---

That trend is having a dramatic impact on the region’s health care landscape, with the few hospitals and clinics that do accept Medi-Cal feeling the strain of new patients.

Community Regional Medical Center (CRMC) in Downtown Fresno recently saw its one-millionth emergency room patient come through its doors, emphasizing the steady increase in patients seen over the last few years. The hospital currently treats an average of 355 patients a day through its emergency department, which was expanded to roughly the size of a football field in 2007.

Hospital staff attributes the increase to the recent surge in Medi-Cal patients resulting from the Affordable Care Act’s expansion of coverage. According to a statement from the hospital, CRMC now has more inpatient Medi-Cal discharges than any other hospital in California.

“Medi-Cal patients are always the highest utilizers of emergency departments,” said Dr. Gene Kallsen, a UCSF Fresno clinical professor of emergency medicine with privileges at CRMC. “There are not enough doctors accepting Medi-Cal for those patients to go somewhere else. Or they have a doctor who accepts Medi-Cal, but they can never get to them on short notice when they need to get to them.”

That population is expected to continue to grow as local health groups hosting enrollment events report hearing from many new Medi-Cal patients.

Nonprofit health care group Clinica Sierra Vista has hosted two major enrollment events since the current period began in November. The enrollment days were in addition to the organization’s weekly counseling hours, and administrators say they will host two more last-minute events during the final weekend of January.

So far this year, 75 percent of those seeking enrollment assistance from the group have been first-time enrollees. Nearly 85 percent of those patients have opted for Medi-Cal enrollment, said Melissa Reyna, outreach enrollment program manager with Clinica Sierra Vista.

“We also anticipate that we will see more interest from residents at the end of the period since people are sometimes busy with the holidays or they might be weighing their options before making a decision,” she said.

Clinica Sierra Vista has nine health care clinics in Fresno County and helped to enroll 5,900 residents during the last Covered California open enrollment period. The number of patients interested in Medi-Cal has continued to increase each year and Reyna said the group is hearing from many residents who have discovered they are newly eligible.

Both Medi-Cal and Covered California’s health insurance plans are promoted during open enrollment, but only Medi-Cal remains available to residents all year. Covered California plans close to most patients in February, with special enrollment periods remaining open for a select group of patients. Those who have experienced a major life event, like marriage, childbirth, or loss of insurance, can still register during the additional insurance windows, Reyna said.

Locally, Covered California plan options remain limited, with Kaiser Permanente Fresno serving as one of the main health care providers. The hospital saw more than 8,000 unique Covered California patients between June 1, 2014 and June 30, 2015, according to a report released earlier this month by the state health care exchange.

During that time period, only 542 Covered California patients were reported using the facility’s emergency department. The majority was instead shown to be taking advantage of the hospital’s outpatient services and follow-up care.

With more patients signing up for Medi-Cal compared to Covered California, similar infrastructure will need to be built to keep up with demand.

Over the last two open enrollment periods, more than 40,000 Central Valley residents signed up for a Covered California plan compared to the 42,000-plus residents enrolling in Medi-Cal in Fresno County alone. That Medi-Cal figure also only represents the 11-month period between December 2014 and November 2015 — the most recent available month of data from the California Department of Health Care Services.   

While enrollment figures remain highest in Fresno County, a majority of the region’s newly insured patients are believed to live in the Valley’s rural communities. To help meet them closer to home, Community Medical Center announced a new partnership with Adventist Health’s Central Valley Network in December.

The relationship has created a new managed Medi-Cal health plan, which was made available to Kings County residents at the start of this month. The plan is equally financed, jointly owned and operated collaboratively between the two health care groups.

Over the next few years, the health plan will be made available to Medi-Cal patients throughout the surrounding counties and will allow patients to receive treatment from both Adventist and CMC physicians, thereby relieving some pressure on local emergency rooms.