Physician Participation in Medi-Cal: Ready for the Enrollment Boom?
Janet M. Coffman, Denis Hulett, Margaret Fix, and Andrew B. Bindman, University of California, San Francisco
Will California physicians be able to handle the Medi-Cal population surge? This report looks at physician participation in Medi-Cal and implications for access to care.
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. Without a large increase in the number of full-time equivalent (FTE) 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.
This report by the University of California, San Francisco, presents findings from physician surveys conducted in 2011 and 2013 to assess California physicians’ participation in Medi-Cal and discusses implications for beneficiaries’ access to care.
Among the study’s findings:
- The ratio of primary care doctors participating in Medi-Cal was 35 to 49 FTEs per 100,000 enrollees, well short of the range of 60 to 80 that the federal government estimated are needed. The ratio of non-primary physicians participating in Medi-Cal was between 68 and 102 FTEs per 100,000 enrollees, a range 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%) was significantly lower than the percentage with any Medicare patients (77%) and much lower than the percentage with any privately insured patients (92%).
- The distribution of Medi-Cal visits among California physicians is highly skewed. About one-third (35%) of physicians accounted for 80% of Medi-Cal visits, and about one-third (34%) accounted for the remaining 20% of Medi-Cal patients.
- Emergency doctors, hospitalists, anesthesiologists, and others who work primarily in hospitals had the highest rate of Medi-Cal participation (82%), while psychiatrists had the lowest (47%).
- Physicians at community health centers and public clinics had the highest rate of Medi-Cal participation (92%), and those in solo practice had the lowest (54%).
- Medi-Cal participation rates were highest in the North Valley/Sierra region and lowest in the Central Coast region.
- Among California physicians, 62% said they accept new patients covered by Medi-Cal compared with 75% taking new Medicare patients and 79% accepting new patients with private insurance.