Looking at California’s remarkable Medi-Cal enrollment numbers, the million-dollar question is whether there will be enough physicians available to meet increased demands. Traditionally, physician participation in the Medi-Cal program, especially among non-primary care physicians, is low. One arguable reason for low participation is low reimbursement rates. Physicians may be unable to take on new Medi-Cal patients and keep their practice afloat. However, with the transition of individuals from Healthy Families and Low Income Health Programs (LIHPs), along with Medicaid Expansion, the total number of Medi-Cal beneficiaries has reached an estimated 11.5 million (up from 9.4 million, 2013-2014). This represents a significant increase of beneficiaries, demonstrating the importance of the current available workforce.
To provide insight on this issue, the California Healthcare Foundation (CHF) recently released a report that assessed physician participation in the Medi-Cal program. Findings in the report are based on phone surveys of physicians conducted in 2011 and 2013. Additionally, findings are reported based on several categories, such as acceptance of Medi-Cal versus other insurance types, and Medi-Cal participation by major specialty.
Here are some key findings from the report:
- In 2013, 69% of California physicians accepted Medi-Cal patients
- California physicians are less likely to accept new Medi-Cal beneficiaries (62%) than individuals with Medicare (75%) or private insurance (79%)
- Community clinics (92%) are more likely to care for Medi-Cal beneficiaries than small group practices (76%) and private doctors (54%)
- OBGYNs (76%) and Pediatricians (75%) are more likely to serve Medi-Cal beneficiaries than general practitioners (64%) and psychiatrists (47%)
Between 2011 and 2013, physicians with any Medi-Cal patients increased from 64% to 69%. The percentage of physicians with 1% to 9% Medi-Cal patients increased significantly. Among primary care physicians, the percentage of Medi-Cal patients increased from 35% to 42%. For non-primary care physicians, Medi-Cal patients increased from 32% to 38%. Although more physicians are participating in Medi-Cal, among all participating physicians, on average, less than 30% of their patients are enrollees. Approximately 40% of physicians carry the burden of providing 80% of all Medi-Cal visits. Thus, despite the increase in physicians participating in Medi-Cal, an access problem likely still exists in certain areas due to unequal distribution of participating providers across the communities that need them.
Considering the increase of Medi-Cal enrollees, low acceptance of Medi-Cal patients is cause for concern. If new beneficiaries are unable to gain timely access to care in their communities, they are more likely to utilize emergency departments. Although an easy and accessible resource, services rendered in emergency departments are episodic in nature and much more costly. When the goal is to move towards a healthcare system that emphasizes cost containment and preventive care, increased ED use is a step backwards.
To improve the overall health of Californians, vulnerable populations must be a priority because of the difficulty that many Medi-Cal beneficiaries may experience when attempting to access needed services. While the issue may be complex, the data show us that we need to continue thinking through ways to increase the number of physicians who are willing to take on larger caseloads of Medi-Cal beneficiaries.