Infants Denied Medi-Cal Coverage

A new healthcare initiative designed to enroll more uninsured children in Medi-Cal, the state’s medical coverage program for the poor, is depriving some newborns of coverage.

As a result, social workers and patient advocates said, infants and their families have been rejected when they have sought medical care.

Under state law, children born to mothers covered by Medi-Cal were entitled to 12 months of continuous coverage, said Lucy Quacinella, a San Francisco attorney who last year sued the state on behalf of a child and mother who were denied care.

But many of those children, like Quacinella’s client, were mistakenly signed up by medical providers for separate, briefer coverage under an initiative called Gateway. The dual enrollment was causing them to be dropped from Medi-Cal rolls after two months or less.

Gateway, ironically, was intended to broaden state coverage for uninsured children. It was not intended to cover children already signed up for Medi-Cal.

Fixing the problem is difficult because the Gateway computer system does not communicate with the Medi-Cal system, state officials and Quacinella said.

Quacinella said parents learned of the problem only when their child had to see a doctor -- and many have not returned after being turned away.

“Without coverage, working poor families are less likely to address their children’s healthcare needs,” she said.

A San Francisco Superior Court judge in September ordered the California Department of Health Services to fix the problem. Quacinella and other advocates had filed their lawsuit in July.

The court gave the department until April 1 to change its computer system. It also ordered the department to reinstate Medi-Cal coverage to infants who had lost coverage through Gateway.

Lea Brooks, a health department spokeswoman, said the department was given the $357,000 necessary to make the changes after the August budget had been approved.

But, after the court’s ruling, the department filed an appeal and requested more time, until July 1, 2004, to change its computer system.

Stan Rosenstein, deputy director of medical care services for the department, said the department was working to link the Medi-Cal and Gateway computer systems as the court ordered, but he said it probably would take longer.

“We run 60,000 transactions through there in a month,” he said. “It’s a fairly complex system.”

Rosenstein stressed that although children born to mothers on Medi-Cal were entitled to yearlong coverage, mothers still had to notify their eligibility workers of a baby’s birth to ensure coverage.

Octaviana Arenas, who is on Medi-Cal, thought she had done everything by the book.

Arenas, 26, said she had sent a copy of her daughter Gabriela Geronimo’s birth certificate to her state eligibility worker two weeks after her birth.

Last week, Gabriela, now 2 months old, developed a bad cough. Arenas took her to a clinic, where she learned that the baby was not covered by Medi-Cal. Arenas, who speaks only Spanish, was told that a doctor would not see the baby unless she paid $30.

“I felt bad because I didn’t have the money and I had to tell them that,” Arenas said through an interpreter. She took Gabriela home without seeing a doctor.

Arenas sought help from Mother and Child Health Access, a Los Angeles-based social services agency for low-income families. They discovered that Gabriela had been signed up for temporary coverage through the Gateway program when she went to a doctor for a routine checkup two weeks after she was born.

Arenas was lucky enough to know of a social service agency that could help her. Days after she had been turned away, after social workers had intervened, her daughter’s Medi-Cal coverage was reinstated.

Celia Valdez of Maternal and Child Health Access said many parents have not understood that Medi-Cal coverage through the Gateway program was temporary.

Providers, she said, often have not explained it, and sometimes have not spoken the same language as the parents.

Also, Valdez said, long waits at county health offices and busy signals when families call their eligibility workers make keeping track of a child’s coverage a daunting task.

“It’s so complex that even people who work in this field have a hard time trying to navigate the system,” Valdez said. “People give up.

“The only thing they clearly understand is that they got turned away,” she said. “The kids shouldn’t have to pay the consequences.”