The Medi-Cal Policy Institute today released Speaking Out: What Beneficiaries Say about the Medi-Cal Program, the first statewide survey ever conducted of Medi-Cal beneficiaries and their perspectives about Medi-Cal and what improvements are needed.

Although the state spends more than $20 million annually to enroll low-income Californians in the Medi-Cal and Healthy Families programs, no consumer survey had ever shown how well beneficiaries feel Medi-Cal meets their health needs or what improvements might make it more attractive to those eligible for coverage.

The survey of more than 2,400 current and former Medi-Cal beneficiaries uncovered broad frustration with required paperwork and found that more than half experienced some difficulty finding doctors or dentists for treatment. Minorities are more likely to find Medi-Cal a difficult program to navigate and are less likely than Caucasian beneficiaries to obtain care at their preferred location.

However, respondents overwhelmingly agree that Medi-Cal is a good program and that it covers most of the medical services people need. In addition, 88% of former beneficiaries now enrolled in private insurance agree that their necessary health services were largely covered by Medi-Cal.

"This study should dispel any notion that Medi-Cal beneficiaries undervalue the health care services they receive in this program," said Crystal Hayling, director of the Medi-Cal Policy Institute. "Yet those in Medi-Cal are clear about improvements needed to make the program work better for themselves and for others who are uninsured but may be eligible."

The statewide survey of current and former Medi-Cal enrollees found that:

• 92% say Medi-Cal is a good program.
• 84% agree "Medi-Cal is worth the hassle because of what you get in return."
• 84% believe Medi-Cal covers most of the medical services people need.
• 80% reported that Medi-Cal provides high quality medical services.
• 80% responded that the eligibility and social service workers at the enrollment office are helpful, including 44% who said that a worker went out of his or her way to help with a problem or to answer a question.

  "It is good to know this program really helps people in need," noted Hayling. "But since there are nearly one million children eligible for public health insurance who are not enrolled, we need to pay attention to what current consumers tell us can be done to make it better."

  Among the problems cited in the survey:
• 78% believe that the amount of paperwork and documentation required to enroll in the program is too much.
• Beneficiaries reported that the locations for signing up for Medi-Cal were unpleasant (60%) or that the hours were inconvenient (59%).
• Asian beneficiaries were most likely to respond that the Medi-Cal program overall is too complicated and confusing (78%), followed by Spanish-speaking Latinos (69%), English-speaking Latinos (60%), African American (59%), and Caucasian (58%) beneficiaries.
• Only 60% of English-speaking Latinos, 53% of Asians, 52% of African Americans, and 46% of Spanish-speaking Latinos receive care at their preferred location, while 72% of Caucasian beneficiaries reported that they are able to get care at their preferred location.

  The survey also found that in order to improve Medi-Cal:
• 72% of beneficiaries believe upgrading the quality of care is very important.
• 78% of Medi-Cal recipients say obtaining more doctors in the program is very important.
• 91% of beneficiaries believe that making the process of signing up for Medi-Cal easier is an important change.
• The most important health care improvement needed is dental care (22%).

  "Medi-Cal is difficult to enroll in," said Mike Perry, vice president of Lake Snell Perry and Associates. "Once enrolled, there are challenges to staying a part of the program, seeing doctors and getting the dental care you need."

  The report also identifies which of the policymaking and administrative bodies that direct Medi-Cal would be involved in implementing changes based on the study's findings.

  "This study concludes with a list of action items for improvement of Medi-Cal," said Mark D. Smith, M.D., M.B.A., president and CEO of the California HealthCare Foundation. "They follow from the assumption that Medi-Cal recipients are health care consumers whose wants and needs deserve to be taken seriously."

  Recommendations for action based on the Survey:
• Improve communication with beneficiaries so that they can better understand what services are covered.
• Improve dental care coverage.
• Ensure that beneficiaries are able to locate providers who accept Medi-Cal and to obtain care at their preferred location.
• Simplify the enrollment process; reduce the paperwork needed to obtain coverage and remain enrolled; reduce the time it takes to determine eligibility.
• Improve training for eligibility workers.
• Expand access to enrollment sites, such as new locations and extended hours.
• Inform working families they may be able to retain coverage as their earnings grow and expand or improve efforts to inform people about Transitional Medi-Cal.
• Improve communication with beneficiaries so that they can better understand why they may no longer qualify for Medi-Cal.

  Lake Snell Perry and Associates, in conjunction with Dr. Robert Valdez of the UCLA School of Public Health, conducted the survey for the Medi-Cal Policy Institute of Oakland, California. Lake Snell Perry and Associates conducted the focus groups. Based in Washington, DC, it has conducted numerous qualitative and quantitative research projects with Medicaid and Medi-Cal beneficiaries.

  About the Survey

  The statewide telephone survey of 2,402 current and recent Medi-Cal beneficiaries was conducted in August and September 1999. The survey was supplemented with 11 focus groups of current and recent Medi-Cal beneficiaries held in English, Spanish, Vietnamese, Cantonese and Cambodian. The margin of sampling error for the survey is ±3%.