Snafu keeps thousands of low-income Angelenos out of Medi-Cal

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Several thousand low-income people who were supposed to be switched on January 1st from an L.A. County health plan to Medi-Cal have fallen through the bureaucratic cracks. The county blames differences in personal information kept by the county and the state, and says it has corrected about half of the cases in question.

In the run-up to the Affordable Care Act’s Medicaid expansion, L.A. County received federal funding to get low-income people covered early. Beginning in 2011, it signed more than 300,000 people up for coverage under a program called Healthy Way L.A.

The idea was that once those people became eligible for Medi-Cal on January 1st, 2014, Healthy Way L.A. would end and the county would transition those people onto Medi-Cal.

For most of the participants in the program, the transition went smoothly. But for about 5,000 of them, it didn’t happen, according to the county. Instead, they lost coverage, and for some, that has had serious consequences.

One of them is Yolanda Garate, a diabetic who was not transferred to Medi-Cal on January 1, said her husband, Juan Garate.

"She had a doctor’s appointment but they wouldn’t see her because she didn’t have Medi-Cal," he said. "So she couldn’t get her prescription" for insulin.

Garate said his wife went more than three months without her insulin, causing her health to steadily deteriorate.

Finally, about two weeks ago, an employee at the Garate's clinic, the Eisner Pediatric and Family Medical Center in downtown L.A., called the county and said Yolanda’s case was urgent. A county worker pulled her record and was able to get her Medi-Cal approved, so she finally got her insulin. 

Across L.A. County, community clinics that treat low-income people told KPCC they have had a lot of patients like Yolanda Garate: people who should have been transitioned onto Medi-Cal on Jan. 1, but weren’t.

"It seemed like in the very beginning so many of them were not transitioned," said Olga Duran, director of patient services at Valley Community Clinic in North Hollywood. "It was a high percentage." 

Many of Valley Community Clinic's patients waited weeks or months for their cases to be resolved, said Duran, adding that some are still waiting almost four months later.

"A lot of our patients are chronically ill,"  she said. "They have to have continuity in their medications."

The failure to move Yolanda Garate and other patients onto Medi-Cal grew out of two bureaucracies having different information on the same people, said Tangerine Brigham, the L.A. county official overseeing the transition.

In most cases, the problem was that a last name or a birth date given to the county did not match what the state had on file, said Brigham, director of the office of managed care at the county's Department of Health Services. The state will not switch a person onto Medi-Cal until the information matches up, she said.

"The state is telling us who those individuals are, so we are working to fix the data to move them in," Brigham said.

The county has cleared up about half of the cases, but the process is slow because a county worker has to manually correct each file, she said. In addition, Brigham's staff often has to cross-check information with workers at the county's Department of Public Social Services, and those employees are busy processing roughly 200,000 new applications for Medi-Cal that came in through the state’s insurance marketplace, she noted.

Until everyone is moved onto Medi-Cal, Brigham said she has instructed clinics to contact the county about any patient who has not been switched over and has an urgent medical need. Once contacted, "we can process an application for immediate Medi-Cal," Brigham said.

For non-urgent patients, clinics are adopting different policies. Eisner Medical Center is giving patients a single courtesy visit, said Nelson Samayoa, the employee who helped resolve Yolanda Garate’s case. For subsequent visits, Eisner is charging on a sliding scale. Those who can’t pay have to wait for their Medi-Cal to be approved, Samayoa said.

Clinica Romero in Boyle Heights is developing a similar policy to allow a single courtesy visit for people who lost coverage, said Ingrid Estrada, the clinic's community relations and development director. But until that policy is in place, "we basically have to refer them out and make sure that we’re trying to keep track of them so they can come back as soon as their eligibility is cleared up with the county," Estrada said.

Others, like Valley Community Clinic in North Hollywood, have decided to keep seeing patients even if they can’t pay. The clinic’s Olga Duran said the clinic is hoping to get reimbursed once the patients are finally moved onto Medi-Cal.