Medi-Cal patients' access to care “substantially” worse than those who have employer-based health coverage

A new California Healthcare Foundation report based on California Health Interview Survey (CHIS) data found Medi-Cal patients face significant gaps in access to care compared with those who have employer-sponsored health insurance. Even within the Medi-Cal group, subgroups face access gaps depending on where they live, the language they speak, or their physical limitations.

According to the report, the ranks of Medi-Cal patients grew 50 percent, from 8 million in 2012-2013 to 12 million in 2014-2015. Researchers at the UCLA Center for Health Policy Research compared health access of Medi-Cal patients to that of patients with employer-sponsored insurance (ESI) and examined 45 measures of health access data for non-elderly adults and 28 measures for children from the 2012 and 2013 CHIS.

“It will take a lot of improvement for adults covered by Medi-Cal to have the same access to care as adults with job-based coverage,” said Shana Alex Charles, director of the Health Insurance Studies program at the Center. “Fortunately, children with Medi-Cal have access to care that’s very comparable to kids who are covered by a parent’s employer plan.” 
 
Some findings from the report:

Differences between Medi-Cal patient and ESI patient characteristics: Half the adult Medi-Cal adult patients were in worse health than counterparts covered by ESI – 31 percent of Medi-Cal patients said they were in excellent/very good health compared to 61 percent of patients with ESI. Medi-Cal adults also are more likely to be Latino, non-citizens or without a green card.

Gaps in access between Medi-Cal and ESI patients: Medi-Cal adults fared worse than ESI patients on 29 of 45 measures. For example, adult Medi-Cal patients were more than twice as likely as those with ESI to report they do not have a usual source of care other than the ER (18 percent and 8 percent, respectively), and three times more likely to have trouble finding a general doctor (6 percent and 2 percent, respectively). In contrast, access measures for Medi-Cal children were equal to those of children covered by ESI in 20 of 28 categories.

Large gaps in access exist among subgroups of the Medi-Cal population: There were significant differences among Medi-Cal adults, depending upon whether they lived in a rural area or an urban area, their race or ethnicity, or their native language. For example, 26 percent of Medi-Cal patients in rural areas said they did not have a usual source of care besides the ER compared with 16 percent of their urban counterparts. For Spanish-speaking Medi-Cal patients and patients with any physical limitation, 36 percent of each were told a doctor would not take them as a new patient compared to 7 percent of all Medi-Cal patients.

Read the study: Medi-Cal Versus Employer-Based Coverage: Comparing Access to Care

Read the companion paper by the Urban Institute: MediCal Versus Medicaid: Comparing Access to Care 

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About the UCLA Center for Health Policy Research
The UCLA Center for Health Policy Research (CHPR) is one of the nation’s leading health policy research centers and the premier source of health policy information for California. UCLA CHPR improves the public’s health through high quality, objective, and evidence-based research and data that informs effective policymaking. UCLA CHPR is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit healthpolicy.ucla.edu.

The California Healthcare Foundation is leading the way to better health care for all Californians, particularly those whose needs are not well served by the status quo. CHCF informs policymakers and industry leaders, invests in ideas and innovations, and connects with changemakers to create a more responsive, patient-centered health care system.