California standards that ensure timely access to care for Medi-Cal enrollees will expire in less than a year.
- These standards require that all health plans ensure their enrollees have timely access to medical care, such as being within 15 miles or a 30-minute drive from a hospital.
- Without renewing these standards, health care deserts across the state could expand.
- Strengthening these standards would ensure patients have better and more timely access to health care services, including labor and delivery (L&D), behavioral health, and more.
The framework for these standards needs increased transparency and oversight to ensure all is being done to protect patients.
- Every year, the Department of Health Care Services (DHCS) provides hundreds of exemptions to health plans’ timely access standards, leaving vulnerable Californians with no other option but to travel — sometimes hundreds of miles — for medically necessary care.
- Unfortunately, the current process provides no assurance that health plans receiving exemptions have exhausted all reasonable efforts to ensure providers are available to treat patients.
- Requiring public reporting of the number of alternative access applications that health plans submit — and how many DHCS approves — would not only shed light on health plans’ efforts to ensure care is there when patients need it, but also build public trust in laws intended to protect patients.
Contracting provisions for hospitals with high numbers of Medi-Cal and uninsured patients should be strengthened.
- Medi-Cal plans are legally required to contract with hospitals treating the most vulnerable patients — but the state is not enforcing the contract requirements, putting patients’ ability to access medical care at risk.
- Patients needing emergency care can visit a nearby hospital, but if their health plans don’t offer contracts to regional hospitals, people needing primary or specialty care must travel a great distance.
Timely access standards for hospital L&D units, as well as inpatient and outpatient behavioral health care services, should be incorporated into state law.
- Incorporating timely access standards for L&D services lowers the risks of adverse outcomes for expectant mothers and their babies, while incorporating such standards for all levels of behavioral health care means better care for patients, which results in better health outcomes.
- There are currently no time and distance standards specific to L&D access. Without these protections, health plans may exclude L&D providers from their network, and patients needing care could be forced to go out of network or travel long distances to access in-network L&D services for delivery.
- Currently, health plans must make outpatient mental health and substance use disorder care available to enrollees within 15 miles or 30 minutes away. However, there are no requirements for inpatient or residential behavioral health care, so people in crisis must often travel several counties away to get the care they need.