Santa Clara County Grand Jury
• 2016-2017
2016-2017 Santa Clara County Civil Grand Jury Report You’ve Got Medi-cal – but Can You Get Medical Care?
⚠️ Translation Notice: This content has been automatically translated. The original English text is the official version. Translation may contain errors.
⚠️ Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.
Findings and Recommendations 3 findings
F1
Finding a primary-care physician who will treat new Medi-Cal patients is a critical step in accessing care. There are problems with the accuracy and accessibility of provider directories.
Related Recommendations (6)
R1a
The Santa Clara Family Health Plan should inform members that the printed directory should be used only with the assistance of a member services representative, who can verify the physician is accepting Medi-Cal patients.
R1b
The Santa Clara Family Health Plan should redesign its online provider directory to highlight which doctors are taking new Medi-Cal patients.
R1c
The Santa Clara Family Health Plan should provide members with an English-only, Spanish-only, Vietnamese-only, Chinese-only or Tagalog-only online directory rather than combining all the languages in one document.
R1d
The Santa Clara Family Health Plan should verify that the physician will treat new Medi-Cal patients before issuing a benefits card with that physician’s name.
R1e
The Santa Clara Family Health Plan should discuss the selection of a primary-care physician with the member who has not made his or her own choice before issuing a benefits card.
R1f
The Santa Clara Family Health Plan should improve the find-a-doctor tool to allow members to search for multiple primary-care specialties at one time.
F2
Santa Clara Family Health Plan contracted advice nurses report members’ access- to-care issues to the Health Plan’s clinical services department, which is supposed to inform member services. The chain of communication causes access problems to be missed or misunderstood.
Related Recommendations (1)
R2
The Santa Clara Family Health Plan should direct advice nurses to inform member services directly about access-to-care complaints.
F3
Mainly due to low reimbursement rates, complex paperwork, and payment delays only about half of primary-care physicians in the Bay Area are accepting new Medi- Cal patients.
Related Recommendations (1)
R3
The Santa Clara Family Health Plan should advocate to the governor and the Legislature to raise Medi-Cal reimbursement rates, simplify paperwork, and reduce payment delays.
Conclusions 4
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CL1 Page 8Finding a primary-care physician who will treat new Medi-Cal patients is a critical step in accessing care. There are problems with the accuracy and accessibility of provider directories.
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CL2 Page 9Santa Clara Family Health Plan contracted advice nurses report members’ access- to-care issues to the Health Plan’s clinical services department, which is supposed to inform member services. The chain of communication causes access problems to be missed or misunderstood.
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CL3 Page 9Mainly due to low reimbursement rates, complex paperwork, and payment delays only about half of primary-care physicians in the Bay Area are accepting new Medi- Cal patients.
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CL4 Page 11Coffman, J.M., Hulett, D., Fix, M & Bindman, A.B. (August 2014). Physician participation in Medi-Cal: Ready for the enrollment boom? University of California, San Francisco. Retrieved from http://www.chcf.org/publications/2014/08/physician-participation-medical Coffman, J.M. (October 2016). Physician participation in Medi-Cal: Is supply meeting demand? University of California, San Francisco. Retrieved from http://www.chcf.org/publications/2016/10/physician-participation-medical Connolly, K. & Newman, M. (January 2016). California's health care safety net: A sector in transition. Retrieved from http://www.chcf.org/publications/2016/01/california-safety-net#ixzz3yI35Z2H2 Do you qualify for Medi-Cal benefits? California Department of Health Care Services. Retrieved from http://www.dhcs.ca.gov/services/medi- cal/Pages/DoYouQualifyForMedi-Cal.aspx. Felland, L. (2016). Stepping up to the plate: Federally Qualified Health Centers address growing demand for care. California Health Care Foundation. Retrieved from http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20S/PDF %20SteppingUpPlateFQHCs.pdf Frost, R., Death of the hired man (1914), North of Boston. Garfield, R., Majerol, M. & Young, K. (May 28, 2015). Coverage expansions and the remaining uninsured: A look at California during year one of ACA implementation. Kaiser Family Foundation. Retrieved from http://kff.org/health- reform/report/coverage-expansions-and-the-remaining-uninsured-a-look-at- california-during-year-one-of-aca-implementation Gold, M. & Kenney, G. (May 2014). Monitoring access: Measures to ensure Medi-Cal enrollees get the care they need, Mathematica Policy Research and Health Policy Center, Urban Institute. Retrieved from http://www.chcf.org/publications/2014/05/monitoring-access-medical Graves, S. (April 2013). Expanding horizons: Key facts about the Medi-Cal program as California implements health care reform. California Budget Project. Retrieved from http://calbudgetcenter.org/wp- content/uploads/130402_Expanding_Horizons.pdf