Obamacare: Massive backlog stalls Medi-Cal expansion

San Jose Mercury News by Helen Shen –

June 28, 2014:

A mountainous backlog of Medi-Cal applications is well into its third month, but California officials have provided little information about how and when the largest such bottleneck in the nation might be cleared.

The California Department of Health Care Services first reported 800,000 pending applications in April. A month later, that number had grown by 100,000 and has not budged much since.

As the state works through older applications, new ones continue each day to enter the system, which has been plagued by computer glitches and inefficient procedures for verifying applicants’ personal information.

There are no estimates of processing times or how long delays will persist, though a state official said earlier this month that new applications appear to have slowed. “All the resources are just devoted to getting people moving forward,” said Norman Williams, a department spokesman.

Not only has application processing been delayed, the state has also fallen behind in sending final notifications to enrollees, officials confirmed.

Meanwhile, many low-income people who qualify for Medi-Cal are showing up at community clinics and costly emergency rooms as they have in the past. Others are putting off care.

Although Medi-Cal coverage is retroactive from the time eligible patients apply, some patients don’t know about the rule or simply don’t trust they will be covered until they have a card in hand.

“They’re afraid they may not be approved and that they’ll be stuck with this huge bill,” said Irais Bazan, an enrollment and eligibility manager at Ravenswood Family Health Center in East Palo Alto.

Part of the delays can be attributed to high demand. In California, as in many of the 26 states that opted to expand Medicaid eligibility under the Affordable Care Act, people turned out in much higher numbers than projected. The state health department said it now expects 2.2 million people to enroll in Medi-Cal by next month — 300,000 more than estimated last fall.

Roughly 1.4 million of those applicants were newly eligible for Medi-Cal, which was expanded under the Affordable Care Act, commonly called Obamacare, to serve people who earn up to 138 percent of the federal poverty level. About 600,000 more were previously eligible for coverage but had not enrolled. Experts say the massive outreach campaigns across the country helped alert many of these people to their eligibility.

Adolfo Rodriguez, 35, of East Palo Alto, said his Medi-Cal application has been pending since March. Unaware of retroactive payment options when he visited the county hospital in San Mateo two months ago, he borrowed money from his brother to pay off the $1,400 bill–much larger than he had expected.

He could not afford the pain medications that the doctor prescribed, still does not have a diagnosis and can’t return to work as a truck driver until his condition is fully treated.

“I’m afraid to go (back) to the hospital,” Rodriguez said. “I can’t afford it.”
Since last fall, 40 percent more people have signed up for Medi-Cal than the number who enrolled in private insurance plans through Covered California, the state’s health insurance exchange.

State health officials say about half of the 900,000 pending applications have been filed within the past 45 days — the maximum processing period typically allowed by law. Little is known about the other half, and why they have exceeded this time window.

“It’s difficult to determine exactly who is in that 900,000 and for what reason,” said Williams, the health department spokesman.

Although California experienced an initial swell of applications in December, a second, massive wave of Medi-Cal applications landed in March, as people scrambled to meet the original March 31 health law deadline (eventually extended to April 15) for obtaining insurance coverage.

“We did not anticipate the surge in applications to this extent,” said Anastasia Dodson, associate director of policy at the California Department of Health Care Services.

One problem was delayed development of a digital interface that would connect the state’s new system with old county-based social services computer systems for verifying Medi-Cal eligibility. Some people were able to sign up smoothly by applying in-person at county health departments. But many applications submitted through the state website stalled.

Some have been delayed by missing or inaccurate information. Others were slowed by outdated procedures for verifying residency.

Critics say that launching the Covered California insurance exchange was made a higher priority than improving the online enrollment process for Medi-Cal patients, despite their great numbers.

“In a very short period of time, there was a lot of work to do, and I think the folks that make the priorities decided that the particular piece for Medi-Cal recipients could wait,” said Frank Mecca, executive director of the County Welfare Directors Association of California.

Although open enrollment for private insurance plans closed in mid-April, Medi-Cal enrollment remains open year-round, leaving little breathing room for health officials.

The holdup in Medi-Cal approvals has led to financial uncertainty for many of California’s community health clinics, which depend on Medi-Cal payments to supplement the reduced fees or fee waivers they accept from low-income, uninsured patients.

“We basically don’t know if we’re going to be receiving payment for the services we’re providing,” said Carmela Castellano-Garcia, chief executive of the California Primary Care Association, which represents more than 1,000 community clinics and health centers.