New enrollment forms the Medi-Cal program is using because of changes brought about by federal health reform are so confusing that they could lead to tens of thousands of eligible recipients losing their benefits, say advocates for the poor.

County officials say the new format will ultimately make it easier for recipients to remain eligible from one year to the next. But critics say the forms ask for detailed information about income and tax deductions that many recipients might not understand or have at their disposal. To make matters worse, the forms are currently available only in English and Spanish, leaving many recipients unable even to read them.

“We are very concerned,” said Shirley Sanematsu, senior health attorney with the Western Center on Law and Poverty “We just don’t see how this is going to be tenable.”

New rules under the federal Affordable Care Act have expanded Medi-Cal and changed how eligibility for the program is determined. As a result, the state has had to change the forms that counties send out each year to people already enrolled in the program to see if they are still eligible.

As a beneficiary of the program for six years, Johnnie Sanders thought she had mastered how to fill out the annual form to renew her Medi-Cal coverage.

But when the 71-year-old from Carson received her renewal package in the mail recently, she discovered that the forms were unrecognizable.

“They were so complicated,” said Sanders, who is disabled and cannot work. “It used to be every year they were pretty much the same.

“This time they sent them out it’s totally different. The first part of the application wanted you to put down your employer, where you worked. It was different, very confusing.”

Counties began mailing the first batch of new redetermination forms to beneficiaries in April. These forms are due by the end of June — but the state will likely be unable to process them until July, according to Gov. Jerry Brown’s revised state budget released May 13. The state is first trying to reduce a backlog of 900,000 new Medi-Cal applications, due in part to the fact that officials prioritized the open-exchange enrollment software over Medi-Cal’s.

Medi-Cal recipients will be sent the renewal forms on different dates, depending on when their benefits are due to expire. Approximately 8.5 million people — more than 20 percent of the state’s population — will receive the forms this year.

Although the state does not expect to process the redeterminations on time, Department of Health Care Services spokesman Anthony Cava said the agency will continue to move forward with mailing out renewal packages. He said the budget sets aside money to maintain benefits for people whose annual redetermination has been delayed.

Half of the renewal forms being sent out in April were originally supposed to be due in January, but the state delayed the renewal process for several months because of a flood of new Medi-Cal enrollments under the Affordable Care Act. Now counties are being asked to play catch-up, sending out forms to those people whose renewals were delayed along with those due for renewal in June and beyond. That amounts to about 1 million renewals a month statewide.

Eligibility based on tax information

Medi-Cal coverage used to be restricted to certain low-income groups such as people with disabilities, children and pregnant women. Under the revised rules, Medi-Cal eligibility is based on income and most legal California residents making less than 138 percent of the federal poverty level, just over $16,000 for an individual or $32,900 for a family of four, can apply for the program. The new eligibility renewal forms request tax information that county workers will seek to verify through federal databases, including by accessing tax returns.

Maria Gardner, Deputy Director for the Department of Social Services of Santa Barbara County, said the changes should simplify the renewal process. Before, applicants had to answer more questions and provide copies of pay stubs or other documents as proof that the information they put on the form was correct. Now, with applicants’ permission, counties will be able to verify the information electronically in most cases and renew eligibility automatically each year, she explained.

Applicants can also provide information over the phone to county workers instead of sending in the forms. These factors could lead to more people retaining their Medi-Cal benefits, she said.

Gardner said her department has seen an increase in calls from Medi-Cal recipients since the county sent out its first batch of about 4,400 renewal packets last month. However, she attributed the increase to people’s surprise at the new format, not to anything inherently complicated about the paperwork.

“This looks completely different to them,” Gardner said. “It’s kind of a learning curve more than anything.

“We hope that, as things settle down, clients will become familiar with what the process is.”

New forms present barriers to access

But advocates maintain that the forms are complicated, redundant and difficult to understand. Instead of filling out one form, as they did previously, most recipients now have to fill out at least two, although some counties have combined them into a single package.

The questions on the forms ask for tax information related to income and deductions that recipients may have difficulty answering, particularly those who – like Sanders – don’t file taxes, or who work multiple jobs, said Cori Racela, a staff attorney with the non-profit Neighborhood Legal Services, which helps Los Angeles County residents access healthcare.

In addition, the forms have only been translated into English and Spanish, despite regulations requiring they be available in other widely spoken languages, Racela noted.

The attorney said the organization received about 10 calls from Medi-Cal recipients in April who were struggling with the renewal forms, and expects to receive many more.

“The predominant problems are people are getting forms that, first of all, may not be in a language that they speak or read, and second of all are really confusing so they want help to fill it out,” she said.  “Sometimes they’re not clear about what they’re getting. They don’t even understand that this is what they need to do to renew their Medi-Cal.”

For student Heather Lore of Ojai in Ventura County, the forms seemed simpler than her initial application for health benefits, but repetitive. The 39-year-old mother qualified for Medi-Cal this year under the Affordable Care Act, but her sons, ages 12 and 8, already received state health benefits and their coverage is due for renewal in June. As a result, Lore had to fill out forms for each family member.

“That seemed redundant and time consuming and a little bit confusing,” she said.

Medi-Cal backlog complicates issue

In a written statement, Cava said Medi-Cal recipients can get help filling out the forms in numerous ways, either by phone, in person or by email. He said county eligibility workers will also reach out to recipients who don’t provide the required information in time — before they are un-enrolled. Cava said the department does not expect to see any jump in people losing coverage because of the forms.

Advocates for the poor and union representatives for county welfare workers foresee other difficulties, however.

In an April 24 letter to Department of Health and Human Services secretary Diana Dooley, several health advocacy groups along with the County Welfare Directors Association and Service Employees International Union pointed to ongoing problems with the computer system designed to determine Medi-Cal eligibility. They also noted the backlog of approximately 900,000 new Medi-Cal applications that are pending verification. Having to deal with redeterminations on top of these problems will overload county workers and put people at risk of losing coverage, the letter argued.

Meanwhile, Sanders said she is waiting anxiously to see if her renewal forms get approved.

“Why keep asking every year for different kinds of forms to be filled out?” she said. “Why should I be deluged with this big package of applications and paperwork every year? It’s hard on older people.”