Rural Medi-Cal patients faced with unjust health care barriers due to lack of state oversight, CA State Auditor Report finds

My Patient Rights | Stay Informed | Rural Medi-Cal patients faced with unjust health care barriers due to lack of state oversight, CA State Auditor Report finds

Rural Medi-Cal patients faced with unjust health care barriers due to lack of state oversight, CA State Auditor Report finds

In August, the California State Auditor released a report detailing the Department of Health Care Services’ (DHCS) lack of oversight of the Regional Model health plan, a program intended to provide adequate access to care for Californians on Medi-Cal living in rural communities. The audit findings paint a troublesome picture of the care patients receive since the Regional Model was adopted in 2013. According to the 2019 report, DHCS failed to provide an “acceptable level of care,” defined as the quality of care received and access to health care providers. Some patients were forced to travel significant distances to receive care and received a lower quality of care compared to patients enrolled in other State-run programs.

Regional Model plans contracted with Anthem Blue Cross Partnership Plan (Anthem) and California Health & Wellness (Health & Wellness) to provide care to patients in 18 counties. While patients with Anthem and Health & Wellness should have received equal access to health providers and the same quality of care, the audit found this was not the case. In some instances, patients had “to travel hundreds of miles to reach certain health care providers, including obstetricians, oncologists, neurologists, and pulmonogists.” Regional Model health plans contracting with two different insurance providers created uneven service delivery for patients. Depending on health services received, state law requires distance traveled for care to range “from 10 to 60 miles,” but “in many cases, the distances that the Regional Model health plans required far exceeded the limits state law imposes.”

Additionally, in transitioning counties to a Regional Model, DHCS failed to properly educate and assist county representatives in identifying alternative health systems. Specifically, DHCS did not adequately advise counties on the possibility of participating in a county organized health system (COHS). The auditor’s report found that a COHS Model could have helped improve access to Medi-Cal providers, thus ensuring better access to care for patients.

Low-income individuals and families that qualify for Medi-Cal should be the last to experience barriers to care. However, studies have found that’s not the case. Low-income and rural communities experience more barriers to care than patients living in more urban areas, primarily due to distance and lack of transportation. Since 1995, 20 of California’s 50 rural hospitals have closed, with four more at risk of shutting their doors. And, California will be experiencing a shortage of primary care providers within the next 15 years, with areas like the Central Valley, Central Coast and Southern Border areas especially impacted.

DHCS plays an integral role in ensuring California patients can access the care they need, no matter where they live. Yet, this latest audit suggests poor oversight of health plans and their services to residents living in rural communities in the state. At My Patient Rights, we have heard countless stories of patients failing to get the care they need, when they need it. These stories serve as a reminder that patients must be their own best advocate within the healthcare system. Visit our website to find out more about what that looks like, and learn what steps you can take today to fight back. We are here to help!

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