You’ve enrolled for Medi-Cal through California’s insurance exchange and finally have the health insurance coverage you’ve needed for years. Only one problem – a recent audit shows California’s Medicaid plan is failing to help many enrollees. And, that getting a Medi-Cal card doesn’t always guarantee you health care.
The fact is – according to the study – not all patients can get to their doctors easily, and some can’t find providers who take their insurance. Enrollees may have to travel completely out of their area to see a specialist willing to accept their insurance and, for some; it hasn’t been easy, especially for the elderly who can’t drive or for those on limited incomes.
In order to control costs in its rapidly expanding Medi-Cal program, California has relied heavily on managed care insurance companies to treat patients. The state pays insurers a fixed amount per enrollee and expects the companies to provide access to doctors and comprehensive care.
However, in a recent, scathing state audit, it was shown that California is failing to make sure those plans deliver. As a result, many enrollees have insurance cards, but often have trouble getting in to see doctors.
The source of the problem? Apparently, the California audit found the state didn’t verify that insurers’ directories of doctors were accurate. In addition, it didn’t check to make sure that the plans had enough doctors to meet patients’ needs. And, to compound the problem, the state Department of Health Care Services didn’t do its own required annual audits of the plans.
Meanwhile, thousands of phone calls to an office – created specifically to investigate complaints – went ignored and unanswered every month.
Focused on three health plans, the audit underscores a broader problem in California – a glaring lack of sufficient oversight of a program that now serves about 12 million people, three-quarters of whom are in managed care. Those advocating change suggest that the state moved too rapidly in its effort to shift enrollees into managed care plans, granting too much unsupervised responsibility to health insurers.
Unfortunately, given the fact so many Californians are enrolled and the importance of adequate oversight, the state has a long way to go to reach that goal.
On a brighter note, new proposed federal regulations designed to improve Medicaid managed care could significantly help by requiring states to ensure patients enrolled in plans, such as Medi-Cal, have enough access to doctors and hospitals. They would also limit profit margins and establish a quality rating system for the plans. Better yet, a proposed bill in California would require plans to provide accurate and up-to-date provider directories.
Many critics argue that – even if oversight improves – the state still needs to increase Medi-Cal payments to doctors and other providers so that more will choose to participate, thereby, making it easier for enrollees to find health care closer to home as well as finding doctors willing to accept their Medi-Cal card.
Currently, a coalition of unions, doctors and hospitals are pushing to raise rates in California. But, if that doesn’t happen in the near future, more regulation will only go so far, and the loser will be the patient who expects his Medi-Cal card to guarantee health care as promised.
The Affordable Care Act Bill or Obamacare was designed to make it easier for all Americans to get health insurance. You deserve to have the best health insurance rates – and the way to do that – is by getting a free health insurance quote today?
Have you or someone you know had trouble finding a doctor who accepts Medi-Cal in close proximity to where you live? Feel free to share your thoughts in the comments section below.