California faces huge increase in Medi-Cal patients

Not long ago, Dr. Del Morris, the new president of the California Academy of Family Physicians, thinks he caught a glimpse of the future of Medi-Cal, the state’s health-care program for the poor. And he shuddered.

For a few days in mid-January, as the flu season peaked, so many new Medi-Cal patients “saturated” the emergency rooms of four Stanislaus County hospitals that ambulances often couldn’t unload their patients, Morris said. The backup prevented emergency medical technicians from responding to calls, which firefighters handled until neighboring county ambulance workers were pulled in to help.

As California grapples with 10 million Medi-Cal recipients — nearly 30 percent of the state’s population — and no foreseeable increase in the number of family physicians and specialists to treat them, health-care experts wonder who’s going to care for all those people.

The growing number of Medi-Cal enrollees came into sharp focus last week when Gov. Jerry Brown was forced to add $1.2 billion to next year’s budget to pay for an unexpected surge of enrollees. The reason: California is doing such a good job of getting people to sign up for coverage under the Affordable Care Act that more than 800,000 residents are expected to be added to “traditional” Medi-Cal rolls by next year.

Because they’re eligible under the old rules, the state must pay 50 percent of the cost of their coverage — unlike the 1.4 million who have so far enrolled in the expanded Medi-Cal program aimed at covering childless adults for the first time. For those recipients, the federal government will pick up all of the costs for the next three years.

Under the Affordable Care Act, the federal government reimburses primary care doctors who accept Medi-Cal at Medicare rates, which are much higher.

But the bump is scheduled to go away next year, so even family physicians like Dr. Esteban Lovato are highly concerned.

The Oakland doctor said he’s now getting paid about $42 for every Medi-Cal patient he sees. But next year, that will tumble to $21.60 per patient.

At that rate, Lovato worries, even fewer doctors are likely to accept Medi-Cal recipients. Many of his physician friends have long refused to do so, he said. They call him “crazy.”

To combat the problem, three bills have been introduced in the state Legislature to restore or increase Medi-Cal payments and add primary-care doctors in the state.