California Health Insurance/Medi-Cal Question? (Santa Clara: car rental, 2015, rental)

[Ultrarunner]

Ads are running daily in my market saying California has underfunded Medi-Cal for children. There are also media stories about the ongoing problem of uninsured Californians.

Affordable Healthcare Act is and has been law of the land.

Participation is mandatory with premiums based on income and coverage is not subject to pre-existing conditions

So how is it Children needing Health Care in California are not getting it?

Just an honest question from someone trying to understand...

[onetoughkitty]

Money wasted trying to use and update an antiquated system. It takes months for Medi-cal to approve people into the system, including children. Not to mention, a lot of doctors are pushing back by not seeing patients on Medi-cal. I work in a healthcare system where the directors would specifically tell their staff to book these types of patients 6-8 weeks out in order to avoid dealing with them.

[Ultrarunner]

Sounds like "Coverage" in name only... and expense and failing to deliver on promises.

I realize something as vast as the Affordable Healthcare Act takes time... on the other hand, I don't understand the barrage of of ads on TV saying California children are suffering and not getting proper care.

Prior to the Affordable Healthcare Act the majority of Californians had coverage... and from reading the stories it seems nothing has really changed...

[2sleepy]

It has to do with provider reimbursement:
"Reimbursement rates dropped Jan. 1 for Medi-Cal primary care providers in two ways: A provision of the Affordable Care Act temporarily set primary care reimbursement rates at Medicare levels, significantly higher than Medicaid payments. The increase lasted two years and expired on Jan. 1. A state reduction in Medi-Cal reimbursement for primary care providers hit on the same day. The 10% rate cut, approved by the California Legislature in 2011, was held up while the matter was thrashed out in court. Last year, the courts upheld the state's right to reduce provider reimbursement and health care officials decided to implement the cutbacks in phases. The last phase, which includes primary care providers, went into effect Jan. 1."

Will Twin Medi-Cal Cuts Affect Access? - California Healthline

[cgk2013]

The same ads are running in our area too. From my understanding, Medi-Cal reimburses much less than say a private insurance company to physicians. Less doctors are accepting Medi-Cal patients either due to having too many patients already or because they would rather not deal with Medi-Cal. Therefore, many children are having to wait months to see a doctor.

For instance, my sister had the hardest time finding a pediatrician in her area that accepted Medi-Cal for my nephew. She was upset that he had to be on Medi-Cal in the first place, after having to switch him from Blue Shield when the Affordable Healthcare Act went into place. My sister and her husband own a small business and would have preferred he be kept on their existing policy. They were told they could not. On top of that, when Covered California was rolled out, he was without insurance for over six months while they were waiting for a "case worker" to get him into the system. It was a "cluster" to say the least.

It's a very sad situation that children are having to wait so long to see a doctor and I hope they get this issue resolved quickly.

[Ultrarunner]

Was not aware of the double reimbursement cut...

Guess it's kind of like my car rental insurance willing to pay $10 per day for a replacement car... yes, they will pay but where can I find a $10 car rental?

I work on the engineering side in the medical field and seems like Doctors are retiring left and right... these are all Docs with long established practices with in house staff.

Spoke to one yesterday on his last day... he is 61 and decided to close up shop... said medicine has changed so much since he started 35 years ago... he found himself having to add staff just to keep compliant with all the paperwork and billing demands and this is not what he signed up for.

Maybe we will have a system like Europe... "Everyone" is covered... if you want to chose your Doctor and Hospital you need to pay for a supplemental coverage which is not inexpensive...

Remember working in Germany and Austria and all my colleagues paid out of pocket for supplemental Health Insurance...

I guess offering Insurance with few providers is one way to limit expenses for the Insurance Provider...

On the other hand... a lot of my friends have lifetime medical from years of military or public safety service as Firefighters and Police Officers... most of us don't.

[nightlysparrow]

Each county runs Medi-Cal differently. For example, in Ventura County, it's run as an HMO called Gold Coast Health Plan. Some counties may not be efficient in the way they administer Medi-Cal funds.

[cb73]

One of the (ignored) complaints of ACA way back when it started was that the numbers just wouldn't work. They added millions to the MediCal rolls without addressing that significantly more doctors would be needed--and those doctors would need to be able to afford to take a loss on those patients.

It works if there's a lot of doctors and each only see a few MediCal patients. But there's way too many new MediCal patients to make that work.

Doctors coming out of medical school today have HUGE student loans--there's no way they can pay them off by taking the financial loss of treating a lot of MediCal patients.

If the people that designed ACA had wanted it to be workable, they would have tied in something for the government to underwrite medical school costs and graduate more doctors (with no student loans) that could then accept less fees and still be ok.

But for now, we have a lot of areas of California where people may have "insurance" but won't find medical care.

[NoMoreSnowForMe]

I haven't seen the ads, but it makes no sense to me. I'm on Medi-Cal, and have always used it through the county I'm living in, using the county clincs/hospitals. I've had it in Santa Clara, Shasta and now Del Norte County.

It can take a while to get a primary care physician, but you can always be seen by whoever is on staff. And you can always go to the emergency room.

As far as kids go, they're the only ones that are being accepted by most of the dental clinics that accept Denti-Cal.

So, I have a feeling they're twisting facts to suit their purpose, whatever that is. It can take 6 months to get assigned a primary care physician in Santa Clara and Shasta Counties. I got one here in Del Norte County in about 3 months. But, getting in to see a doctor is not a problem - in the county clinics.

And yes, there are different health care management companies assigned to different counties, and some have differing additional coverage. The one that manages Del Norte County just approved a free pair of eyeglasses every two years. But, other than something like that, they still have to abide by what's covered by Medi-Cal. So, maybe people are complaining that private doctors won't accept it? Sure, you can hit your head against a brick wall, or just use the county facilities, which are great, in my opinion.

So, whoever is putting out these commercials has some agenda and is twisting the facts. In my opinion.

[Ultrarunner]

I will look to see if there is a link to any of the spots...

The one I see often has a young mom with her son that suffers from allergies... they must travel 60 miles and waited months for a specialist appointment... it urges people to contact State Legislature in support of increased funding for kids...

It could be sponsored by Doctors for all I know...