State Agency Running Medi-Cal Didn’t Know How Many Docs Took its Insurance

July 17, 2014

The state’s Medi-Cal provider list had a higher number of physicians than were even licensed to practice in California last year.

The state’s Medi-Cal provider list had more physicians than were even licensed to practice in California last year.

By Hannah Guzik

The California agency that oversees the state’s low-income health plan vastly overstated the number of doctors who accepted patients through the program last year, even as the number of people enrolled was set to skyrocket under the federal Affordable Care Act, the California Health Report has found.

The state’s Medi-Cal provider list had more physicians than were even licensed to practice in California last year.

The list had some duplicated names and may have also included doctors who were deceased or retired, Department of Health Care Services spokesman Anthony Cava conceded Tuesday.

“DHCS tracks enrolled physicians in Medi-Cal, but providers are not required to notify us if they stop seeing Medi-Cal members,” he said. “The list you reference could have also included doctors who were deceased and retired, and we are working diligently to continue improving the list to ensure only providers who should be listed are included.”

The accuracy of the list is important because it is one of the tools the state can use to determine if there are enough doctors to serve those in Medi-Cal’s fee-for-service program, which about 9 percent of California residents are enrolled in. Many of the doctors listed are also enrolled in Medi-Cal managed-care plans, which serve about 20 percent of the state’s population.

About 2.2 million people have signed up for Medi-Cal, the state’s low-income health plan, since the program was expanded under the Affordable Care Act. In total, 10.9 million people are enrolled.

State’s list inaccurate

In response to a public records request, the Department of Health Care Services said in May that there had been 109,000 physicians taking Medi-Cal in spring 2013.

But, after a California Health Report blog post referenced that on Monday, the California Medical Association said that the figure must be incorrect because it’s greater than the total number of licensed physicians in the state that year.

According to the Medical Board of California’s 2012-13 annual report, there were only 104,422 licensed doctors in California last year. A significant number of those physicians also did not accept Medi-Cal, according to the Medical Association.

“They have some bad data,” spokeswoman Molly Weedn said. “They don’t have any idea how many physicians are actually accepting new Medi-Cal patients.”

Agency working to improve list

When asked about the accuracy of last year’s data, the Health Care Services department said it is in the process of improving its provider list.

“When we provided the information you reference, it did not reflect the ongoing efforts by DHCS to improve the provider list,” spokesman Anthony Cava said. “We have conducted an extensive review of the list to remove providers who do not participate in Medi-Cal, such as those who have not billed the department for any services provided to members in a year.”

When the agency provided the Health Report with the physician list in May, the number of doctors had dropped by nearly 25 percent to 82,605.

Cava said the reduction in listed providers “has not resulted in a decrease in access to care.”

Doctors’ group concerned by inaccuracies

The Medical Association is troubled by the fact that the provider list was so inaccurate last year, and questions how accurate it is this year, Weedn said.

“This highlights that they’re continuing to put out really inflated numbers and then say that it’s OK to move forward with cuts (to the state’s reimbursement rate to doctors) because there’s plenty of physicians,” she said.

The list is supposed to be of doctors who are enrolled as fee-for-service providers, which means they get reimbursed directly from the state. Many of the providers listed also participate in Medi-Cal managed-care plans, which are health plans that contract with the state to provide benefits. About 70 percent of Medi-Cal beneficiaries are enrolled in managed-care plans.

Managed-care plans are required to maintain their own doctors’ lists. But the plans’ doctor directories that are distributed to patients are often highly inaccurate, the California Health Report found last month.

The Health Care Services department said it doesn’t keep its own list of doctors enrolled in managed-care plans.

“DHCS doesn’t currently have a count of the number of providers in the managed care plan networks, but it’s important to know that the plans are contractually obligated to ensure adequate access for their enrolled Medi-Cal members,” spokesman Norman Williams said.

Chris Perrone, director of the health reform and public programs initiative at the California HealthCare Foundation, said the state’s list of Medi-Cal doctors is a “terrible” tool for understanding how many doctors participate or whether that has changed over time.

“I’m hopeful that it can be improved in the future,” he said.

The HealthCare Foundation is working with UC San Francisco researchers to analyze trends in Medi-Cal physician participation through 2013 and plans to release that data later this month.

“You can have an ER doctor who’s on the list so he can serve patients when he’s on-call in the emergency room, but he’s not really participating in the program as a regular primary-care provider,” Perrone said. “The list doesn’t make those kinds of distinctions.”

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2 Responses to State Agency Running Medi-Cal Didn’t Know How Many Docs Took its Insurance

  1. Pingback: California Health Report: State Agency Running Medi-Cal Didn’t Know How Many Docs Took its Insurance |

  2. Pingback: State Agency Gave Massive Overstatement of Doctors in Medi-Cal Program — California Political Review

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