Under the Affordable Care Act (ACA), the numbers of patients enrolled in Medi-Cal has increased over the past three years, but a new study published by the California Health Care Foundation shows that fewer physicians are accepting these patients—largely because of the dismal payment rates.

Medi-Cal has long been underfunded, resulting in decreased access to health care for patients and dangerously low reimbursement rates for participating physicians. Currently, payments to doctors for a typical office visit under Medi-Cal are far less than the cost of providing care.

In 2013, according to the study conducted by researchers at the University of California, San Francisco, 69 percent of physicians reported having at least one Medi-Cal patient, but by 2015 this number had slipped to 64 percent. During the same period, Medi-Cal enrollment increased by 39 percent. The researchers also found that providers were less likely to accept new patients with Medi-Cal than those with Medicare or private health insurance coverage.

Providers that who specialize in psychiatry, internal medicine or family medicine are the least likely to accept Medi-Cal, according to the report. Approximately three quarters of emergency room physicians in the state accept Medi-Cal, while only 37 percent of psychiatrists do.

Other findings of the study include:

• 40 percent of physicians provide 80 percent of Medi-Cal visits.
• Physicians are more likely to report difficulty obtaining referrals for Medi-Cal patients than for privately insured patients
• The most frequent reasons physicians limit Medi-Cal patients in their practices are payment rates and administrative hassles.
• Not surprisingly, the report concludes that raising physician reimbursement rates and making more timely payments to physicians may increase physician participation.

More than 13.3 million Californians—about one-third of the state’s population—are now covered by Medi-Cal. More than 5 million have gained coverage since the ACA took effect, expanding eligibility for the program.

Physicians' ability to treat Medi-Cal beneficiaries is critical to ensuring Medi-Cal enrollees have adequate access to care. Without a sufficient number of doctors serving Medi-Cal beneficiaries, Medi-Cal enrollees may not be able to receive care in a timely manner. Fully funding Medi-Cal is critical to ensuring access to health care for Californians most in need. That’s why the California Medical Association (CMA) is supporting Propositions 55 and 56 on the November ballot.

Each year, taxpayers spend $3.58 billion on tobacco-related health care costs through Medi-Cal. As part of the Save Lives California coalition, CMA is backing the California Healthcare, Research and Prevention Tobacco Tax Act of 2016, also known as Proposition 56. Prop. 56 is a life-saving tobacco tax initiative that would raise California’s cigarette tax by $2 per pack, with an equivalent increase on other tobacco products containing nicotine, including e-cigarettes. Most smokers start in their teens, and tobacco taxes are proven to reduce teen smoking, yet California has one of the lowest tobacco taxes in the nation. Prop. 56 will not only save lives and prevent children from starting smoking, it will also work like a user fee, taxing tobacco to help pay for tobacco-related health care costs. It is estimated to provide as much as $1.4 billion per year to fund California's existing health programs, including Medi-Cal.

Prop. 55—The California Children’s Education and Health Care Protection Act of 2016—will temporarily extend for 12 years the current tax rates on the wealthiest Californians—singles earning more than $250,000 and couples earning more than $500,000 a year. The measure will direct funds specifically to K-12 public education and community colleges, while also allocating funds to health care for low-income children and their families.