Myths & Facts Print E-mail

Don't most low-income Californians already have access to the care they need through Medi-Cal?


What’s Behind It?

In the health reform discussion, assuring that low-income Californians can afford and access appropriate care is a primary policy goal. Medi-Cal, California's version of the joint federal/state Medicaid program, is the source of health insurance for one in six Californians. Some assume that most low-income Californians can already get the health care they need through Medi-Cal.


The Broader Picture

Many low-income uninsured Californians are not eligible for Medi-Cal. Medi-Cal eligibility is based on a number of factors, such as income, assets, family size, age, disability, and citizenship. Among those eligible for Medi-Cal are low-income children and pregnant women, families receiving or eligible for cash aid (such as CalWORKs and Supplemental Security Income), low-income individuals with specific health needs (for example, breast or cervical cancer), and individuals who are aged, blind, or disabled according to Social Security rules. However, many low-income, uninsured Californians are not eligible for Medi-Cal. For example, childless adults without a disability are generally not eligible for Medi-Cal, no matter how low their income.

Those eligible for Medi-Cal often experience difficulty enrolling in the program. While many uninsured Californians are ineligible for Medi-Cal, as many as one-third of uninsured children and 3 - 9% of uninsured adults may be eligible for Medi-Cal. Reasons for not enrolling in Medi-Cal range from a lack of awareness of eligibility, to the social stigma that remains from the program's historical link to welfare, to the confusing and onerous enrollment process. In one survey, 52% of those enrolled in Medi-Cal think that signing up requires too much paperwork. Similarly, among those eligible for but not enrolled in Medi-Cal, perceived difficulties with the application process (for example, that the application is long and difficult and that waiting times at county offices are too long) were the greatest impediment to enrollment. Documentation requirements, including a new federal rule that requires many applicants to show proof of citizenship, exacerbate this problem.

Once enrolled in the program, Medi-Cal beneficiaries often have trouble accessing the care they need. Medi-Cal reimbursement for most services is much lower than rates paid by commercial insurers or Medicare. Low reimbursement is a major reason that many physicians, particularly certain specialists, limit the number of Medi-Cal patients they see or refuse to treat them altogether. One study found that nearly one-half of urban physicians don't have any Medi-Cal patients in their practice. The same study found that as a result of low physician participation in Medi-Cal, there is only one medical specialist for every 25,000 Medi-Cal beneficiaries, compared to one for every 10,000 Californians overall. Accordingly, more than one-half of beneficiaries report difficulty finding doctors.


The Bottom Line

The Medi-Cal program would have to change significantly in order to provide coverage and appropriate, accessible health care services for California's low-income population.

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