Global Courant 2023-04-25 17:00:43
Canned music boomed from the phone as Jessica Sanchez waited, fidgeting and shifting her pregnant belly in her chair at the Santa Monica health center.
It had been an hour since Sanchez and an associate at the Venice Family Clinic called a Los Angeles County office for help. At an antenatal appointment, Sanchez, 33, had abruptly discovered that her health insurance had been cut months earlier. The news shocked Sanchez, who was already in her third trimester.
A repeating recorded voice repeats told her, “Your call is important to us. Please stay on the line.” Sanchez checked her phone, pulled out a bundle of pastel thread, and started crocheting again for the baby boy she’s expecting.
“By the time they pick up,” said Sanchez, 33, “I’ll be done with this blanket.”
Jessica Sanchez is in her third trimester of pregnancy and is struggling to get her Medicaid reinstated.
(Mel Melcon/Los Angeles Times)
As the federal government has rolled back rules that helped keep people on hold on Medicaid during the COVID-19 pandemic, healthcare providers fear the consequences could be disastrous for patients. Federal rules had prevented states from starting people off the program, even if changes, such as an increase in income, would otherwise make them ineligible.
Now millions of people are expected to lose their Medicaid coverage — including many who still qualify — as California and other states go back to check whether people meet the requirements. Federal officials estimation that nearly three-quarters of children and teens who lose coverage will do so even though they remain eligible for the program.
Keeping eligible patients on Medicaid has long been a “bureaucratic nightmare,” says Jim Mangia, president and CEO of St. John’s Community Health, a network of community clinics in the Los Angeles area. Before the pandemic started, he said, hundreds of their patients would accidentally lose their coverage every month. “Now it’s going to be a downright disaster.”
Many people have moved or been displaced during the pandemic and could miss important notifications that their messaging is compromised, Mangia said. If they don’t return the necessary paperwork on time, they could lose their coverage under Medi-Cal, California’s Medicaid program. He estimated that between 10% and 15% of St. John’s patients could lose it.
Community clinics say many patients are also facing long waits for help from LA County, which they expect will only worsen with millions across the country to be updated for the coming year. The Medi-Cal cases come on a rolling basis, with a new round of patients due for renewal each month.
David Kane, an attorney at the Western Center on Law and Poverty, called it “a perfect storm.” A record number of Medi-Cal filings during the pandemic means large numbers of Californians will have to go through the renewal process, potentially overwhelming county agencies tasked with handling the renewal process, many of them staff shortage. Before the renewal process began, LA County officials told the state they expected to need more staff and warned that new hires could be slower to handle cases.
“We haven’t gotten any assurance that they’re completely ready for this,” Kane said. Legal attorneys have sued the county in the past for wrongly stopping Medi-Cal coverage for thousands of people, and a judge ruled five years ago that the county had broke the law by terminating coverage even though people had submitted their paperwork on time.
Nick Ippolito, an assistant director with the LA County Department of Public School Services, said that “we are committed to helping our customers maintain their Medi-Cal coverage with no or minimal disruption.” He said the department made a strategic decision to continue sending the usual paperwork during the COVID-19 emergency — without closing them if people didn’t return it — so that Medi-Cal enrollees could make it a habit to and return and report the packages with new information.
Many Angelenos could have their Medi-Cal automatically renewed if the county checks information against a federal database for other government programs. At a recent meeting of the County Board of Supervisors, Department Director Jackie Contreras said tens of thousands of cases per month are expected to be successfully handled through auto-renewal, meaning the individual will simply get a message that their Medi-Cal coverage will continue.
But many more — more than 120,000 in June alone, including some undocumented or others whose cases cannot be verified by the federal database — will likely require manual processing, with people submitting their information by mail, phone, online or according to provincial figures at a county office to maintain their health insurance.
At the district meeting, community clinics and other advocates expressed concern about how that could play out. For example, there’s a state website where people can fill out their renewal information called BenefitsCal, but a Venice Family Clinic employee told the county board that it didn’t recognize uploaded paperwork or even simple address changes.
As of earlier this year, BenefitsCal was only used for one fraction of Medi-Cal applications or renewals, according to statewide data. Lena Silver, associate director of litigation and policy advocacy at Neighborhood Legal Services in Los Angeles County, said even creating an account can be difficult for some Medi-Cal recipients who don’t have email accounts or Internet access. When someone creates an online account, the system also needs to link that new account to provide information about their benefits, but that doesn’t always work, Silver said.
“Because of all these problems with the online system, people end up calling, which also overloads the lines,” said Dina Dimirjian, a staff attorney at the Health Consumer Center at Neighborhood Legal Services of Los Angeles County.
Contreras told provincial leaders wait times averaged more than 40 minutes in January and less in February, but would likely be higher in March, possibly as much as an hour and a half, depending on the time of day. Ippolito said in an interview that Medi-Cal is the most complex program and “you have to spend some time on the phone with people to answer their questions.”
Valerie Ibarra-Figueroa, a health insurance specialist at the Venice Family Clinic who helped Sanchez, said she’s used to waiting more than an hour on the phone with the county when patients have problems with Medi-Cal. She has to carefully juggle all other work while on hold because she has to be ready immediately if someone answers or risks hanging up, she said.
Sanchez had been waiting with Ibarra-Figueroa for over an hour for someone to pick up her call when a DPSS employee finally picked up the line. Ibarra-Figueroa quickly handed the phone to Sanchez, who explained that she was 31 weeks pregnant and had just learned that her coverage had been cut.
“So can you guys get it active now?” she asked.
Valerie Ibarra-Figueroa of the Venice Family Clinic helps Jessica Sanchez get her health insurance back.
(Mel Melcon/Los Angeles Times)
After some back and forth, Sanchez put Ibarra-Figueroa back on the phone to understand what she was being told. “I understand the process about that,” Ibarra-Figueroa said on the phone. “But because of the pandemic protection, she shouldn’t have been cut off anyway.”
Ibarra-Figueroa said she couldn’t get a clear explanation as to why Sanchez lost her health insurance in February, before the federal rule was reversed. DPSS officials have said that since renewal paperwork begins to be sent out this month, no one would have their Medi-Cal cut off for not returning it before the end of June.
To solve the problem, Sanchez, who worked as a housekeeper before her pregnancy made it difficult to go through, was eventually asked to prepare an affidavit explaining her financial situation, which Ibarra-Figueroa quickly scanned and uploaded for the county to review.
After the call, Sanchez pondered aloud what might happen before her Medi-Cal coverage was reinstated.
“What if I gave birth before then?” asked Sanchez.
Kane pointed out that last year, an average of more than 178,000 calls to DPSS were dropped each month — more than a quarter of calls coming to the customer service center, according to county data — and tens of thousands more were getting a “high call volume” message saying they would later have to call back.
Even when clinic staff and patients reach out on the phone, “sometimes we don’t get the support they need,” says Karem Martinez, a lead enroller at East Valley Community Health Center in Pomona. “We either get led back to the queue and have to wait again – or they just hang up.”
During the pandemic, LA County saw the number of Medi-Cal cases rise from less than 1.7 million to nearly 2.2 million as people were able to keep their coverage, it said provincial data. DPSS’s workforce has not kept pace with the growing caseload across all programs, Ippolito said. The LA County department has been hiring but is struggling with attrition: Contreras told county officials her department had 167 job openings for employees handling Medi-Cal, which she expected to fill in May, but would have more positions to fill to be completed again in June.
If “we’re not ahead of our turnover, having more positions won’t help,” Contreras told the board.
The LA County employees who handle the calls earn between $43,000 and $62,000, according to Ippolito. LA County Supervisor Holly Mitchell said that as the county bureau faces the coming wave of extensions, “they are in the best possible position.” But “when Starbucks has sandwich signs in front of their stores that say, ‘We will pay for childcare’…everyone rushes to try and bring in top talent,” Mitchell said.
Contreras told county regulators the state is ready to allocate $34 million to help the department handle the extensions, which could help with hiring. But the funding is a one-time allocation and “obviously we want to be able to hire and retain someone,” Ippolito said.
Meanwhile, Sanchez got a call from the county a few days after her visit to the Santa Monica clinic and shortly before she was due to have her next ultrasound.
Her Medi-Cal had recovered much to her relief, she was told.
