Newly eligible stuck in Medi-Cal backlog in Sonoma County

March 10, 2014

Community clinics like Alliance Medical Center in Healdsburg are on the frontlines of the massive reorganization of health care and coverage.

Community clinics like Alliance Medical Center in Healdsburg are on the frontlines of the massive reorganization of health care and coverage.

By Leilani Clark

Late last year, a self-employed Santa Rosa mother found herself navigating the Covered California website in search of affordable health coverage.

After filling in the required information — a frustratingly slow process — she discovered that she and her partner qualified for Medi-Cal, the state’s Medicaid program for low-income residents. The Affordable Care Act, known as Obamacare, allows states to expand Medicaid.

The news turned out to be a blessing and a curse.

“The Covered California site just sort of dropped me off,” said the 39-year-old mother of two who requested that her name be withheld because of the medical details she shared in this story. “They sent my paperwork to the state and then seemed to be expecting that the state would call me. I know from experience that that’s just not going to happen, or it’ll be months.”

About 9,000 Medi-Cal applications from newly eligible Sonoma County residents have not been processed yet, due to the deluge of applications under Obamacare, said Joy Thomas, communications and outreach manager for the Sonoma County Human Services Department.

It’s unclear how long the newly eligible will have to wait for their applications to be processed in the county. The county’s goal is to enroll 75 percent of its 18,000 previously uninsured residents by the end of 2014. An additional 18,000 people who once had private insurance are also now eligible for Medi-Cal in Sonoma County.

According to the California Department of Health Services, Medi-Cal provides services to more than 8 million residents statewide. Under the Obamacare expansion, roughly 1.4 million more state residents have become eligible.

Though the state claims that Medi-Cal is not only easier to qualify for but also comes with an improved, streamlined application process, the Santa Rosa mother said she’s had a different experience. After waiting for a few weeks to hear back about her application, she called the state to find out what was going on. She was told that her family’s information was in the system, but no one knew how long it was going to be before coverage was sorted out, she said.

In the meantime, an emergency medical condition forced the state to expedite her application, and she was assigned to a community clinic. Eight weeks later, in late February, her partner still didn’t have coverage.

Thomas with Sonoma County acknowledges that there is a backlog, as employees deal with the torrent of applications. “We know that there are many people who have applied for Medi-Cal in recent months who are still waiting for their applications to be processed,” she said. “We’ve added a significant number of staff and expanded our service center, which is experiencing a record number of calls. We understand the urgency involved in getting people access to the healthcare they need.”

Health-care reform has opened the Medi-Cal gates to hundreds of thousands of previously uninsured residents in California. Whereas previously one had to be disabled, elderly, pregnant or living in extreme poverty, now all individuals and families at or below 138 percent of the federal poverty level can receive Medi-Cal benefits. That translates to an annual income of $15,856 or less for a single adult, or $32,499 and under for a family of four.

Using the new modified adjusted gross income calculator, an applicant’s property and assets no longer determine eligibility, unless the applicant is over 65, disabled or living in a long-term care facility.

But some California counties were seemingly unprepared for this influx of applicants. Kim Seamans, economic assistance division director for Sonoma County Human Services, is asking people to be patient as the department works through thousands of applications, the largest number ever processed at one time. Even with about 75 new staff members, the system is in overload, she said.

Still, the county is participating in continued outreach, including upcoming Covered California education and enrollment events to reach out to the Spanish-speaking population, a group with lower application numbers so far.

Seamans said the expansion of Medi-Cal is ultimately a good thing for the community. The access to healthcare is “great for people who are eligible, because they’ll be able to choose or be assigned a medical home,” she said. “They’ll get regular treatment for chronic conditions that they couldn’t get access to before. The hope is that the need for emergency care will be reduced.”

That “medical home” — a doctor’s office or clinic where all a patient’s needs are managed in a coordinated fashion– would likely be one of the many community clinics in Sonoma County. Established to serve low-income and uninsured residents, these clinics are on the frontlines of a massive reorganization of health care and coverage. The number of patients at Alliance Medical Center, which has locations in Healdsburg and Windsor, has been growing since early fall when enrollment through Covered California first began, said development director Tresa Thomas Massiongale. Though it has yet to see a tidal wave of new patients, Thomas Massiongale said there has been an “increase in folks accessing care here” and that the center sees new people every day.

“Community health center nurses, dentists and doctors are working at a fever pace all of the time,” she said. What’s more, the work doesn’t stop once someone is enrolled in Medi-Cal. “The distinction is that there is a difference between health care and health-care coverage,” Thomas Massiongale said.

Qualifying for health insurance — which provides access to essential preventative care that can reduce costly health emergencies — is just the first step. After that, the newly insured need to actually step through the doors of the clinic to access that care in a responsible, consistent manner, she said.

Once the state and county get the Santa Rosa mother’s Medi-Cal coverage sorted out, she plans to petition for a return to her Kaiser Permanente doctor, a medical home she trusts. Meanwhile, she’s learning to quiet the voice in the back of her mind that tells her she should feel shame for seeking help from the state.

“I had Medi-Cal when I was 20 and I got really bad care, but I’m smarter now,” she said. “I know that if I get Kaiser they’ll treat me like any other Kaiser patient, so I don’t have to go to the clinic. But there’s definitely a stigma about it, and I feel it.”

This story was produced for the California Health Report in partnership with the North Bay Bohemian. 

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2 Responses to Newly eligible stuck in Medi-Cal backlog in Sonoma County

  1. Pingback: California Health Report: Effects of Health Care Changes on Medi-Cal |

  2. Sobhana

    June 6, 2014 at 1:55 pm

    My two friends applied December 17, and their applications were acknowledged. Still waiting, waiting five months later. Do we need an advocate?

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