Comparing Physician and Dentist Fees among Medicaid Programs

This is archived content, for historical reference only.

Medi-Cal’s fee-for-service rates play a critical role in the way beneficiaries can access care. Despite the program’s generous benefits package, low reimbursement rates have discouraged participation by many doctors and dentists. Low fees prevent the state from providing beneficiaries access to comprehensive provider networks similar to those available to people with private insurance. Low fees also impact Medi-Cal managed care by limiting capitation rates.

This report, conducted in 2001 by The Lewin Group, compares fee-for-service payment rates in the Medi-Cal program to those paid by every other state’s Medicaid program. Data used in the report reflect the August 2000 increases in Medi-Cal payment rates to physicians.

This report looks at:

  • The Medi-Cal program in a national context;
  • The impact of recent fee increases; and
  • Payment variations across clinical categories.

This report should give state policymakers the information needed to begin a dialogue on Medi-Cal fee structure and how to bring it into alignment with private insurance to give beneficiaries access to more doctors and dentists.