The Affordable Care Act has been hailed for dramatically increasing the number of low-income California residents enrolled in Medi-Cal, the state version of Medicaid. But it hasn’t done nearly as good a job as actually hooking up the patients with doctors.

On Thursday, a legislative committee voted to conduct an audit to find out why.

The heavy influx of new patients, coupled with computer problems, caused a quick backlog of 900,000 Medi-Cal applicants earlier in the year that has reportedly been reduced to 400,000. But having insurance coverage is not the same as having access to medical care, as Medi-Cal and Covered California (CC) patients are finding out.

State Senator Richard Lara (D-Bell Gardens), whose committee asked California State Auditor Elaine Howle to review the situation, said, “Just because we want to give millions of people medical insurance and cards doesn’t necessarily mean they’re going to be able to receive services.”

Howle will focus on three counties, but the California Health Report said it was uncertain if she would select the same three counties—Fresno, Butte and Imperial—that it used for a damning story in June. The report found that half the primary-care doctors on lists given to low-income patients by insurance companies weren’t taking new patients or couldn’t be reached by phone for one reason or another.

Some listed doctors have died, some have moved and some have retired. But the problem extends far beyond bad communication between doctors and insurance companies. The state doesn’t pay doctors a whole lot to handle Medi-Cal patients and as a result many have reduced how many patients they see.

The California HealthCare Foundation recently highlighted the problem when it presented a report from the University of California, San Francisco, which found that there were 35-49 physicians for everyone 100,000 Medi-Cal patients. That is far short of the federal standard of 68-102. The study was conducted from 2011-2013, before Obamacare increased the rolls.

Doctors in public clinics and community health centers had the highest participation (92%) while physicians in solo practices were at 54%. Only 62% said they accepted new Medi-Cal patients.

More than 7 million Californians, one in every five residents, are enrolled in a Medi-Cal managed care plan. But that’s just three-fourths of all Medi-Cal patients. The rest see doctors who receive about the lowest rate of reimbursement in the country, according to the Los Angeles Times.

The state reduced reimbursement rates 10% for Medi-Cal doctors during the budget crisis but lawsuits held up the cuts until last September―after the budget was back in balance.   

The Medi-Cal problem is not unlike that faced by Covered California, where there are literally no lists of participating doctors. Insurance companies like Blue Shield of California and Blue Cross say the network of doctors participating in Covered California is somewhere around 60% of their regular networks, but since there are no lists that’s a hard number to verify.

When Covered California rolled out last year, the website briefly posted what was purported to be legitimate network lists. They weren’t. They had dead, retired and absent doctors listed and were quickly pulled. More importantly, the doctors and the insurance companies don’t agree on who should be in the CC network.

It is being represented as a contractual disagreement, but probably won’t be solved before this November’s open enrollment, if ever.

Not surprisingly, complaints about Medi-Cal are way up this year. Monthly complaints to the Department of Health Care Services’ Managed Care Ombudsman Office about the program have increased 82% since 2013, according to the California Health Report.

–Ken Broder

To Learn More:

Legislative Committee Orders Audit of Medi-Cal Directories after Reports of Inaccuracies (by Hannah Guzik, California Health Report)

Medi-Cal Struggles to Provide Services to Ever-Growing Clientele (by Chris Megerian, Los Angeles Times)

Huge Increase in Cases Handled by Medi-Cal Complaint Office This Year (by Hannah Guzik, California Health Report)

Physician Participation in Medi-Cal: Ready for the Enrollment Boom? (by Janet M. Coffman, Denis Hulett, Margaret Fix and Andrew B. Bindman, University of California, San Francisco)

State Grossly Overstated Number of Doctors Treating Medi-Cal Patients (by Ken Broder, AllGov California)