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Medi-Cal Backlog Leaves California Residents in Health Limbo

Photo of several stacks of medical files on desk and a woman behind them reading one to depict how Medi-Cal Backlog Leaves California Residents in Health Limbo

California’s infamous government efficiencies have led to a lawsuit filed by health advocates over a huge backlog of Medi-Cal applications. As of September 1, 350,000 applications remained in limbo in the enrollment system – a system weighed down by computer troubles that have blocked county government attempts to verify patients’ Medi-Cal eligibility, and frustrating the progress of Obamacare’s healthcare insurance coverage.

The lawsuit, filed in Alameda County Superior Court, states California is not in compliance. By law, the state’s Department of Health Care Services is required to process applications for Medi-Cal – the state health insurance program for low-income residents – within 45 days. But hundreds of thousands of applications have sat around longer than that, many for nine months or more. The backlog reached 900,000 applications a few months ago.

Some applicants have been waiting to receive their Medi-Cal cards since the end of last year. According to advocates, the applicants include children, pregnant women and adults with life-threatening health conditions, who have been delaying treatment or paying cash for health care.

Medi-Cal is California’s Medicaid program. This is a public health insurance program which provides needed health care services for low-income individuals including families with children, seniors, persons with disabilities, foster care, pregnant women, and low income people with specific diseases such as tuberculosis, breast cancer or HIV/AIDS. Medi-Cal is financed equally by the State and federal government.

According to state officials, about 11 million people receive Medi-Cal benefits in California, including 2.2 million who applied since January, as a result of the Affordable Care Act, also known as Obamacare, which expanded eligibility for the program.

Who Pays for Health Services Provided by Medi-Cal?

For many individuals who enroll in Medi-Cal, there are no premiums, no co-payments, and no out of pocket cost. Some households will see affordable costs, such as a low monthly premium. For some Medi-Cal kids, the premium is only $13 per child.

Who’s Eligible for Medi-Cal?

To be eligible, annual income must be 138 percent of the federal poverty level or less (in 2014 that would mean an individual who earned $16,105 or less). For a family of four, annual income must be $32,913 or less.

Individuals can also get Medi-Cal if they are:

  • 65 or older
  • Blind
  • Disabled
  • Under 21
  • Pregnant
  • In a skilled nursing or intermediate care home
  • On refugee status for a limited time, depending how long you have been in the United States
  • A parent or caretaker relative or a child under 21 if:
    • The child’s parent is deceased or doesn’t live with the child, or
    • The child’s parent is incapacitated, or
    • The child’s parent is under employed or unemployed
  • Screened for breast and/or cervical cancer (Breast and Cervical Cancer Treatment Program)

The lawsuit seeks:

  • An order to force the state to meet the processing timeline of 45 days for all Medi-Cal applications.
  • Approval of new Medi-Cal applications on a temporary basis while the state verifies an applicant’s income
  • Notification to applicants of their right to an administrative hearing in the event that their application processing extends for longer than 45 days.

If you need health insurance, now is a good time to get a free quote.

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