Physician Participation in Medi-Cal: Is Supply Meeting Demand?

Janet M. Coffman and Margaret Fix, University of California, San Francisco

Enrollment in Medi-Cal surged between 2013 and 2015. This report looks at physician participation in Medi-Cal and implications for access to care.

June 2017

Enrollment in Medi-Cal, California's Medicaid program, surged with the implementation of the Affordable Care Act (ACA), from 8.6 million in September 2013 to 13.4 million three years later. Medi-Cal now covers nearly one in three Californians. These Medi-Cal enrollees benefit from no- or low-cost coverage for a wide array of physical health, mental health, and long-term care services, when needed. They also benefit from many legal and other protections not available to uninsured patients, including federal "equal access" standards for Medicaid and, for those enrolled in managed care, network adequacy requirements. For some of these protections to work, an adequate number of physicians must serve Medi-Cal enrollees. Physician Participation in Medi-Cal: Is Supply Meeting Demand? summarizes a study conducted by the University of California, San Francisco, that evaluated physician participation in Medi-Cal between 2013 and 2015.

Key findings:

  • Primary care physicians in California were more likely to serve Medi-Cal patients than uninsured patients, but less likely to have Medi-Cal patients in their practices than patients with private health insurance.
  • Non-primary care physicians were more likely to serve Medi-Cal patients than uninsured patients, but less likely to have Medi-Cal patients in their practices than patients with either Medicare or private insurance.

    Physicians with Any Patients, by Coverage Type and Physician Type, California, 2015

  • Rates at which physicians accept new Medi-Cal patients and uninsured patients varied across specialties, practice settings, and regions.
  • From 2013 to 2015 the percentage of California physicians serving Medi-Cal patients decreased from 69% to 64%, but the overall number of full-time equivalent (FTE) physicians serving Medi-Cal patients increased by 9%. This is probably because, among physicians serving Medi-Cal patients in 2015, the overall share of their patients on Medi-Cal increased (many patients who had been uninsured in 2013 were covered by Medi-Cal in 2015).

    Physicians with Medi-Cal Patients, California, 2011, 2013, and 2015

  • The increase in the number of FTE physicians participating in Medi-Cal did not keep pace with the growth of Medi-Cal enrollment, so the ratios of FTE physicians per 100,000 Medi-Cal enrollees with full-scope benefits decreased between 2013 and 2015.
  • For both primary care and non-primary care physicians, the ratios of FTE physicians per 100,000 Medi-Cal enrollees with full-scope benefits fell below national and state recommendations.

These findings support the conclusion that Medi-Cal provides a vital safety net to low-income Californians — and also that further investments and improvements are needed to ensure adequate access to care for all beneficiaries. The report discusses approaches that California might consider to address this challenge. Recommendations include:

  • Increasing provider reimbursement
  • Reducing administrative burdens for physicians and their offices
  • Increasing opportunities for physicians to train in communities where physician shortages are greatest, and recruiting new doctors from within those communities
  • Taking additional steps to increase the capacity of existing physicians and improve the overall efficiency of care provided to Medi-Cal patients. These include:
    • Adopting health plan and provider payment reforms that foster team-based care and encourage providers to pursue alternatives to face-to-face visits.
    • Expanding the integration of behavioral health and primary care, so that primary care providers get the support they need to care effectively for patients with mental health and substance use conditions.
    • Changing California scope of practice laws to give non-physician professionals greater autonomy in the care of patients.

The 2017 edition of the full report, which includes a more thorough discussion of these recommendations, is available under Document Downloads, along with prior studies examining the issue.