Timely Access & Network Adequacy
Access to Care at the Right Time and Place
Affordable coverage is a key entry point to the health care system, but coverage is just the first step to getting the care you need. Getting care at the right time and place, and using that care wisely: That’s the hard part. Whether new to coverage or already covered through a group or “grandfathered” plan, many Californians would benefit from additional consumer protections and transparency initiatives. As a lead voice for health care consumers, Health Access develops and advocates for various proposals designed to give consumers confidence in their care and coverage. Thanks to the ACA and California’s commitment to full implementation, most Californians can get access to affordable insurance. But does that insurance give people the care they need when they need it? Does it provide financial security and access to necessary care that is safe and cost effective? Not yet.
- Timely access to care adequate networks of providers. Whether you have Medi-Cal managed care, a subsidized plan through Covered California or coverage through your job, your coverage won’t do you much good if the wait time to see a doctor stretches into weeks or months, or if you must drive a long distance to the hospital or primary care clinic. Where there are strong protections in place (like timely access standards or geographic access standards), those protections need to be fully enforced. But for too many issues, the current standards fall short and additional oversight of health plans is needed whether through legislation, regulation, investigation, or standards imposed by Medi-Cal or Covered California contracts. While “narrow networks” aren’t necessarily a problem for consumers, especially if integrated with a robust medical home care delivery model, their prevalence in the newly reformed individual market makes the need for vigilance on these protections even more urgent.
- For those enrolled in Medi-Cal, especially those in fee-for-service plans outside a managed care plan, reimbursement rates are some of the lowest in the nation. We should pursue targeted rate increases tied to improved access.
Health Access Analysis
- SB 1135 (Monning) Consumers Deserve to Know Rights: Where to Complain, Timely Access, Language Access. A Health Access fact sheet (March 2016).
- SB137 Accurate Provider Directories (April 2015). A Health Access, Consumers Union and California Pan-Ethnic Health Network fact sheet.
- Networks: What Do Health Consumers Care About? (March 2015). A Health Access powerpoint presentation.
- About Time: The Story on Winning Timely Access to Health Care (January 2010)
- California Consumer Update: New Rights to Timely Access to Care (January 2010)
- Timely Access: California Consumer Update (January 2010)
- Timely Access Back Story (January 2010)