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.
About the Authors
Ninez Ponce, PhD, MPP, is the director of the UCLA Center for Health Policy Research. Susan Babey, PhD, is a senior research scientist and director of the Chronic Disease Program at the center; Tara Becker, PhD, and A. J. Scheitler, EdD, are senior public administration analysts at the center. Petra W. Rasmussen, PhD, MPH, is an associate policy researcher at the RAND Corporation.