A change mandated by the state that was supposed to improve medical care and save money is failing — at least in Plumas County — and Public Health Director Mimi Hall wants to remedy the situation.
The state of California changed the way it administers Medi-Cal in 28 rural counties, but unlike the success the transition enjoyed in urban areas, rural clients are suffering.
“This is a serious rural county issue,” Hall told the supervisors during their Feb. 4 meeting.
She explained that in November 2013, the state changed from a fee-for-service plan to managed care. Hall stressed that this change has nothing to do with the Affordable Care Act, but was strictly a state decision designed to save the state money while improving patient care.
Medi-Cal clients were given a choice of two companies: Anthem Blue Cross or California Health and Wellness. But to access health care, the clients must locate medical care providers who accept their plan. Many local providers have opted out because the reimbursement rates are lower than in the past. Pharmacies have been particularly impacted.
For example, Chester Medi-Cal recipients can no longer fill a prescription in Chester, and must travel out of town to do so. The nearest pharmacies that accept Medi-Cal are in Susanville or Greenville.
Supervisor Kevin Goss, who operates Village Drug in Greenville, said that on a recent Friday the pharmacy filled 240 Medi-Cal prescriptions and earned $28 in total.
“That is unsustainable,” Hall said. “Pharmacies are opting out because it’s not a living rate.”
During an interview last week, Hall said that when she broached the problem with the state’s director of health care services, he suggested mail order as a solution for rural clients.
Hall said that approach doesn’t work when someone needs immediate access to medication.
She also cited an example of a local woman who suffered from cancer and was referred to Enloe Medical Center in Chico for treatment.
The woman had to change her provider to one that Enloe accepted, but when she returned home, she had to switch plans again because the pharmacy that provided her drugs accepted an alternate plan.
“Some of our consumers are experiencing a complete lack of access to care,” Hall said.
According to Social Services Director Elliott Smart, there are roughly 2,500 Medi-Cal recipients in Plumas County, which represents roughly 12 percent of the population. Statewide, roughly 14 percent of the population is on Medi-Cal.
Hoping to improve the situation, Hall scheduled a stakeholder meeting in Quincy on Feb. 7 that included county officials, hospital administrators and other health care providers.
“This is a really, really big issue,” she said.
And it’s an issue that is affecting other rural counties as well. Hall plans to collect data from those counties so efforts can be coordinated to resolve the problems Medi-Cal clients are facing.
“We need to figure out how to provide better access,” she said.