State Panel Gives Medi-Cal a Poor Bill of Health : Insurance: Little Hoover Commission calls the program an empty promise of medical care. It offers three sets of recommendations for remedies.


The Little Hoover Commission on Wednesday issued a scathing report on the state Medi-Cal insurance program for poor Californians, saying it constitutes an empty promise of health care to many of the 3.7 million adults and children who depend upon it.

The $8.1-billion program is “riddled with procedures that block access to medical care and discourage doctors from participating in the system,” said Commission Chairman Nathan Shapell. “The result is similar to a lottery. If you’re lucky, enough to have your number come up, you’ll get health care. If you’re not, you’ll suffer frustration and delays while facing an endless line of closed doors to vital medical care.”

And because access to preventive care is limited under the program, Medi-Cal’s money ends up spent on the most expensive forms of care: hospitalization and the emergency treatment of conditions that might have cost less had they been tended to earlier, the commission charged.

John Rodriguez, deputy director of the California Department of Health Services and state Medi-Cal director, could not be reached for comment. However, a spokesman said the department had not been provided with a copy of the report and therefore would have no comment until it had a chance to review the commission’s findings.


One year in the making, the commission report is called “A Prescription for Medi-Cal.” It includes 28 recommendations for money-saving efficiencies that the commission contends will enable the program to cover more people for the same amount of money.

But at a news conference Wednesday, commissioners had few hard figures to document their projections of savings, nor could they project how many more people these reforms could bring under Medi-Cal’s umbrella without increasing total program costs. Richard Terzian, chairman of the commission’s Medi-Cal subcommittee, acknowledged that with Californians’ unequivocal rejection of spending propositions in last week’s election, it may be necessary for Medi-Cal to reduce the number of services it currently covers in order to meet the basic medical needs of the greatest number of patients.

For example, Medi-Cal now spends $800 million on so-called optional services, not federally mandated, such as occupational therapy, podiatry, acupuncture and hearing aids, Terzian said.

The commission’s recommendations fall into three categories. The first addresses the goal of streamlining eligibility and reimbursement procedures so that patients are not deterred by complicated application procedures, and doctors and hospitals are not frustrated by long waits for payment.


The second set calls for expanded use of the state’s mass purchasing capabilities to bargain for discounts in the provision of medical care. For example, the state has realized significant savings in the last six months by purchasing drugs in bulk. Previously, the commission charged, California’s program paid top dollar for pharmaceuticals--as much as four times the amount paid by other agencies taking advantage of bulk purchase discounts.

The third set of recommendations calls for development of priorities in health care services “so that any rationing that must occur takes place by logic rather than by chance,” Shapell said in a letter to Gov. George Deukmejian and legislative leaders that accompanied the 146-page report.

The commission, composed of non-salaried citizens and legislators, monitors the efficiency of California government agencies.