Medi-Cal Access Reporting Survey: What's Happening in Your Practice? To Your Patients?

The Medi-Cal Access Reporting Survey is a platform for Medi-Cal providers across the state to voice their concerns about access issues in the Medi-Cal system.

The responses collected in this survey will be used to document and demonstrate network inadequacy and access issues to stakeholders, health plans and the Department of Health Care Services to advocate for access reform.

Return to this form throughout the year to document additional access issues you encounter.

If you have any questions about the survey, please contact Abhinaya at anarayanan@familydocs.org or call (415) 345-8667.

Background Information
Please enter your role, affiliated organization, and specialty below. We encourage you to provide your name, but respect your decision to remain anonymous. If operating out of an FQHC or community clinic, please note the name of the health center.

First Name (optional):

Last Name (optional):

Clinic name (if applicable):

Organization Membership:
Please check all organizations of which you are a member. Member of an organization not listed? Check "Other" and type in the organization's name.

Are you or the clinic with which you are affiliated currently accepting new Medi-Cal patients? *This question is required.

Documentation of Access/Continuity Problems: Complete Section A OR Section B
Complete Section A if you are reporting a specific access/continuity issue or referral problem relating to a patient.
Complete Section B if you are reporting a policy of a managed care plan that is creating access/continuity problems for your patient population.

For each submission, please report the Medi-Cal managed care plan associated with the access/continuity problem if applicable, as well as the city and county where the access issue was experienced.
You can submit responses for both sections and/or submit multiple responses for each section if you have more than one issue to report by clicking the "Add Another" button.

Section A: Patient Access/Continuity Problems

Please DO NOT identify patient's name in accordance with HIPAA privacy regulations.

City

County

Unmet Health Care Need
Please limit your response to 50 words

Date of service (if applicable)

calendar

Continuity, Access, or Referral Problem
Please limit your response to 300 words.

Health Plan (if applicable)

Remove Item

Section B: Plan Policies that Create Barriers to Care

Effect of Medi-Cal/Medicare Payment Parity
The ACA requires state Medicaid agencies to reimburse primary care physicians with a specialty designation of family medicine, general internal medicine or pediatric medicine, at parity with Medicare for specified Evaluation and Management (E&M) and Vaccine Administration services.

If applicable, does the Medi-Cal/Medicare payment parity policy allow you to see more Medi-Cal patients?

Your stories are vital to us ... They will be used to advocate for plan policy change and ensure all Californians have access to the care they need. To better understand these access issues, we would like to contact you to gather additional information through a short interview.

Please indicate below if you or an alternate staff person is willing to be contacted for an interview regarding the access issues described in this survey. *This question is required.

Phone number:
Enter in (xxx) xxx-xxxx format This question requires a valid number format.

Email address: This question requires a valid email address.