Valley patients caught in Medi-Cal enrollment backlog

07/22/2014 10:29 PM

07/22/2014 10:31 PM

More than 25,000 people in the San Joaquin Valley, including Merced residents, are caught in a statewide backlog of unprocessed Medi-Cal applications that officials are working to resolve in the next six weeks.

The applications have been stuck, in many cases for months, and the wait for Medi-Cal cards “is screwing up access to care” for thousands, said Stephen Schilling, chief executive officer of Clinica Sierra Vista, an organization that runs community health centers in Fresno and Bakersfield.

The state says it has a plan to reduce the backlog and county human services directors say they’re working as fast as they can to get Medi-Cal applications processed.

The enrollment bottleneck could have been avoided if the state had taken the advice of county directors, said Peggy Montgomery, director of the Kings County Human Services Agency.

County directors wanted Medi-Cal applications to be kept out of CalHEERS, a super-computer system developed for Covered California, the state’s health benefit exchange under the federal Affordable Care Act. “Unfortunately,” Montgomery said, “they did not listen to us.”

The new system had glitches from the first applications last October. But the volume of applications, both Medi-Cal and Covered California, repeatedly overloaded its capacity.

Last month, the Merced County Human Services Agency reported that 17,400 referrals had been forwarded to HSA from Covered California, but issues with CalHEERS had hindered the referral process.

Thousands of Californians rushed to meet a March 31 enrollment deadline for Covered California health plans to avoid tax penalties that face the uninsured in 2014. At the same time, thousands of people were newly eligible for Medi-Cal under an expansion of the state-federal insurance for low-income people that allowed poor, childless adults to have coverage for the first time.

After the enrollment deadline, Merced County HSA found itself still processing applications filed last October.

By April, the statewide backlog of pending Medi-Cal applications reached 900,000. As of this week, the number had been whittled to about 600,000. According to a state plan, the backlog should be cut to 350,000 by Sept. 1.

In the Valley, Merced has 6,056 applications pending and Fresno County has about 10,500. Tulare County has about 5,800, Madera more than 2,700 and Kings County has 579.

According to federal and state guidelines, processing Medi-Cal applications generally should be completed within 45 days of receipt.

Now, applications get stuck in the CalHEERS system, “even though it’s clear and we know they’re eligible,” Montgomery said.

According to Corrina Brown, family services program manager at Merced County HSA, the state has eased up on some of the other requirements and renewals to free additional staff and resources to get the pending applications processed.

Brown said the goal is to complete processing pending applications by October.

“It’s an ambitious goal, but we’re fighting against a system that is flawed,” Brown said. “We spend many hours troubleshooting to ensure we arrive to the correct eligibility determination.”

Brown said that Merced County’spending applications include duplicates of people who were put in the system by the state or people who already have Medi-Cal.

“We want people to know that our staff is working to reach our goal of helping families,” Brown said.

On Monday, the California Department of Health Care Services, which oversees Medi-Cal, submitted a plan to the federal government’s Center for Medicare and Medicaid Services that outlines fixes to address system issues, including the problem of duplicate applications.

“We’ve just been putting a lot of resources and energy into this,” said Norman Williams, a spokesman for the department. “We’ve gone into the field to understand the issues they’re facing at the ground level. We have teams dedicated to working on the technology and we’re making progress.”

The goal, Williams said, is to reach “a level where virtually everyone is within that 45-day (enrollment) period.”

Patients who are stuck waiting for Medi-Cal cards are anxious.

Irving Toscano, 21, of Fresno, applied for Medi-Cal at a Clinica Sierra Vista health center in March. He’s still waiting for the card to arrive in his mailbox, he said Thursday.

Toscano, a security officer, said he’s healthy and hasn’t needed to use Medi-Cal, but “in case of an emergency, accident of something, I’m nervous or scared that I won’t be able to pay the bills because I won’t have insurance; I won’t be covered.”

Health center officials said enrollment delays are making it difficult for patients who have health problems to get appointments with medical specialists.

“The specialist will not see the patient until they have active coverage,” said Gloria Madrigal at United Health Centers of the San Joaquin Valley.

Williams said patients with immediate health needs should go to a hospital.

They also can call or go to county Medi-Cal offices for help with their applications. “It’s not the best solution,” he said, but the state is addressing the backlog of applications. “We want to improve this and move as quickly as possible.”

Williams said 2.2 million Californians have been enrolled in Medi-Cal since October, bringing the state caseload to 10.9 million.

County health directors have seen unprecedented enrollment increases.

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