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Monitoring Access: Measures to Ensure Medi-Cal Enrollees Get the Care They Need

Marsha Gold, Mathematica Policy Research, and Genevieve Kenney, Health Policy Center, Urban Institute

Two health policy experts offer an actionable framework and a targeted set of measures for monitoring access to ambulatory care for Medi-Cal enrollees.

A doctor listening to a child's back with a stethoscope.

With the enactment of the health reform law, the US has taken a major step toward filling gaps in health coverage and removing other financial barriers that limit access to health care. Millions of low- to moderate-income people will gain health benefits as states expand their Medicaid programs and develop their marketplaces for private health plans.

Even for those with coverage, access to health care services can be hampered. Barriers are especially likely for those who are most vulnerable because of low income, race or ethnicity, language, geography, mental or physical disabilities, or chronic conditions that require intensive services. Among the insured, those on Medi-Cal are especially at risk due to such factors as economic status, Medi-Cal provider payment policies, and growing competition over the available pool of providers in the state as more Californians gain coverage.

This report, prepared by Mathematica Policy Research and the Urban Institute with support from the California Health Care Foundation (CHCF), provides a framework for monitoring access to ambulatory care for Medi-Cal enrollees together with a targeted set of recommended measures and benchmarks. It is intended as an actionable starting point for policymakers and other stakeholders to monitor changes in access to care, to identify disparities in access across subgroups or regions, and to compare access between Medi-Cal enrollees and other insured populations.

With this report, CHCF inaugurates a series of studies that provide the most comprehensive examination of access to care for Medi-Cal enrollees ever undertaken. Additional installments in this series will be released over the next two years, beginning this summer.

The complete report is available under Document Downloads.

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