Medi-Cal reimburses doctors for treating the poor

December 5, 2008 

What is Medi-Cal?

California's version of the federal Medicaid program that provides public health care aid for the state's low-income, blind and disabled.

Who is eligible?

Residents on many state programs are eligible for Medi-Cal as well as Californians who are 65 or older, blind, disabled, under 21 years of age, pregnant or have certain other circumstances.

Why do some Medi-Cal patients have problems getting treatment?

There are a number of reasons Medi-Cal patients may have difficulty scheduling a doctor's appointment, but the main one is money.

Reimbursements for private physicians who treat Medi-Cal patients are driven by funding at the state level. The amount physicians are reimbursed is generally lower than the cost of administering treatment, so many doctors limit the number of Medi-Cal patients they treat just to keep their doors open. In other words, private doctors get very little money for what is often a whole lot of work.

Adding to the problem is the cumbersome process of applying for Medi-Cal reimbursement, said John Alexander, executive director of the Merced County Health Care Consortium.

It also probably doesn't help that Merced County has the second-highest Medi-Cal population in the state, behind Tulare County, said County Public Health Director John Volanti.

Add to that the severe shortage of doctors, particularly specialists, in the region.

What can be done?

The good news is that help may be on the way. In fall 2009, Merced County is expected to launch a County Organized Health System. The program will give the county the ability to reimburse private doctors differently from the standard rates set now in the fee-for-service program.

"We think the best solution for Merced County is to move to a different delivery system," said Stan Rosenstein, chief deputy director of health care services at the California Department of Health Care Services.

Rosenstein said the changes in the repayment process will make accepting Medi-Cal patients a more appealing move for local physicians, improving -- at least in theory -- access to health care.

Other similar forays into the organized health system program by other counties have been "extremely successful," Rosenstein said.

-- Danielle Gaines

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