Medi-Cal backlog puts low-income patients in limbo

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 county’s Human Services Department has received 12,792 Medi-Cal applications since the beginning of the year. More than half of those applications are still pending. As of June 30, 6,981 applications have not been processed. Each application represents an average of 1.8 people, according to the county.

Barton became stuck in the backlog when, with the help of a family friend, she applied for Medi-Cal through the Covered California website. Her application went through four different computer systems before ending up in the hands of one of Sonoma County’s 198 eligibility workers.

But her application was missing material. First, she was notified she had to send in a copy of her driver’s license. Then it was copies of her tax return. Barton estimates she’s racked up at least $25,000 in out-of-pocket medical costs while waiting for coverage. She could afford such expenses when she was working as a commercial photographer, shooting for companies such as Williams Sonoma and Pier 1 Imports. But her debilitating disease has curtailed most of that work.

“I need Medi-Cal,” she said. “But the process of applying has been so awful.”

California is not alone in its enrollment problems. Five other states, including Alaska, Kansas, Michigan, Missouri and Tennessee, have been singled out for delays linked to the expansion of Medicaid, the federal low-income health program. Twenty states are not participating in the expansion.

Federal health regulators are now clamping down on California. In July, the Centers for Medicare and Medicaid, a federal agency, demanded the state develop a plan to eradicate the backlog.

Health care advocates have railed against the problem.

“It’s unacceptable,” said Sonoma County Supervisor Shirlee Zane, who heaped blame on the state. “We’ve done our part to get people enrolled. We’ve hired new people, we’ve trained eligibility workers. Our problem has been the state - unlike Sonoma County, they were not prepared.”

The criticism has been echoed by local officials statewide, prompting a lobbying push in Sacramento for a more streamlined application process.

“We’ve spoken to many counties who are frustrated by the big volume of applications they’ve received, and various technology issues,” said Elizabeth Landsberg with the Western Center for Law and Poverty, a health advocacy organization. “People are worried and they are confused.”

The July 14 letter from the state Department of Health Care Services, which regulates the low-income health program and processes Medi-Cal cards, outlined three key factors that have contributed to the backlog: A lot of applications submitted at once, technology upgrades that didn’t work and duplicate applications.

“The demand for Medi-Cal coverage was a lot greater than people ever expected,” said Dylan Roby, an analyst at the UCLA Center for Health Policy Research, which produces simulation models to project Medi-Cal’s growth. “I think that demand overloaded the system because so many people were coming in at one time.”

By the end of June, California had signed up 2.2 million newly eligible people for Medi-Cal, bringing the total enrollment to 10.9 million.

But problems continue. While counties in California continue to sift through the pile of 600,000 pending applications, eligibility workers are also certifying millions of Medi-Cal renewals - a process that every applicant must undergo annually. The state checks for changes in family size and income.

Those applicants are being affected by the delay as well.

“My concern is that people, especially those who need health care immediately, are having to delay health care or pay out of pocket,” Roby said. “Some people may have signed up back in October, and their system still hasn’t been processed.”

Seamens said the county has the ability to fast-track people’s applications if there is an immediate health need. But caseworkers must paper-process applications with missing fields, or when there are mistakes in applications, further delaying the process.

The backlog is further exacerbated because eligibility workers process applications through various entry points - online, through the mail, over the phone or in-person.

The county has chipped away at its own backlog, which hovered around 9,000 applications in May.

County officials said given the complexity of the computer systems, along with significant user errors, some problems were expected. Thousands of applications remain pending because applicants left fields missing, for example, or filled in income information incorrectly, officials said. County eligibility workers send letters or call the applicants to gather missing data.

“In the grand scheme of things,” Seamens said, “I think this will just be kind of a bad memory.”

Pedro Toledo, the chief administrative officer at Petaluma Health Center, understands the reasons given by government officials for the delay, but patients are suffering, he said.

“It’s affecting a lot of our people, especially those who have a chronic disease like diabetes,” Toledo said. “People want access. A lot of people are having to make choices of whether to buy medications, or buy groceries. It’s also peace of mind; people will no longer have to worry about what happens if they have a catastrophic event.”

Three-quarters of the patients at Petaluma Health Center - 7,300 people - are Medi-Cal patients. Barton, who visited the clinic on Wednesday, is hoping to become one of them. Enrollment workers and insurance experts were there to speed her application.

“I’ve gone through every range of emotion - first feeling sad, but now empowered,” Barton said. “But I have to think, if I had Medi-Cal, I wouldn’t have to go through all this.”

You can reach Staff Writer ?Angela Hart at 526-8503 or ?angela.hart@pressdemocrat.com. On Twitter @ahartreports.