The Waiting Room: L.A. County’s Medi-Cal Backlog

April 9, 2014

Marady Preap of Long Beach, proudly displays his new insurance card, though he said the process of getting covered was often confusing. Photo: Jessica Portner

Marady Preap of Long Beach, proudly displays his new insurance card, though he said the process of getting covered was often confusing. Photo: Jessica Portner

By Jessica Portner

As the deluge of applications for Medi-Cal continues to flood into Covered California, local health advocacy groups and providers throughout Los Angeles County say the sizable enrollment backlog is delaying health care services for needy residents.

In L.A. County, 175,000 applications for the Medi-Cal program, which was expanded under the Affordable Care Act, were still being processed as of mid-March, and some were filed as far back as October, according to Katie Murphy of Neighborhood Legal Services of Los Angeles County (NLSLA). In California, 700,000 people are still awaiting enrollment in Medi-Cal, according to the state’s Department of Health Care Services. Covered California doesn’t currently collect data on how many applications statewide are still pending in the private insurance exchange.

“We are building the plane as we fly it, which is funny, but not so funny,” said Murphy of NLSLA. The legal advocacy group currently has 30 hearings underway. One or two new cases have arrived each week since the applications process opened in October. They represent residents who believe their applications were unfairly rejected or are languishing in a bureaucratic standstill. “For people going without surgeries or doctors appointment every one of these delays is meaningful,” she said, “People are struggling to get the care they need.”

Mark Chan, a self-employed 36-year-old Arcadia resident applied though Covered California at the end of January and was told he wasn’t eligible for private insurance exchange. He has yet to receive a letter confirming or denying his eligibility from Medi-Cal. “I always have allergies and that’s the main concern because it can turn into something else,” said Chan. “I am little nervous that it’s lost in a mail and it’s been a while. It’s a big question mark in my head.”

Sign-Up Struggles

Louise McCarthy, President and CEO of the Community Clinic Association of Los Angeles County, said one reason for the backlog of Medi-Cal applications has to do with information-gathering hurdles. For months, the state’s electronic applications systems that handled the new Medi-Cal expansion weren’t in sync, which meant that many people weren’t able to get real-time eligibility determinations when they walked into a clinic. CALHEERS, the Covered California web portal, was not connected with Medi-Cal system SAWS (the county’s eligibility system for Medi-Cal) until January, she said. “That’s frustrating for the clinics,” she said, “Folks want people to walk out with insurance.”

McCarthy also said clinics and enrollers have sometimes had to act as translators for people, which means less time helping applicants with the follow-up paperwork necessary to move the through the Medi-Cal enrollment process quickly. While Covered California’s website has been translated into 13 languages, Khmer and Tongan—languages of the Cambodian and Tongan communities—are not among them. As a result, enrollment counselors in places like Long Beach, which has a large Cambodian and Pacific Islander population, often must help applicants apply on paper, a labor-intensive effort that also makes it harder for government health departments to process. “We are doing everything in our power to look on the bright side because it’s been a monumental effort to get them enrolled, but I want [the state] to say they will fix things ASAP,” said McCarthy.

Health departments say one factor that’s contributing to the Medi-Cal backlog is the ACA’s extraordinary popularity. Anthony Ly, Health Access Outreach Program Coordinator at the Long Beach Health Department, said that at a recent one-day event, more than a dozen enrollers from different organizations, including faith-based groups, local school district officials, and health clinics, signed up 278 people in four hours. People were waiting in line since 6 am that day, he said. “It’s exhausting, but groundbreaking,” said Ly of the ACA. “The system is still working its kinks out so we can’t expect it to work perfectly.”

Behind The Numbers

Norman Williams, a spokesman for the California Department of Health Care Services, which oversees Medi-Cal, agrees there are challenges, but asserts that the backlog figures have a back-story.

Of the more than 2.5 million Californians enrolled since Covered California launched October 1, about 1.5 million of those have signed up for Medi-Cal, he said.

Of the 700,000 people who were awaiting enrollment in Medi-Cal as of mid-March, nearly half had applied within the past 45 days. That is the sign-up period allotted for counties to process applications, he said.

He added that the 700,000 number of pending Medi-Cal applications includes people who didn’t have the required documentation to verify eligibility, such as proof of income. Others may have submitted an incomplete application or supplied incorrect information.

“The response to the ACA’s expansion of coverage opportunities has been tremendous,” said Williams. “DHCS is working with Covered California and our county partners to quickly verify eligibility for the many other applicants who are being found eligible for Medi-Cal each day.”

He added that if someone needs immediate health care, they have options. They can go to the hospital for emergencies or visit their county human services office to confirm their eligibility, and receive a temporary identification card. Once Medi-Cal eligibility is determined, he said, coverage is retroactive to the month the person applied.

Hope and Nerves

Many local health providers in L.A. County say that enrollment in the private insurance exchange through Covered California has not generated as many complaints. James Scullary, a spokesman for Covered California, said they had already surpassed their goal to enroll 1 million by the end of the month. But he said they don’t collect data on the number of pending applications in the private insurance exchange.

Scullary suggests that those who have applied, but not received, their insurance cards, should contact the provider, such as Kaiser, Blue Shield, or Healthnet. There is also the option, he said, of paying out-of-pocket and later submitting the bill to the insurance company for reimbursement.

Upfront payment is often not an option for low-income residents. Chien “Andy” Chow, who lives in Southern California and works as a baker in a pastry shop, applied six weeks ago through Covered California for a Blue Shield plan and has yet to receive his card in the mail. Chow, 54, who has high blood pressure, high cholesterol and diabetes, is looking forward to going to the doctor for a colon check, his first. Like many California residents seeking health care, he is experiencing a mix of emotions—hope, excitement, and nerves. “I have been worried because everything has been up in the air,” he said, “but I feel very, very good that I will have it.”

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