Primary care access to new patient appointments for california medicaid enrollees: A simulated patient study

Joy Melnikow, Ethan Evans, Guibo Xing, Shauna Durbin, Dominique Ritley, Brock Daniels, Lindsey Woodworth

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


PURPOSE We undertook a study to evaluate variation in the availability of primary care new patient appointments for Medi-Cal (California Medicaid) enrollees in Northern California, and its relationship to emergency department (ED) use after Medicaid expansion. METHODS We placed simulated calls by purported Medi-Cal enrollees to 581 primary care clinicians (PCCs) listed as accepting new patients in online directories of Medi-Cal managed care plans. Data from the California Health Interview Survey, Medi-Cal enrollment reports, and California hospital discharge records were used in analyses. We developed multilevel, mixed-effect models to evaluate variation in appointment access. Multiple linear regression was used to examine the relationship between primary care access and ED use by county. RESULTS Availability of PCC new patient appointments to Medi-Cal enrollees lacking a PCC varied significantly across counties in the multilevel model, ranging from 77 enrollees (95% CI, 70-81) to 472 enrollees (95% CI, 378-628) per each available new patient appointment. Just 19% of PCCs had available appointments within the state-mandated 10 business days. Clinicians at Federally Qualified Health Centers had higher availability of new patient appointments (rate ratio = 1.56; 95% CI, 1.24-1.97). Counties with poorer PCC access had higher ED use by Medi-Cal enrollees. CONCLUSIONS In contrast to findings from other states, access to primary care in Northern California was limited for new patient Medi-Cal enrollees and varied across counties, despite standard statewide reimbursement rates. Counties with more limited access to primary care new patient appointments had higher ED use by Medi-Cal enrollees.

Original languageEnglish (US)
Pages (from-to)210-217
Number of pages8
JournalAnnals of Family Medicine
Issue number3
StatePublished - May 1 2020


  • Barriers
  • Health
  • Health services accessibility
  • Insurance
  • Medicaid expansion
  • National health insurance
  • Patient Protection and Affordable Care Act
  • Practice-based research
  • Primary care access
  • Secret shopper
  • Simulated patient
  • United States
  • Vulnerable populations

ASJC Scopus subject areas

  • Family Practice


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