I see. You propose the opposite view...that is... with the $1.00/hr. increase in wages and thus too much money to qualify for Medicaid and so now removed from Medicaid. Succintly said...too much money to qualify for Medicaid.
Now off Medicaid, this MAY increase the D.P.C. patient volume if the patients choose to join a D.P.C. practice and can afford it. More than likely, if patient was on Medicaid, then chances are they are way to poor to afford a DPC fee even with $1 dollar more per hour. That's $40.00 more per month. You would have to have a DPC fee of half that for a patient to even consider it.
In other words, if you are poor enough to qualify for Medcaid, chances are you not going to get off Medcaid without a real struggle.
I asked a bus driver in San Diego yesterday...How were you able to get off Medicaid?
Her answer was simple....I wanted more so I found a job.
Once off Medicaid, the patients may choose not to join a DPC (still can't afford it).
But, wage increases are very rare.
More likely, are job layoffs which put people on Medicaid.
So, again, a hybrid DPC/Medicaid has the potential to swing the Medicaid way...and the DPC physician suddenly has more Medicaid patients than planned for.
The California Medicaid patients are for all practical purposes doomed to be on Medcaid because the cost of living is so high and the wages are so low that they really hardly ever get off.
It's better for them if they stay on Medicaid. What they would call a "learned helplessness."
It's not seasonal in Los Angeles or San Diego or Oakland or San Bernardino. That is year round honest to goodness poverty. What they call generational poverty. Or, what my father, an attorney would say..."It's awful tough being born poor."
It may be seasonal in the agricultural city of El Centro but their unemployment rate is 25 PERCENT all the time.
I do not know if one can create a contract with a new DPC patient that would state if you the patient ever found yourself on Medicaid, then I will continue to take care of you as long as you re-join my DPC practice when able to.
This again to me sounds like it might not be legal and could also backfire by the patients being on Medicaid forever and never getting to the point
of rejoining the DPC practice.
These are things to think about.