This policy note explores disparities in access to pediatric subspecialty care in California by insurance coverage, geographic location, race/ethnicity, and language. Using the available literature and interviews with stakeholders, it identifies barriers to access, which include a potential shortage of trained pediatric subspecialists, gaps in care delivery, low reimbursement rates and payment levels, and lack of care integration. Innovative care delivery models for improving the capacity of pediatric subspecialty care, including expanded use of technology, team models of care, and standard care processes, are also examined.

Among the recommendations proposed to ensure adequate access to pediatric subspecialty care: increase the number of pediatricians specializing in pediatric subspecialties; address payment and reimbursement issues that impede the access of children with special health care needs (CSHCN) to pediatric subspecialty care; increase the capacity of pediatric subspecialists by better utilizing physician extenders and general pediatricians; improve access to telehealth services for pediatric subspecialty providers; improve the availability of pediatric subspecialty services to underserved populations; improve communication between general pediatricians and providers; develop benchmarks and collect accurate data on workforce supply; and assess the standards of care available to CSHCN in California.

Nine out of 10 Californians under the age of 65 will be enrolled in health insurance programs as a result of the Patient Protection and Affordable Care Act (ACA), according to a joint study by the UC Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research.

The Affordable Care Act (ACA) will significantly expand access to affordable health coverage in California starting in 2014. Californians with the lowest incomes will have access to coverage under the expansion of Medi-Cal, while millions of low- and middle-income families will be eligible for subsidies through the California Health Benefit Exchange (the Exchange). Demand for health insurance in the state will also increase as a result of the minimum coverage requirement.

The level of enrollment in the new and expanded programs and the resulting share of Californians who gain coverage under the ACA will depend on a range of factors, including the ease of enrollment and retention, outreach strategies, and language accessibility. 

We used the California Simulation of Insurance Markets (CalSIM) model, version 1.7, to predict changes in health coverage in California under the ACA using two  scenarios: one based on typical responses by individuals and employers to expanded coverage offerings (the “base” scenario) and another based on a more robust enrollment and retention strategy planned by state coverage programs (the “enhanced” scenario). 

Based on the results of our CalSIM model, we estimate that in 2019, after the ACA is fully implemented:

Between 89 and 92 percent of Californians under the age of 65 will have health coverage, compared to 84 percent without the law.

Between 1.8 and 2.1 million Californians will enroll in subsidized coverage in the California Health Benefit Exchange.

Between 1.2 and 1.6 million individuals will be newly enrolled in Medi-Cal.

Between 3 and just under 4 million Californians will remain uninsured,1 million of whom will not be eligible for coverage due to immigration status.

Under our enhanced scenario, we assume that greater enrollment in Medi-Cal and the California Health Benefit Exchange could be achieved through many factors,including:

Simplified enrollment and redetermination processes and systems; Robust outreach and education; Culturally competent and linguistically appropriate outreach and enrollment assistance; Pre-enrollment from existing health and human service programs; and Use of institutional connections to reach individuals in life transitions to maximize seamless coverage.

Between 1.2 and 1.6 million more Californians are predicted to be enrolled in Medi-Cal in 2019 than otherwise would have been under current law

Language barriers could deter more than 100,000 Californians from enrolling in the state’s Health Benefit Exchange. The study recommendations include investing in linguistically and culturally appropriate marketing and outreach as well as investing in primary care and workforce diversity in underserved areas, among other actions.