The Issue
Current California standards require health plans to ensure that their enrollees have timely access to medical care — such as being within 15 miles or a 30-minute drive from a hospital. Unfortunately, many people covered by Medi-Cal still face significant hurdles to access care. This can be addressed by renewing and strengthening these standards to ensure patients have better and more timely access to health care services, including labor and delivery (L&D), behavioral health, and more.
- Without action, California’s standards protecting timely access to care for Medi-Cal enrollees expire on Jan. 1, 2026.
- Every year, Medi-Cal managed care plans can apply for and receive hundreds of exemptions to these standards, and there is no transparency around when or why they are granted.
- Medi-Cal plans are legally required to contract with hospitals treating high numbers of Medi-Cal patients — but the state is not enforcing the contract requirements, putting patients’ ability to access medical care at risk.
- In areas without a hospital L&D unit, an expectant mother who needs to travel as few as six extra miles faces an 11% increase in the likelihood of a negative outcome — yet current law is silent on standards for access to L&D services.
- Current law requires health plans to make outpatient mental health and substance use disorder services accessible to enrollees — within 15 miles or 30 minutes away. However, health plans are not required to make acute behavioral health care services accessible near a person’s home. As a result, people in crisis must often travel several counties away to get the care they need.
For the past eight years, the Legislature has renewed the standards that govern how far and how long a patient must travel for care, but without action in 2025, they will lapse. This could cause millions of patients to lose access to timely and coordinated care. If Medi-Cal patients cannot access in-network providers in the communities where they live, the protections afforded under current “time and distance” standards for health plans are hollow.
What’s Needed
The state must renew, strengthen, and increase enforcement of California’s timely access to medical care standards to help patients relying on health care providers of last resort. Incorporating timely medical access standards for L&D services and acute behavioral health care, whether for inpatient or outpatient services, is critical to reduce the risks of adverse outcomes for expectant mothers and their babies, and to ensure that behavioral health patients receive the care they need in a timely manner.