Stanislaus County clinics expect wave of people seeking care

STANISLAUS COUNTY -- Officials who manage safety-net clinics in Stanislaus County said they expect to see a wave of people seeking health care with the federally funded Medi-Cal expansion next year.

These county residents have contact with the local health system when they walk into an emergency room or use a health clinic to take care of an urgent medical need. But they are expected to seek health care more often once enrolled in Medi-Cal, especially those with diabetes or other ongoing medical conditions.

Stanislaus has 135,000 people enrolled in the statewide health program for the poor. County health centers and other safety-net clinics provide most of the care for this population.

Mary Ann Lee, director of the county Health Services Agency, said flatly that the county is not ready for thousands more residents to enter the program.

An official with a nonprofit community health system said they're making an effort to accommodate an influx of patients.

"Our big challenge will be capacity — how to increase access to these newly insured," said Christine Noguera, interim chief executive officer of Golden Valley Health Centers, which has clinics in Stanislaus and Merced counties.

Golden Valley estimates that more than 10,000 of its patients are uninsured adults who will become eligible for Medi-Cal. The Affordable Care Act will extend eligibility to people with higher incomes and others who were previously excluded, such as childless adults.

Noguera said many of those 10,000-plus patients visit clinics only when they can pay the sliding-scale fees, but they need more frequent treatment for chronic illness. Medi-Cal coverage will allow them to seek care more often.

"The other thing that will happen is people who are not our patients will also become eligible and will look for medical practices open for patients," Noguera said. There is also a huge number of young adults who are uninsured, she said, but they won't be first in line to apply for Medi-Cal.

Right now, it can take two months for new patients to get an appointment at a Golden Valley clinic, depending on location, Noguera said.

Stanislaus County officials recently asked their state representatives to go easy with the Medi-Cal expansion. The Health Services Agency doesn't have extra clinic space, and has a hard time recruiting doctors to meet current needs, officials said.

George Kilian, director of Scenic Faculty Medical Group, whose doctors work in the county health centers, said many of the people who will join Medi-Cal are county residents who already seek services, mostly on an episodic basis.

"We all assume there will be a lot more patients," Kilian said. "We also assume not everyone will be accommodated as they might wish."

Trouble recruiting doctors

He said Scenic Faculty has tried for two years to fill openings for three physicians. One challenge is the valley's stigma as an undesirable place to live, he said, plus the county can't match the pay of large groups, such as Kaiser Permanente, that hire graduates of the county's residency program.

"There are not as many primary care docs looking for jobs as there once was," Kilian added.

Lee said the county Health Services Agency is not prepared to handle the internal processes needed for the expansion, such as claims processing, eligibility management and provider network contracting.

She said the agency is trying to estimate how many county residents will join Medi-Cal but hasn't come up with a number. Some of them are uninsured adults who see doctors through the county's indigent health program and will become eligible for Medi-Cal.

Noguera said Golden Valley has six positions open for doctors needed to meet current and future needs. She wasn't sure how long it will take to recruit them.

"This is the Central Valley; we have a physician shortage," she said.

Lee said the federal government's temporary increase in Medi-Cal reimbursements, aimed at coaxing more private doctors to accept Medi-Cal patients, might not have the desired effect. More likely, those doctors will be busy with people who obtain insurance or employer-based benefits through the Affordable Care Act, which seeks to extend coverage to most uninsured Americans.

Alternative delivery

The county could rely more heavily on care models other than face-to-face visits with doctors, such as Internet serv-ices, email and phone calls. Care teams composed of nurses and other midlevel providers could handle routine patient visits.

To make that feasible, the federal government needs to change reimbursement policies that don't pay for doctors to email patients or talk with them on the phone, Lee said.

Golden Valley has frequent staff meetings on the expansion, which promises to improve the lives and productivity of people who aren't getting care for chronic illness, Noguera said. In January, the nonprofit opened the Care Now urgent clinic on Florida Avenue in Modesto as an entry point for new patients with routine health issues.

The group also is looking into opening another health center in Modesto and expanding hours, with more evening and Saturday appointments, to more efficiently use its clinics, Noguera said.

Lee said the county is waiting for direction from Sacramento on whether the state will manage the expansion or build on county health programs to care for patients. It's also assessing facility needs and exploring grant opportunities.

"If we get a lot more patients, I assume we will be looking for additional physicians," Kilian said. "But you can only cram so many people into a building."

Bee staff writer Ken Carlson can be reached at kcarlson@modbee.com or (209) 578-2321.