California Patients Struggling Under Managed Care

California approved moving patients enrolled in Medi-Cal, the state’s Medicaid program, to a managed care system last year, and the transition has been a rocky one for many California patients, according to an article in the LA Times. The purpose of the transition is to cut millions from the Medi-Cal budget to help the state’s rocky economy. A noble pursuit to be sure, but at what cost? If reforming Medi-Cal causes patients with disabilities, the elderly, and the chronically ill to lose access to the medical care they so desperately need, is it worth it?

According to the article:

But for some of these low-income seniors and disabled patients, the transition has been anything but smooth, forcing severely ill patients to give up their doctors, delay treatment and travel long distances for specialty care.

As of this month, the state has transitioned 333,000 people, many with diseases such as multiple sclerosis, lupus and metastatic cancer. State health officials said managed care oversees all of the patients’ treatment and guides them through the healthcare system, helping prevent unnecessary procedures and hospital visits.

Patients could apply for temporary exemptions if they wanted to stay on a fee-for-service plan, where the state pays doctors based on the specific treatment provided instead of a managed care general rate that is usually less. But the patients had to meet a high bar: They had to be in ongoing care for a serious illness and any change could cause their condition to deteriorate.

“The criteria is met by very few people,” said Susan McClair, senior medical consultant with the state Medi-Cal Managed Care Division.

One of the biggest issues with managed care continues to be access, as there simply aren’t enough providers that service managed care patients. The article goes on to report:

Shifting patients into managed care has been a “disruption” for many, in part because there simply aren’t enough specialists who will accept patients on Medi-Cal managed care, said Liz Forer, executive director of Venice Family Clinic. The patients’ complicated illnesses overwhelmed family practice providers at Venice Family Clinic, Forer said. They weren’t equipped to treat patients with end-stage organ disease, multiple types of cancer or Parkinson’s disease.

Managed care is not the solution for California. To find out how you can help fight back against this broken system, please visit Pharmacy Choice and Access Now today!