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Provider participation in Medi-Cal does not keep pace with growth of enrollment



July 22, 2016
Area(s) of Interest: Payor Contracting Payor Issues and Reimbursement 

New 2015 data shows that the percentage of physicians participating in Medi-Cal has declined since 2013, while during the same period, Medi-Cal enrollment increased by 39 percent. The numbers show that provider participation in Medi-Cal has not kept pace with the growth in enrollment, and raise serious concerns about whether the numbers of physicians participating in Medi-Cal can meet the increased demand.


A California Healthcare Foundation survey of California physicians shows that Medi-Cal participation declined from 69 percent in 2013 to 63 percent in 2015. The numbers of specialty care physicians participating in Medi-Cal also dropped during this time, from 70 percent to 64 percent.


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 roughly $16—far less than the cost of providing care.


“No physician, no care giver, should ever have to choose between providing care to those who need it and staying in business,” said Dustin Corcoran, CEO of the California Medical Association (CMA).


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.


The share of physicians accepting new Medi-Cal patients is also an indicator of the program's capacity to meet demand. The 2015 data shows that only 63 percent of physicians taking Medi-Cal were accepting new patients, while 74 percent reported accepting new Medicare patients and 82 percent reported accepting new privately insured patients.


Fully funding Medi-Cal is critical to ensuring access to health care for Californians most in need. That’s why CMA is supporting Propositions 55 and 56.


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 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 $2 billion per year to fund California's existing health programs, including Medi-Cal.


The California Children’s Education and Health Care Protection Act of 2016—now known as Prop. 55—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.

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