California physicians, lawmakers and health care advocates have raised concerns that children from low-income households in rural communities could lose access to health care under a proposal in Gov. Jerry Brown's (D) revised fiscal year 2012-2013 budget plan, California Watch reports (Snyder, California Watch, 5/29).
Brown has proposed cutting payment rates to Healthy Families, California's Children's Health Insurance Program, in October and then moving all children out of the program by the middle of 2013 and into California's Medi-Cal program. Medi-Cal is California's Medicaid program (California Healthline, 5/9). The move would affect nearly 900,000 children (California Watch, 5/29).
Brown is hoping that the state would save about $64 million next year by implementing the changes because Medi-Cal payment rates are lower than rates in the Healthy Families program (California Healthline, 5/9). Physicians currently participating in Healthy Families would face an average cut of nearly 20% under the plan.
Potential Effects of Brown's Plan
Although the transfer might not be a problem for physicians in urban areas who typically provide care to both Healthy Families and Medi-Cal beneficiaries, it could limit access to health care for children in more remote areas, according to California Watch.
Stuart Cohen, a San Diego pediatrician and California chair-elect for the American Academy of Pediatrics, said, "In the more rural areas or outlying areas, there would be quite a loss or a strain" during the switch, adding, "Access to care would be a huge issue."
Cohen said that some rural physicians who do not already accept Medi-Cal beneficiaries and are at full capacity would not have enough financial incentive to continue providing care to Healthy Families children who switch to Medi-Cal.
According to a Legislative Analyst's Office report released in February, 29% of surveyed pediatricians who provide care for children covered under Health Families but do not accept Medi-Cal beneficiaries said they were unwilling to start accepting Medi-Cal patients, while 46% of such physicians said they were unsure.
Assembly member Bill Monning (D-Monterey) said, "We already face shortages in rural areas of providers -- not only in primary care, but specialty services and providers." He added, "We have to be very cautious that we don’t maneuver ourselves out of access for families. ... You can't move children who are currently in Healthy Families to an environment where there aren't providers that accept Medi-Cal."
He said that officials from the state Department of Health addressed questions about Brown's proposal during a budget subcommittee meeting last week. (California Watch, 5/29).
Support for Alternative Plan
Monning said that a Senate budget subcommittee on health approved an alternate plan last week. He said he expects an Assembly budget subcommittee to pass the plan as well.
Opponents of Brown’s plan said the state should transfer only the approximately 186,000 children covered by Healthy Families whose families earn less than 133% of the federal poverty level. Those children already are expected to move into Medi-Cal in 2014 under a provision in the federal health reform law (California Watch, 5/29).