Medi-Cal Physician and Dentist Fees: A Comparison to Other Medicaid Programs and Medicare

Stephen Zuckerman, Aimee Williams, and Karen Stockley, Urban Institute

For many years, Medi-Cal fees for physician services, on average, have been near the bottom nationally among Medicaid programs, and well below the rates paid by Medicare. This research revisits the issue and looks anew at dental services.

April 2009

Medi-Cal fees for physician services, on average, have for many years been near the bottom nationally among Medicaid programs, and well below the rates paid by Medicare. This report by the Urban Institute, funded by the California HealthCare Foundation (CHCF), compares 2008 Medi-Cal physician fees for selected procedures with fees paid by other states' Medicaid programs and by Medicare. Researchers also examined changes in fees for the same set of procedures from 2003 to 2008, and Medicaid fees for selected dental procedures in 2008.

Findings include:

  • Overall, Medi-Cal fees were 83% of the Medicaid national average in 2008. California's fees rank 47th overall among states when adjusted for geographic differences in the cost of providing medical care. Among the 10 largest state Medicaid programs, California ranks ninth.
  • Considerable variation exists in Medi-Cal fees across procedures in relation to national averages, with relative fees ranging from less than 70% to more than 140% of the national average.
  • From 2003 to 2008, Medi-Cal physician fees grew, on average, by only 2%. This compares to 15% growth in average Medicaid fees nationwide and 21% general inflation during this period.
  • Low average Medi-Cal reimbursement extends to dental care, with fees for most procedures falling short of those for Medicaid nationally.

A related Health Affairs article, "Trends in Medicaid Physician Fees, 2003–2008," written by Urban Institute staff and funded by CHCF and the Kaiser Family Foundation, is available free of charge through the External Link below.