California Healthline

Is UC Davis Medical Center Skimping On Care For The Poor?

August 12, 2016

By Pauline Bartolone

For at least 20 years, Leslie Love relied on the UC Davis Medical Center’s hospital and clinics for her health care. Her children and grandchildren went to the same doctors there.

“They cared about me,” said Love, a 57-year-old teacher’s assistant who lives near the academic medical center, which is located in Sacramento. “There’s people there that I can trust.”

But that trust was recently broken: Love has been fighting for follow-up care since her knee surgery at UC Davis in 2014. Love’s current Medi-Cal managed care plan, Health Net, ended its contract with the UC Davis Health System in January 2015. As a result, Love could no longer see the physicians there who had treated her knee.

The pullout, which affected an estimated 3,700 patients at the time, means that Health Net’s now nearly 123,000 Medi-Cal managed care enrollees in Sacramento County can no longer seek primary care at UC Davis.

Ever since the contract ended, tension has been building over what some critics say is limited access for Medi-Cal patients at UC Davis’ health clinics.

Consumer advocates say that because UC Davis Medical Center is a designated public hospital, it — along with four other University of California medical centers — has a mission to serve the poor.

They say UC Davis is not fulfilling that mission, because the health system generally no longer accepts primary care patients covered by Medi-Cal managed care contracts. Medi-Cal patients still can get specialized and emergency room care there, as well as in-hospital stays.

The Health Equity Action Team, a group of advocates, is holding a press conference today at the Guild Theater in Sacramento, to ask UC Davis to step up its commitment to offer primary care to Medi-Cal patients.

UC administrators say their five academic medical centers around the state, including UC Davis, are among California’s top health providers for Medi-Cal patients. But they contend the system would be financially burdened if it were required to provide all medical services to all of them.

A spokeswoman at the University of California’s Office of the President said Health Net ended the contract after “seeking unreasonable terms,” and that the university continued to provide services to many former Health Net members after the contract lapsed. The president’s office did not elaborate on the scope of services UC Davis provided to those patients after the contract was terminated, or how long it continued to provide them.

Medi-Cal now covers some 13 million Californians — about one-third of the state’s population. Some 80 percent of Medi-Cal enrollees are covered by managed care plans. The UC health systems are under pressure to offer basic health care for many of these new enrollees while still maintaining their role as prestigious providers of cutting-edge medical treatments.

Yet for some patients, losing UC Davis means being cut off from health care providers they know and trust. Love’s knee is hurting again — but she can’t go back to UC Davis for care.

“I know they got tired of my face, because I would go back and back and back [to] find out what’s going on,” Love said of her conversations with UC Davis. “Are you guys really just throwing me out just like that?” she said she told them.

Love’s advocates at Legal Services of Northern California say they have helped dozens of Medi-Cal patients in similar situations since January 2015.

“[It’s] very traumatic for these clients,” said Amy Williams, the nonprofit’s deputy director. They have very complex medical conditions, she said, and some have needed emergency room treatment while trying to find alternative care.

“It’s making low-income people feel like they’re ‘less-than,’” Williams said.

UC Davis officials said in a written statement that Medi-Cal enrollees make up the largest proportion of patients who visit their health system. UC Davis’ current Medi-Cal managed care contracts emphasize “specialty care services, but could include primary care,” they said.

Even students at UC Davis School of Medicine are weighing in. More than 140 medical students signed a letter to UC Davis and UC health system administrators, urging them to reinstate primary care for Medi-Cal patients.

“Without primary care Medi-Cal [patients] being served at our hospital, many students feel that we no longer can uphold our institutional mission and remain a top primary care school,” they wrote. “UC Davis, historically a beacon to poor families in one of the neediest areas of Sacramento, now stands out in its unwillingness to provide basic care for its neighbors.”

Dr. John Stobo, executive vice president of UC Health, said “no matter how you want to slice and dice [the] data, the UC system as a whole is either the first, second or third biggest provider of Medi-Cal services in the state.”

State Sen. Richard Pan (D-Sacramento), a former UC Davis pediatrician who treated Medi-Cal patients, said that contracting with Medi-Cal health plans sets an example for medical students.

“It’s very concerning when the UC, which is a … public teaching institution, is not fulfilling a mission,” Pan said. “If a public institution can’t take care of people under public health coverage, then [UC Davis needs] to stand up and say, ‘You know what, legislature, governor? We need to raise the [Medi-Cal] rates.’”

Legal Services of Northern California’s Williams said she understands that UC Davis can’t contract with all Medi-Cal plans because of the low reimbursement rates. But, she says, the contracts for primary care “can’t look like zero.”

Some of her clients who were cut off from services at UC Davis a year and a half ago are “still suffering” in their search for services elsewhere, Williams said.

And Love, nearly two years after her knee surgery at UC Davis, said she’s still trying to find the care she needs to fully recover.

“They don’t even want to see if I’m ok,” says Love of her former medical provider. “You throw a patient away for a dollar?”

CLARIFICATION: An earlier version of this story stated that the UC Davis Health System has a mandate to serve the poor. The story now replaces the word “mandate” with “mission” and attributes the statement to consumer advocates. The story also has been updated with comments from the University of California on the termination of the Health Net contract.