It only takes an hour to enroll in a Covered California health plan with the subsidies. However, if you are erroneous flipped into Medi-Cal, it can take weeks to return to your Covered California health plan. The difficulty with extricating you and your family from Medi-Cal revolves around verification rules and a lack of staff to handle service requests.
It can weeks or months to get out of Medi-Cal
Some people only learn they have been flipped into Medi-Cal when they are at their doctor’s office and the receptionist tells them their health insurance has been cancelled. What follows for many people is a nightmare scenario of trying to learn why their Covered California plan was terminated, who terminated it, why they are in Medi-Cal, and how to get of the Medi-Cal system.
The federal Medicaid program was created in 1965. The Medicaid health insurance program for low-income adults and children is administered by the states and known as Medi-Cal in California. The rules for determining eligibility for Medicaid, as implemented by many states, was in part designed to keep people from qualifying for the low-cost health insurance.
Specifically, individuals had to prove their income was low enough for Medi-Cal benefits. To prove you could be eligible for Medi-Cal you needed to provide the case workers all sorts of financial information such as pay stubs, all income streams, cash in the bank, and how many cars you owned. The system was designed to keep people from receiving low-cost health care by creating high hurdles they could not jump over.
Old, outdated rules, trap people in Medi-Cal
In an odd twist, the rules meant to keep people from receiving Medi-Cal health insurance, now traps people who really are not eligible for the program. Under the Affordable Care Act, Medicaid eligibility was expanded in California. Through a Covered California application, any adult can be determined preliminarily eligible for Medi-Cal just by having a monthly income under 138 percent of the federal poverty level.
For individuals and families already in a Covered California health plan, all it takes is one little date error in the income section to have a bureaucratic tidal wave wash away your enrollment. Once the CalHEERS software program of Covered California flags you as potentially being Medi-Cal – even if you are not eligible – it is game over. Covered California then forwards the information to the respective county Medi-Cal office for the individual and family.
Unfortunately, Medi-Cal is still working under the old rules regarding income verification. A simple correction to the income date entry could easily fix the error. Medi-Cal does not recognize simple errors. Before they can release a person from the grips of the Medi-Cal program, the individual must supply proof-positive documentation that their income is over 138 percent of the federal poverty level for adults or 266 percent FPL for children in the household.
The first challenge of getting out of Medi-Cal is communicating with a case eligibility worker. The customer service of Medi-Cal is on par with trying to get help with your Packard-Bell computer with a DOS operating system.
Note to politicians, any candidate for a legislative or executive branch office that promises to fix the woeful Medi-Cal customer service will surely get elected. There are 12 million Californians in some sort of Medi-Cal program versus a handful of county case eligibility workers to provide assistance.
Understaffed County Medi-Cal Offices
Each of the 58 counties in California manage their own Medi-Cal eligibility and enrollment for their county residents. The county Medi-Cal offices are understaffed and overworked. When the world shut down with the Covid public health emergency it was difficult to contact Medi-Cal. Now, Medi-Cal has resumed normal operations and it is still impossible to talk to a human at most county Medi-Cal offices.
What Medi-Cal is very efficient about is terminating Covered California plans. As I write this, a client just texted me saying Blue Sheild informed him his health plan was cancelled. A check of the Covered California website shows Los Angeles County went in and terminated the health plan. There is no explanation from Medi-Cal or Covered California.
This gentleman, and thousands like him, must now call the county Medi-Cal office to prove they are ineligible for Medi-Cal health insurance.
Tips for communicating with a Medi-Cal case eligibility worker.
- Be patient
- Have your Covered California case number ready. Medi-Cal can view your Covered California account.
- Calmly report that Covered California determine you were eligible for Medi-Cal and you do not know why.
- Let the Medi-Cal case eligibility worker review the case and tell you why the Medi-Cal eligibility occurred.
- Ask what specific documents they need to determine that you are not eligible for Medi-Cal.
- Ask exactly where copies of the documents should be sent to and what Medi-Cal form should accompany the documents.
The Medi-Cal case eligibility workers are just following the rules. There are specific steps, conditions, and verification documents they need to have in place before a negative action or ineligibility is determined for each case.
Across California, the county Medi-Cal offices are fielding thousands of phone calls from the millions of Californians enrolled in a variety of Medi-Cal programs, every day. The state is trying to serve 12 million people based on 1960s rules and customer service mindset.
If Medi-Cal was private company offering a service, they would have a 1-star rating for customer service. It is the bitter taste of poor customer service from Medi-Cal that inclines most people to not want anything to do with any proposed government run health care program.