Medi-Cal Compensation Inadequate, Doctors Say, as Enrollment Boom Looms

By Kleffman, Sandy | Pasadena Star-News, July 22, 2012 | Go to article overview

Medi-Cal Compensation Inadequate, Doctors Say, as Enrollment Boom Looms


Kleffman, Sandy, Pasadena Star-News


When Dr. Jerold Kaplan made a home visit last year to a man with a foot wound, he billed Medi-Cal - the state's health care program for the poor and disabled - what he thought was a modest $90.

His payment: $8.96.

The Berkeley wound surgeon received a bit more for his home visit to a quadriplegic last year: $13.44.

Medi-Cal told him it cut both payments in half because of late paperwork. But even at the full rate, he would have received no more than $27 for a house call - barely enough to cover gas.

As California gears up for a major expansion of Medi-Cal under national health reform, such compensation is leading to a critical concern: Will enough physicians be willing to see the influx of new patients?

Many doctors now refuse to accept Medi-Cal patients or sharply limit the number they see because of what they describe as extremely low reimbursement rates. As a result, patients report difficulty getting timely care, a problem the expansion could worsen.

"Medi-Cal has gotten so ridiculous in its reimbursement there are a lot of doctors that aren't interested in working for it," Kaplan said.

Now covering 7.7 million Californians, Medi-Cal is the state's version of the federal Medicaid program.

Grow by 900,000 kids

It is expected to grow by 900,000 children with the state's recent elimination of the Healthy Families program, which provided low-cost insurance for children and teens. The state will enroll an additional 1.5 million or more adults when national health reforms take effect in 2014.

All told, Medi-Cal could balloon by 30 percent, financed largely by an additional $9 billion a year in federal money beginning in 2014.

Many consumer advocates strongly support the expansion and argue that it will greatly benefit the state by giving preventive care to those who are uninsured, helping them avoid more serious - and more costly - illnesses.

"It's going to be a huge boon to not just the newly covered Californians, but to our health care system as a whole," said Anthony Wright, executive director of Health Access California. But Wright agreed work needs to be done to make sure the program is ready.

California has one of the lowest Medicaid reimbursement rates in the nation, ranking 47th of 50 states.

And it could drop further. In a budget move, state lawmakers last year approved a 10 percent pay cut for Medi-Cal providers. But the cut is on hold pending a ruling on a lawsuit doctors filed.

While patients generally laud the program, 23 percent of adults report difficulty in finding a primary care doctor who will accept Medi-Cal, and 34 percent have had trouble finding a specialist, according to a 2011 survey by the California HealthCare Foundation.

"If they can get established with a physician at all, they have to wait much longer for an appointment and as a result, they are going to the emergency room for routine care and that clogs up the ER," said Dr. …

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