Editorial: The great Medi-Cal paper waste

Remember the telephone book? That giant, multi-thousand-page behemoth that used to land on your doorstep once a year? Well, neither do we, barely. The heyday of the phone book is long gone, and yet communications with friends and businesses is easier than it’s ever been before.

Can it be that California officials haven’t noticed that? A new federal rule that took effect in July allows health insurance plans to stop automatically printing and mailing lengthy Medi-Cal provider directories, some of which are the size of phone books, to all new enrollees and make the information available digitally. Anyone without online access or who preferred having a hard copy could still request one.

The change seems like no-brainer in the 21st century, when people increasingly prefer to get information through their smartphones or laptops instead of relying on dead-tree versions that may be out of date as soon as the ink is dry. Providers drop in and out of the Medi-Cal program, which is California’s version of Medicaid. Yet the three California health plans that have asked the California Department of Health Care Services for permission to take advantage of the new rule are still waiting for approval. One of them, L.A. Care, submitted its proposal back in June and is still waiting to hear back.

The state should allow the plans to stop this wasteful process and redirect the money they save toward providing care for the state’s poorest and most vulnerable. It’s too bad that this rule wasn’t undertaken sooner to avoid the cost of sending printed directories to the 5 million Californians who signed up for Medi-Cal through the Medicaid expansion of the Affordable Care Act. But state officials should go one step further and encourage the other 19 Medi-Cal health plans to move toward this model too.

Like the telephone books that Americans rarely crack open, provider directories are expensive to produce and distribute. L.A. Care says it has spent $1 million to mail out its two-volume, 7-pound, 2,546-page directory to new enrollees just in the last year. Part of the reason the directories have become such a financial burden is because changes in the law intended to make provider lists more useful required more frequent updates and more details, such as provider email addresses and languages spoken. These are sensible changes that reflect the level of information users expect to find quickly through an online search. What’s not sensible is increasing the size of a printed version that’s already unwieldy, unhelpful, out of date and wasteful of precious public resources.

The saga of the provider directories is not the biggest problem in the world. It’s not even among the top 100. But it illustrates how hard it can be for government to adapt to a changing world, even when it wants to.

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