CHCF: Physician Participation in Medi-Cal: Ready for the Enrollment Boom?

From our colleagues at the California Health Care Foundation:



By the end of 2015, the Affordable Care Act will add more than two million enrollees to Medi-Cal, the nation’s largest state Medicaid program. This estimate has heightened concerns about whether there are enough doctors to care for them all. Californians are likely to have difficulty accessing health care through Medi-Cal unless the number of participating physicians grows or California finds other ways to deliver services.

The percentage of physicians treating any Medi-Cal patients increased between 2011 and 2013 from 64% to 69%, according to a new report prepared by researchers at the University of California, San Francisco. Yet their findings suggest that Medi-Cal enrollees face significant challenges due to statewide variations in physician availability.

Among the findings from the 2013 survey:

  • The ratio of primary care doctors participating in Medi-Cal was 35 to 49 per 100,000 enrollees, well short of the 60 to 80 that the federal government estimates are needed. The ratio of non-primary physicians participating in Medi-Cal was between 68 and 102 physicians per 100,000 enrollees, within the federal estimate of need (85 to 105 per 100,000).
  • The percentage of physicians with any Medi-Cal patients (69%) was significantly lower than the share with any Medicare patients (77%) and much lower than the percentage with any privately insured patients (92%).
  • The distribution of Medi-Cal visits among California physicians is highly skewed. About one-third accounted for 80% of Medi-Cal visits, and about another third accounted for the remaining 20% of Medi-Cal patients. 
  • Physicians at community health centers and public clinics had the highest rate of Medi-Cal participation (92%), and those in solo practice had the lowest (54%).

See the complete report, along with an interactive infographic.

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