Physician Participation in Medi-Cal: Ready for the Enrollment Boom?

Janet M. Coffman, Denis Hulett, Margaret Fix, and Andrew B. Bindman, University of California, San Francisco

Will California physicians be able to handle the Medi-Cal population surge? This report looks at physician participation in Medi-Cal and its implications for access to care.

August 2014

Recent and projected enrollment increases in Medi-Cal, California's Medicaid program, due to the Affordable Care Act have heightened concerns about whether sufficient numbers of physicians are participating in Medi-Cal to provide beneficiaries with adequate access to care. Without a large increase in the number of full-time equivalent (FTE) primary care physicians participating in Medi-Cal or another means of increasing efficiency in primary care, such as greater use of nonphysician clinicians or phone and electronic visits, Medi-Cal beneficiaries are likely to have difficulty accessing this basic level of care.

This report by the University of California, San Francisco, presents findings from physician surveys conducted in 2011 and 2013 to assess California physicians' participation in Medi-Cal and discusses implications for beneficiaries' access to care.

Among the study's findings:

  • The ratio of primary care doctors participating in Medi-Cal was 35 to 49 FTEs per 100,000 enrollees, well short of the range of 60 to 80 that the federal government estimated are needed. The ratio of non-primary physicians participating in Medi-Cal was between 68 and 102 FTEs per 100,000 enrollees, a range which overlaps with the federal estimate of need (85 to 105 per 100,000).
  • The percentage of physicians with any Medi-Cal patients in their practice (69%) was significantly lower than the percentage with any Medicare patients (77%) and much lower than the percentage with any privately insured patients (92%).
  • The distribution of Medi-Cal visits among California physicians is highly skewed. About one-third (35%) of physicians accounted for 80% of Medi-Cal visits, and about one-third (34%) accounted for the remaining 20% of Medi-Cal patients.
  • Emergency doctors, hospitalists, anesthesiologists, and others who work primarily in hospitals had the highest rate of Medi-Cal participation (82%), while psychiatrists had the lowest (47%).
  • Physicians at community health centers and public clinics had the highest rate of Medi-Cal participation (92%), and those in solo practice had the lowest (54%).
  • Medi-Cal participation rates were highest in the North Valley/Sierra region and lowest in the Central Coast region.
  • Among California physicians, 62% said they accept new patients covered by Medi-Cal compared with 75% taking new Medicare patients and 79% accepting new patients with private insurance.

The 2014 edition of this report, along with prior studies examining the issue, is available under Document Downloads.

An interactive infographic summarizes the study's main findings.

Reader Comments

My comment is regarding the largest grouping of eligible "Medi-Cal" recipients which are Latino's living here in California that are not mentioned in this article. Hispanics make up 62 percent of the uninsured, presenting a unique challenge for any "expansion". The reality is Hispanics who are eligible for Medi-Cal are unlikely to sign up for coverage than other groups because they have a variety of misconceptions from stories they have heard of past Medi-Cal recipients within family.
This likely $200,000+ study and validation duplicates data that is >10 years old. My data analysis in 2010 when fee for service Medi-cal was 50% of members showed less than 1/2 of licensed docs "participated" in Medi-Cal. As the authors own validation showed, docs hedge their bets by signing on (participation) yet see little or no Medi-Cal patients. The 50K participating docs is really 4000 docs since only 20% of those participating provide 80% of the care to this program. The 80% see less than 3 patients a month--hardly fulfills a participating definition. Using "participation" grossly over estimates access and the problem is worse than the academics presented. Hospital based and community paid docs are required by contract to "participate." Nice study but common experience in the trenches would tell them their metrics are perhaps grossly underestimating the problem. Managed care data (encounters) are historically invalid and underestimate care episodes. Nice try. Rob MD
Excellent report. California faces a serious challenge meeting the needs of the expanded Medi-Cal population in terms of access to physicians. The task is especially heavy on Medi-Cal managed care entities, in particular, the public plans. This task has not been helped by the remarkably low rates physicians receive for Medi-Cal patients, whether in managed care or fee-for-service settings.
This report clearly illustrates that California will have a shortage of physicians to care for Medi-Cal patients. Therefore, we ALL need to work together to engage other healthcare providers to collaborate in providing health care services. This means, PAs, NPs, CNMs, etc. Please don't forget that as Allied Health Professionals we are a valuable resource to the present documented shortage of physicians.