Another in a series of Q&A columns answering consumers’ questions about the Affordable Care Act.
State officials have used those phrases since last year to describe the new, easier, more efficient Medi-Cal application process.
But something happened between their mouths and reality:
"A hole fell out of the middle of the system," says Jen Flory, senior attorney for the Western Center on Law & Poverty.
Nearly 1 million Californians are now stuck in a monumental backlog of Medi-Cal applications that shows few signs of abating. Some of them applied as soon as enrollment began in October last year.
I hear from them every day. People who have heard nothing for months. People who are sick, need care and don’t know what to do.
In today’s column, I will describe what went wrong with the Medi-Cal expansion and what you can do if you’re still waiting.
Q: I applied for health coverage through Covered California. I filled in the application online and was told I was eligible for Medi-Cal. … After a few weeks with no communication, I called my local office and was told to call back in four weeks. I called back in April, and the lady told me I have been approved but I should call back in May. I called back in May, and the gentleman said my application is still pending. This entire process began on Feb. 3, and we are heading into June. Do you have any advice?
A: Yes, but first a quick refresher:
Medi-Cal is the state’s version of the federal Medicaid program and provides publicly funded insurance to low-income Californians.
Under Obamacare, California expanded the ranks of recipients to include those who earn up to 138 percent of the Federal Poverty Level (about $16,100 for an individual and $27,300 for a family of three) as well as childless adults.
The expansion is expected to push enrollment in Medi-Cal to 30 percent of the state’s population.
Since Oct. 1, when enrollment began, state officials urged Californians who might be eligible for the Medi-Cal expansion to apply via the website for Covered California, the state’s health insurance exchange.
Those who enrolled from October through December were told they could look forward to coverage starting in January. The central website was supposed to be able to determine income eligibility and communicate that to county social service agencies, which do final processing using different computer systems.
Thus the “no-wrong-door” and “one-stop-shop” talk.
Instead of those terms, Flory uses “overwhelming mess,” “fiasco” and “jaw-dropping” to describe what actually happened.
It turns out the Covered California website, which cost $454 million and counting, couldn’t communicate with the county systems for months. The website also had programming defects that caused applications to be wrongly denied and put on hold, says Frank Mecca, executive director of the County Welfare Directors Association of California.
“The plan was that the interface [among the computer systems] would be ready on Oct. 1,” he says. “It wasn’t ready until Jan. 21.”
The outcome? “Most of those applications could not be processed and were essentially stuck there,” he says.
Then, the state got slammed with more applications than expected. As of March 31, 1.9 million people had enrolled in Medi-Cal, compared with the 1.4 million Californians who purchased Covered California plans.
In addition, some people didn’t provide documents that allow the state to verify eligibility, says Tony Cava of the state Department of Health Care Services (DHCS), which administers Medi-Cal.
As a result, a whopping 900,000 Medi-Cal applicants remain stuck in enrollment purgatory. More than half of those applied within the last 45 days, Cava says. By law, applications are supposed to be processed within that timeframe, he says.
There are some steps you can take if your application is stuck or you need care while waiting:
Call or visit your county human services office to kick-start your application. You can find contact information on the DHCS website.
If you need medical care, the county may be able to give you a temporary identification card that will allow you to access services until your enrollment is complete, Cava says.
If you can’t get through to a county worker, and you’ve been waiting for more than 45 days, call the state at 855-795-0634 to request a hearing, Flory says.
Go to the hospital for emergencies, Cava says.
Please note that your eligibility dates back to the month you applied, so you may be able to get paid back for your non-emergency costs, assuming you received care from a doctor or hospital that accepts Medi-Cal patients, Flory says. Emergency care will be covered wherever you receive it, she says.
You also may receive retroactive benefits for the 90 days prior to your application date. But for anyone considered newly eligible under the new Medi-Cal rules, your retroactive coverage cannot predate Jan. 1, Cava says.
Medi-Cal enrollment continues all the time. Given the troubles I’ve just described, you may think it’s not worth applying, even if you think you’re eligible.
But you should.
Just be prepared to wait.
Questions for Emily: AskEmily@usc.edu
Learn more about Emily here.
The CHCF Center for Health Reporting partners with news organizations to cover California health policy. Located at the USC Annenberg School for Communication and Journalism, it is funded by the nonpartisan California HealthCare Foundation.