News Health Systems

Nearly a Million Medicaid Applications Backlogged in California

Nina Liss-Schultz

The giant system backlog means that many state residents eligible for the program aren’t receiving the care they need. Multiple sources report that people hoping to be covered through the program are putting off going to a doctor until their enrollment is confirmed.

In California, nearly a million applications for the state’s Medicaid insurance program remain stalled in the system’s purgatory, with little sign of budging.

The massive backlog was first reported in April, when the California Department of Health Care Services said that 800,000 applications for enrollment were waiting to be processed. The number grew to over 900,000 by May and hasn’t changed in the last two months, as bureaucrats struggle to keep up with the inundation. According to the San Jose Mercury News, officials have also confirmed that the state has fallen behind in “sending final notifications to enrollees.”

The Medicaid program, called Medi-Cal, provides much-needed health care to a range of people, including those who are low-income and individuals with disabilities and certain diseases, such as HIV, AIDS, and breast cancer. As part of the Affordable Care Act, California expanded Medi-Cal on the first day of this year, making significantly more people eligible for the government-funded health insurance program. People newly eligible for Medi-Cal were able to apply for enrollment last fall through the state’s online health insurance marketplace.

By and large, the population most likely to benefit from Medi-Cal is Latinos. In 2012, seven million Californians (or one in five people in the state) were uninsured. Almost 30 percent of Latinos in California are uninsured, compared with 17 percent of African Americans and about 14 percent of white people. Latinos make up 40 percent of the population of California, but almost 60 percent of the uninsured individuals in the state. Additionally, the Department of Health Care Services estimates that about 40 percent of people eligible for Medi-Cal are Latino, and nearly 20 percent speak Spanish as their primary language.

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At least part of the bottleneck can be attributed to the number of people enrolling. Before the expansion, there were 8.5 million Americans using Medi-Cal for health insurance. According to the local paper, an additional 2.2 million people will have signed up by the end of the month—300,000 more than originally projected.

Since last fall, 40 percent more people have signed up for Medi-Cal than the number who enrolled in private insurance through Covered California, the state’s health insurance exchange. Roughly 1.4 million of those applicants were newly eligible for Medi-Cal, which was expanded to serve people up to 138 percent of the federal poverty level. About 600,000 more were previously eligible for coverage but had not enrolled.

The giant system backlog means that many state residents eligible for Medi-Cal aren’t receiving the care they need. Multiple sources report that people hoping to be covered through the program are putting off going to a doctor until their enrollment is confirmed.

California is not the only state experiencing backlogs in Medicaid enrollment this year. Illinois faces the next biggest pile-up, while Florida, Texas, and North Carolina have each reported backlogs of at least 10,000.

News Health Systems

Two-Thirds of California’s Uninsured Gain Coverage Through Obamacare

Nina Liss-Schultz

Prior to the coverage expansions created by the Affordable Care Act, California had the nation's largest population of uninsured non-elderly adults at nearly six million.

More than two-thirds of Californians who were uninsured at the start of the Affordable Care Act’s implementation have since gained health-care coverage, according to a new report.

Prior to the coverage expansions created by the ACA—also known as Obamacare—California had the nation’s largest population of uninsured non-elderly adults at nearly six million.

Most of those people wanted health coverage but felt they couldn’t afford it, according to the Kaiser Family Foundation, which has followed a group of Californians who were uninsured in the summer of 2013 as part of a longitudinal survey on the effects of the ACA, which has been roundly rejected by Republican-held state legislatures for the past two years.

By 2014, 58 percent of those previously uninsured had purchased coverage during the state’s first open enrollment period: 1.6 million had enrolled in Medi-Cal, the state’s version of Medicaid, and another 1.4 million had bought private insurance through Covered California. During the state’s second open enrollment, which ended this year, an additional 1.3 million people enrolled in coverage, bringing the total number of newly insured up to nearly 4.3 million.

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That leaves some 1.7 million people still without insurance in the state.

“For the people that didn’t have health insurance, California has been very successful in enrolling two-thirds of that group,” Mollyann Brodie, senior vice president at the Kaiser Family Foundation, told the Los Angeles Times. “But the group that is left is a harder-to-reach group.”

That group is comprised in large part of undocumented immigrants who are barred by law from receiving coverage through the ACA. Deferred Action for Childhood Arrivals (DACA) recipients in California have been eligible for Medi-Cal since the beginning of 2014. And this year, Gov. Jerry Brown approved in his budget a measure that expands Medi-Cal eligibility to all children in the state, no matter their immigration status.

A bill, SB 4, which would expand Medi-Cal to include undocumented adults and allow those adults to purchase private insurance through Covered California, is currently being considered in the Democratic-led state assembly.

News Human Rights

Latinos, Low-Income People Benefit From ACA’s First Year in California

Emily Crockett

The Affordable Care Act, in its first year of implementation in California, has expanded health insurance to people who have been historically underserved by the health-care system, especially Latinos and low-income people.

The Affordable Care Act (ACA), in its first year of implementation in California, has expanded health insurance to people who have been historically underserved by the health-care system, especially Latinos and low-income people.

A new report from the Kaiser Family Foundation took a detailed look at how the first year of fully expanded health coverage in California has impacted the lives of newly insured low- and moderate-income people, and what barriers many still face to either getting new coverage or making use of the coverage they have.

“California is a bellwether state for understanding the impact of the ACA,” the report’s authors note. “The state’s sheer size and its high rate of uninsured prior to ACA implementation means that its experience in implementing the ACA has implications for national coverage goals.”

California had the largest number of uninsured residents of any state in the country before ACA implementation—6.8 million uninsured people, which was 18.5 percent of the state’s population and 14 percent of the entire uninsured population nationwide.

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California was an early and enthusiastic adopter of the ACA, which helped a much larger number of people than expected to gain insurance coverage between October 2013 and September 2014. Medi-Cal, the state’s Medicaid program, covered 2.7 million new people, and 1.7 million gained coverage through Covered California, the state insurance exchange.

The report found that the ACA coverage expansion disproportionately benefited low-income people (those making less than 138 percent of the federal poverty level), Latinos, young people, and people who don’t work full-time—all of whom tend to lack insurance more often than other groups.

As might be expected, people who already had insurance before the ACA took effect were richer, whiter, and more likely to have full-time employment than both the newly insured and the uninsured. It was much harder to get affordable health insurance before the ACA without a full-time job, and people of color and low-income people faced other barriers.

At 41 percent of the newly insured, Latinos were by far the largest racial or ethnic group to gain insurance coverage in California after ACA implementation. Latinos also currently make up more than half, 54 percent, of the uninsured population in the state. 

Unauthorized immigrants are not entitled to any subsidies under the ACA, leaving many of them without affordable health-care options.

Despite active outreach efforts in California, the report says, reaching Latinos was a challenge for the Department of Health and Human Services partly due to linguistic issues and insufficient staff resources. 

Other challenges in implementation included Medi-Cal backlogs that delayed applications, technological issues, and a shortage of people to assist applicants in person.

Newly insured people had more regular care than uninsured people, but they were still more likely to go to a clinic or a health center than a regular doctor in an office, often due to cost concerns.

Newly insured people were also just as likely as uninsured people to postpone or go without care at some point. That could be due to problems finding a provider or navigating the health system, failing to understand their benefits, or being worried about out-of-pocket costs, according to the report.

Those out-of-pocket costs are still a problem for low-income people; almost half of the newly insured reported difficulty paying their premiums. But they still benefited from lower medical bills and less anxiety about being able to afford care.