Ask Emily: Medi-Cal renewals — another backlog on horizon?

File photo: Frank Vigil looks over paperwork as he waits to register for health care insurance during an enrollment fair at Ambrose Community Center on March 28, 2014, in Bay Point, California.
File photo: Frank Vigil looks over paperwork as he waits to register for health care insurance during an enrollment fair at Ambrose Community Center on March 28, 2014, in Bay Point, California.
Justin Sullivan/Getty Images

Covering California series icon 2013

Another in a series of Q&A columns answering consumers’ questions about the Affordable Care Act.

Let’s start with some good news (because everything is relative): The backlog of Medi-Cal applications that I called “monumental” last month is now merely “massive.”

About 600,000 people – some of whom applied last year – are still waiting for their Medi-Cal applications to be processed, down from 900,000 previously, state officials report.

The bad news is that despite this troublesome, long-standing backlog, the state is about to create another one by asking 8.5 million current Medi-Cal members to renew their status using new forms, new eligibility criteria and new ways of defining income.

Their renewal forms will be met by the same overwhelmed county workers who are processing the backlogged first-time Medi-Cal applications, the same computer glitches that have contributed to the application backlog and the same dearth of help for desperate consumers.

“We’ll work these renewals as quickly as we possibly can, but we only have so many people and so many hours in the day and a computer system that works only so well,” says Frank Mecca, executive director of the County Welfare Directors Association of California. 

County social service agencies process Medi-Cal applications and renewals.

“The state’s direction to the counties is basically, ‘Do your best’,” he says.

Some advocates believe that state officials want Californians to drop out of the program during the renewal process, saving the state money.

“People will be falling off of Medi-Cal” as a result of the renewals, says Jen Flory, senior attorney for the Western Center on Law & Poverty. 

But state health officials do “not believe that more people than usual could lose Medi-Cal coverage,” says Tony Cava of the state Department of Health Care Services (DHCS).

Q: I just received my Medi-Cal renewal packet, due by July 31. I imagine the renewals are just as backlogged?

They will be soon if they’re not already.

A quick refresher: Medi-Cal is the state’s version of the federal Medicaid program, which provides publicly funded insurance to low-income residents. The Affordable Care Act expanded Medi-Cal eligibility to childless adults and those with higher incomes than before.

The response has been overwhelming. More people signed up for Medi-Cal than purchased private health plans through the state’s health insurance exchange, Covered California, and applications continue to pour in.

By next year, Medi-Cal is expected to provide health insurance to about 11.5 million Californians – a whopping 30 percent of the state’s population.

The expansion has been plagued with problems, including the inability of the state computer system to communicate with county systems for months, programming defects that continue to delay applications and that massive backlog I mentioned earlier.

That’s just for first-time applications. Renewals are conducted annually to reassess people’s eligibility for the program.

The state started sending out renewal notices in April despite the existing application backlog, Cava says.

The California Endowment has given the state $26 million (which was matched by the federal government) to help enroll Californians in the expanded Medi-Cal program.  

The private foundation also offered $6 million to provide assistance to people who need to renew. The gift was no-strings-attached and also was expected to be matched by the federal government.

No brainer, right?

The state declined the offer.  

The form has not even been finalized, according to a letter written by DHCS Director Toby Douglas in June: “The form that is currently being used, while legally sufficient, is not the form that we have all been working toward perfecting for future use.”

Nor has this form been translated into other languages, as previous renewal forms were.

“People tend not to respond to things they don’t understand,” Flory says.

In fact, he adds, glitches in the state’s computerized eligibility system have made it impossible for renewals to be processed.

The stakes are high.

The state already has informed counties how to dump Medi-Cal members who haven’t returned their forms within the 60-day deadline, Mecca says.

That means counties can kick you off the rolls if you don’t respond in time, but can’t yet renew you if you have. (Until the county processes your renewal form, however, you remain covered.)

So if you have received a renewal packet in the mail, please don’t ignore it. “Do anything you can to get the form in,” Flory says.

In fairness, getting the right people off the rolls is important. Medi-Cal recipients may have moved to a different county or out of state or – gulp – died. Removing them saves money.

It’s the people who should be on the rolls that advocates worry about.

Here’s where to turn for help:  

A final note: State lawmakers who were unhappy that the administration didn’t accept the $6 million from The California Endowment are pushing a bill that would require the state to accept the money. Stay tuned.

Questions for Emily:

Learn more about Emily here.

The CHCF Center for Health Reporting partners with news organizations to cover California health policy.  Located at the USC Annenberg School for Communication and Journalism, it is funded by the nonpartisan California HealthCare Foundation.