The Department of Health Care Services has notified county Medi-Cal offices that they no longer must include case eligibility worker contact information on letters of Notice of Action to Medi-Cal beneficiaries. For many individuals and families trying to manage their Medi-Cal eligibility and enrollment, this change will only create additional frustrations.
The listing of a case eligibility worker on a Notice of Action from Medi-Cal will now be at the discretion of the of the county issuing the notice. Of course, most people complain that the listed case eligibility worker can never be contacted and never returns phone calls. Perhaps the elimination of a human contact is not that big of an issue.
Case Worker Contact No Longer Listed
The Department of Health Care Services All County Welfare Director letter number 24-13, dated October 25, 2024, stated the reason for an optional human contact on Notice of Action letters to beneficiaries.
County Contact Information Requirements Update
Since the implementation of CCR Section 50179(b) and ACWDL 13-13, the evolution of technology and county business practices have rendered the requirement that NOAs contain contact information for specific case workers obsolete. Many counties have shifted to task-based case management, in which the actions or tasks needed on a particular case are assigned to workers, rather than the entire case. Counties may assign cases to a unit consisting of multiple workers or utilize other methods of organizing cases to support task-based case management, such as call centers. These business practices vary county to county based on size, organization, populations served, and other factors. Because the county contact requirement previously described in Section 50179(b) and ACWDL 13-13 is no longer in alignment with current county practices and process efficiencies, updates to the rule were necessary.
A Notice of Action is sent to Medi-Cal beneficiaries or potential beneficiaries regarding the status of their eligibility for benefits. The notice could be informing the individual or family that they are eligible for Medi-Cal, there is a change to their benefits, or they are being terminated from the health insurance program. In all those scenarios, the eligibility determination may be incorrect.
When there is an error in a county Medi-Cal determination, it is nice if the beneficiary has an actual person to talk to. These people are known as case eligibility workers that work with most aspects of the eligibility determination process. Case eligibility workers seem to be going the way of most customer service departments for any business where access is governed by automated phone menus and chatbots.
Medi-Cal Efficiency versus Customer Service
It is hard to fault counties trying to become more efficient. Medi-Cal enrollment has drastically grown since the expanded MAGI Medi-Cal under the Affordable Care Act. While Medi-Cal enrollment is up, county funding and staff have not seen a similar increase of employees. For many large counties, it is not feasible to have one case worker responsible for thousands of Medi-Cal beneficiaries. Changes to the workflow had to be made.
Instead of one point of contact, it can be more economical and efficient to break the process into various parts handled by different units. Because a large proportion of the eligibility determinations and enrollment are fairly straightforward and routine, it is easier to break the work up into an assembly line operation. Of course, many individuals and families are anything but uniform and routine. Many have complicated situations that really need personalized attention.
The All County Welfare Directors letter stated, “This change is not expected to have system impacts.” Anecdotally, there have been some system impacts. I have seen more Medi-Cal changes to Covered California accounts that indicate a lack of coordination.
- There have been more Covered California cases where family members were erroneously determined ineligible for the health insurance subsidies, but not enrolled in Medi-Cal. In other words, the subsidies were turned off and the individuals must pay the full premium, but are not eligible for Medi-Cal. This appears like one unit determined the eligibility, but the other unit never enrolled the individual into Medi-Cal.
- One client, who is over 65 years of age, is eligible for Covered California because the individual was not eligible for Medicare. The county flipped the individual into Medi-Cal even though the documented income was over the Medi-Cal threshold. That was finally sorted, when someone at the county changed the monthly income to $33,000 per month. The document pension is $33,000 annually. The erroneously high monthly income zeroed out the monthly subsidy until we could fix the issue.
- For another client, the county Medi-Cal office applied old income numbers for a family that reported the birth of a child. The adult eligible for Covered California had their subsidies turned out, but not enrolled in Medi-Cal, when the income Medi-Cal entered clearly made the individual Medi-Cal eligible. The individual was able to get the county to recognize the documented household income, subsidies restored. Two weeks later, someone at the county flipped the income back to the old erroneous amount.
All these cases feel like different people working on different aspects of the Medi-Cal eligibility and enrollment. In all instances, there was no specific case eligibility worker to contact to review and fix the case. It may be more efficient to run the Medi-Cal applications and changes through a business rules assembly line operation. Unfortunately, when errors occur, no one at a county Medi-Cal office is accountable for resolving the issue. Individuals and families are spending many hours correcting really stupid mistakes, and they have no one to advocate for them at the county level.
