July 16 2014
Medicaid: CA Docs Jumping Ship
Patrice J. Lee
Do you remember the President’s (broken) promise that if you like your doctor you could keep your doctor? We’ve seen how ObamaCare invalidated that claim as more narrow networks of doctors and healthcare providers mean your preferred doctor may not accept your new ObamaCare plan.
In California, finding a doctor is becoming increasingly more difficult for those with Medicaid. From 2013 to last year some 26,395 doctors stopped accepting Medicaid. At the same time, a surge of two million new patients joined the Medicaid rolls thanks to ObamaCare.
According to the California Health Report, an independent journalism project that reports on public health and community health issues in the state, nearly 25 percent fewer physicians were signed up to treat low-income patients. That's due in part to ObamaCare, which forced an update of provider requirements and others because they had not accepted a Medicaid patient in the past 12 months.
With another 600,000 people waiting for the state to process their Medicaid applications, we wonder about the access and quality of care these patients are now enjoying. How easy is it to find a doctor accepting Medicaid and accepting new patients in California and then how long does it take to get an appointment and to actually see your new doctor?
California Health Report explains:
About 109,000 physicians were enrolled in Medi-Cal last spring, according to the Health Care department. But by this May, that number had dropped to 82,605.
Of the doctors enrolled in May, 38,845 were primary-care providers and 43,760 were specialists.
In the last year, the Health Care department has updated its provider requirements, as part of the Affordable Care Act, Cava said. Those requirements “have strengthened the department’s ability to deny or terminate providers who do not comply with application requirements,” he said.
On its own, the agency’s list of providers isn’t necessarily a reflection of whether Medi-Cal patients have sufficient access to doctors. The list doesn’t specify whether the doctors are accepting new patients or how many they can accept, Cava said. While some doctors on the list may have up to 2,000 Medi-Cal patients, others might see only a handful or none.
The Department of Health Care Services claims this drop in doctors has not resulted in a decrease in access to care. For the sake of these patients, we hope so but there's more to the story.
A recent report finds that healthcare facilities are leaving poor neighborhoods. According to Post-Gazette/Journal Sentinel analysis, the number of hospitals in 52 major cities in the United States has fallen from its peak of 781 in 1970 to 426 in 2010, a drop of 46 percent. Nearly two-thirds of the roughly 230 hospitals opened since 2000 are in wealthier, often suburban areas.
Most of the facilities closed were small to mid-size community hospitals in poor urban neighborhoods and public hospitals, leaving many low-income neighborhoods with no safety-net hospital. And when the hospitals close, the doctors leave.
Furthermore, doctors already are scarcer in poor neighborhoods. More than half of the federally designated "primary care shortage areas" in the 52 major metropolitan areas fall in census tracts of highest poverty.
The minimum eligibility level to qualify for Medicaid is now 133% of the federal poverty level ($29,700 for a family of four in 2011) for nearly all Americans under age 65. Those suffering in poor neighborhoods likely qualify for Medicaid and thus more closed healthcare facilities.
This will just drive more people to the fewer options available - negatively effecting their access and quality of care.