California extended Medi-Cal to unauthorized residents. The results are mixed.

California took the final step this year in opening up Medi-Cal, its Medicaid program, to every eligible resident regardless of immigration status. This is a significant expansion of an already extensive security program.

Annual Medi-Cal costs are now 157 billion dollarsinnings about 15 million low-income residents make up more than a third of Californians. Of those, about 1.5 million are immigrants living in the U.S. without authorization, costing an estimated $6.4 billion, according to the Department of Health. They were gradually added to the program as the state removed legal residency as an eligibility requirement children in 2016, young people aged 19-25 years in 2020, people 50 years and older in 2022 and that’s it adults remained in January

As California’s public insurance grows, immigrant advocates are praising the Golden State for an expansion that helped bring the uninsured rate down to record low 6.4%. However, providers and hospitals warn that the state has not adequately expanded its workforce or increased Medi-Cal payments enough, leaving some enrollees unable to find providers to see them in time — if at all.

“Coverage doesn’t necessarily mean access,” said Isabelle Becerra, CEO and president of the Orange County Coalition of Community Health Centers, during an Oct. 2 health policy summit in Los Angeles. “There is not enough labor force. We are all fighting for those doctors. We are fighting each other for those doctors.”

While the state has increased Medi-Cal payments for primary care, maternity care and psychiatric services to 87.5% of what Medicare pays, private insurance still pays more, according to data. California Legislative Analyst’s Office.

AND voting initiative this month could guarantee revenue from the managed care plan tax to increase pay for health care providers who serve Medi-Cal patients.

Some believe the next chapter will require more than Medi-Cal to cover immigrants.

In 2022, state Assemblyman Joaquin Arambula, a Democrat, proposed allowing the law approximately 520 thousand uninsured unauthorized residents who earn more than 138% of the federal poverty level can apply for state-subsidized health insurance through Covered California, the state’s health care exchange. However, the bill died in committee this year.

The latest installment in the Faces of Medi-Cal series looks at how Medi-Cal has impacted its new enrollees. They include Vanessa López Zamora, who is finally being treated for hepatitis and cirrhosis, but is finding it difficult to see a gastroenterologist near her home; Douglas Lopez, an amusement park worker who believes dental insurance makes him feel better; and Daniel Garcia, who suffers from gout but has refused to seek a primary care physician. All spoke to KFF Health News in Spanish after recently becoming eligible for Medi-Cal.

“I started feeling bad for a long time”

In March, Vanessa Lopez Zamora’s belly swelled so much that it looked like she was pregnant. She vomited and felt pain for several days.

She went to her local emergency room at Kaweah Health Medical Center, but there was no specialist available, she said. So the 31-year-old was taken by ambulance to Adventist Health Bakersfield, about 80 miles from her home in Visalia.

According to her, doctors diagnosed her with hepatitis A and C and cirrhosis of the liver, which caused internal damage to her liver and esophagus. She spent four days in the hospital and for further treatment received a referral to a gastroenterologist, which she can accept as a new application for Medi-Cal, an option she could not afford before when she had stomach pains and nausea.

“It was a very long process because I started feeling bad a long time ago.” said Lopez Zamora, an accountant for a local radio station in Visalia in the San Joaquin Valley. “My girls are very young and if I can’t get the treatment I need, I won’t know how long I have left.”

Lopez Zamora, who came to California from Mexico City when she was 8, is grateful for the care she received at first.

But she is also disappointed.

The gastroenterologist the hospital referred her to is in Bakersfield — a difficult trip for Lopez Zamora, who doesn’t drive and can’t afford to go to another city.

Limited access to specialists—from gastroenterologists to cardiologists—has been a longstanding problem for many Medi-Cal patients, especially those living in rural or understaffed areas. The San Joaquin Valley, where López Zamora lives, has the least supply of specialists in the state, according to the California Health Foundation.

Michael Bowman, a spokesman for Anthem Blue Cross, its Medi-Cal plan, said in an email that Anthem has an extensive network of specialists serving Medi-Cal beneficiaries, including more than 100 gastroenterologists within a 20-mile radius of Visalia.

She manages her cirrhosis with medication and diet, but in August her gastroenterologist in Bakerfield found signs of precancerous conditions in her stomach.

Lopez Zamora said she was looking for a specialist closer to home. Currently, she relies on her mom, who has to take the day off to get to appointments, or she takes the bus. She tried using Medi-Cal-provided transportation, but ended up in the hospital. And she postponed meetings twice.

“They gave me a ride but didn’t bring me back because they couldn’t find an Uber,” she said.

“Very simple process”

Medi-Cal provided Douglas Lopez with dental treatment he could not afford.

The 33-year-old was making minimum wage as a janitor at an amusement park in 2022, and the emergency Medi-Cal plan he signed up for only covered emergency withdrawals.

That year, Lopez experienced a sharp pain in his back teeth while eating his favorite coconut and tamarind candies from his native Guatemala.

The dentist told him he needed some files and three root canals. He began treatment, but the bills rose: $150 for the first session, then $200, then $300.

“I couldn’t afford it,” recalled Lopez, who lives in Fullerton. “I had to pay rent and food.”

Fearing that he would lose his teeth, he stopped eating anything that might hurt him.

In January, Orange County automatically enrolled Lopez in Molina Healthcare’s Medi-Cal plan when the state expanded coverage to unauthorized residents ages 26-49. The exposure changed his care, he said.

So far, Lopez has visited the dentist six times: for a cleaning, three root canals, two filings and an X-ray. And Medi-Cal paid the bill.

Lopez’s experience is different from that of many other Medi-Cal enrollees, who are fighting get the care you need. This was discovered by the UCLA Center for Health Policy Research 21% of California dentists visited Medi-Cal patients of all ages, based on data from 2019 to 2021. Often, these dentists limit the number of Medi-Cal patients they will see; only 15% of adult students may receive dental care in a given year.

Lopez said Medi-Cal provided him with assistance.

“It was a very simple process. I was so excited that I was looking for a dentist,” Lopez said. “The fear of losing teeth due to lack of treatment is gone.”

“Something You Can’t Even Use”

Last year, the stabbing pain in Daniel Garcia’s hand and foot became so bad that the 39-year-old went to the emergency room.

Garcia has gout, a type of inflammatory arthritis that can cause severe pain and swelling in the joints. When he became eligible for Medi-Cal coverage this year, he thought he would finally be able to see a doctor for treatment.

But the Los Angeles County resident said he hasn’t been able to find a primary care provider willing to take his Molina Healthcare insurance.

“It’s frustrating because you have something you can’t even use,” said Garcia, who failed his annual medical. “I called and they said they don’t take my insurance.”

Molina declined to comment on the Garcia case and did not respond to questions about the Primary Care Network.

almost 6 million People in California live in 611 primary care shortage areas, according to a KFF analysis that found the state would need to add 881 primary care practitioners to close the gap.

Garcia, a construction worker, said he had read that he could manage his arthritis by changing his eating habits. He now eats healthier and has cut down on sugar and coke. As for the pain, he relieves it with ibuprofen. He gave up looking for a provider.

Do not allow patients to the emergency department, which may be 12 times more expensive as primary care, is one of the arguments for expanding Medi-Cal. Studies have shown that expanding health care coverage not only leads to fewer emergency room visits, but that expanding coverage also results in patients using preventive care more often, said Drishti Pillai, director of immigrant health at KFF, a nonprofit on health care, which includes KFF Health News. .

“This can help save health care costs because diseases no longer go untreated for a long time, in which case they can become more difficult and expensive to treat,” Pillai said.

I prepared this article KFF health newsnational newsroom, which creates in-depth journalism on health issues and is one of the main operational programs in KFF — an independent source of health policy research, polling and journalism. KFF Health News is the publisher California Healthlineeditorial independent service California Health Foundation.