Dr. Hector Flores Calls for Long-Term Medi-Cal Stability Amid Federal Policy Shifts

Dr. Hector Flores, newly installed president of the Los Angeles County Medical Association (LACMA), discussed the national health policy outlook with Michelle Baass, Director of the California Department of Health Care Services (DHCS), in a conversation moderated by Dr. Toluwalasé A. Ajayi, chair of the American Medical Association Board of Trustees.

The conversation took place at the California Medical Association’s (CMA) annual Medical Group Symposium, where Dr. Flores and Director Baass offered perspectives from the physician and policymaking sides of a challenge familiar to California’s medical community: maintaining access to care amid a rapidly changing federal health policy landscape and significant pressure on Medi-Cal.

For Dr. Flores, these policy debates are grounded in day-to-day clinical reality. Roughly 40% of the patients at his independent practice are covered by Medi-Cal, and his medical group manages its own Independent Practice Association (IPA) giving him a firsthand view of the reimbursement and access challenges facing physicians who care for vulnerable populations.

Barriers to Care for Medically Complex Patients

Access to specialty care remains particularly difficult for medically complex patients. Reimbursement is often inadequate, and not all specialists accept Medi-Cal.

But Dr. Flores says specialists are not to be blamed—they deserve to be compensated fairly for the care they provide. Improving access requires adequately funding Medi-Cal so that physicians and health care organizations can sustainably provide more and better care for patients.

Fee-for-Service vs. Population and Value-Based Care

The discussion also addressed the significant pressures H.R. 1 places on California’s health care budget and the resulting changes to coverage for Medi-Cal members with Unsatisfactory Immigration Status (UIS).

Director Baass discussed the state’s transition of this population from Medi-Cal managed care to a fee-for-service (FFS) model to maintain compliance with H.R. 1. While options are limited in the current environment, Dr. Flores warned that such a transition could have serious consequences for continuity of care.

Maintaining contact with patients is already difficult, particularly when patients move around. Moving away from a managed-care model can make coordinated and preventive care more difficult. Primary care physicians and IPAs depend on eligibility lists they receive from the HMO each month, but if patients move to FFS, it will be hard to find them since many patients frequently change addresses and telephone numbers. Dr. Flores warned that patients may delay seeking treatment until their conditions become more serious, leading not only to worse health outcomes but also to more expensive care.

Telehealth access also presents challenges as California navigates these changes.

Vaccines

Director Baass emphasized that changes to federal vaccine recommendations do not necessarily mean Californians will lose access or coverage. California can continue covering vaccines based on recommendations from state public health authorities and recognized medical organizations, even when federal recommendations change.

The state’s approach is intended to preserve access to vaccines despite shifts in federal health policy.

Coding Challenges

The panel also heard concerns about coding challenges facing FQHCs and other providers navigating Medi-Cal and the new rules to confirm compliance with work requirements.

Dr. Flores, as well as a few audience members, noted the need for some further guidance from the state, while Director Baass said DHCS is working to solidify appropriate codes and clarify the language surrounding them.

Growing Administrative Burden

Audience members also raised concerns about the additional administrative burden physicians and practices may face as H.R. 1 is implemented.

Dr. Flores acknowledged that clinicians should expect “some bumps in the road” as the health care system adjusts to the new environment. He also emphasized the role organizations such as LACMA and CMA can play in helping physicians navigate policy changes and reducing the burden on individual clinicians and practices.

“Medi-Cal Has to Be Fought for Every Year”

Dr. Flores returned repeatedly to a larger challenge facing California health care: the lack of long-term stability surrounding Medi-Cal.

“Medi-Cal has to be fought for every year,” he said. “Medi-Cal has to be negotiated every year.”

Taking it one step further, Dr. Flores called for a longer-term conversation about how California can modernize and stabilize Medi-Cal.

He also urged physicians and health care organizations across the system to share responsibility for caring for Medi-Cal patients rather than simply directing patients toward safety-net providers. Understanding that independent practices experience skyrocketing costs while reimbursement drops, LACMA joined the LA County Safety Net Coalition and supported the successful Measure ER to help fund and coordinate the care of the uninsured. Transparency and collaboration, he argued, are essential to ensuring that no one is caught by surprise.

Ultimately, the case for maintaining access is both human and economic. Ensuring that patients receive appropriate care earlier can prevent conditions from becoming more serious—and more costly to treat.

For Dr. Flores, doing the right thing for patients is also the smart thing to do from a cost perspective.