ACA Fail Fractal
Access Problems for California Medicaid?

Since the passage of the ACA, California’s Medicaid program, called Medi-Cal, has seen 3.5 million new first-time users, and almost one-third of state residents are covered through that program. But not all is well for those enrolled in Medi-Cal. The LA Times reports on a new audit that highlights how poor state records have made it difficult for enrollees to reach doctors:

Auditors analyzed the provider directories of three plans — Anthem Blue Cross in Fresno County, Partnership HealthPlan of California in Solano County and Health Net in Los Angeles County — and found that they contained inaccurate information for 3% to 23% of providers.

The state is required to certify that health plan networks offer enough doctors, and that patients don’t have to drive too far to get care. But the audit found the state couldn’t be certain the plans were meeting patients’ needs, because the Department of Healthcare Services wasn’t verifying the data that plans submitted to the state.

For instance, although the department had not found “any inaccuracies in the three provider directories,” auditors said they discovered wrong telephone numbers and listings for doctors who were no longer in the programs.

In one way, this might seem like a relatively superficial problem. The state just has poor records and should correct those—wrongly listed telephone numbers do not tell any kind story about a structural issue with Medicaid. But at another level, the problem might be more serious, because the audit may have turned up not only incorrect phone numbers for doctors but also listed doctors who aren’t “in the programs”—i.e. who aren’t offering health care to Medicaid patients. And earlier in the story, the LA Times also cites a case of a state resident finding that some of the doctors on the state list were no longer accepting new patients.

In other words, there are at least some signs that Medi-Cal’s difficulties are not just a matter of clerical errors, but also something worse: there may be serious access problems for Californians on Medicaid. That possibility illustrates the fact that it’s never enough when evaluating health care reforms to look at how many more people are “covered.” The more important questions are how much and what type of care that official coverage gets someone, and whether our system is affordable and efficient enough that those covered in it can have a reasonably good health care experience.

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