Poor caught in dispute over Medi-Cal reimbursements

Consumers have been complaining this year that Covered California insurance plans have doctor’s networks that are too narrow. The doctors they want to see don’t accept the insurance, they say.

While a relatively new problem for California’s upper- and middle-class residents, this situation has been a problem for the poor for decades.

 “It is very hard to get through to someone at Medi-Cal to get help if you can’t find a doctor.” — Elizabeth Landsberg

The state’s insurance program for the poor — which covers a quarter of the population — has the narrowest doctor’s network of all.

People enrolled in Medi-Cal, the state’s low-income health program, have a much slimmer list of doctors that they can see, compared to those with non-government health insurance plans.

“I wouldn’t say that poor people are less likely to complain necessarily, but I do think it’s hard to complain when you don’t know what your rights are which is the case of many health care consumers,” said Elizabeth Landsberg, director of legislative advocacy for the Western Center on Law and Poverty. “It is very hard to get through to someone at Medi-Cal to get help if you can’t find a doctor.”

California doctors are less inclined to accept Medi-Cal because the state has one of the lowest reimbursement rates in the nation for doctors who treat low-income patients. Many doctors can’t afford to pay their bills if they accept Medi-Cal patients, according to the California Medical Association.

After the deluge of complaints from people with Covered California plans, the state Department of Managed Health Care announced last month that it’s investigating whether two insurers misled consumers.

To compound the problem, people enrolled in Medi-Cal are given doctor directories that are highly inaccurate, as the Health Report detailed in a story last week.

The state Department of Health Care Services says that the number of doctors enrolled in Medi-Cal plans is sufficient to meet the needs of patients. However, the inaccuracy of the directories raises the question of whether the plans are accurately reporting how many doctors are available.

After the deluge of complaints from people with Covered California plans, the state Department of Managed Health Care announced last month that it’s investigating whether two insurers misled consumers. People say many of the doctors who were advertised as being in the plans’ networks didn’t actually accept the insurance.

It remains to be seen whether the state will conduct a similar investigation of the plans offered to people with Medi-Cal.
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Ed’s Note: Hannah Guzik is a reporter for the California Health Report, where this story originally appeared.