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Medi-Cal seen as relief for some, confusing burden for others

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Business owner Lori Golden wasn't looking for charity.

But the 62-year-old Northridge resident said that's what it felt like when she tried to buy an Obamacare health insurance policy through the Covered California exchange — and instead learned that her income was so low it qualified her to receive benefits through California's healthcare program for the poor.

"I'm upset. I sort of feel like I'm being forced to go into Medi-Cal," Golden said.

Supporters of national healthcare reform tout the expansion of Medicaid — called Medi-Cal in California — as one of the great successes of the Affordable Care Act.

For many needy people, learning they're eligible for the usually free program has been a tremendous relief — assurance that, after decades of forgoing care or worrying about medical expenses, they'll now be able to afford medications, see a doctor or seek emergency care without worrying about ending up broke.

But the news isn't wholly welcome for others, who find the complexities of signing up with Medi-Cal bewildering and onerous. And some, like Golden, who don't consider themselves low-income and don't know how Medi-Cal works, also fret over being placed on state healthcare rolls — "on the dole" — and would rather just pay for insurance.

"To me, Medi-Cal sounds like something that's free — and I'm not looking to get a government handout," she said. "That embarrasses me."

Golden, who publishes the free newspaper the Pet Press, used to pay $341 a month for a high-deductible policy through Aetna, which discontinued her coverage when it stopped selling to individuals in California in 2013.

She was sure she could afford a subsidized Covered California plan, which cost less than half as much per month. But such low-priced policies aren't available for Medi-Cal-eligible Californians, who are welcome to buy insurance through the exchange only if they give up any subsidy.

Without government help, the comprehensive plan Golden was eyeing would have cost around $600 a month. A higher-deductible plan with larger co-pays would still have cost more than $400 a month.

As part of the Affordable Care Act, somewhere between 1 million and 2 million Californians were expected to become newly eligible for Medi-Cal by 2015. The health program already serves more than 9 million people.

On Jan. 21, Covered California reported that 584,000 had been "determined likely eligible" for Medi-Cal after visiting CoveredCa.com and an additional  630,000 transitioned into Medi-Cal from separate low-income health programs run by counties. Patients signing on for Medi-Cal join a health plan and receive their care from networks of participating doctors, clinics, hospitals and pharmacies, much like other managed care patients who have private insurance.

The low-income insurance program, once mainly for women with children and people with disabilities, is now open to any adult earning less than 138% of the federal poverty level (in California, $32,499 a year for a family of four and $15,856 for a household of one.)

Also newly eligible are children in households earning up to 266% of the poverty line. That means a family of four making a little more $60,000 a year can be split in two, with parents able to buy subsidized coverage but children receiving theirs through Medi-Cal.

Martin Gross, a self-employed lawyer and Obamacare proponent in Mar Vista, bought Kaiser Permanente policies for himself and his wife through Covered California.

But when his 16-year-old son qualified for Medi-Cal, it gave him pause.

"I said, 'Wait a minute — I'm not that poor. Why is my son on Medi-Cal?' " he recalled. "I wasn't crazy about it. It was a hit to my ego."

Gross said he would have liked to have had the option of paying what he used to for his son's coverage.

"I just didn't want to pay double," he said, referring to what would have been the unsubsidized Covered California cost.

Edward Chavez, co-chairman of the health enrollment team at One L.A., a community group that works through religious congregations, said that he and other advocates had encountered similar resistance to Medi-Cal among the mainly Latino and working-class clients he has in the northeast San Fernando Valley.

Legal permanent residents worry that getting coverage from the government will endanger their immigration status. Chavez advises them that it won't, and directs them to a U.S. Citizenship and Immigration Services fact sheet, which indicates that receiving Medicaid benefits does not make a resident a "public charge," and thus ineligible for permanent residency.

Others look down on Medi-Cal as substandard.

"They think the care is not as good," Chavez said, adding that many "just disappear" once they hear their only way onto a Covered California plan is to pay the unsubsidized price.

Katie Murphy, managing attorney at Neighborhood Legal Services of Los Angeles County, which fields calls from people seeking help with Obamacare sign-ups, said that once new Medi-Cal recipients learn more about the program, their misgivings go away.

"I think people don't understand that Medi-Cal is much more like Covered California than they think — both are managed care and both are 'handouts' to the extent the government is paying part of people's premiums," she said.

But Murphy also noted that new enrollees may be getting distressed because some communications from the state are confusing.

For instance, she said, official notification letters have been delayed getting out. Once delivered, the letters "have a lot of complicated messages" and fail to explain clearly that a recipient's Medi-Cal application could take some time to review. Federal law allows 45 days to determine eligibility.

New Medi-Cal enrollees who contacted The Times also complained of long waits and confusing interactions with well-intentioned but flustered county workers who process Medi-Cal signups. Work at the counties had been slowed by problems with the state's computer system, Murphy said.

Patients whose eligibility is confirmed can see a doctor who accepts Medi-Cal immediately, but still must wait for a packet in the mail that lets them select their health plan and complete their managed care enrollment.

"There's a big learning curve," said Gross, who spent hours on the phone to make sure his son could continue seeing his Kaiser Permanente doctors through Medi-Cal. "I would imagine if the other million people like me had the same problems, 90% would throw up their hands and say, 'I'm done.'"

In Golden's case, she tried researching the program online, but said consumer-friendly information on Medi-Cal was hard to come by. Before committing, she said she wanted to know, "Can I still see my eye doctor? Can I still go to Rite-Aid, where they have my prescriptions?"

Then a self-employed friend pointed Golden to a Covered California-certified insurance agent who told her she could use her estimated 2014 income — instead of the adjusted income reported on her 2013 tax return — to apply through the exchange.

The agent started an application for a subsidized Blue Shield policy. If Golden is approved, she will pay $111.47 a month, and will carry a $2,250 deductible.

"I'm thrilled with that!" she said. "Even though this is with a subsidy, at least I'm paying into the system."

eryn.brown@latimes.com

Twitter: @LATerynbrown

Copyright © 2014, Los Angeles Times
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Laws and LegislationAffordable Care Act (Obamacare)Personal IncomeInsuranceCrime, Law and JusticeMedicaidImmigration
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