SACRAMENTO, Calif. — California wants to pay doctors more to persuade them to see more Medi-Cal patients. More than 15 million Californians rely on Medi-Cal, which is almost 40% of the state’s population.
ABC10 spoke with experts who say the rates Medi-Cal pays doctors aren’t keeping up with growing demand, and it could not only hurt your wallet but your health.
Helping patients from all walks of life see the world to its fullest is one of the reasons. Dr. Paymaun Asnaashari got into optometry.
“I think we take sight for granted, so knowing that, each day I’m helping people see to their greatest potential,” said Asnaashari.
He runs Arden Park Optometry in Sacramento. He sees about 16 patients a day, and they include everyone from kids to grandparents and working professionals.
He’d like to see even more patients, but when it comes to accepting patients covered by Medi-Cal, he says he simply can’t afford it. In fact, he’s stopped taking them altogether.
“The reimbursement rate for a Medi-Cal eye exam is very low, and it makes it difficult for a small business owner like me to accept a patient…,” he said.
Medi-Cal is California’s Medicaid healthcare program, a government-funded health insurance program for people with low incomes or disabilities.
“What’s occurring though is as costs are going up, the state contribution is not in line with those costs,” said UC Davis economist Keith Taylor.
As a result, doctors helping Medicaid patients aren’t getting paid as much as they would on the open market, so practices like Arden Park Optometry are disincentivized from participating in Medi-Cal.
“And, that means we have a limited amount of providers for these lower income folks to get their medical services,” said Taylor.
Taylor says it’s hurting rural communities the most where some people must travel 90 miles for eye care or forgo care altogether.
“It could absolutely be life-threatening for preventative care,” said Taylor.
The California Optometric Association says the state’s reimbursement rate hasn’t increased in more than 20 years, so Medi-Cal’s reimbursement for a new patient eye exam is $47, while the average cost for a patient with no insurance is $200.
Experts say it’s not a new problem and years of state budget struggles are hindering efforts to increase Medi-Cal reimbursements despite calls to do so.
Last year the state increased a tax on managed care providers and plans to use the money to increase the rates for doctors, but it comes as the state faces a $27 billion deficit.
Gov. Gavin Newsom released his latest budget proposal earlier in May. Optometrist advocates say they’re disappointed and his plan delays action in moving the reimbursement increase forward.
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