Californias Massive Medicaid Program Works for Some, but Fails Many Others
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Californias Massive Medicaid Program Works for Some, but Fails Many Others
By Angela Hart and
Bernard J. Wolfson
March 2, 2023
Californias Massive Medicaid Program Works for Some, but Fails Many OthersAngela Hart and Bernard J. WolfsonNewborns. Former inmates. College students. Expectant moms. People with disabilities. Foster kids. Homeless people. Single dads.Your neighbor. Your co-worker.You.Californias Medicaid program, called Medi-Cal, serves a whopping 15.4 million people, offering care from cradle to grave: Half of all births are covered by Medi-Cal, as are more than half of all stays in nursing homes.Everything about Medi-Cal is massive, from its upcoming fiscal year budget of $139 billion to the expansive list of benefits and services it offers. The way the program works or doesnt could spell life or death for many enrollees.Its critical, from the single pregnant mom, to the extremely frail elderly population that needs a nursing home, said Jennifer Kent, former director of the state Department of Health Care Services, which administers Medi-Cal. If it werent for Medi-Cal, so many people would either be dead or would be severely compromised.In a new series, California Healthline will shed light on Medi-Cals successes and failures through the experiences of its enrollees. They include Stephanie Lammers, who cant get her troubling abdominal symptoms checked at a clinic 50 miles from her small Calaveras County town because the transportation Medi-Cal is supposed to provide isnt trustworthy; Carolina Morga Tapia, a Fresno woman who credits Medi-Cal with helping her have five healthy children; and Lucas Moreno Ramirez, a Los Angeles County man with stage 4 lung cancer who had to fight to keep his treatment going.Medi-Cal is at a critical juncture as it attempts to serve the needs of a diverse patient population with a dizzying array of medical needs from childhood vaccinations and cancer screenings to state-of-the-art care for rare genetic disorders. Roughly half of enrollees are Hispanic, and, next year, California will become the first state to expand eligibility to all immigrants who qualify, regardless of their legal status.Medi-Cal is also undertaking several new initiatives that aim to save taxpayer money and improve quality. State officials are demanding that the 23 health insurers that serve most Medi-Cal patients provide better care or face significant penalties, including potential expulsion from the program.The state is also adding innovative social services that fall outside the traditional realm of medicine, including helping some enrollees pay for rent and buy groceries.People are watching California, said Cindy Mann, who served as federal Medicaid director under former President Barack Obama. What the state is doing is ambitious and very aggressive. It makes a significant mark on health care and health policy, not just because of the size and breadth of its program, but by being very comprehensive.But only a sliver of enrollees will get the new social services, even as many patients struggle to obtain basic care or get in to see their doctors. In reality, the type of care you get in Medi-Cal depends on where you live and which insurer provides your benefits.That means the program is working for some, but failing for many others.If you are in Medi-Cal, we would like to hear from you, whether you live in a big city or a rural region, regardless of your age, race, or ethnicity, and whatever your medical, dental, or mental health condition. Have you had difficulty seeing the right doctor for what ails you, even to the point of putting your life at risk? Or did Medi-Cal provide good care, perhaps sparing you serious harm or disability? Either way, please consider sharing your experience with us.Here are snapshots of patients who have used the program at a critical time in their life.I Just Dont Go to the Doctor AnymoreWhen Stephanie Lammers leans over to put on her shoes, it feels as if shes squishing something inside her abdomen, she said.Lammers, 53, has been suffering from frequent bouts of nausea, pain, and bloating for six months.Her gastroenterologist wants to perform diagnostic procedures, including a colonoscopy and, if anything shows up, a biopsy. But Lammers, who lives in a motel with her boyfriend and teenage daughter in the Gold Rush town of San Andreas, doesnt have a working car and cant readily get to the clinic which is 50 miles away.For Lammers, like many Medi-Cal enrollees who live in rural areas, lack of transportation is a major impediment to obtaining care. The problem is particularly acute for patients who need to see specialists.Lammers dermatologist and eye doctor are over an hour away from San Andreas, the county seat of Calaveras County, about 125 miles northeast of San Francisco. She isnt seeing a neurologist, despite a series of mini-strokes and stress-related seizures. And she hasnt been to a podiatrist in two years, even though her toes are twisted over one another and hang down, causing her to trip. Shes often in excruciating pain when she walks.Medi-Cal is supposed to provide free transportation to enrollees who cant otherwise get to their appointments.But Lammers, whose health plan is California Health & Wellness, owned by Centene, the nations largest commercial Medicaid insurer, stopped using its ride service nearly a year ago, after she missed dozens of appointments because drivers just didnt show up, she said. She was getting threatening letters from doctors offices over the no-shows.Once she had to hitchhike more than 30 miles home from a counseling appointment. On other occasions, Lammers said, she did not receive the reimbursement she was owed for arranging her own rides.I just dont go to the doctor anymore, Lammers said. If I go to the doctor, my boyfriend has to take the day off work, and if he takes the day off work, we have no money.During the last three months of 2022, Lammers canceled five appointments she had scheduled for the diagnostic abdominal procedures because her boyfriend had to work each time and couldnt take her. She finally stopped rescheduling.California Health & Wellness contracts with Modivcare, a Denver-based medical transportation company that is no stranger to patient complaints and lawsuits.Before she gave up on the ride service, Lammers said, she would call California Health & Wellness to try to resolve the issue, only to be told that Modivcare was a separate company. Im like, If you guys hired them and put them in charge of transportation, who oversees their screw-ups?Courtney Schwyzer, a member of a legal aid team representing L
Thursday, March 2, 2023 at 10:00 am