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In summary
The student loan repayment program that risks being cut from the California budget is funded by Proposition 56, a tobacco tax approved by voters in 2016.
San Bernardino County is home to Dr. Brian Savino. It is also an area of California with a pressing need for medical providers. Savino, an emergency room doctor, would love to serve the place where he grew up for as long as he can.
But owing about $ 200,000 in student debt is a heavy burden – that’s a payment of $ 3,200 per month, he said. Seeking relief, he applied this year to a new state loan repayment program for doctors and dentists.
Now, the future of the program, he said, would provide it with the financial security to work with underserved populations is hanging in this week’s budget negotiations between the governor and the legislature. Governor Gavin Newsom’s May Budget Revision Eliminates Funding CalHealthCares Program unless the federal government helps; the Legislative version of the budget rejects this reduction, keeping the program intact regardless of federal funding.
Under the program, each beneficiary receives up to $ 300,000 in loan repayment in exchange for five years of service. To qualify, providers must maintain a workload in which at least 30% of their patients are on Medi-Cal, the state’s version of Medicaid. Savino estimates that his Medi-Cal workload is already close to 40%.
During recent budget discussions, many lawmakers, Democrats and Republicans were quick to argue that during a pandemic, the state should not make cuts to health care. And that should especially not eliminate efforts to improve supplier access, a persistent problem in many parts of the state, said assemblyman Jim Wood, a Democrat from Healdsburg.
“We’re just getting to the point where we are rebuilding this network of providers to provide services to people,” Wood said at a hearing on May 19. “And now we’re going to literally pull the rug out of that, and we’re going to decimate our supplier network.”
Legislative Assembly budget plan released last week also rejects Newsom’s proposed cuts optional Medi-Cal benefits, such as some adult dental services, eyeglasses, diabetes, and hearing tests. Lawmakers and Newsom must reach a budget deal before the June 15 deadline, in which they will have to decide where they can afford to make cuts.
CalHealthCares is funded by Proposition 56, a tobacco tax approved by voters in 2016. In addition to the loan program, the tax also funds additional payments for physicians, dentists and other healthcare professionals who provide certain services to Medi-Cal patients. Newsom budget would displace $ 1.2 billion in revenue from the Prop. 56 from funding these efforts to instead fund the increased costs of the Medi-Cal program.
The revised budget assumes 14.5 million people will be on the Medi-Cal list by July 2020 – the highest on record, and about 2 million more than December 2019 due to the coronavirus-induced recession.
The governor’s budget, however, leaves in place $ 67 million of the Prop. 56 that would allow certain things to continue, such as the completion of the loan repayment promise for the first group of dentists and doctors.
In the spring of 2019, the state announced the first group of providers who would obtain repayment of their loans under this program: 240 doctors and 38 dentists. The average debt of the first recipients of the program was $ 396,768.
While Newsom’s May budget would honor 2019 recipients with their five-year service obligation, this year’s pool of applicants – more than 1,000 vendors, including Savino, who were supposed to know last month whether they were selected – are now pending.
“Once you graduate from medical school and look at your personal bet, you have to decide, ‘Am I going to take my call and go to these underprivileged populations, or go somewhere where I can get that debt paid off?” Because it’s stuffy, ”Savino said.
Historically, Medi-Cal’s reimbursement rates have been significantly lower than those paid by Medicare or private insurance. Doctors have long blamed these low rates for preventing them from participating in Medi-Cal.
The loan repayment program also aims to help solve the overall problem of the state shortage of doctors, mentionned Lupe Alonzo-Diaz, president and CEO of Physicians for a Healthy California, which administers CalHealthCares.
For example, by 2030, California will need about 10,500 additional primary care physicians to adequately serve the state’s population, according to a 2017 study by the University of California, San Francisco. The greatest shortages are expected in the state’s central valley, near the southern border and on the central coast, according to the study.
“Then you add to that the very specific challenges that medically underserved communities can face, especially communities of color,” she said.
And it’s not just about adding more doctors, she said, but also that providers are diverse and go to areas that need them.
Many times, she added, providers who grow up in underserved areas want to come back and work with people in Medi-Cal.
Dr. David Benavidez, originally from California, was first told about the state’s loan repayment program while in Alabama, where he completed his residency. “I thought to myself, ‘How cool would it be to serve the people I was a part of over 20 years ago? “, He said. “I was raised by a single mother; she raised four of us and we were on Medi-Cal.
Benavidez, a child and adolescent psychiatrist, is one of last year’s CalHealthCare beneficiaries. He primarily sees Medi-Cal patients in Fresno County. With about $ 350,000 in student debt, the only reason he can afford to see low-income patients is because of the scholarship, he said.
Marc Bernardo, a dentist who works in Riverside and San Bernardino counties, said worrying less about money and more about his job allowed him to really focus on the most vulnerable patients. Like Benavidez, he is among the first group of providers whose loans are expected to be repaid.
He works part-time in his family’s dental office and the other half of his week is spent providing dental services to people with developmental disabilities. These are people who cannot physically go to a dental office, so Bernardo goes to their home.
“It is important to serve not only those who are in the lowest income brackets, but also those who have a disability, who are not even earning,” said Bernardo. “I think it’s a large population that is being overlooked.”
He estimates that nearly 70% of all his patients are on Medi-Cal, he said.
Eliminating this program at such an early stage ultimately hurts patients, Savino said, and is a step backwards on the governor’s promise to create a “healthier California.”
“The doctors will be fine. We are some of the most privileged people and we will find a place to support ourselves, ”said Savino. “I think the focus here is on the vulnerable populations who depend on Medi-Cal. It makes very little difference if you have Medi-Cal, but you cannot see a doctor.
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