State must keep Medi-Cal funding for phone appointments

A physician uses his cell phone for a medical discussion. (Photo: apr.org)

The mother on the other end of the phone call was worried about her newborn’s increased fussiness and stomach issues.  After taking a thorough history, the problem became clear: The mother had switched from breastmilk to a formula that triggered symptoms related to the baby’s known history of milk protein allergy. I advised a switch to a hydrolyzed formula.

This phone appointment was no different in process or outcome than if we had met over a video connection or in-person. But the California Department of Health Care Services is proposing to treat it differently when the pandemic ends.

If the department has its way, phone appointments with clinicians at federally qualified health centers – like Venice Family Clinic where I am a pediatrician– will no longer be eligible for Medi-Cal reimbursements.

Reversing course when the pandemic ends by eliminating reimbursements for audio calls ignores the digital divide in our lower-income communities

This short-sighted proposal would roll back a vital component of the telehealth programs launched during the COVID-19 pandemic to protect patients and health care staff.

That is why federally qualified health centers like ours are supporting Assembly Bill 32, a measure that would make permanent the telehealth innovations achieved during the pandemic, including Medi-Cal reimbursement for audio telehealth visits. The California Medical Association, the California Association of Public Hospitals and Health Systems and the California Primary Care Association are also supporting the measure.

Early in the pandemic, federal and state governments moved quickly to adopt emergency changes that made Medi-Cal and Medicare reimbursements available for services provided over the phone and via video teleconferencing systems.

These emergency regulations transformed health care by making it more readily available to people who needed it the most – essential workers and people living in low-income communities – as well as older and rural patients. The impact has been extensive in California, where a survey of 43 health centers  found 48.5% of primary care visits and 63.3% of behavioral health visits happened via telephone between March and August 2020.

Reversing course when the pandemic ends by eliminating reimbursements for audio calls ignores the digital divide in our lower-income communities and the many challenges to in-person visits.

Our clinic serves 27,000 people in need, and many don’t have the high-speed broadband, extensive data plans, digital savvy or computer access to readily access a video conferencing system. Almost all our patients – including the 4,500 patients experiencing homelessness – have a phone or access to one.

For parents, the ability to easily connect to a health care provider over the phone often means the difference between getting the care their children need or going without it. At Venice Family Clinic, 13% of patients miss their in-person pediatric visits while only 3% miss their scheduled phone appointments.

While phone calls cannot replace in-person exams or the personal touch that helps patients struggling with serious illnesses or chronic conditions, they significantly improve access to care for people in need or living in rural locations. Our patients often have limited transportation options and may have to take several buses to get to one of our sites. They frequently work in jobs with little or no sick leave, so they may lose all or part of a day’s pay to see a health care provider.

Imagine the exhausted mother, instead of speaking to me by phone, getting on at least two buses – and perhaps more – to travel to and from our Clinic with her fussy infant. Along the way, she may have exposed her baby to COVID-19 or other infectious diseases for which the newborn had not yet received all the needed vaccinations.

The pandemic pushed us to figure out how to make care more accessible to children and families who have benefitted tremendously from phone visits. Reducing their access to healthcare would be the wrong move. We should not retreat from the progress we’ve made. Instead, let’s continue to make it possible for parents to ease their minds and their children’s suffering through a comprehensive phone call with their clinician.

Ed’s Note: Michelle Aguilar, M.D., is the head of the pediatric practice at Venice Family Clinic, a community health center that serves 27,000 people in need at 14 sites in the greater Los Angeles area.

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