Medical coverage is one thing but physicians and patients alike will tell you coverage does not mean that they will have access to timely medical care. The issue that California is facing is that the Accountable Care Act (ACA) has covered a tremendous number of patients with Medi-Cal leading many to believe they will have access to medical care and the state will pay for that care. In fact, over the past three years, patients covered by Medi-Cal have increased 39%. The problem is that more and more physicians have opted out of seeing and treating Medi-Cal patients. This study reports that the number of Medi-Cal physicians per 100,000 beneficiaries has dropped from 120 to 107. More specific data shows that
Self-reported data from a voluntary survey of California physicians show physician participation in Medi-Cal declined from 69% in 2013 to 63% in 2015. (Physicians are identified as participating in Medi-Cal if they report any of their patients are covered by Medi-Cal.) The percentage of specialty care physicians participating in Medi-Cal likewise dropped during this time, from 70% to 64%.
The thing that makes this even more concerning is this number is probably greatly inflated as it also does not measure the number of physicians that limit their Medi-Cal patients or even looks at the timeliness of Medi-Cal patients to access to primary or specialty care.
From the study:
The share of physicians accepting new Medi-Cal patients is also an indicator of the program’s capacity to meet demand. If a decreasing share of participating physicians are willing or able to take new Medi-Cal patients, beneficiaries in the program may have trouble getting the care they need. The proportion of physicians accepting new Medi-Cal patients has historically lagged behind the proportion accepting new patients covered by Medicare, which has a higher reimbursement rate, as well as behind the proportion accepting new patients with private health insurance.
The 2015 data show this disparity continues: 63% of physicians reported accepting new Medi-Cal patients while 74% reported accepting new Medicare patients and 82% reported accepting new privately insured patients. A previous study, funded by the California Health Care Foundation, indicates physicians providing primary care to adults may overestimate the extent to which they accept new Medi-Cal patients.
Previous studies (for examples, see here and here) suggest that prior to the ACA enrollment surge, California adults with Medi-Cal faced more challenges accessing care than those with private insurance. The 2015 physician participation indicators raise red flags. Other important access metrics on ACA 411 (such as Timely Appointment and Delayed or Forgone Care) will be updated with 2015 data later this year and breakdowns by source of insurance will be added. Examining these indicators together will provide more insight into access barriers for Medi-Cal beneficiaries in the post-ACA era.