J.C. Aguirre was born with hemifacial microsomia, a condition where constricted blood flow during his gestation caused deformities on the left side of his face and body. He is blind in his left eye and has no hearing in his left ear, and his top two vertebrae are an irregular shape and fused together. He receives specialty care through the California’s Children Services (CCS) program, a Medi-Cal carve-out focused on children with special health care issues.
A remarkably articulate 15-year-old resident of Merced, Aguirre is satisfied with the care he receives through CCS. But the primary care he receives through his Medi-Cal managed-care insurer, the Central California Alliance for Health, is another matter. Aguirre says he has had seven primary-care physicians in as many years.
“I have not had one consistent primary-care doctor,” Aguirre said. He blames the turnover partly on a large proportion of primary-care physicians in his community nearing retirement age, and younger physicians preferring to practice in more urban areas of the state. When he needs a doctor, it often takes 30 days or longer to obtain an appointment.
Aguirre noted that he often needs to consult a primary-care physician if he has tingling in his body. It’s a minor issue for most people, but for him it could lead to loss of bladder control and potentially even paralysis if not tended to in short order.
Moreover, many primary-care doctors are reluctant to learn enough about his specific condition to want to provide the care he may need, he added.
Aguirre is apparently not alone among younger Medi-Cal enrollees accessing such services. A joint committee of lawmakers unanimously ordered an audit Wednesday on children’s access to primary-care doctors in the Medi-Cal program, the state’s low-income health program that is overseen by the California Department of Health Care Services.
The issue of pediatric Medi-Cal enrollees having inconsistent access to primary care caught the attention of two California lawmakers, Assemblyman Jim Wood, D-Eureka, and Sen. Anthony Cannella, R-Ceres. They recently asked the Joint Legislative Audit Committee to approve the audit.
“We are concerned that California is not fulfilling its obligation to ensure that children enrolled in Medi-Cal are receiving required timely well-child visits and preventative care services,” they wrote in an April 6 letter to the audit committee.
“We are particularly concerned about children of color facing health disparities that could be perpetuated and/or exacerbated by poor monitoring and oversight,” they wrote.
Wood and Cannella cited federal regulations that will require Medicaid managed-care plans, called Medi-Cal in California, to provide non-urgent primary care appointments within 10 business days beginning in July.
Mike Odeh, director of health policy at Children Now, an Oakland-based advocacy group, said his organization supports an audit.
“Between troubling data and a lack of data, there is a cause for concern,” Odeh said. He added that California is only one of four states that does not keep data on well visits for children.
Wood told the Audit Committee on Wednesday that “Medi-Cal is the cornerstone of children’s health care” in California, covering three out of five children, but that when it comes to primary-care access, it performs in the lowest quartile of all states. He added that a secret shopper survey conducted last year in two counties found that only about a third of calls to primary-care physicians participating in Medi-Cal resulted in an appointment within 10 days.
Other numbers were also mentioned in the letter to the committee:
- In 2013, nearly 12 percent of children enrolled in Medi-Cal had no doctor visit in the past year, compared to 7 percent of children enrolled in employer-based coverage.
- In 2015, only 36 percent of infants and toddlers enrolled in Medi-Cal were receiving what are considered crucial development screenings.
- More than a quarter of 2-year-olds and 13-year-olds enrolled in Medi-Cal are not fully immunized.
The Joint Legislative Audit Committee also on Wednesday ordered an audit of Medi-Cal managed-care insurer Health Plan of the San Joaquin regarding payments of bonuses to personnel and other management practices.
Aguirre said via email that he was “pleased to know that the Department of Health Care Services will be audited … for timely access issues.”
California State Auditor Elaine Howle told the committee that the primary-care audit would focus on preventative care for children and whether or not the Health Care department is enforcing timely access rules. The auditor will also examine contract language ensuring both managed-care insurers and providers are following guidelines, she said.
“We’ll also be looking at services for children and families where English is a second language, and see what policies and procedures are in place to provide services and address disparities,” Howle said.
Howle estimated that it will take her agency about six months to complete the audit.
Earlier this week, the Health Care department declined comment on the possibility of being audited. Spokeswoman Katharine Weir said in an email that the agency “is committed to providing the right care, at the right place, and the right time to our beneficiaries, and to providing strong oversight of the Medi-Cal program.”