California Physicians’ Participation in Medicaid

Recent increases in enrollment in Medi-Cal (California’s Medicaid program) due to the Affordable Care Act have heightened concerns about whether sufficient numbers of physicians are participating in Medi-Cal to provide beneficiaries with adequate access to care. Medi-Cal beneficiaries may have difficulty obtaining ambulatory care if there is a low percentage of physicians in their communities who accept Medi-Cal patients, or if the total supply of physicians is low relative to population size. Medi-Cal beneficiaries who have difficulty accessing ambulatory care may delay seeking care for chronic conditions, which may result in preventable hospitalizations and emergency department visits. 

Researchers affiliated with Healthforce conducted surveys of California physicians in 2011 and 2013 to assess their participation in Medi-Cal and discuss implications for beneficiaries’ access to care. These surveys were conducted in partnership with the Medical Board of California, the agency that licenses physicians in California. These voluntary surveys were distributed to physicians with their licensure renewal materials and a mandatory survey that includes questions on race/ethnicity, languages spoken, training status, medical specialty, board certification, work hours, and practice location. 

Major findings from the 2011 and 2013 surveys include the following:

• The 2013 survey found that only 62% of California physicians accepted new Medi-Cal patients into their practices. Physicians were more likely to accept new Medicare patients (75%) and new patients with private insurance (79%). The percentage of physicians accepting Medi-Cal varied widely by major specialty, practice type, and region. 
• Between 2011-2013, the percentage of California physicians with any Medi-Cal patients in their practices increased, as did the ratio of full-time equivalent Medi-Cal physicians to Medi-Cal enrollees. However the ratio of primary care physicians to Medi-Cal enrollees remained below the level recommended by the US Health Resources and Services Administration.
• The percentage of Medi-Cal enrollees in physicians’ practices varies substantially. Forty percent of physicians provided 80% of Medi-Cal visits.