens. That alone will add at least 900,000 children to the Medi-Cal ranks, and 1.5 million or more adults will be enrolled when the national health plan takes effect in 2014.

And lawmakers last year shaved 10 percent more from the pay to Medi-Cal providers, a move now contested by physicians.

Medi-Cal, covering 7.7 million Californians, is expected to grow by 30 percent in two years, costing $9 billion more — financed primarily by federal funds.

UPDATED, 3:35 p.m. July 19 to add the following commentary from the Contra Costa Medical Association on the matter of the Healthy Families program’s fiscal woes.

“The California Legislature recently approved Governor Jerry Brown’s proposal to phase out the Healthy Families program entirely in 2013, forcing approximately 880,000 children into the Medi-Cal program instead. Fewer physicians are able to accept new Medi-Cal patients due to the inadequate reimbursement rates that generally do not cover the costs of medical practice.

“In fact, the Legislative Analyst’s Office estimates that only 25 per cent of physicians who are treating Healthy Families kids will be in a position to continue providing care once the program is eliminated in 2013. Because the Legislature once again did nothing to address the structural funding deficiencies in Medi-Cal that make it impossible for many physicians to participate, the Legislature’s decision will only further strain access to care for Medi-Cal patients.

“The California Medical Association (CMA) opposed efforts to eliminate the Healthy Families program, and along with other provider and children’s groups, has proposed a compromise effort to restructure Healthy Families by moving only the “bright line” children — those whose parents earn between 101 and 138 percent of the federal poverty level — into Medi-Cal. The state will be required to transition these children to Medi-Cal due to the requirement of federal health reform.”

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