California this year took the final step in opening Medi-Cal, its Medicaid program, to every eligible resident, regardless of immigration status. It’s a significant expansion to an already massive safety net program.

Annual Medi-Cal spending is now at 157 billion dollarsservice approximately 15 million low-income residents, more than a third of Californians. Of those, about 1.5 million are immigrants living in the U.S. without authorization, costing about $6.4 billion, according to the Department of Health Services. They were gradually added to the program as the state lifted legal residency as an eligibility requirement for children in 2016, young adults between the ages of 19 and 25 in 2020, people over 50 years old in 2022 and all remaining adults in January.

As California’s public insurance numbers grow, immigrant advocates are praising the Golden State for an expansion that helped reduce the uninsured rate to a record low 6.4%. Providers and hospitals, however, warn that the state has not adequately expanded its workforce or increased its Medi-Cal payments enough, leaving some enrollees unable to find providers to see them in a timely manner – if at all.

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

Although the state has increased Medi-Cal payments for primary care, maternal care and mental health services to 87.5 percent of what Medicare pays, private insurance still tends to pay more, according to the study. California Legislative Analyst’s Office.

A voting initiative approved this month guarantees that revenue from a tax on managed care plans goes toward increasing the salaries of health care providers who serve Medi-Cal patients.

Some believe the next chapter for immigrant coverage will require more than Medi-Cal.

Democratic State Assemblyman Joaquin Arambula proposed legislation in 2022 to allow it the approximately 520,000 unauthorized uninsured residents earning more than 138 percent of the federal poverty level to apply for state-subsidized health coverage through Covered California, the state’s health exchange. The bill, however, died in committee this year.

The latest installment of the “Faces of Medi-Cal” series looks at how Medi-Cal has affected newer enrollees. They include Vanessa López Zamora, who is finally being treated for hepatitis and cirrhosis but is having trouble seeing a gastroenterologist close to home; Douglas Lopez, an amusement park worker who credits dental coverage for increasing his well-being; and Daniel Garcia, who suffers from gout but has given up looking for a primary care provider. All spoke to KFF Health News in Spanish after recently becoming eligible for Medi-Cal.

“He started feeling sick a long time ago”

In March, Vanessa López Zamora’s stomach had swelled so much that she looked pregnant. She vomited and was in pain for 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 transferred by ambulance to Adventist Health Bakersfield, about 80 miles from her home in Visalia.

Doctors diagnosed her with hepatitis A and C and cirrhosis, which caused internal damage to her liver and esophagus, she said. She spent four days in the hospital and for further treatment received a referral to a gastroenterologist, who she can see as a new Medi-Cal enrollee — an option she couldn’t afford in the past when she had stomach pain and nausea.

“It was a very long process because I started feeling sick a long time ago.” said López Zamora, an accountant at 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.”

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

But she’s also frustrated.

The gastroenterologist the hospital sent her to is in Bakersfield — a tough commute for López Zamora, who doesn’t drive and can’t afford to travel to another city.

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

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

She treats her cirrhosis with medication and diet, but in August, her gastroenterologist in Bakerfield found signs of a precancerous condition in her stomach.

López Zamora said he was looking for a specialist closer to home. For now, she relies on her mother, who has to take the day off work to get to appointments or take the bus. She tried to use Medi-Cal transportation, but she got stuck at the hospital. And he rescheduled his dates twice.

“They drove me, but they didn’t take me back because they couldn’t find an Uber,” she said.

“A very simple process”

Medi-Cal got Douglas Lopez the dental treatment he couldn’t afford.

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

That year, Lopez suffered a sharp pain in his back teeth when he ate his beloved coconut and tamarind balls from his native Guatemala.

A dentist told him he needed more filings and three root canals. He started treatment, but the bills got expensive: $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.”

Worried that he would lose his teeth, he stopped eating anything that caused him pain.

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

So far, Lopez has been to the dentist six times, for a cleaning, three root canals, two filings and x-rays. And Medi-Cal paid the bill.

Lopez’s experience contrasts with that of many other Medi-Cal enrollees, who struggle to get the care they need. The UCLA Center for Health Policy Research found that 21% of dentists in California saw Medi-Cal patients of all ages, according to data from 2019 to 2021. Often those dentists limit the number of Medi-Cal patients they will see; only 15% of enrolled adults could receive dental care in a given year.

Lopez said Medi-Cal came through for him.

“It was a very simple process. I was so excited to find a dentist,” Lopez said. “The fear of losing my teeth because I don’t get treatment is gone.”

“Something you can’t even use”

Last year, the stabbing pain in Daniel Garcia’s arm and leg got so bad that the 39-year-old went to the emergency room.

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

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

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

Molina declined to comment on Garcia’s case and did not respond to questions about the primary care network.

Almost 6 million Californians live in a total of 611 primary care shortage areas, according to a KFF analysis, which found the state would need to add 881 practitioners to close the gap.

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

Keeping patients out of the emergency room, that may be 12 times more expensive as primary care, is one of the arguments for expanding Medi-Cal. Studies have shown that not only does expanding medical coverage lead to lower rates of emergency room visits, but expanding coverage also leads patients to use more preventive care, said Drishti Pillai, director of immigrant health policy at KFF, an organization health information nonprofit that includes KFF Health News. .

“It can help save health care costs because conditions are no longer left untreated for a long time, in which case they can become more complex and expensive to treat,” Pillai said.

This article is part of “Faces of Medi-Cal,” a series exploring the impact of the state’s safety net health program on enrollees.

This article was made by KFF Health Newswhich publishes California Healthlinean editorially independent service of California Health Care Foundation. KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling and journalism. This story continued CALÓ news. It can be republished free of charge.