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No Cause for Pride

December 29, 1987

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.

The survey included some special praise for California--not only for its quality controls, including high standards for nursing-home care, but also for innovations. That is good to hear. It has only limited significance to the 3 million Californians who qualify for the care but frequently cannot obtain it. As long as Gov. George Deukmejian continues vetoing Medi-Cal funding increases and proposing cutbacks, fewer doctors, dentists and hospitals will be able to participate.

Like so many other studies, the report makes clear the cost effectiveness of adequate health-care services for everyone. The denial of ready access to health care for the poor only postpones care until complications make the cost of services much, much higher. An adequately funded program both for Medi-Cal and for the medically indigent adults who are not eligible for Medicaid programs makes sense economically as well as in terms of justice and compassion.

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