Latino Group Criticizes Medi-Cal

The state’s fledgling managed care program for Medi-Cal is “rife with deficiencies” that, combined with upheaval fostered by federal welfare reform, endangers basic health care services to impoverished Latinos and other minorities, especially in Los Angeles County, a Latino health advocacy coalition charged Monday.

The report, by the nonprofit Latino Coalition for a Healthy California, blasted the state’s approach to managed care for the poor, citing inadequate translation of enrollment materials, poor or inaccurate beneficiary education, botched or questionable patient enrollment practices, and paltry payments and support for doctors and hospitals that were the backbone of the old Medi-Cal system.

The transition to the new Medi-Cal system in Los Angeles County, where more than half of the 1.2 million targeted beneficiaries are Latino, is particularly precarious, according to the report. At the same time, the public health system is in the midst of a massive restructuring that is fraught with uncertainty, the report said.

Throw into the mix federal welfare reform, in which immigrant aid will be restricted, and it will be even more difficult for women and children to enroll in Medi-Cal and navigate the system, the report said.

Although the new Medi-Cal system holds promise as well as pitfalls for the 2 million Latinos included, “the challenges in this report bring into question the fundamental premise of Medi-Cal managed care to control public costs while improving access to care,” the report said.

A top state health official who oversees Medi-Cal had only a terse comment in reply.

“I was not provided with a copy of this report until this morning and I have not yet read it,” said J. Douglas Porter. “I would have appreciated receiving [it] on a more timely basis in light of our efforts to work with this organization.”

The coalition’s 16-page critique comes on top of complaints from physician groups, community organizations and even the federal government, which has twice delayed full implementation of the program in Los Angeles County, mainly because of problems in patient enrollment and education. Full start-up of the system, which essentially offers beneficiaries a choice between two health maintenance organizations, isn’t expected until January at the earliest.

But the report is unique in that it examines the wider context of Medi-Cal reform, said Carmela Castellano, executive director of the Latino Coalition for a Healthy California, a public policy organization with networks in Los Angeles, Alameda and San Joaquin counties.

“This is about the working poor who rely on the safety net,” Castellano said. “We need comprehensive solutions, not just Band-Aids.”

Among the report’s main contentions:

* Although the state changed Medi-Cal enrollment contractors this January, some significant problems persist, such as errors in beneficiary information and mistaken assignments to providers. Delays in translating information have created linguistic barriers for many Medi-Cal beneficiaries.

* Some providers have improperly urged patients to enroll with them.

* Some commercial plans lack a background in providing culturally and linguistically competent services to minorities. Experienced Medi-Cal providers are in danger of losing revenue and being squeezed out of the system.

* Federal welfare reform may shrink Medi-Cal rolls and swell the ranks of the uninsured, increasing pressure on the frayed safety net.

* Los Angeles County’s safety net clinics and hospitals face formidable challenges as they attempt to serve the indigent and compete in the new health care market.