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Drop in Percentage of Physicians Participating in Medi-Cal Raises Red Flags

Amy Adams, California Health Care Foundation

Self-reported data from a voluntary survey of California physicians show physician participation in Medi-Cal declined from 69% in 2013 to 63% in 2015. (Physicians are identified as participating in Medi-Cal if they report any of their patients are covered by Medi-Cal.) The percentage of specialty care physicians participating in Medi-Cal likewise dropped during this time, from 70% to 64%.

Physician Participation in Medi-Cal from 2013 to 2015

Physicians' willingness to treat Medi-Cal beneficiaries is critical to ensuring Medi-Cal enrollees have adequate access to care. Without a sufficient number of doctors serving Medi-Cal beneficiaries, Medi-Cal enrollees may not be able to receive care in a timely manner. Beneficiaries may delay seeking needed care with disastrous effects or may end up receiving care in more costly settings.

There are many other ways to examine trends in physician participation in Medi-Cal. The share of physicians accepting new Medi-Cal patients is also an indicator of the program's capacity to meet demand. If a decreasing share of participating physicians are willing or able to take new Medi-Cal patients, beneficiaries in the program may have trouble getting the care they need. The proportion of physicians accepting new Medi-Cal patients has historically lagged behind the proportion accepting new patients covered by Medicare, which has a higher reimbursement rate, as well as behind the proportion accepting new patients with private health insurance.

The 2015 data show this disparity continues: 63% of physicians reported accepting new Medi-Cal patients while 74% reported accepting new Medicare patients and 82% reported accepting new privately insured patients. A previous study, funded by the California Health Care Foundation, indicates physicians providing primary care to adults may overestimate the extent to which they accept new Medi-Cal patients.

Previous studies (for examples, see here and here) suggest that prior to the ACA enrollment surge, California adults with Medi-Cal faced more challenges accessing care than those with private insurance. The 2015 physician participation indicators raise red flags. Other important access metrics on ACA 411 (such as Timely Appointment and Delayed or Forgone Care) will be updated with 2015 data later this year and breakdowns by source of insurance will be added. Examining these indicators together will provide more insight into access barriers for Medi-Cal beneficiaries in the post-ACA era.