Medi-Cal Lag for Eligible AIDS Patients Assailed

Many eligible AIDS patients are being deprived of Medi-Cal benefits because of inefficiencies at the Los Angeles County Department of Health Services, officials of an AIDS treatment center charged Tuesday.

Michael Weinstein, president of the AIDS Healthcare Foundation, said 26 of the 84 county AIDS patients referred in the final stages of their illness to the Foundation’s Chris Brownlie Hospice arrived without completed Medi-Cal paperwork. Most of the patients should have been enrolled because they had been treated for AIDS in the county health system for months before arriving at the hospice, Weinstein said.

Without other insurance or financial assets, a diagnosis of AIDS is supposed to guarantee a patient Medi-Cal coverage within 60 days of the filing of a complete application. Weinstein said the county has performed poorly in qualifying patients for Medi-Cal. This has not only hurt patients, but blocked a source of state revenues to augment its budget, he said.

County health officials said in response that they are equally frustrated with slow processing of AIDS-related Medi-Cal applications. But Irving Cohen, the county health department’s assistant director for finance and administration, said the fault lies with the state Department of Social Services.

Harold Giles, chief of the social services department branch responsible for approving Medi-Cal applications submitted by the Los Angeles County health department, declined to comment on Cohen’s assertions. Officials of the state Department of Health Services’ Medi-Cal eligibility branch could not be reached.

At issue is a Medi-Cal program so burdened by paperwork that many eligible Californians--not just AIDS patients--fail to receive benefits, according to a report last year by the Little Hoover Commission. Among the barriers to Medi-Cal participation is an 11-page application form that demands more information on income and assets than even the U.S. Internal Revenue Service requires of taxpayers, the commission said.

The $8.1-billion program is “riddled with procedures that block access to medical care and discourage doctors from participating in the system,” commission Chairman Nathan Shapell said in releasing the report.

Weinstein said that inefficiencies in the county health department had exacerbated the problem. The Hoover Commission found that incomplete or withdrawn Medi-Cal applications in the county were 31.5%, the highest rate among the counties, and far in excess of the statewide average of 12.2%.

But the county health department’s Cohen said that for a year the county has been asking the state why it has been denying Medi-Cal eligibility to some AIDS patients and delaying it in others.

Weinstein said the foundation, which runs on charitable contributions and fees from patients or health insurers, cannot cover the cost of caring for these patients while waiting months for the state to approve their Medi-Cal applications.

Lynn Kersey of the Los Angeles Homeless Health Care Project said similar problems occur with pregnant women trying to get Medi-Cal for prenatal care and follow-up pediatric services for their babies. In such cases, Medi-Cal regulations require approval of completed applications in 45 days.

But Kersey said some women who applied when they were pregnant still are not in the program, even though their babies are already a year old.

A class-action lawsuit was filed in federal court last summer against the county health department and the county Department of Public Social Services, seeking enforcement of the 45-day turnaround time on processing applications. Also named in the case, which is still pending, are the County Board of Supervisors and the state Department of Health Services.

Cathy Winans, a vice president of the Hospital Council of Southern California, said member hospitals also are experiencing Medi-Cal enrollment delays, and that most have placed their hopes for relief in program reforms mandated by the Legislature last year.

A state law passed last September requires the state health department to submit proposals to simplify the Medi-Cal eligibility process to the Legislature by Dec. 31, 1991,