California can take no comfort from the ranking of its Medi-Cal poverty health program as sixth among the nation's Medicaid programs. The high rating "demonstrates the overall mediocrity of state Medicaid programs more than it signals the state's excellence," the Public Citizen Health Research Group concluded in its ground-breaking study.
Efforts to bring a major increase of resources into the programs, jointly financed with federal and states funds, failed in the final budget negotiations in Congress. A three-year package of $2.3 billion in increased federal funds was cut to $633 million, but it will at least help address the particular problems of deteriorating prenatal care and will upgrade nursing-home care, which receives about half of all Medicaid funds.
California's Medi-Cal program scored behind Minnesota, Wisconsin, New York, Massachusetts and Connecticut in the overall rating--a most unsatisfactory position for a state with such enormous wealth and resources. In one category, quality control, California excelled, tying for third place among the states. In two categories it lagged enormously, ranking 31st on its reimbursement system and 49th on the availability of providers.
Those shocking failures in reimbursement and availability of providers come as no surprise. The low fees paid doctors and dentists, averaging 50% or less of prevailing rates, and the cumbersome payment system have discouraged health-care providers from accepting Medi-Cal patients. Medi-Cal claims to have 70,000 participating providers, but many of them have only token caseloads or have closed their doors to new Medi-Cal patients, and for good reason. Some professionals report that the fees are so low and the claims process so cumbersome that they do not bother billing the state when they have a Medi-Cal patient. This is further complicated in California by cut-rate contracts with hospitals, driving more and more hospitals out of the system. The result is inferior service, and sometimes no service, for those eligible for Medi-Cal.