The California Department of Managed Health Care will regularly fine health plans for mistakes and bad conduct that affects members. However, when a county Medi-Cal office rips the health insurance away from Covered California member, there is no accountability. When will Medi-Cal get penalized or receive a fine for jerking people around.
Medi-Cal Left Her Completely Without Health Insurance
Phoebe had been enrolled in a Covered California health plan with the subsidies for several years. Phoebe is one of my clients. In January of 2023 we updated Phoebe’s Covered California income estimate. This open enrollment income change made Phoebe eligible for a Silver 94 plan that she enrolled into.
At the beginning of March, Phoebe received a notice from Covered California to verify her income, due April 13. Before she sent the income attestation form to Covered California, she was notified that her health plan enrollment had been terminated. Phoebe’s health plan had been terminated as of March 31st.
Medi-Cal Meddles In Covered California Accounts
When we reviewed Phoebe’s case history, it showed that the county Medi-Cal office had been making changes to her Covered California account. One change was doubling her income by adding an old income entry that we had ended. Technically, with a doubling of the income, Phoebe was way over the Medi-Cal income threshold.
I called Covered California see why Medi-Cal had gotten into Phoebe’s account triggering the health plan termination. There was no explanation. She was never under a pending Medi-Cal review. The Covered California customer service represented saw that Medi-Cal could not verify her citizenship. Phoebe was born in the United States and there has never been a question about her citizenship.
However, the lack of citizenship or lawful presence explains why in the Covered California eligibility results showed that Phoebe was ineligible for both Covered California and Medi-Cal. With a few clicks on a computer keyboard, a county Medi-Cal worker ripped Phoebe’s health insurance away leaving her completely uninsured. It didn’t even show that she was pending Medi-Cal eligible. She had become uninsured.
The only notice Phoebe received that she was uninsured was from health insurance company. Covered California did notify her that her case was sent to Medi-Cal. The county Medi-Cal office never notified her that they were going to tamper with her account. Medi-Cal gave her no opportunity to verify her citizenship or income before they summarily terminated her health insurance without her knowledge.
What Medi-Cal has given Phoebe is a giant headache and anxiety attacks. She must now spend hours on the phone attempting to untangle this Medi-Cal mess. The Medi-Cal worker told Phoebe that it could take 45 days to make an eligibility determination. That is over a month without insurance. Medi-Cal is suppose to protect people, not traumatize them.
Medi-Cal Deserves To Be Fined Like L.A. Care and Health Net
The Department of Managed Health Care recently fined L.A. Care Health Plan $300,000 for deceptive enrollment tactics. Gosh, what could be more deceptive than going into a person’s Covered California account and making unauthorized and erroneous changes that result in the termination of the person’s health insurance?
The Department of Managed Health Care also fined Health Net for failing to properly reimburse plan providers for services to their members. Phoebe can’t even generate a claim for health care services with a provider because Medi-Cal stripped her of health insurance.
When will the Department of Managed Health Care fine county Medi-Cal offices who egregiously terminate the health plan of an unsuspecting Covered California member who was following all the rules of the ACA marketplace exchange?
When will Medi-Cal misfeasance be addressed?
My guess is that Medi-Cal is considered above the law and outside any accountability. If proponents of government single payer health insurance ever wonder why the public is skeptical – or downright hostile to the concept -, they only need to review how government Medi-Cal offices torment Californians by meddling in their Covered California accounts.
