Cutting down Medi-Cal managed care plans is big mistake

Headquarters of the Department of Health Care Services in Sacramento. (Photo: Matthew Corley, via Shutterstock)

Anyone who has tried to access health care has likely run into hurdles. From difficulty getting appointments, to barriers to specialty care, to obtaining authorization for appropriate treatments or medications, it can feel like a Herculean task for many to receive the care they need.

Patients are rightly frustrated, as are physicians like me who want to provide the best and most timely care possible. And while increasing access to care has been a major policy goal in California for decades – and some progress has been made – it unfortunately appears that the obstacles to health care for Sacramento County patients are about to get larger.

Care disruptions as the result of the DHCS plan will particularly harm those living with chronic illnesses.

In a move that will impact countless patients in managed care plans throughout the county, the California Department of Health Care Services (DHCS) is proposing to reduce the number of Sacramento County Medi-Cal managed care plans from five down to just two.

This means that a huge percentage of the 480,000 Medi-Cal beneficiaries in the county will have their health care disrupted as they are forced to seek new physicians and health care facilities.

And it also means the managed plans they are being funneled into will be stretched to properly provide service to potentially hundreds of thousands of displaced Medi-Cal patients, as well as their existing patients – both Medi-Cal enrollees and patients with employer-based coverage. Care disruptions as the result of the DHCS plan will particularly harm those living with chronic illnesses.

As a physician who treats chronic illness, I know that these patients require consistent care and disease management by trusted providers who understand them and their needs.

Chronically ill patients must already navigate barriers like health plan prior authorization that can delay their treatment while they wait for approvals, and “step therapy” that requires them to try and fail on sometimes multiple medications before their insurer allows their doctor to prescribe the drug that actually works for them. Adding the burden of being forced to change managed care plans and find new doctors will be devastating to them.

Indeed, according to a UCLA Center for Health Policy Research study, Medi-Cal enrollees already have much more difficulty finding physicians, including specialists, who accept their insurance. And we all know that patients who don’t seek the care they care get sicker – impacting their quality of life, threatening their lives, and exponentially increasing the cost of their treatment when they finally do seek care.

At a time when the COVID pandemic has exposed grave health inequities among our most vulnerable populations, now is not the time to throw the health care of nearly a half million Sacramento County Medi-Cal patients into chaos.

The proposed DHCS plan to cut Medi-Cal managed care plans in the county from five to two will not only disrupt Medi-Cal patients’ access to care, it threatens to upend the ability of the two managed care providers to properly service new and existing patients as their membership rolls grown by tens to hundreds of thousands.

Sacramento County leadership is urged to stand up for patients in our community and reject the current DHCS plan.

Editor’s Note: Dr. Robert Gish, a liver disease specialist with a practice in Sacramento, is a Professor of Medicine at Loma Linda University, an Adjunct Professor of Medicine at the University of Nevada School of Medicine in Las Vegas, and a Clinical Professor at the University of California Skaggs School of Pharmacy and Pharmaceutical Sciences. He currently sees patients both in-person and via telemedicine at various clinics in California.

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