Why does no one accept Medi-Cal?
Asked by: Guido Nitzsche | Last update: July 3, 2025Score: 4.1/5 (72 votes)
Why do some doctors not accept Medi-Cal?
It is due to factors like reimbursement rates, administrative complexity, and network agreements. Some plans may pay less for services or have stricter rules, making it less beneficial for doctors to accept them. Ultimately, it's about balancing their income and the ease of handling claims.
What is going on with Medi-Cal?
Medi-Cal resumed its normal renewal processes on April 1, 2023. From that start date, it has 14 months to redetermine eligibility for around 15 million current enrollees. It's estimated that during this “unwinding period,” two to three million Californians may leave the program.
Why does nowhere accept Medicaid?
One reason is that reimbursement rates for Medicaid are lower than for Medicare or commercial insurance. Another (often overlooked) factor, however, is physician's risk of payment denials and the administrative hassle they face trying to get reimbursed by Medicaid.
Is Medi-Cal as good as Covered California?
Medi-Cal provides benefits similar to the coverage options available through Covered California, but often at lower or no cost to you or your family. All of the health plans offered through Covered California or by Medi-Cal include the same comprehensive set of benefits known as "essential health benefits.”
What You NEED TO KNOW About New Medi-Cal Eligibility Rules
What is the disadvantage of Medi-Cal?
The perception that Medi-Cal offered poorer coverage or less respectful treatment than other types of insurance. Concerns among noncitizen respondents that applying for Medi-Cal might affect their immigration status.
What disqualifies you from Medi-Cal?
To qualify, you must: Meet the medical requirements of Social Security's definition of disability. Be working and earning income (this can be part-time work). Have countable income less than 250% of the federal poverty level (in 2024, this equates to $3,158/mo.
Can doctors refuse Medicaid patients?
When uncovered costs become too great, physicians are ethically justified in refusing to accept Medicaid patients, according to Sade. “If they do accept such patients, however, they are ethically obligated to offer them the same care as they do for all of their patients,” Sade says.
Why don't therapists accept Medicare?
Many therapists don't accept Medicare or any other types of insurance because of low reimbursement rates and the unpaid hours they have to spend filling out complicated paperwork—only to have some claims get denied and go unpaid anyway.
Why is Medicaid not accepted?
One likely reason fewer doctors accept Medicaid patients is that those claims are paid at a lower rate than other insurance. More providers would be interested in Medicaid if the program's reimbursements were similar to Medicare payments, according to the report.
What is the new law for Medi-Cal 2024?
Beginning January 1, 2024, a new law in California will allow adults ages 26 through 49 to qualify for full-scope Medi-Cal, regardless of immigration status. All other Medi-Cal eligibility rules, including income limits, will still apply.
What does Medi-Cal not cover?
Restricted scope Medi-Cal covers limited services. It does not cover medicine or primary care. If you have pregnancy-related limited scope Medi-Cal, you will have the full scope of Medi-Cal benefits, if the service is medically necessary.
What is the new name for Medi-Cal?
California Advancing and Innovating Medi-Cal (CalAIM) is a far-reaching, multiyear plan to transform California's Medi-Cal program and to make it integrate more seamlessly with other social services.
Do most doctors accept Medi-Cal?
Do All Doctors Have to Accept Medi-Cal? Not necessarily. Doctors can refuse to take Medi-Cal patients. Before receiving treatment, check whether the provider accepts Medi-Cal Fee-For-Service payments to avoid having to pay out of pocket.
Why are doctors refusing Medicare?
In recent years, physician groups and some policymakers have raised concerns that physicians would opt out of Medicare due to reductions in Medicare payments for many Part B services, potentially leading to a shortage of physicians willing to treat people with Medicare.
What does Medicaid not cover?
Though Medicaid covers a wide range of services, there are limitations on certain types of care, such as infertility treatments, elective abortions, and some types of alternative medicine. For example, the federal government lists family planning as a mandatory service benefit, but states interpret this differently.
Why do psychiatrists not take Medicare?
Psychiatrists with characteristics that may signal higher quality to patients (for example, greater experience or more prestigious training) may be more likely to opt out because Medicare patients would be more willing to pay higher fees for those psychiatrists.
How many weeks of therapy will Medicare pay for?
There's no limit on how much Medicare pays for your medically necessary outpatient therapy services in one calendar year.
Why don't a lot of therapists take Medicaid?
Most providers do not accept Medicaid and Medicare because they pay less and it takes more work to get the payment than with private insurance. Many private practice therapists do not accept Medicare and Medicaid as the law does not allow them to.
Why do so few doctors accept Medicaid?
That's because Medicaid physician payment rates have historically been well below those of Medicare or private insurance rates. This fee discrepancy has contributed to many physicians' reluctance to accept new Medicaid patients, which has left them clustered in a subset of practices.
Who gets denied Medicaid?
The most common reason an applicant is denied Medicaid is income or assets above the eligibility criteria. In most states in 2025, an applicant's monthly income must be less than $2,901/month, and their assets (including money in bank accounts) must be less than $2,000.
How to deal with dismissive doctors?
If the doctor is being dismissive, push back. Engage them as you would a partner. Let them know you appreciate their expertise, but remind them that you are the foremost expert on your own body. Work together to reach a diagnosis and treatment plan.
How much money can you have in the bank on Medi-Cal?
eligibility for Medi-Cal. For new Medi-Cal applications only, current asset limits are $130,000 for one person and $65,000 for each additional household member, up to 10. Starting on January 1, 2024, Medi-Cal applications will no longer ask for asset information.
Do I have to pay back Medi-Cal?
The Medi-Cal program must seek repayment from the estates of certain deceased Medi-Cal beneficiaries. Repayment only applies to benefits received by these beneficiaries on or after their 55th birthday and those who owned assets at the time of death.
Is Medi-Cal for poor?
Medi-Cal provides comprehensive health coverage for children and families. Depending on income and family size, you and your family may be eligible to free or low-cost Medi-Cal. Your income must be within the limits for the appropriate family size based on the Federal Poverty Levels (FPL).