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Quality of Life

Access Issues Prompt Lawmakers To Order Audit Of Medi-Cal Managed Care


More than 7 million people who have Medi-Cal coverage are enrolled in managed care plans.

Lawmakers have ordered an audit because they say they've received numerous complaints from Medi-Cal patients who are having trouble getting care.

California health officials say they haven’t found many problems.

But a recent examination by the California Medical Association revealed some serious shortcomings.

The CMA looked at a list of network providers from California Health & Wellness. That’s one of the largest Medi-Cal managed care plans.

Of the 54 primary care providers listed in Butte County, only 15 accepted new patients. The same number of physicians accept new Medi-Cal patients in Imperial County, out of a list of 27.

Statewide, 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.

CMA President Richard Thorp said Medi-Cal patients deserve better.

“They need to know they have not just a card that says they have healthcare, but that card will also get them in the door somewhere where they can actually be seen,” Dr. Thorp said.

Thorp said specialty care is even harder to get for Medi-Cal patients. Thorp said for example, the closest pediatric gastroenteroligst who will treat Medi-Cal patients is in Oakland, a 200-mile drive away from Butte County.

More than 2 million people have enrolled in the Medi-Cal program since the beginning of the year.