As California gears up for a major expansion of its publicly funded health program for the poor, a statewide survey released Thursday shows that Medi-Cal enrollees have more trouble finding doctors and use the emergency room more frequently than people with other health coverage.
But overall, perceptions of the program were positive, with more than 70% of all recipients reporting that Medi-Cal provided high-quality care.
The survey â€" called Medi-Cal at a Crossroads â€" comes at a critical time, as the state continues to cut costs and simultaneously prepare for new enrollees.
"At a time when the program is being cut back, it is poised for a dramatic expansion," said Mark Smith, president and chief executive of the California HealthCare Foundation, which commissioned the survey. "Trying to figure out what it does well and where there is room for improvement is really important."
Smith said the survey highlights some of the obstacles the state will face when the coverage expansion takes effect in 2014. About 7.6 million people receive Medi-Cal services now, and if theU.S. Supreme Courtdoesn't throw out the federal health reform law, an additional 2 million California residents could be newly eligible for enrollment.
California Department of Health Care Services Associate Director Len Finocchio said it was validating to see that Medi- Cal works well for the vast majority of enrollees. He said the department knows that there are some beneficiaries who have difficulty maneuvering through the program.
"We are not shying away from the issues that we have to deal with," he said. "We are working on that all the time."
Having enough doctors who accept Medi-Cal patients may prove to be the greatest hurdle for the state as it enrolls more beneficiaries. Reimbursement rates for doctors have been cut significantly and now are among the lowest in the nation.
Nearly a quarter of Medi-Cal recipients reported having difficulty finding a primary care provider who accepted their insurance, compared with 11% of people with other health coverage. And 34% of Medi-Cal enrollees said it was difficult finding a specialist, compared with 13% of people with other health coverage. Even more people in fair or poor health reported difficulty finding a specialist.
"Almost half of the people who are the sic kest are having the hardest time finding doctors," said Tresa Undem, a partner at Lake Research Partners, which conducted the survey. "That is a big challenge for the program."
Their ER use was also higher. Among those in fair or poor health, Medi-Cal patients were more than twice as likely as those with other health coverage to say they visited the emergency room in the prior year.
Enrolling the newly eligible could also pose a problem, Undem said. Only about a third of those not yet enrolled said they knew how to apply and many didn't know they would qualify. Finnocio said the state is already planning how to get the word out about eligibility and enrollment, and new applicants will be able to sign up in person, online, over the phone or by mail.
Jolina Barsanti, 34, receives health insurance through her employer but her husband and young children are covered under Medi-Cal. Barsanti, who lives in Alameda County, said she has been generally pleased wit h the program but said she wished it included dental coverage for her husband and vision coverage for her whole family.
Barsanti said that because she works, she has to pay about $1,250 before Medi-Cal picks up any costs. "It is expensive," she said. "We can't afford that, especially living in the Bay Area."
Enrollees with disabilities had the worst perceptions of the program.
"This is a wake-up call that these patients are not particularly happy with the status quo," Smith said, adding that the state needs to closely monitor their ongoing transition into managed care. "These are patients for whom mistakes can translate into really serious medical problems."
anna.gorman@latimes.com
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