I spend the majority of my time (and space) writing about the new state health insurance exchange, Covered California.
But the behemoth in California’s Affordable Care Act implementation is Medi-Cal, the state’s decades-old version of the federal Medicaid program, which provides publicly funded insurance to low-income residents.
About 12 million Californians are in Medi-Cal now. That’s roughly one in three state residents. By comparison, about 1.4 million Californians are enrolled in Covered California.
Given its size, Medi-Cal’s annual renewal process is now one of its greatest challenges.
This year, Medi-Cal has changed the process again. Already, people are complaining that they’re getting dropped when they shouldn’t be.
Under the new rules, individuals and families earning up to 138% of the federal poverty level can qualify. This year, that equates to about $16,200 for a single adult.
When Gong received the letter in late January saying he was going to be dropped, he began a month-long quest to get reinstated.
He submitted his renewal materials, which is allowed within a grace period. But in response, he received another termination letter in mid-February saying that he can’t be in Medi-Cal because he’s not a California resident.
(Whether or not you think Oakland belongs in California, it is generally accepted to be within our borders.)
At that point, he and his mother, Judyth Collin, made dozens of unanswered calls to county workers, (county workers process Medi-Cal applications and determine eligibility) and visited county offices.
Finally, Collin reached a supervisor by phone who helped Gong get back on Medi-Cal in early March, she says.
Gong’s problems aren’t isolated.
“We’re hearing from people who have been cut off who have turned in their forms,” says Jen Flory, senior attorney at the Western Center on Law and Poverty. “And we’re hearing from people who are trying to contact their county workers and are having trouble getting through.”
Theoretically, this year’s renewal process should be easier than last year’s. If you enrolled in Medi-Cal or completed renewal forms last year and your county can determine that your eligibility hasn’t changed, you should receive a letter this year confirming your enrollment for another year.
“For the first time, we’re not sending out an enormous blank packet for people to fill out,” says Cathy Senderling-McDonald, deputy executive director of the County Welfare Directors Association.
Some people may not qualify for auto-renewal and will receive a notice that requests additional information, such as proof of income or state residency. If you receive that, you will have at least 30 days to respond, she says.
Roughly 1 million Californians will be asked to renew each month, according to the state Department of Health Care Services, which administers Medi-Cal at the state level.
The stakes are high, but it’s hard to gauge the impact because Medi-Cal officials decline to say how many people have been dropped from the program as a result of the renewal process this year and last.
“These data are not available currently,” says Tony Cava of DHCS.
Here’s my advice: If you’re in Gong’s situation and get a termination notice because you didn’t submit renewal information — whether or not it was your fault — get the paperwork in as soon as possible.
You have 90 days from the date of termination to submit that information. If you do and you’re still eligible for the program, you will be reinstated retroactive to the date you were kicked out, Flory says.
Next, reach out to your county case worker. I know, easier said than done.
The roughly 15,000 county workers dedicated to Medi-Cal are overwhelmed. They’re juggling an onslaught of new applications, the renewal process (some of last year’s load was pushed into this year), plus persistent computer problems.
For instance, the state computer system won’t allow county workers to deny applications themselves or drop people who are ineligible, Senderling-McDonald says. Which leads to backlogs and mistakes.
“There’s a lot of manual work that counties are still doing to get around the issues in the computer system,” she says.
But there’s hope. The state is working on the technical problems. By July, county workers are scheduled to have the ability to deny applications on their own, Senderling-McDonald says.
There’s also $150 million in the current-year state budget to beef up county Medi-Cal resources, including money for overtime pay, she says.
Until things get better:
• Don’t ignore letters you receive from Medi-Cal. Because the forms are changing, your annual renewal probably won’t look like it has in the past.
• Ask for a supervisor if you’re having trouble reaching someone at your county human services agency. Be persistent.
• Request an eligibility hearing by calling (800) 952-5253 if you receive a notice that you’ll be losing your benefits. Doing this will flag your case for attention and it may get resolved before your hearing date.