Children with Medi-Cal face significant barriers to care – urge the legislature to reinstate tobacco tax revenues

May 30, 2017
Area(s) of Interest: Access to Care Advocacy 

According to a UCLA Center for Health Policy Research study, 34 percent of Medi-Cal families report difficulties accessing pediatric specialty care. The analysis showed that children on Medi-Cal had fewer than half the number of appointment slots compared to those available to privately insured children.

Several factors contribute to this problem. Barriers to access are created by low Medi-Cal reimbursement – California ranks 48th in the country – combined with excessive paperwork, payment delays and poor responsiveness from fiscal intermediaries challenged by processing complex medical payments.

Due to low Medi-Cal reimbursement rates, physicians who see Medi-Cal patients often do so at a financial loss to their practices. In order to maintain viable practices that can continue to serve their communities, physicians who do take Medi-Cal often need to limit the number of Medi-Cal patients that can be treated in their practice.

“When the state sets reimbursement so low, they are denying care,” said Gilbert Simon, M.D., Sacramento pediatrician and medical director for the Sacramento Family Medical Clinic.

With 13.7 million Californians – and 50 percent of all the state’s children – relying on Medi-Cal programs to provide basic and specialty care for serious health care issues, the stakes are high. Because they do not have ready access to physicians, Medi-Cal patients are more likely to postpone needed care due to long appointment wait times. They are also twice as likely to use emergency room visits to access specialty care (compared to individuals with private insurance or Medicare).

Pediatric subspecialists are hard to find for children outside of a city with a university, medical school or tertiary care center, said Dr. Simon.

“It is a question of geography – if you are in a city, you are OK,” he said. “But when you are in a rural area, you are out of luck.”

For example, 12,000 children are diagnosed with chronic respiratory illness in Imperial County every year. In 2017, the county had more than double the state’s rate of asthma-related emergency room visits and hospitalizations for children between ages 5 and 17. Environmental allergens abound because of the vast desert region’s extreme temperature changes, air pollution and pesticide exposure. About 30 percent of the children in the county live in poverty and 55 percent of the population is insured by Medi-Cal.

Children with asthma in Imperial Valley are usually referred to Rady Children's Hospital-San Diego, said Anthony Magit, M.D., MPH, a pediatric otolaryngologist and clinical professor of otolaryngology at UC San Diego School of Medicine. Some have to travel 122 miles to get to the hospital from Calexico, but with the distance they must travel, Dr. Magit says “most never make it, because it is hard to get transportation.”

It doesn’t have to be this way.

Children with asthma in Imperial Valley – and across the state – could be given ready access to the physicians they need if California invested in its physician workforce. Currently, California has some of the lowest reimbursement rates for providers in the nation, creating an unsustainable disparity between the number of Medi-Cal patients and the physicians who are able to accept them as patients. This is particularly true of pediatric subspecialists.

"When the reimbursement for specialty care is so low, specialists can only afford to accept a small percentage of patients that truly need and deserve the care," said Patrick Tellez, M.D., MPH, a pediatric allergy and immunology specialist and Chief Medical Officer for North County Health Services, which provides health care to a diverse community of low-income patients at 13 health centers in North San Diego and Riverside counties.

Governor Jerry Brown's budget proposal, however, simply adds more patients to the back of the line and maintains the status quo, which does nothing to help patients gain needed access to doctors and dentists.

The California Medical Association (CMA) co-sponsored a tobacco tax increase in 2016 (Proposition 56), with a significant allocation of the revenue to be used to improve access to care for California patients. Instead, Gov. Brown’s budget proposed to take $1.3 billion of tobacco tax revenues for existing state budget obligations. Even the Legislative Analyst’s Office reported this use of funds goes against the “common sense view” of the tobacco tax.

“People voted overwhelmingly in support of improving payments for programs and providers to ensure that patients can see a doctor when and where they need one,” says CMA President Ruth Haskins, M.D. “We must honor the will of the voters and use the new health care revenue for its intended purpose.”

California children should not have to make the long trip to get care for life-threatening and treatable conditions like asthma. California legislators must act to restore the tobacco tax funds to the Medi-Cal program. The time is now for legislators to help the children of California get the care they need.

Last week, the Assembly and Senate Budget Subcommittees rejected the Governor’s budget proposal, but we're not out of the woods yet. Each house has introduced different tobacco tax spending proposals that will need to be reconciled in conference committee.

Please contact your legislators and urge them to use the tobacco tax money as voters intended – to ensure that the 13.7 million Californians who rely on Medi-Cal for primary and specialty care can access a doctor when they need one.

"California cannot afford to continue starving this program by diverting tobacco tax revenues to cover the state’s general fund obligations," says Dr. Haskins. "The children of California deserve better." 


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