Huge Increase in Cases Handled by Medi-Cal Complaint Office This Year

The California office that handles complaints from people in the state’s low-income health program has seen its monthly caseload increase by 82 percent this year compared to 2013.

The Department of Health Care Services operates Medi-Cal, the state’s Medicaid program. The department’s Managed Care Ombudsman Office responds to complaints from Medi-Cal enrollees. The office helps people access services that should be covered by their plan.

The Ombudsman Office looked into an average of 9,466 cases monthly through June this year, according to the department.

Last year the office handled an average of 5,205 cases monthly.

California expanded Medi-Cal under the federal Affordable Care Act this year, making more people eligible for the insurance plan. About 2.2 million people have signed up since the expansion. A quarter of the state’s population, or 10.9 million people, are now enrolled in the program.

An additional 490,000 are still waiting for their applications to be processed.

While the increase in enrollment has been touted as a sign of the expansion’s success, the application backlog and the significant increase in the number of cases the Ombudsman Office is investigating show that implementation has been rocky for many.

In addition to increase in cases, the office has seen a jump in the number of phone calls and emails it receives this year, the Health Care Services department said in response to a public records request.

The monthly average number of people contacting the Ombudsman Office increased 51 percent during the first six months of this year compared to 2013. Through June, the office received an average of 21,689 calls and emails monthly, whereas last year the average was 14,381 monthly.

A higher proportion of calls and emails the office receives have resulted in cases this year, meaning that more people are contacting the officials with serious or complicated issues. In 2013, about 32 percent of calls and emails resulted in cases. In the first six months of 2014, 44 percent of calls and emails resulted in cases.

The number of cases that the office logged during the first six months of this year has already surpassed the total number last year. In 2013, the office investigated 54,813 cases, but it has already seen 56,793 this year.

The office doesn’t track how many phone calls or emails it misses due to people hanging up from being on hold or otherwise attempting to contact the Ombudsman officials. The office also doesn’t track how many people have called or emailed multiple times seeking help, but it’s working to upgrade its software to do that, Health Care Services spokesman Norman Williams said.

The office doesn’t record how long it takes cases to be resolved, so it’s unclear whether the increase in cases has resulted in delays for those seeking help.

But Elizabeth Landsberg, director of legislative advocacy at the Western Center on Law and Poverty, said she’s heard from many people who are newly enrolled in Medi-Cal and are having trouble getting help.

The Ombudsman Office “is understaffed and many folks just don’t know about it,” she said.

“Folks often think it’s normal to have a long wait for a doctor so it’s hard to complain when you don’t know things aren’t as they should be.”

The state increased the number of employees in the Ombudsman Office from nine to 21 in March, following the increase in calls and emails. Their staff also grew because of the state’s efforts to enroll more people in managed-care plans, Williams said.

“With the significant increase in Medi-Cal enrollment of more than 2.2 million since January, a high volume of contacts to the Ombudsman since then are related to health care plan issues, including how to access services or who to contact at the plan level with specific questions,” he said.

A review of the office’s workload earlier this month showed that about 4 percent of the calls received had been classified as complaints, Williams said. About 60 percent of the calls were requests for expedited plan enrollment or disenrollment, or to switch plans. Other issues included eligibility and continuity of care between health plans, Williams said.

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