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Impatient helps man mistakenly enrolled in Medi-Cal get his private plan back



Photo by 401(K) 2012 via Flickr Creative Commons

About two weeks ago, we received a note from a man who was fed up with fighting for his health insurance.

"Elliot" — he asked that we not use his real name for privacy reasons — had been uninsured for several years before the Affordable Care Act was enacted. He couldn't find an affordable plan because of a pre-existing condition (high blood pressure). So, he says, he was thrilled to be able to buy insurance through Covered California, and was satisfied with the private plan he purchased for 2014.

But when Elliot tried to renew his coverage for this year, he hit a roadblock: He received a letter from Covered California, stating that his income level disqualified him for a plan on the exchange. It said he should contact Medi-Cal instead.

Elliot wrote to us:

"What was especially odd about this confusing letter was that my income (which, granted, had been near, though not below, the [$16,105 for an individual] threshold for Covered CA) had actually increased since 2014. That being the case, how could I be deemed eligible for Covered CA in 2014 and then ineligible in 2015?"

Labyrinth of bureaucracy

He became mired in the labyrinth of insurance bureaucracy: He called Covered California, where a representative referred him to Medi-Cal. After weeks passed with no response, he called, wrote, faxed and emailed Covered California.

The response? Crickets.

Finally, he writes, he received 11 letters in one day:

"Each letter said the same thing (I opened four of them and left the rest unopened): I did not qualify for Covered CA because of my income level. If I disagreed with the Covered CA assessment, the letters said, I could always go before a judge and plead my case. (That is so NOT going to happen!)"

At that point, Elliot says, he gave up fighting. He writes:

"Since that time, I have received a Medi-Cal card and am now officially part of that program, much to my displeasure. Despite my repeated efforts, I never did find out why Covered CA determined that my income was insufficient for participation in their program. I'm frustrated, angry, tired, and--most of all--extremely doubtful about a program for which I was once grateful and to which I once lent my wholehearted support."

He clarifies that while Medi-Cal is an important resource, he believes the system is already strained by people who truly need it, and "I wanted to reduce my burden on the state." 

At that point, Elliot found this story by my colleague Stephanie O’Neill, about people being switched from private health plans to Medi-Cal, sometimes mistakenly. He shared his experience with her, and she passed it on to me.

So I decided to contact Covered California on Elliot's behalf and try to find out what had gone wrong.

A magic wand?

Last Wednesday, I contacted the Covered California media office. I reached a spokesman, and mentioned that I would be reporting on why Elliot had been switched from his health plan, and what he'd need to do to resolve the situation.

The spokesman took down Elliot's name, and said he'd look into it.

Given how long Elliot had been fighting his case alone, I thought this would be the beginning of a long journey. So imagine my surprise when Elliot wrote to me the following day: "You didn't tell me you had a magic wand, but you certainly must!"

It turns out that after I called, a Covered California representative called Elliot, discussed his case and re-enrolled him in the same plan he had last year, retroactive to the beginning of this month.

What happened?

So what happened? We're still trying to figure that out.

Elliot heard one explanation from the Covered California representative who called him: He says she told him there was "clearly a glitch in the system" that had incorrectly listed his projected income for 2015. "Whether this inaccuracy stemmed from a clerical or software problem is currently unknown," he writes to me.

I heard something different when I contacted Covered California. Spokesman Dana Howard says he isn't familiar with Elliot's individual case, but he explains that if IRS data show a person's income is close to the Medi-Cal threshold, Covered California will "often" place that individual in Medi-Cal to ensure he receives "the most affordable" care.

Elliot, though, says he'd rather shoulder some of the cost of his care, and writes:

"Strange to think that something as minor as a Covered California system glitch could have undermined my best intentions. And how miraculous to discover, after all is said and done, that the power of the press can make things right again!"

If you believe you were mistakenly moved from a Covered California plan to Medi-Cal, or if you've encountered any other problems with your insurance, let us know in the comments section below or e-mail us at Impatient@scpr.org.