State Medi-Cal plans rarely work for patients | Tim Talk | Tim Hunt | |

Local Blogs

By Tim Hunt

State Medi-Cal plans rarely work for patients

Uploaded: Jul 27, 2017

While Senate Republicans wrestle to find a way to “repeal and replace” ObamaCare, Covered California officials are assuring the public their system works fine.
The state has enrolled more than 14 million people in MediCal—35 percent of the state’s 39.5 million population. Representations from bureaucrats notwithstanding, the state Dept. of Health was sued earlier this month for “separate and unequal” coverage. A spokesperson denied any issues with MediCal, an assertion that is laughable on its face.
As I have previously written, many physicians refuse to take new MediCal patients because the reimbursement rates are so low. The suit seeks to force the state to raise reimbursement rates and reduce delays in MediCal patients receiving care. That obviously takes more doctors who will accept the state plan. The suit also says that 54 percent of the MediCal population are Latino thus there is a civil rights violation when comparing the state plan with private plans.
Of course, the entire contention is that medical care is a right—a clause that cannot be found in the United States Constitution.
The safety net is emergency rooms because federal law requires anyone needing care be seen in emergency rooms.
And that’s not good news for MediCal. Tracy Seipel reported in the East Bay Times this summer that visits to emergency rooms soared by 44 percent between early 2014 when ObamaCare took effect and late 2016. Naturally, that was opposite of what President Obama assured Americans when he was pushing the Democrat-dominated Congress to adopt his bill. Expanding the federal Medicaid program (Medi-Cal in California) was supposed to lower ER visits because people would be enrolled in managed care plans and would be treated more efficiently and cheaply.
I guess that promise goes along with “you can keep your plan and keep your doctor.”
One person called out in the news story was assigned a doctor for primarily care who refused to see her. So, she used the ER for routine prescription refills, lab work and check-ups.
The state budget that too effect July 1 included additional funds for Medi-Cal reimbursements, but it’s still a minor dent in a huge problem. Rate need to climb to the point where they are comparable with Medicare for enough physicians to see patients and that will substantially dent the state budget that is precariously balanced.
Until this year, Gov. Brown has demonstrated little support for the Medi-Cal patients beyond accepting the federal Medicaid funds. He kept the reimbursement rates very low, while pouring money into k-12 and community college education.
Given that Medicaid costs at the federal level are soaring at an unsustainable rate, you have a fiscal and personal train wreck looming.