Medi-Cal beneficiaries face “significant” gaps in access to care compared with individuals who are enrolled in employer-sponsored health plans, according to a study published by the California HealthCare Foundation, Payers & Providers reports. CHCF publishes California Healthline.
Medi-Cal is California’s Medicaid program.
For the study, UCLA researchers used the 2012-2013 California Health Interview Survey to compare 45 different aspects of health care between Medi-Cal beneficiaries and individuals with work-based health plans.
The study found “significant” gaps in 29 areas of care delivery, as well as differences in the health care needs and socioeconomic status between Medi-Cal beneficiaries and individuals enrolled in employer-sponsored health plans.
For example, the study found that 61% of individuals with commercial plans said they were in good or excellent health, compared with 31% of Medi-Cal beneficiaries.
However, when such differences were controlled for variations in the populations, the study found gaps between the two cohorts in just nine areas of care delivery. For instance:
24% of children enrolled in Medi-Cal visited an emergency department in the last year, compared with 13% of children covered by their parent’s employer-based health plan;
22% of Medi-Cal beneficiaries said they had not visited a physician in the last year, about 50% higher than the percentage of commercial plan enrollees who had not;
18% of Medi-Cal beneficiaries said they did not have a constant source of care other than the ED — at least 50% higher than the proportion of commercial plan enrollees who did not have a usual source of care;
17% of children enrolled in Medi-Cal had height-to-weight ratios that suggest they were obese, more than 50% higher than the percentage of kids with commercial plans;
12% of Medi-Cal beneficiaries said they had delayed care over cost concerns, about 20% higher than the percentage of commercial plan enrollees who had done so; and
9% of Medi-Cal beneficiaries said they had come across physicians who said they were not accepting their type of coverage, more than four times the rate of commercial plan enrollees.
According to the study, there were fewer gaps in access to care among children enrolled in Medi-Cal, compared with children covered by commercial health plans. Meanwhile, Medi-Cal managed care plans often performed as well as commercial coverage, Payers & Providers reports.
Companion Report Examines Medicaid Provider Access
In a companion report to the UCLA study, the Urban Institute found that Medi-Cal beneficiaries’ access to providers was similar to that of Medicaid beneficiaries across the country.
However, the report noted that cost concerns were significantly higher in California, compared with other states. Specifically, more than 33% of Medi-Cal beneficiaries had unmet medical needs because of costs, compared with about 23% of Medicaid beneficiaries in other states (Shinkman, Payers & Providers, 7/9).