Ed’s note: This is part 2 of a 2-part series looking at some of the misconceptions and confusions about changes that are taking place in California health care under the Patient Protection and Affordable Care Act, or as it’s commonly known, Obamacare. Part 1 will ran yesterday, looking at the local impact of the ACA in general.
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Changes are coming to Medicaid across the nation and Medi-Cal in California, thanks to the Patient Protection and Affordable Care Act, which goes into effect on Jan. 1, 2014.
As of September, approximately 2.6 million beneficiaries were eligible for Medi-Cal in Los Angeles County, or 26 percent of the county’s roughly 10 million residents, according to Tony Cava, spokesman for the state Department of Health Care Services.
Though Medi-Cal recently faced cuts in 2011, the ACA provides for both increased rates for primary care physicians and broader eligibility for individual patients and families.
Several doctors in the Santa Clarita Valley said they thought the new Medi-Cal benefits would be a boon for residents who cannot get any other insurance, but also worried about whether the provider benefits wouldn’t trickle down to individual private practices.
Provider Benefits under Obamacare
In 2011, the state legislature passed Assembly Bill 97, which among other things authorized a 10 percent reduction in Medi-Cal provider benefits, starting on June 1, 2011.
“This bill would require, except as otherwise provided, that Medi-Cal and specified non-Medi-Cal provider payments be reduced by 10 percent,” the law reads.
Through the 10 percent decrease is still in effect, the ACA provides for Medi-Cal rate increases for physicians, retroactive to Jan. 1, 2013.
“…state Medicaid agencies (are required) to reimburse primary care physicians with a specialty designation of family medicine, general internal medicine or pediatric medicine, at parity with Medicare for specified Evaluation and Management (E&M) and Vaccine Administration services,” according to the Medi-Cal website. “The increased minimum payment level applies to specified primary care services and to services rendered by these provider types paid by Medicaid managed care plans that are contracted by states to provide the primary care services.”
Not many people have read the ACA in it’s entirety, but Feldman says that she has.
As one of the three pediatricians in the Santa Clarita Valley who accept Medi-Cal, roughly 40 percent of her patients are on the government plan, she said.
“We’re not getting as much for our Medi-Cal patients as we were before. That’s a problem, because half of Medi-Cal is pediatrics,” Feldman said.
She said that this is mainly due to the fact that most of Medi-Cal operates like an Health Management Organization.
“Very few of the HMOs directly contract with a physician,” she said. “They contract with what are called IPA’s, Independent Physicians Associations.”
Feldman is part of Preferred IPA of California, which contracts with Medi-Cal.
“They pay us a rate per patient per month to take care of all the services,” she said.
But Feldman said that while the ACA has increased the money going into Preferred IPA, they are also now required to provide more services, meaning that the money to individual doctors and practices cannot go up.
“That rate cannot go up,” she said, “because Medi-Cal is now contracting with (Preferred IPA) for all services.”
State Senate Bill X1-1, which amends Medi-Cal to implement provisions of the ACA states that “The bill would also add, commencing January 1, 2014, benefits, services, and coverage included in the essential health benefits package…to the schedule of Medi-Cal benefits.”
Patient Benefits under Obamacare
Under the ACA, Medi-Cal is expanding for patients as well.
“The bill would extend Medi-Cal eligibility to specified adults,” according to SB X1-1.
Under the ACA, individual adults making less than $15,856 per year and families making less than $32,499 per year are newly eligible for Medi-Cal, according to the Los Angeles County Department of Health Services.
This allows patients to get health insurance who can’t afford coverage through the Covered California marketplace.
“If you weren’t quite at the level where you qualified for help at Covered California, you might qualify for Medi-Cal,” said Covered California Spokesman James Scullary.
Cheryl Laymon agreed. Laymon is the CEO of Samuel Dixon Family Health Centers, which primarily serves the uninsured and underinsured in the Santa Clarita Valley and Val Verde.
“The eligibility for Medi-Cal is now reaching a lot more people than it ever did before,” she said.
Both private health insurance through Covered California and Medi-Cal are giving SCV residents better access to health care, Laymon said.
Though she said that Los Angeles County’s uninsured population would probably never go away, Laymon acknowledged the ACA’s benefits.
“It’s not going to answer everything, but it’s still a good step in the right direction,” she said.
And despite Feldman’s disappointment Medi-Cal provider rates under the ACA, she believed it was ultimately a good thing, because it would bring in more insured patients.
“If and when the Affordable Care Act actually revs up, I believe it will be a boon to private practices,” she said.
To learn more about Medi-Cal and changes under the Affordable Care Act, click here.
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Source: Santa Clarita News