Measuring Up? Access to Care in Medi-Cal Compared to Other Types of Health Insurance (2018)

To see how Californians with Medi-Cal coverage are faring in accessing health care, this report examines data from the 2017–18 California Health Interview Survey (CHIS). This analysis focuses on one main question: Do Medi-Cal enrollees face greater difficulty accessing health care services than Californians with employer-sponsored insurance (ESI) or coverage purchased through the individual market (IM)?

Key findings include:

• Medi-Cal enrollees differ considerably from Californians with ESI or IM plans in terms of socioeconomic factors and health status. Yet even after adjusting for these factors, adults in Medi-Cal were still more likely than those with ESI to report no usual source of care, being told a doctor wouldn’t accept their health insurance, having trouble finding a specialist that would see them, having had no doctor visit in the last year, and having had more than one ER visit in the last year.
• Children in Medi-Cal generally experience comparable access to care as children with ESI, with one exception: They are more likely to report no usual source of care other than the ER, even after adjusting for health and socioeconomic factors.
• Although at first glance Medi-Cal access appears worse than IM, deficiencies disappear when the differences in the populations’ health and socioeconomic status are taken into consideration. The only two measures that showed a difference between the two groups after adjusting for health and socioeconomic factors revealed that those with Medi-Cal fared better. Adults with Medi-Cal were less likely to report delaying getting a prescription in the past year or delaying medical care due to cost or insurance. The latter may reflect higher out-of-pocket costs and copayments in the IM.

Overall, this research points to the need for improvement in several areas for Medi-Cal enrollees: ensuring a usual source of care, increasing the supply of providers that will take Medi-Cal patients, and facilitating access to specialists who will see Medi-Cal patients. Addressing these critical areas would help close the gaps in access to care for many California adults and children.