Historical Medi Cal Provider Issues

54% of MD’s accept Medi-Cal  4.3.2015

Litigation on Medi-Cal violating Judges order and putting people into HMO’s, rather than fee for service. CA Health Line 8.10.2017

Number of Medi-Cal Providers down by 25% californiahealthline.org/2014/7/15

Paul Ryan – more and more MD’s just won’t take Medi-Cal – Medicaid Fact Checker Washington Post 2.1.2017

Video on problems finding doctors

Many large physician groups no longer contract with health plans serving adult Medi-Cal patients, saying that government reimbursements are too low to cover the cost of treating patients.

For the typical office visit, Medi-Cal pays doctors only about a third of what their peers at federally qualified health centers receive, $150 on average. If the health centers’ fees exceed what insurers will pay, their administrators can bill the state for the residual amount. So, the state is forced by federal law to pay more for office visits at federally qualified health centers than it would have paid physicians in private hospital groups. Sacramento Bee 10.2.2017

The U.S. Supreme Court’s ruling October 2014 that private health care providers cannot file lawsuits against state Medicaid agencies over low reimbursement rates could limit future Medi-Cal lawsuits, the Los Angeles Times‘ “PolitiCal” reports.  CA Health Line

Medi-Cal is California’s Medicaid program (Megerian, “PolitiCal,” Los Angeles Times, 3/31).

Los Angeles Times 8.14.2014 – Few Providers, etc

There are now about 11 million Medi-Cal beneficiaries, constituting nearly 30% of the state’s population

Under the Affordable Care Act, the federal government pays 100% of the costs for newly eligible Medi-Cal enrollees for the first three years. But the state is responsible for 50% of the costs for those who qualified for the program before the Obamacare expansion, even if they hadn’t previously enrolled

With payments of $18 to $24 a visit, “doctors can’t continue to accept new patients and keep their doors open,” said Molly Weedn, a spokeswoman for the California Medical Assn. Without enough doctors, Medi-Cal patients could continue landing in costly emergency rooms — the opposite of Obamacare’s aims.

There is application backlog of about 490,000 people,

California has already demonstrated to the rest of the country that it can dramatically cut its rate of uninsured, largely by increasing the size of Medi-Cal. Now it needs to show that its public insurance program can actually deliver the care its new enrollees are counting on. latimes.com

Money in CA budget to expand Medi-Cal but 10% reduction in payments to MD’s  california health line.org

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11 comments on “HMO – Managed Care Providers

  1. Teri L says:

    Stanford Medical told me I would have to drop my Medi-Cal to get their full financial assistance (charity care)?

    I was told that I could not come to Stanford for any health care if I was a Medi-Cal recipient……… because then Stanford would be commiting FRAUD. I was told I would have to ‘quit’ my Medi-Cal or get the permission from Kaiser (who I have for my Medical-Cal) to see a ‘out of network’ surgeon…….

    How do I opt out of Medi-Cal?

    If I quit or gave up my Medi-cal , will I be able to reinstate it or reapply when I am ready…assuming I still qualify/?

  2. I live in Sacramento County and Medi Cal wants me to choose a Medi Cal managed care plan.

    But we both know by law I can keep straight Medi Cal.

    How do I fix this?

    • I’m not familiar with any law that says you can keep straight fee for service Medi Cal and not pick an HMO or have one picked for you. If you have a citation that I don’t, please place it in the reply section. You don’t have to put in your name.

      This page on Medi Cal’s site, clearly states you have to pick an HMO. More details on the change, as it used to be that you were right and you could have fee for service.

      You can also contact Medi Cal through our contact page.

  3. HELP!!!

    I have blood in my stool. Medi-Cal won’t let me have a colonoscopy for 3 months.

    What can I do to get an appointment sooner?

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