Medicaid Managed Care's Impact On Safety-Net Clinics In California

Abstract

A growing percentage of Medicaid patients are receiving medical care within a managed care system. This policy change has raised concerns about whether safety-net providers can maintain their share of Medi-Cal (California Medicaid) patients. From 1995 to 1997 several of California's counties implemented mandatory Medi-Cal managed care. The majority of California's safety-net primary care clinics experienced a decline in the percentage of their patients insured by Medi-Cal. However, after the overall decline in the number of Medi-Cal beneficiaries was controlled for, the increased penetration of MediCal managed care in a county was not independently associated with a decline in clinics' share of Medi-Cal patients. Despite this fact, it may become increasingly difficult for clinics to maintain their current level of services with declining Medi-Cal enrollment and other anticipated reforms in their funding.H e a l t h c a r e p r o v i s i o n f o r p o o r and historically underserved communities in California is changing rapidly. As is true in most states, a substantial proportion of MediCal (California Medicaid) beneficiaries have changed or are in the process of changing from a program of traditional fee-for-service (FFS) reimbursement to enrollment in managed care plans. The

A Framework for Evaluating Safety-Net and other Community-Level Factors on Access for Low-Income Populations

“…Similarly, among low-income insured residents, we observe geographic variation in the percentages of individuals covered by programs such as Medicaid, and the State Children's Health Insurance Program (SCHIP). The eligibility criteria for these public programs vary by state and depend on the availability of federal and state funds to pay for medical care for low-income people (Norton and Lipson 1998;Brown, Wyn, and Teleki 2000;Bindman et al 2000;Lillie-Blanton and Lyons 1998;Bronstein and Adams 1999;Adams and Bronstein 1999). Because of the categorical and episodic nature of Medicaid eligibility and changes in state regulations and financing, individuals cycle on and off insurance, often with long spells of no insurance Short, Graefe, and Schoen 2003;IOM 2000;Kasper, Giovannini, and Hoffman 2000;Schoen and DesRoches 2000;Brown et al 1999;Short 1998;Davis 1996;Short and Lefkowitz 1992;Short, Cornelius, and Goldstone 1990;Short, Cantor, and Monheit 1988).…”

Medicaid Expansion and the Patient Protection and Affordable Care Act: Lessons and Hopes for Implementation of Healthcare Reform

“…Since 1996, the state has required that all nondisabled, nonaged Medicaid beneficiaries in large urban counties enroll in a Medi-Cal managed care plan (Bindman et al 2000). California counties are integral to this process, with some of the largest counties supporting a county-operated quasi-public, nonprofit health plan.…”

The rising number of uninsured Americans: how adequate is our health system?

“…Since collection rates for services rendered to uninsured patients are low, providers in poorer communities rely more heavily on the Medicaid dollars they receive as compared with providers in more affluent areas. Managed care plans group the Medicaid beneficiaries together and contract with specific providers, often leaving safety net providers with increasing numbers of uninsured patients, and no Medicaid patients to help Uninsured Americans balance the financial burden (Bindman et al, 2000;Wendland, 1998). This trend of increasing service utilization with decreasing revenues can only further erode these providers' ability to subsidize the treatment of the uninsured (Cunningham, 1999).…”