Adults with Disabilities in Medi-Cal: The Beneficiary Perspective
Medical Subject Headings
Disabled Persons; California; Insurance - Health; Managed Care Programs; Fee-for-Service Plans; Delivery of Health Care
Medi-Cal provides health care coverage to nearly 750,000 Californians with disabilities. Care is delivered to this population through one of two primary delivery systems: traditional fee for service and managed care. To date, there has been a lack of information about how well the program is doing at delivering health care services to people with disabilities through either delivery system.
In light of recent proposals to expand Medi-Cal managed care for people with disabilities, the California HealthCare Foundation commissioned the Center for Disability Issues and the Health Professions to conduct a series of focus groups to solicit direct input from people with disabilities and their families.
Based on input from the study focus groups, there appear to be significant problems in both the Medi-Cal fee-for-service and managed care delivery systems in providing services to beneficiaries with disabilities. Focus group participants in both systems expressed an almost universal lack of understanding about Medi-Cal benefits, services, and grievance procedures.
Across the board, participants reported difficulty finding physicians and adequately accessing services, programs, and facilities. Nearly all participants reported difficulty in locating a primary care physician, but it appears to be slightly easier for those in managed care plans to find a primary care physician. All focus group participants, regardless of service model, expressed difficulty with locating specialists.
Some of the barriers identified through this study may be unique to the Medi-Cal program, while others are likely to be indicative of problems that all people with disabilities experience, regardless of the type of health insurance they have.
Premo, B., Kailes, J., Schwier, E., Richards, C. (2003). Adults with disabilities in Medi-Cal: The beneficiary perspective. Report by the Center for Disability Issues and the Health Professions, Medi-Cal Policy Institute, California HealthCare Foundation: Oakland, CA. Retrieved from https://www.chcf.org/wp-content/uploads/2017/12/PDF-MediCalDisabilitiesBeneficiaries.pdf