Low-income children in rural California communities are in jeopardy of losing their doctors and health care plans under Gov. Jerry Brown's budget proposal, according to state lawmakers, doctors and health advocates.

The governor is proposing to transfer nearly 900,000 children enrolled in Healthy Families, the state's Children's Health Insurance Program, to Medi-Cal -- a program aimed at serving the state's poorest families, seniors and disabled residents.

While combining the two programs might be a painless transition for children in urban areas with doctors who typically provide care to both Healthy Families and Medi-Cal patients, the transfer could severely limit access to health care for those on the outskirts.

"In the more rural areas or outlying areas, there would be quite a loss or quite a strain," said Stuart Cohen, a San Diego pediatrician and California chairman-elect for the American Academy of Pediatrics. "Access to care would be a huge issue."

And there would not be much incentive for rural doctors at full capacity to continue caring for their Healthy Families children if they have not already agreed to serve Medi-Cal patients, Cohen said.

The governor's proposal not only forces Healthy Families patients to move to Medi-Cal, but it also would require doctors to accept Medi-Cal's monthly reimbursement -- an average cut of nearly 20%.

Healthy Families doctors receive a monthly average of $103 per patient. They would receive an average of $84 per patient if they decide to make the switch to Medi-Cal, but California Medical Association spokeswoman Molly Weedn said the reimbursement often can be much less.

"Rates that physicians are reimbursed for a Medi-Cal patient are less than what a large pizza costs," she said. "It's really incredible that a physician can be reimbursed $18, $20 [per month]."

A survey referenced by the Legislative Analyst's Office asked pediatricians who now provide care to Healthy Families patients, but not Medi-Cal patients, if they would be willing to make the switch. The February report said 29% would not and 46% were not sure.

Anthony Wright, executive director at Health Access California, a health care advocacy group, said there likely would be a disruption of care for Healthy Families patients in rural areas when their doctors face the decision of whether they can accept a smaller payment.

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State budget puts health care for kids at risk