Beth Barton’s medical bills continue to pile up from emergency room visits, prescriptions and tests. The progression of a genetic disease called Ehlers-Danlos syndrome, which slowly breaks down connective tissues in Barton’s skin, joints and blood vessels, means the freelance photographer can only work a few hours a month.
Prior to this year, Barton couldn’t afford medical insurance as an adult because her ailments stamped her with a pre-existing condition. But President Barack Obama’s health care overhaul meant Barton would qualify for coverage after signing up for Medi-Cal, the state’s low-income health care program. Then she could find a primary care physician.
But those plans have been on hold for Barton and hundreds of thousands of poor residents of California, where the enrollment backlog for Medi-Cal has resulted in diminished or delayed health care for some of the most needy. The waiting list for those who became newly eligible for the free coverage on Jan. 1 is now at about 600,000 people statewide, including at least 12,500 residents of Sonoma County.
The wait has forced people to postpone care, pay out of pocket for medical costs or sacrifice other living essentials, including food and housing.
Barton, 30, of Petaluma said she is barely hanging on.
“Medi-Cal was my saving grace,” she said. “I applied in Sonoma County before Christmas, because I kept getting sicker and sicker. I called and kept calling. Then March came. Then April came. I’m still waiting. Now it looks like I’ll have to start all over.”
Eight months after California opened up its low-income health program to millions of poor people, data gathered this summer show that in Sonoma County, more than half of newly eligible county residents who have applied for Medi-Cal benefits since Jan. 1 are still waiting for coverage.
Applications for roughly 12,565 of the county’s 18,000 previously uninsured people, many of whom are teetering on the brink of poverty, are stuck in the backlog.
State and county health officials blame the delay on technology glitches, combined with a record number of Californians seeking Medi-Cal. State officials have set a goal to deal with those glitches and reduce the backlog nearly in half by September. Officials with the state Department of Health Care Services deferred to a July 14 letter that summarized that response and offered few additional details about the problem and the state’s strategy to address it.
The state has not released data showing the county- by-county breakdown of the backlog. Officials said they were still reviewing the data for any violations of patient privacy.
The county’s Human Services Department has brought on 39 new eligibility caseworkers since the Affordable Care Act went fully into effect, and in May deployed what it called its “power team” – a group of 16 specialists whose sole job is to work the backlog.
“I think we’re doing the best we can, given the circumstances, with the tools we have,” said Kim Seamens, division director with the Human Services Department, who oversees Medi- Cal determinations in Sonoma County. “We’re making really good progress, and it’s moving along much more smoothly than it was a few months ago.”
Under the Medi-Cal expansion — a major part of the Affordable Care Act — people without kids and the uninsured poor became eligible for coverage, many for the first time in their lives. A family of four that earns $32,000 a year can now apply, or a single person making $16,000 annually. Here, county health officials braced for the influx.
The 20 most common ailments that caused patients to be admitted for treatment at Sonoma County hospitals last year were reported by the Office of Statewide Health Planning and Development:
1. Major joint replacement 1,953
2. Septicemia 1,934
3. Esophagitis, gastroenteritis and miscellaneous digestive disorders 712
4. Pneumonia 709
5. Heart failure 609
6. Gastrointestinal hemorrhage 537
7. Bowel procedures 480
8. Intracranial (brain) hemorrhage 475
9. Appendectomy 467
10. Cervical, spinal fusion 462
11. Cholecystectomy (gall bladder removal) 460
12. Myocardial infarction 431
13. Renal failure 424
14. Cardiac arrhythmia 420
15. Cellulitis (tissue infection) 419
16. Gastrointestinal obstruction 365
17. Kidney and urinary tract infections 361
18. Uterus, ovary and fallopian tube procedures 328
19. Lower extremity and humerus procedures except hip, foot, femur 311
20. Pulmonary edema 307
The Office of Statewide Health Planning and Development data for California counties is available at http://oshpd.ca.gov/HID/Products/PatDischargeData/FrequencyTables/CountyFreq/index.html