As California moves forward with Medi-Cal expansion under the provisions of the Affordable Care Act, the state is worried that it may not have enough physicians to absorb the newly insured patients. As part of the Act, states are instructed to expand their Medicaid eligibility provisions, although some states are opting out of following instructions. Poverty-level adults without children, children who qualified for Healthy Families, and people with incomes slightly above federal poverty guidelines will soon be able to obtain Medi-Cal coverage. The Healthy Families program will no longer exist.
Although the idea behind the healthcare overhaul is to increase access to medical care, in California it may effectively be that new Medi-Cal enrollees are simply granted an empty coverage that no one will accept. California has one of the lowest physician reimbursement rates in the country. Because of the low reimbursement rates, many physicians in California limit the number of Medi-Cal patients they are willing to take on or flat out refuse to see them at all. Additionally, in inland, rural areas there are already significantly fewer physicians than there are in the coastal areas.
The state government attempted to cut Medi-Cal reimbursement rates by an additional 10%, an effort which has been thwarted in federal court so far. However, the Affordable Care Act requires that in 2013 and 2014 states increase their Medicaid payments to equal MediCare payments. Potentially the increase will coax some primary care physicians back into the Medi-Cal market.
The physician shortage is a nationwide issue; in fact the numbers of primary care physicians have been declining for decades due to the increased cost of medical school and a growing income difference between primary care physicians and specialists. However, the Affordable Care Act aims to encourage young physicians to enter the primary care market by increasing the availability and flexibility of primary care residencies.
It remains to be seen how California will be able to pay for the Medi-Cal expansion in the coming years. However, it is still worthwhile to plan for eligibility as part of your comprehensive estate plan. Discussing with your lawyer and determining whether it will be worthwhile for you and your spouse to qualify for Medi-Cal in the future is an integral part of the process. Medi-Cal eligibility is not the only type of medical care coverage one should consider in their plan though. Some of you will qualify for VA health-related benefits, such as the VA Aid and Attendance Non-Service Connected Disability Pension, which may be a better option for you.
Alternatively, you and your spouse may want to consider long term care insurance to cover the costs of skilled nursing or similar expenses, or life insurance to help handle any final medical bills and expenses. Another alternative might be an irrevocable trust set aside for the payment of medical bills, although there are major reasons why an irrevocable trust may not be worthwhile in your situation. Speaking with a qualified estate planning attorney about how to deal with the changes to Medi-Cal and whether Medi-Cal eligibility planning, such as through a QMap trust, will help.