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Hours on hold, limited appointments: Why California babies aren't going to the doctor

Jenny Gold, Los Angeles Times on

Published in Health & Fitness

"It's most of the state, not just the Central Valley," said Kathryn E. Phillips, an associate director at the California Health Care Foundation. California has not trained enough new doctors to meet the needs of the population, she said, and the current workforce is aging. In rural areas in particular, it can be difficult to recruit new pediatricians to join a practice.

Historically, Medi-Cal has paid doctors far less than other insurers, and the program has struggled to find enough willing to accept the rates. In 2021, for example, Medi-Cal paid $37 for a checkup with a toddler.

"Medi-Cal patients basically don't keep the lights on. You can't make ends meet," said Dr. Eric Bell, a pediatrician in Orange County. About a quarter of his patients have Medi-Cal, but the practice stays afloat because of payments from privately insured patients. That may change as the state has increased the Medi-Cal rates significantly this year, up to $116 for a toddler checkup.

In Los Angeles, families often face long wait times to get an appointment with a Medi-Cal provider— 82% of children in the county did not receive a developmental screening in the first three years, 2020 state data showed.

At UCLA, Kuo said patients at her practice must book their well-child visits three to six months in advance. "We get patients coming from Palm Springs to UCLA because there's no access."

Many Californians — especially those with low incomes — can't afford the costs or time to make such a long drive, especially for the multiple visits recommended each year for a baby or toddler. Medi-Cal provides a transportation benefit to members, but many families don't know it exists or say it is difficult to arrange.

"Families are so stressed about housing. They're stressed about the price of gas. The cost of living here is so high," said Dr. Lisa Chamberlain, a professor of pediatrics at the Stanford School of Medicine. A doctor's visit for a seemingly healthy child is "just not going to make it to the top of the list."

Rosa Benito, 21, lives with her parents and five siblings in Thermal, a town in Riverside County, where the family works in agricultural fields. Getting her siblings to the doctor is a constant struggle.

"We just have my dad and his little gray car, " she said. The family goes to a clinic in Moreno Valley, over an hour away, but it's only open during the workday, and their farming jobs don't offer sick time. Taking a child to the doctor means missing work, which they can't afford.

And since her parents lack documentation to be in the country legally, they're scared of the long travel to the clinic for fear that they'll be pulled over by Border Patrol. "It just turns into a bigger problem. The kids would be without a guardian," explained Benito. Unless there's an emergency, the trip often isn't worth it.

Luz Gallegos of TODEC, a legal center in the Inland Empire serving immigrants and farmworkers, said many families stick with traditional "remedios" for their children and only bring them to the doctor for vaccines when it's time to enroll in kindergarten. Some have lingering fears that using their child's Medi-Cal benefits could affect their immigration status.

"Our families don't think about prevention. They think about surviving."

The Medi-Cal problem

While family challenges can play a role in missed visits, the state auditor found that the blame for California's poor performance fell largely on the Medi-Cal program.

"By failing to prioritize implementing our recommendations, DHCS has... left certain children at risk of lifelong health consequences," the auditors wrote in their 2022 report.

 

Celia Valdez, director of health outreach and navigation at Maternal Child Health Access, an L.A. nonprofit that manages several social service programs, says they hear daily from families who don't know how to navigate the Medi-Cal bureaucracy: missing insurance cards, an unexplained switch in their assigned pediatrician, coverage that is suddenly terminated. "People are lost, and by the time they get to someone who can help them, critical time has passed," said Valdez.

For Alexia Peralta of Hawthorne, the problems started about two months after her son was born last year, when his Medi-Cal enrollment went awry. She tried to book his 4-month well-child visit and was told he didn't have coverage; she would have to pay $145 for the visit — an impossible sum.

She spent seven months in limbo — calling Medi-Cal repeatedly, waiting on hold for hours to speak with someone in Spanish, only to be disconnected. Several times, she thought she'd solved the problem, only to get to the pediatrician's office and be turned away.

"I feel frustrated, mad and sad. I tried to get all these things for my child and got the run-around," she said. He missed both his 4-month and 6-month vaccines.

Eventually, with the help of a home visitor from a Shields for Families program, a nonprofit in L.A., Peralta was able to get her son re-enrolled. At 15 months, he is still catching up on his vaccines.

Trying to fix the system

The health department said the challenges are not unique to California, and that the pandemic "resulted in large backlogs of children who needed to catch up on preventive services, a worsening crisis in the health care workforce, and limited additional capacity for pediatric services."

In response, the department "has made historic investments and launched new initiatives" that "look to lift our youngest Californians and allow them to be healthy and to thrive." This includes sending educational materials to families about recommended care, creating new contracts with Medi-Cal plans that more closely track children's healthcare, and continuing to fine plans that fail to perform.

The state is also pumping money into the primary care workforce and is expanding residency and loan repayment programs. There are new Medi-Cal benefits to pay for doulas and community health workers, who can help patients navigate care, the response said.

"The big ship is slowly turning," said Mike Odeh, senior director of health at Children Now, who serves in an advisory group for the department. "But I want to emphasize how big the ship is and how hard it is to turn, given that we have decades of plans not providing care for kids. Changing that is going to take a lot of work."

Former State Sen. Richard Pan, who was chair of the Health Committee before terming out in 2022, said he is not yet convinced the department's response to the audits has been adequate. The devil is in the details, he said — are the fines against plans high enough? And how many plans will end up complying?

"Give us the proof that it's been fixed. Show us the data. Unfortunately, I'm not in a position now to hold hearings, but I think that's the next follow through," he said. "The buck should always stop at the state."

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This article is part of The Times' early childhood education initiative, focusing on the learning and development of California children from birth to age 5. For more information about the initiative and its philanthropic funders, go to latimes.com/earlyed .


©2024 Los Angeles Times. Visit at latimes.com. Distributed by Tribune Content Agency, LLC.

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