CHA News Article

Report Explores Physician Participation in Medi-Cal and Implications for Access to Care
Underscores need for ongoing monitoring of physician participation in Medi-Cal

The California HealthCare Foundation (CHCF) has released a report by the University of California, San Francisco, presenting findings from physician surveys conducted in 2011 and 2013 that assess California physicians’ participation in Medi-Cal. The report also discusses implications for Medi-Cal members’ access to care. Titled Physician Participation in Medi-Cal: Ready for the Boom?, the report assesses the rates of physicians with any Medi-Cal patients in their practice, the degree of Medi-Cal participation, the adequacy of the supply of physicians participating in Medi-Cal, Medi-Cal participation by geographic region, the rates of physicians accepting new Medi-Cal patients and changes in Medi-Cal participation over time.

 “Recent and projected enrollment increases in Medi-Cal, California’s Medicaid program, due to the Affordable Care Act have heightened concerns about whether sufficient numbers of physicians are participating in Medi-Cal to provide beneficiaries with adequate access to care,” the report states. “Without a large increase in the number of full-time equivalent primary care physicians participating in Medi-Cal or another means of increasing efficiency in primary care, such as greater use of nonphysician clinicians or phone and electronic visits, Medi-Cal beneficiaries are likely to have difficulty accessing this basic level of care.”

Key findings of the study include:

  • The ratio of primary care doctors participating in Medi-Cal was 35 to 49 full-time equivalent (FTEs) per 100,000 enrollees, well short of the range of 60 to 80 that the federal government estimated is needed. The ratio of non-primary physicians participating in Medi-Cal was between 68 and 102 FTEs per 100,000 enrollees, which overlaps with the federal estimate of need (85 to 105 per 100,000).
  • The percentage of physicians with any Medi-Cal patients in their practice (69 percent) was significantly lower than the percentage with any Medicare patients (77 percent) and much lower than the percentage with any privately insured patients (92 percent).
  • The distribution of Medi-Cal visits among California physicians is highly skewed. About one-third (35 percent) of physicians accounted for 80 percent of Medi-Cal visits, and about one-third (34 percent) accounted for the remaining 20 percent of Medi-Cal patients.
  • Physicians in facilty-based specialties (e.g., emergency doctors, hospitalists, anesthesiologists) had the highest rate of Medi-Cal participation (82 percent), and psychiatrists had the lowest (47 percent).
  • Physicians practicing in community health centers and public clinics had the highest rate of Medi-Cal participation (92 percent); physicians in solo practice had the lowest (54 percent).
  • Medi-Cal participation rates were highest in the North Valley/Sierra region and lowest in the Central Coast region.
  • Among California physicians, 62 percent said they accept new patients covered by Medi-Cal, compared with 75 percent taking new Medicare patients and 79 percent accepting new patients with private insurance.

The 2014 edition of the report, along with prior studies examining this issue, are available on the CHCF website at www.chcf.org/publications/2014/08/physician-participation-medical.

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