California’s ambitious plan to enroll former prison and jail inmates in health insurance as part of an expansion funded by the Affordable Care Act has been foiled by an applications logjam, administrative errors and bureaucratic roadblocks.
Advocates across California who work with former inmates have been trying since January to get them signed up for Medi-Cal, the state’s low-income health plan, in the hopes that having access to doctors, mental health services and addiction treatment might help keep them out of jail.
However, a number of state and county computer problems and miscommunications have hampered their efforts.
As many as 900,000 electronic Medi-Cal applications are waiting to be processed statewide, a backlog that has affected not just inmates, but anyone attempting to sign up for the health plan. Federal health reform opened the gates of Medi-Cal to low-income, childless adults for the first time this year. That includes women but many of the newly eligible Californians are men.
Inmates who filled out paper applications beginning early this year have also experienced delays in getting coverage. Some paper applications were sent to the wrong counties, and counties that received completed applications sometimes didn’t know how to process them, state and county officials said.
“We really wanted to be enrolling people,” Alameda County Sheriff’s Office Lt. Shawn Peterson said. “But what we learned is that the pipeline was kind of broken.”
Officials at the Department of Health Care Services and Covered California, the state’s insurance enrollment portal, said they are working to resolve the technical problems and application backlog.
The Health Care Services department is working with counties and Covered California to process the “remaining vast number of applications and quickly deliver health coverage to all who are eligible,” spokesman Anthony Cava said.
But the delay concerns advocates, because they say the first few days after release are the riskiest and most challenging for former inmates. Access to services can keep former inmates from relying on emergency rooms for care or landing back in jail.
Health officials also worry about former inmates bringing untreated Hepatitis C, HIV or tuberculosis back to their communities. Having access to a primary-care doctor can encourage them to seek treatment.
Enrollment efforts slowed
Some California counties are trying to have inmates in their jails apply for Medi-Cal before they are released. However, despite the fact that open enrollment began in October, many of these efforts have been slowed due to the problems at the state level.
In January, inmates in some county jails filled out paper enrollment forms and deputies submitted them to local social services departments, which mailed them to the state. Except in rare emergency situations, inmates must give their consent in order to enroll in Medi-Cal.
Once the system was up and running, counties had hoped to have inmates fill out applications for Medi-Cal during the intake process or shortly before their release. The applications were to be sent electronically to social services agencies that would finish the enrollment using the Covered California portal. The process was supposed to be automated and require fewer employees than traditional paper processing, said Randy Morris, assistant agency director for the Department of Adult, Aging, and Medi-Cal Services of Alameda County.
But enrollment did not go as planned. When the electronic enrollment system for Medi-Cal experienced glitches early this year, the counties were overwhelmed and unsure how to proceed, Morris said. Because each case took much longer than expected to process, the staffing figures were “dramatically off target,” he said. At least in Alameda County, there weren’t enough employees to process the applications from inmates quickly.
In addition, the California Department of Corrections and Rehabilitation sent some paper Medi-Cal applications for state prisoners directly to Covered California in January, instead of sending them to the counties where the inmates were scheduled to be released. Some applications were then sent to the wrong counties, according to the Health Care Services department.
Alternately, some counties received an influx of applications from Covered California for state inmates and were unsure how to complete the eligibility determination process, the agency said.
The state and counties are still working out technology hurdles such as how to keep confidential information private while sharing data about inmates with county workers, who do the actual enrolling.
“We’re running as fast as we can,” Morris said. “It’s a righteous issue we’re dealing with.”
Enrolling inmates could save money
The Health Care Services department said it does not know exactly how many California inmates or ex-felons are newly eligible for Medi-Cal this year. Nationally, of the approximately 10 million people released from prison or jail each year, as many as 90 percent are uninsured, researchers from U.C. San Francisco and San Francisco General Hospital estimated in a 2008 study.
Medi-Cal does not pay for services while inmates are in custody. However, if an inmate is ill or injured enough to require off-site hospitalization or mental health services, Medi-Cal will pick up the tab, saving counties money.
That’s important because under Gov. Jerry Brown’s prison realignment program, jails are absorbing state prisoners. They stay longer than conventional jail detainees — there is no longer a limit on how long inmates can be kept at a jail in California — and are more likely to have histories of substance abuse, mental health problems and chronic disease.
San Francisco Sheriff Ross Mirkarimi estimates signing inmates up for Medi-Cal will save his county $2,500 a year per inmate and help decrease repeat incarcerations by 20 percent.
The Health Care Services department said people who are waiting for their Medi-Cal applications to be processed but need immediate care can apply for a temporary ID card from their county social services agencies. Some primary-care clinics have certified enrollment staff on site and are seeing patients before their coverage to kicks in.
The backlog is a short-term problem, said Rachel Metz, policy director for the Alameda County Health Care Services. However, there are still technology and privacy hurdles to overcome when enrolling inmates.
Another complicating factor is the sometimes-adversarial relationship between inmates and the authorities who need their consent to get them signed up.
Trent Burton knows what it’s like to be newly out of jail and without health insurance — which is why he’s reaching out to former inmates like himself at Healthy Oakland, a community clinic in West Oakland. Burton, 26, still has breathing problems from a gunshot wound eight years ago but only recently enrolled in health insurance, thanks to the expansion of Medi-Cal.
Although Burton understands the importance of having health benefits, even he said he wouldn’t feel comfortable signing papers giving deputies authorization to process an application he had filled out.
“I wouldn’t give them my information,” said Burton, who served a year at Santa Rita Jail for armed robbery six years ago.
Once former inmates are enrolled in Medi-Cal, it’s up to them to use the health benefits if needed — and it remains to be seen whether they will, said Healthy Oakland site director John Holman.
“The biggest hurdle is the education of patients to help them understand what they have in their hands and how to use it,” he said.