Nine of ten Californians who receive health insurance coverage from Medi-Cal have a positive view of the government-run program; 69% are satisfied with the quality of their care; and 78% believe the program covers the care people need, according to a survey released today by the California HealthCare Foundation (CHCF).
Medi-Cal, California's Medicaid program, received lower scores on access to medical specialists, particularly among enrollees in fair or poor health. Among this group of enrollees, nearly half report difficulty finding a specialist who accepts Medi-Cal.
The government program insures 7.5 million Californians and is facing significant challenges as it struggles to adapt to state budget pressures. At the same time, Medi-Cal is preparing for a potential influx of two to three million currently uninsured residents in 2014 if the federal Affordable Care Act (ACA) remains intact after being reviewed by the U.S. Supreme Court.
"Medi-Cal is a complex program with clear benefits for its enrollees and clear room for improvement," notes CHCF President and CEO Mark D. Smith, MD, MBA. "At a time when Medi-Cal faces continued pressures and cutbacks, it is important to see how valuable its enrollees find the program."
The new report, Medi-Cal at a Crossroads: What Enrollees Say About the Program, presents findings from the largest survey of its kind. It polled Medi-Cal enrollees and adults who could become eligible for the program in 2014.
Key highlights from the report:
- The application process — occurring at a county office for most people — is generally a positive experience for survey respondents despite long waits for some. Most enrollees (77%) say the application is easy to fill out. Of those who enrolled at a county office, 74% say the workers were friendly.
- Given the choice, 61% of enrollees say they prefer a variety of in-person enrollment methods, including at a county office, a doctor's office or hospital, or a community center.
- Seventy-nine percent of Medi-Cal enrollees say they cannot or are unsure if they can sign up online.
- Enrollees with disabilities consistently report having less favorable experiences with and perceptions of Medi-Cal. Enrollees in fair or poor health consistently report more difficulty accessing specialists compared to healthier enrollees.
- Thirty-one percent of enrollees note they have delayed seeking health care in the past year due to the cost, including 17% who delayed a recommended test, treatment, or some type of follow-up care.
- Most enrollees (79%) say it is easy to find a primary care physician nearby who accepts Medi-Cal. Far fewer (43%) say it is easy to find specialists who accept Medi-Cal, but a large share (27%) were unsure.
- Enrollees in fee-for-service Medi-Cal are just as likely as those in managed care to report difficulty getting an appointment with a primary care physician (18% versus 19%) but more likely to report difficulty getting an appointment with a specialist (35% versus 30%).
- Adult Medi-Cal enrollees were twice as likely as those with other sources of coverage to report trouble getting an appointment with a primary care provider or a specialist.
- Whether in good or poor health, adults with Medi-Cal are more than twice as likely to say they have visited the emergency room in the past year as adults with other types of coverage.
- Most of those who will be newly eligible for Medi-Cal under the ACA say they think Medi-Cal is a good program (58%), but only about one-third know how to apply for Medi-Cal (35%) or say that applying will be easy (27%).
Challenges Going Forward
Despite the many encouraging findings from this survey, state lawmakers and regulators are anticipating many challenges ahead for Medi-Cal.
"California's difficult budget environment is both a challenge and an opportunity," says Toby Douglas, director of the California Department of Health Care Services, which oversees Medi-Cal. "We are finding new and more efficient ways to deliver coordinated and higher-quality services to beneficiaries. And, we are using federal funds to build a solid health care system infrastructure and consumer-friendly enrollment process in anticipation of health reform."
Policy Implications for Consideration
Against the backdrop of a squeezed state budgetary environment, Medi-Cal faces some complex policy concerns.
- It will be difficult for the program to implement cuts to the rates it pays physicians, or to expand coverage to two to three million new enrollees, without widening the gap in access to care between Medi-Cal enrollees and the general insured population — and running afoul of federal law requiring equal access to services.
- With the expectation that more Californians will be covered by private insurance under health reform, access to specialty care for Medi-Cal enrollees is of particular concern. Whereas the health reform law funds a two-year increase in Medi-Cal payment rates for primary care physicians to Medicare payment levels, there is no similar rate bump for specialists.
- Medi-Cal's expansion of managed care provides an opportunity to improve the experiences of enrollees in poor health and those with disabilities, but careful monitoring is needed to ensure this is successful.
- The state and its county partners will face challenges in providing multiple pathways for people to apply for Medi-Cal — including in person, online, and by mail. With the expected influx of newly eligible residents, challenges for the state are altering perceptions about the enrollment process and addressing the lack of awareness about online enrollment.
For his part, Smith of CHCF stresses the need for widespread education moving forward. "However people apply for Medi-Cal, we want to make sure the system is welcoming and easy to use," he says. "There is a need for a broad outreach effort to inform people about their enrollment options."
A series of short videos with individuals reflecting on their experiences with Medi-Cal is available at www.chcf.org/survey.
Interviews are available upon request.
About the Report
This survey was conducted by Lake Research Partners in late 2011 and early 2012 on behalf of CHCF, and in partnership with the California Department of Health Care Services, among a sample of 1,083 Medi-Cal enrollees under the age of 65. Those enrolled in Medicare or residing in institutional settings were excluded. The margin of error is 3 percentage points for the total results.
This new report also uses data from the California General Public Survey, conducted in May 2011 by Lake Research Partners on behalf of CHCF, of a representative sample of 1,528 Californians age 18 and older. The survey included 505 adults in households with incomes below 138% of the federal poverty level (FPL), 511 adults with incomes between 138% and 400% FPL, and 512 adults with incomes above 400% FPL. The margin of error is 2.5 percentage points for the total results.
About the California Health Care Foundation
CHCF is dedicated to advancing meaningful, measurable improvements in the way the health care delivery system provides care to the people of California, particularly those with low incomes and those whose needs are not well served by the status quo. We work to ensure that people have access to the care they need, when they need it, at a price they can afford.
CHCF informs policymakers and industry leaders, invests in ideas and innovations, and connects with changemakers to create a more responsive, patient-centered health care system.