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. 

Learn more

 Health Access Analysis

Resources for Advocates