State Clash over Moving Patients from Covered California to Medi-Cal

Monday, December 29, 2014

California Insurance Commissioner Dave Jones and Covered California seem to have a difference of opinion about whether customers can automatically be moved from Obamacare to Medi-Cal when their income level falls too low.

Commissioner Jones told the Los Angeles Times that 95,000 people were being illegally booted out of Covered California.  “The law is very clear,” Jones said. “They can't cancel people” except for specific reasons, like fraud.

Health exchange spokeswoman Amy Palmer disagreed, without identifying a number. “It would be inappropriate to renew them and continue to pay a subsidy,” she said. “The law requires us to seamlessly move people from one program to the other.”

And seamless it will be. “There will be no gap in coverage for these people,” Palmer said. “We will make sure Medi-Cal kicks in immediately.”

Those are bold words considering Covered California’s bumpy first year and Jones isn’t buying it. He said people are going to be left uninsured for stretches of time and it can be prevented. He wants Covered California to emulate the Obama administration, which is allowing people on the federal exchange, which 37 states use, to keep their coverage until their new status with Medicaid is confirmed.

It appears people 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. People have been known to inflate their incomes a tad to avoid the crummier Medi-Cal. But judging from published complaints, some people who don’t qualify for Medi-Cal are being dumped by their insurance companies anyway, leaving them in limbo.

Anecdotal evidence the last few months points to a rocky transition as the health exchange re-evaluates customer income qualification. The media reported that people were being dropped by the exchange but not picked up automatically by Medi-Cal, or they were incorrectly dropped without an opportunity to participate in the decision.

U-T San Diego reported that in the closing moments of Covered California enrollment a few weeks ago the computer system was wrongly directing some applicants to Medi-Cal coverage. The story implied that the problem had to do with a computer glitch, acknowledged by the exchange, which affected people who were modifying estimated income levels.

But exchange computer problems have been sufficiently complex, and transparency by officials not unexpectedly opaque enough, to keep people guessing about how and when their coverage will be sorted out. The metric for measuring the inconvenience, emotional toll and problems from having medical problems during an unexpected insurance gap have not yet been devised.

For now, most everyone is buoyed by the things they can measure: high enrollment rates, the slowing increase in medical costs and the lack of a catastrophic computer meltdown. The final judgment, hopefully, will have something to do with measuring health outcomes and people’s well-being.

–Ken Broder


To Learn More:

California Regulator Assails Obamacare Cancellations (by Chad Terhune, Los Angeles Times)

Covered CA Glitch Diverting Some to Medi-Cal (by Paul Sisson, U-T San Diego)

Patients Unexpectedly Shunted from Covered California to Medi-Cal (by Ken Broder, AllGov California)

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