Physician Participation in Medi-Cal

University of California, San Francisco

This report uses data from a Medical Board of California survey; it finds that low participation rates are a continuing problem and discusses the implications for low-income patients.

July 2010

Medi-Cal, California's Medicaid program, covers nearly 7 million people. This number is expected to grow substantially in 2014 under new eligibility rules enacted as part of federal health care reform. Physicians' willingness to include Medi-Cal patients in their practices is essential if program beneficiaries are to have adequate access to care.

In 2008, with support from the California HealthCare Foundation, the University of California, San Francisco (UCSF), developed and conducted a new survey to determine levels of physician participation in Medi-Cal. The study found that low levels of physician Medi-Cal participation are a significant problem.

Among the study's findings:

  • California physicians are much less likely to have Medi-Cal patients (68%) than patients with private insurance (92%) or Medicare coverage (78%), with widely varying participation rates among specialties.
  • While 90% of California physicians are accepting new patients and 73% are accepting new Medicare patients, only 57% reported accepting new Medi-Cal patients.
  • Medi-Cal patients are concentrated in a small share of practices, with 25% of physicians providing care to 80% of Medi-Cal patients.

Given the uncertain impact of federal health care reform, it will be crucial for the state to monitor physician participation in Medi-Cal as an indicator of access to care among low-income residents. UCSF's new survey method provides an opportunity for California lawmakers to establish a regular, systematic method for collecting this key information from physicians.

This report explains the survey methodology, presents the survey's findings regarding the shortage of primary care and specialist physicians participating in Medi-Cal, and discusses the implications for low-income patients in the state.

The 2008 survey report, along with prior studies examining the issue, is available under Document Downloads.

Reader Comments

As a follow-up to the comments: (1) The survey did ask physicians to specify the percentage of their patients who are insured by Medi-Cal (and also for each of three other groups: insured by Medicare, privately insured, uninsured). (2) One need not hypothesize about the percentage of primary care physicians for whom Medi-Cal accounts for 30% or more of their practice, as this data is provided in Figure 4 of the report. For example, 22% of family medicine physicians and 15% of general internists have 30% or more of their patients insured by Medi-Cal. (3) It is a reasonable assumption that one should be able to validate the survey data using actual Medi-Cal claims (for fee-for-service patients) and encounter data (for managed care enrollees), but for a variety of reasons, the data collected by the California Department of Health Care Services cannot support this type of analysis.

- Chris Perrone, Deputy Director of the CHCF Health Reform & Public Programs Initiative
I agree with Rob MD on the validity of self reporting participation in Medi-Cal. Does "yes" mean I have one Medi-Cal patient or hundreds. Am I accepting new Medi-Cal patients, or is my practice closed to Medi-Cal.

CMA reports that 30% of the States physicians are treating Medi-Cal patients. This statistic supports Rob's hypothesis on fewer that 25% PCPs have a practice of 30% Medi-Cal
Self reported surveys are historically very inaccurate. The more specific the question e.g. "do you see new patients" paradoxically produces more false responses. I believe the increase participation from 2001-08 is real as physicians hedge being "Par" as much has been said of Medicaid replacing Medicare. One could in the FFS and MC Medi-Cal segments validate the survey with data mining of PCP and specialist office visit load and analysis set by known practice parameters. I believe you would see that fewer than 25% of PCPs are seeing at least 30% of their practice in MediCal. This is a simple analysis--why don't you encourage actual data rather than reported historically incorrect data? Rob MD
Medi-Cal funding is unstable, and the program is regarded generally as "for others, not for me". That is much of the reason that providers don't participate. (Reimbursement is another issue). Medicare, on the other hand, is for virtually everyone over 65, "for me, and everyone else." Funding is more stable. We need the equivalent of Medicare for everyone.