Obamacare: California details plan to cut Medi-Cal backlog to 350,000

Erica Sol and her daughter Guadalupe Curiel attend a screening event for Covered California and Medi-Cal at Our Lady of Peace Parish in North Hills in February. On Monday, California detailed plans to cut the numbers of still-pending applications for Medi-Cal from 600,000 to 350,000.
(Anne Cusack / Los Angeles Times)

California will reduce the number of Medi-Cal applications it has pending under Obamacare by nearly half within six weeks, state officials pledged Monday.

In a letter to the federal government’s Center for Medicare and Medicaid Services (CMS), the director of California’s Department of Health Care Services, Toby Douglas, noted that the number of pending applications for the healthcare program for the poor had declined from 900,000 in March to 600,000 by the end of June -- and said that the state’s continued efforts to push through the backlog would reduce the number to “approximately 350,000 within six weeks.”

Of those who would still be waiting for Medi-Cal cards at that point, most would be people who had applied for the healthcare program within the preceding 45 days -- within the period allotted by law for the application process to be completed, Douglas wrote.

The state healthcare department has been under increasing scrutiny since enrollment in Affordable Care Act (ACA) programs, including Covered California and Medi-Cal, began in October. The ACA, popularly known as Obamacare, expanded the pool of Californians eligible for Medi-Cal.


Unexpectedly large volumes of applications for Medi-Cal and persistent problems with computer systems have made it difficult for counties, which must process applications for the program, to confirm applicant eligibility.

As a result, advocates have complained, some patients have skipped getting needed medical care or filling prescriptions because they are unsure if they’re covered.

Monday’s letter to the CMS indicated that more than 300,000 of the pending applications were filed in March and April, but 10,000 applications from October and November also still awaited resolution, as well as 59,000 from December, 94,000 from January, and 69,000 from February. In Los Angeles, administrators at the Department of Public Social Services said in early July that more than 200,000 people in the county still awaited approval of Medi-Cal applications.

The state’s letter outlining its plan to clear the backlog focuses on fixing the computer troubles that have made it difficult for county eligibility workers to interface with CalHEERS, the state’s new healthcare enrollment system. But Douglas also promised to “proactively inform consumers” caught in the backlog by sending them letters with instructions on how to obtain care while they await their Medi-Cal cards.

The CMS requested the plan in a letter sent to the state agency on June 27.

On July 2, healthcare advocates, concerned about patients who were confused and forgoing care, also wrote the state demanding a plan to address the backlog. That coalition, the Health Consumers Alliance, also set a deadline of Monday.

Jen Flory, senior attorney at the Western Center on Law and Poverty, one of the advocate groups involved, said Tuesday morning that the advocates had not yet received a response from the state, though they did receive a copy of the letter sent to the CMS on Monday night.

The plans laid out in the letter were “not really enough to resolve the backlog situation,” she said. “They’re always hopeful the next fix will solve problems, but it’s proven to be more complicated than they thought. We’re not certain they’ll have that backlog reduced within six weeks. We’re hopeful.”

Flory added that the Health Consumer Alliance hoped the state agency would also extend presumptive eligibility to applicants who had been waiting longer than 45 days, and delay renewals for existing Medi-Cal participants -- another daunting task for county workers.

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