Some enrollees have gotten 18 notices in a day; others can’t get their duplicate applications deleted.
California has greatly reduced the backlog of applications for its low-income health program, but problems with the computer system are still causing headaches for tens of thousands of enrollees.
Programming oversights and glitches have caused the state to send some Medi-Cal enrollees as many as 18 notices in a day, with conflicting messages about their health coverage, said Cathy Senderling-McDonald, deputy executive director of the County Welfare Directors Association of California, a nonprofit that represents the human service directors from each county in the state.
County workers are also unable to delete duplicate applications or remove cases from the system even if the applicants request it.
“Our county eligibility workers need to be able to tell the system, ‘This person is not eligible,’ or, ‘We need to withdraw this application,’” Senderling-McDonald said. “The computer can start that process, but our workers can’t and that was a huge oversight in the programming. We need to deny these 10,000 plus cases that are not eligible.”
The state Department of Health Care Services, which oversees Medi-Cal, is working to fix the computer issues, spokesman Anthony Cava said in an email message.
About 12 million Californians are enrolled in Medi-Cal — that’s 31 percent of the state.
The state was inundated with applications when enrollment opened in late 2013. Computer problems, among other issues, led to a backlog of more than 900,000 applications by March 2014. Last week, a state supreme court judge ruled that applicants who have waited more than 45 days to have their applications approved can receive temporary benefits while their application is being processed.
Some of the application issues have been resolved and the state is now able to enroll more than 80 percent of eligible people in Medi-Cal immediately, Cava said.
He said the agency does not have an update on the backlog, which stood at 170,000 in November.
“We hope to have an update on this number soon,” Cava said.
The state prioritized the development of its insurance marketplace, Covered California, ahead of the Medi-Cal system, resulting in delays and glitches, and contributing to the backlog.
Because the state is still working to remove more than 10,000 duplicate or ineligible applications from the Medi-Cal system, the number of truly pending cases may be difficult to calculate.
Just last week Los Angeles County got clearance to begin putting the duplicate and ineligible cases into separate files, a process that is time consuming for the already-stressed enrollment workers, said Elvia Malvido, eligibility supervisor for the Los Angeles Department of Public Social Services.
The county alone has over 10,000 such cases, she said.
“We’re going to assign them a trouble-ticket file, which is basically a holding place, and we will have workers dedicated to moving all of those until a possible solution develops,” Malvido said.
Although most applications now go through the system quickly, enrollers still have to do some workarounds that are time consuming, she added. Sometimes a case will show that it’s been approved, only to switch back to pending status by the time it reaches another computer.
“We have to try to get the timing just right to hit the buttons,” she said. “That can take a considerable amount of time.”
The counties requested additional funding from the state to help cover the cost of the workarounds as well as the higher caseload due to the influx of applications, Senderling-McDonald said. Gov. Jerry Brown included an addition $150 million in his budget plan announced earlier this month, she said.
The state has also taken action to solve the problem with issuing multiple, confusing notices to Medi-Cal enrollees. In September, Brown signed a law that will let the counties take over the noticing system, as they have done in the past.
The state’s computer system, created in the months leading up to the expansion of the Affordable Care Act, wasn’t designed to send out the notices effectively, Senderling-McDonald said.
“It was not done well and there were multiple notices, confusing notices being sent out to people,” she said.
Although the Legislature approved the changes last August, the new law doesn’t go into effect until Jan. 2016, so enrollees may continue to receive confusing notices for another year, Malvido said.
“Anytime we run a case or a system-level update, it will trigger those notices and we can’t review or stop them before they go out,” she said. “Sometimes we may need to run something five times in a day, to test it, and so the notices will go out five times.”
Malvido, who testified at the state senate hearing on the bill, said counties have gotten letters from people saying, “Take back your insurance coverage, I don’t want it. You’re harassing me.”
Although the Medi-Cal enrollment system is operating significantly better than it did a year ago, the county workers expect it may take several years for it to become a truly smooth process, Malvido said.
“It’s definitely better than it was, but there’s still a lot that could be improved upon,” she said. “There are still issues relaying information back and forth.”
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