March 20, 2017
Area(s) of Interest: Access to Care Advocacy
The California Medical Association (CMA), in partnership with the California Dental Association (CDA), unveiled a budget proposal to improve access to medical and dental care for the state’s 14.3 million Medi-Cal and Denti-Cal patients. The proposal focuses on targeted Medi-Cal investments to increase the number of doctors — both physicians and dentists — who participate in these programs and enable them to accept more patients in order to improve Medi-Cal patients’ access to care provided in California.
Gov. Jerry Brown’s 2017-18 current budget proposal takes $1.2 billion in Proposition 56 tobacco tax funds that were intended to improve access to care and instead, uses them for state general fund purposes. The Legislative Analyst’s Office report on Prop 56 points out that this use of tobacco tax funds goes against the “common sense view” of the initiative’s non-supplantation provision and would be subject to legal challenge.
The governor’s proposal also conflicts with the plain language of the tobacco tax initiative that directs funds to be spent to improve access by improving provider payments; the governor’s proposal does nothing to improve access, coverage or care.
“As a physician who has seen firsthand the escalating numbers of patients unable to find a doctor who can viably accept them into their practice, it is clear that tobacco tax must be put to its intended use of increasing patient access,” said CMA President Ruth Haskins, M.D. “This proposal honors the will of voters and the letter of the law for commons sense investments in the Medi-Cal system that will result in vulnerable patients gaining timely access to care.”
The CMA/CDA plan is fiscally prudent – providing supplemental payments based on a sliding scale to correspond with a provider’s level of participation in the Medi-Cal program without exceeding budgeted special funds.
By tethering the supplemental reimbursements directly to the percentage of Medi-Cal or Denti-Cal patients a physician or dentist serves, the plan will produce measurable results for patients; it will be straightforward for the Department of Health Care Services to administer; and it can be implemented regardless of Medicaid funding decisions on the federal level. Most importantly, it will directly increase access to treatment and services for patients who currently face significant barriers to care.
California’s Medi-Cal and Denti-Cal provider networks suffer from chronic underfunding that directly affects patient care. California provider rates are among the lowest in the nation – 48th of 50 states. As a result, only 20 percent of dentists in California are able to accept Denti-Cal patients and 16 California counties either have no Denti-Cal providers, or none accepting new patients. Forty percent of California physicians provide 80 percent of Medi-Cal visits.
Since California’s Medi-Cal and Denti-Cal programs are the nation’s largest, covering more than a third of California’s residents and 50 percent of children, the state needs a robust provider network to meet the medical and dental needs of these 14.3 million Californians.
The proposal is a common sense solution that targets investments to strengthen California’s Medi-Cal and Denti-Cal provider network and improve patient access to care. Investing tobacco tax revenues as the voters intended will lead to better health outcomes for Medi-Cal and Denti-Cal enrollees and result in long-term savings to the state.