Medi-Cal Versus Employer-Based Coverage: Comparing Access to Care

Urban Institute
Tara Becker, UCLA Center for Health Policy Research
Shana Alex Charles
A. J. Scheitler
Ninez Ponce


Note: The UCLA report and data file were updated on January 4, 2016.

Using data from the 2012-13 California Health Interview Survey, researchers at the University of California, Los Angeles, compared access to care for Medi-Cal enrollees to those with employer-sponsored insurance (ESI).

A companion report by the Urban Institute, based on data from the 2011-13 National Health Interview Survey, compares access to care in Medi-Cal to Medicaid programs in other states. UCLA and the Urban Institute collaborated to develop common methods to control for differences in the health and socioeconomic status among populations, in order to illuminate any disparities.

The two reports, which come on the heels of a California State Auditor’s June 2015 report that raises questions about the monitoring of Medi-Cal members’ needs and access, demonstrate why ongoing monitoring is essential.

Key findings of the two studies include:

  • The access gaps largely reflect differences in the health and socioeconomic status of Medi-Cal enrollees and Californians with ESI. For both types of insurance, access to care is often worse for people who are in poor health, have a disability, have low income, or are of a race other than non-Hispanic white.
  • California adults with Medi-Cal had significantly poorer access than adults with ESI in 29 of the 45 measures. For example, Medi-Cal enrollees were twice as likely to not have a usual source of care other than the emergency room and three times as likely to have trouble finding a doctor.
  • California children with Medi-Cal had significantly poorer access than children with ESI in 11 of the 28 measures.
  • On most measures of access to care, Medi-Cal was comparable to Medicaid in other states after controlling for differences in health and socioeconomic status.

Overall, the findings illustrate how factors such as race and place contribute to disparities in access. They also underscore the importance of Medi-Cal in providing access to care and the challenges faced by Medi-Cal and participating health plans to ensure access that is comparable to that of other insured Californians.

The two reports and corresponding data files are available as Document Downloads.