Counties Worried About Doctor Count Ahead of Medi-Cal Growth

County officials are concerned by a shortage of physicians in the state as California prepares for a Medi-Cal expansion under the federal health reform law, the Ventura County Star reports.

  • Background

Under the reform law, states have the option of expanding Medicaid coverage to individuals with incomes of up to 133% of the poverty level; this is in excess of $92,000 for a family of four.

The law’s Medicaid expansion provision also will expand coverage to low-income adults who have no children. Following the U.S. Supreme Court ruling upholding the reform law, California officials said the state would move forward with implementing its provisions. Forty-seven California counties are participating in the “Bridge to Reform” program, which aims to implement the Medicaid expansion ahead of schedule.

Inland communities — which are facing a shortage of primary care physicians — will have more residents receiving Medi-Cal coverage under the expansion than wealthier coastal communities. The state has an uneven distribution of physicians. For example, Riverside and San Bernardino counties have only one medical school and struggle to attract and retain physicians, while some counties in the northern part of the state have an abundance of doctors.

Meanwhile, a report by the California HealthCare Foundation’s Center for Health Reporting found that nearly half of primary care physicians in the state are not willing to see new Medi-Cal beneficiaries because they say Medi-Cal reimbursement is too low. California also has a large number of physicians who are nearing retirement age, which could affect the number of physicians who treat Medi-Cal beneficiaries.

  • Concerns

Mary Carr, executive director of the Ventura County Medical Association, said that mandates in the reform law and resulting health care trends — such as accountable care organizations, electronic health records and lower physician reimbursement — could result in fewer physicians available to treat newly insured patients. She said the changes “may cause physicians to choose early retirement.”

  • Seeking Solutions

Lee Kemper — executive director of the County Medical Services Program, a consortium of 34 rural counties implementing the Medi-Cal expansion — said Medi-Cal reimbursement rates must be increased in rural areas to attract more doctors. In addition, Senate Health Committee Chair Ed Hernandez (D-West Covina) plans to draft legislation that would expand scope-of-practice definitions for certain health care providers — such as nurse practitioners and physician assistants — to help bolster the state’s health care workforce. In addition, Hernandez said he will try to increase the number of medical students in the state and push for medical residency programs in underserved areas.

*Modified from the Ventura County Star

 

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