Patients Unexpectedly Shunted from Covered California to Medi-Cal

Monday, September 15, 2014

California has experienced an explosion of low-income and disabled Medi-Cal patients since the Affordable Care Act broadened its scope, funding and outreach last year—2.2 million additional enrollees since January, according to the Los Angeles Times.

Now, their numbers are being augmented by people who did not sign up for Medi-Cal—the state’s version of Medicaid—and don’t want to be in it.

Emily Bazar, who writes the Ask Emily column for USC Annenberg’s Center for Health Reporting, wrote a week ago about a stunning number of frantic inquiries coming her way from people who were dropped by their Covered California insurance companies without explanation and, in many cases, were automatically enrolled in Medi-Cal.

It appears they are being kicked out of the subsidized medical insurance program because Covered California has determined their incomes are so low they belong in cheaper (and sometimes free) Medi-Cal. There has been a loud outcry from Covered California policy holders that they can’t find doctors and hospitals in the narrow insurance networks that will treat them, but the exchange’s pool of medical practitioners, and the level of care, is considered to be far superior to Medi-Cal.  

People have been known to inflate their incomes a tad to avoid Medi-Cal. But judging from the complaints Bazar has heard, people who don’t qualify for Medi-Cal are being dumped by their insurance companies anyway.

Insurance agent Evette Tsang, who reported that three clients with incomes above the Medi-Cal threshold were bumped, said, “My biggest problem is we don’t know what income standard they’re using.”

Covered California acknowledges it is manually reviewing income-level claims by enrollees last year and is redirecting some to Medi-Cal. But Bazar could not find out how many have been shifted. People are not being questioned or warned before being reevaluated and moved. And not everyone is actually moved.

Some are suddenly cut loose with no insurance. And for those who claim they make too much money to be on Medi-Cal, they run the risk of illegally participating in the program or being stranded in a no-man’s land with no coverage.

Department of Managed Health Care (DMHC) spokesman Rodger Butler said the agency received 131 complaints about cancellations as of August 1. He said a Covered California enrollee cannot legally be cut loose by his insurance company without 30 days notice.   

Dana Howard at Covered California told the Associated Press that some people were being shifted to Medi-Cal because the federal government updated its poverty level and some borderline consumers dipped beneath the line.

Assemblyman Richard Pan (D-Sacramento) said his Committee on Health would hold hearings September 23 into the cancellations and shifts.

–Ken Broder


To Learn More:

Income Checks Throw Californians Off Health Plans (by Judy Lin, Associated Press)

Ask Emily: Does Covered California Really Have You Covered? (by Emily Bazar, CHCF Center for Health Reporting)

Medi-Cal Patients Can’t Find Doctors; State Needs Audit to Find out Why (by Ken Broder, AllGov California)

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