Cal­i­for­nia wipes out $58.6M in stu­dent debt, helps poor pa­tients get access to doc­tors

The Fresno Bee (Sunday) - - News - BY CATHIE AN­DER­SON can­der­[email protected] Cathie An­der­son: 916-321-1193, @CathieA_SacBee

The state of Cal­i­for­nia will be paying off $58.6 mil­lion in stu­dent loans this year for 247 physi­cians who, in exchange, com­mit­ted to serve a greater per­cent­age of the state’s poor­est and frailest res­i­dents: those cov­ered by Medi-Cal.

“By re­mov­ing the bur­den of stu­dent loan debt, this pro­gram will en­cour­age more providers to make different choices when en­ter­ing the health care mar­ket and be able to pro­vide care for the Med­i­Cal pop­u­la­tion,” said Jen­nifer Kent, direc­tor of the Depart­ment of Health Care Ser­vices, the agency ad­min­is­ter­ing the loan re­pay­ment pro­gram.

Those who accept the awards agree to en­sure that Medi-Cal pa­tients rep­re­sent 30 per­cent of their caseload for five years. That pro­por­tion of Medi-Cal pa­tients would be some­thing of a gold stan­dard, ac­cord­ing to research by Janet Coff­man, a pro­fes­sor in the Philip R. Lee Institute for Health Pol­icy Stud­ies at the University of Cal­i­for­nia, San Fran­cisco.

Work­ing through the Cal­i­for­nia Med­i­cal Board, Coff­man sur­veyed 6,163 doc­tors in 2015 and found that 34 per­cent of pri­mary care physi­cians had no Medi-Cal pa­tients in their patient mix and 28 per­cent had patient rolls in which 30 per­cent paid through Medi-Cal. The re­main­der of pri­mary-care doc­tors fell in the mid­dle.

Medi-Cal pa­tients have long com­plained that they strug­gle to find clin­i­cians, es­pe­cially pri­mary care providers, willing to accept Cal­i­for­nia’s fee sched­ule be­cause it does not cover the en­tire cost of care. More than 13 mil­lion Cal­i­for­nia res­i­dents get med­i­cal cov­er­age through Medi-Cal, and many of them live in ar­eas with a short­age of pri­mary care physi­cians.

While 247 doc­tors might sound like too small a group to ad­dress so great a need, Coff­man said her years of research tell her that this pro­gram could make a dif­fer­ence. She has learned that once doc­tors or any other pro­fes­sion­als have chil­dren, make friends and put down other roots, they tend to want to stay in that com­mu­nity.

“I wouldn’t say that with a loan re­pay­ment you’re nec­es­sar­ily earn­ing as much as you would if you’re work­ing for Kaiser or Sut­ter,” Coff­man said, “but it can be the dif­fer­ence that en­ables folks to say, ‘OK, if I get this loan re­pay­ment in ad­di­tion to salary, I can see my way to work in an ur­ban or ru­ral un­der­served com­mu­nity.”

Most loan re­pay­ment pro­grams re­quire only a one- or two-year com­mit­ment, Coff­man said, but this one has a five-year com­mit­ment – giv­ing doc­tors more time to fig­ure out how to make a prac­tice fi­nan­cially fea­si­ble. Also, some physi­cians with ties to un­der­served com­mu­ni­ties want to re­turn there to prac­tice, she said.

DHCS of­fi­cials said the awardees are prac­tic­ing in 40 ar­eas of medicine, from pe­di­atrics to psy­chi­a­try, and they are in 39 different coun­ties. The 247 providers work in a range of places: hos­pi­tals, com­mu­nity clin­ics, fed­er­ally qual­i­fied health cen­ters, aca­demic set­tings, gov­ern­ment, group prac­tice and pri­vate prac­tice.

Nearly 1,300 providers ap­plied for the CalHealthC­ares loan re­pay­ment pro­gram, which is be­ing funded by an al­lo­ca­tion in the re­vised 2019-20 bud­get and a $2 in­crease in to­bacco taxes that went into ef­fect July 1, 2017. That tax in­crease was part of Propo­si­tion 56, ap­proved by Cal­i­for­nia vot­ers in November 2016.

Al­to­gether, DHCS has $340 mil­lion to put to­ward the loan re­pay­ment pro­gram, and agency lead­ers said in a news re­lease that they plan at least five rounds of the loan re­pay­ment pro­gram. It is run by Physi­cians for a Healthy Cal­i­for­nia, the char­i­ta­ble arm of the Cal­i­for­nia Med­i­cal As­so­ci­a­tion.

DHCS and Physi­cians for a Healthy Cal­i­for­nia will an­nounce the num­ber of den­tal award win­ners later this sum­mer, and the two or­ga­ni­za­tions will will start ac­cept­ing ap­pli­ca­tions for the next round of awards in Jan­uary.

The CalHealthC­ares grants cover up to $300,000 in loans taken out for med­i­cal or den­tal school, and all providers must prac­tice in Cal­i­for­nia and be in good stand­ing with state li­cens­ing boards and DHCS.

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