Computer glitches hamper healthcare delivery to California's poor

By Eryn Brown

April 5, 2014 6:29 PM PT

Reginald Clarke is someone Obamacare was designed to help.

The 55-year-old, who was homeless for a time, now has an apartment in Gardena and a street-cleaning job that pays him $14,000 a year.

He hadn’t visited a doctor in four or five years. Then, last fall, his girlfriend told him he would be eligible for Medi-Cal starting Jan. 1.

“I was excited. I could go get a physical,” he said. “There are a few things I need.”

But joy turned to exasperation when Clarke’s application, filed in December, was mistakenly rejected — and then seemed to disappear from county and state computer systems.

By law, counties have 45 days to process Medi-Cal applications. More than three months after Clarke applied for coverage through the Covered California website, he is still waiting for a permanent insurance card he can use at his doctor’s office. He’s frustrated by how long the process is taking.

“I just don’t understand,” he said. “These people knew years ago that this was going to happen.”

Clarke isn’t alone. After thousands expressed frustration with glitches in signing up for insurance through the state’s online Obamacare marketplace, CoveredCa.com, an even larger number of patients now are encountering additional roadblocks with the second prong of the system: the state’s healthcare program for the poor.

The bottleneck, officials say, has been traced to a new state computer system that for months didn’t communicate properly with county computers trying to confirm the eligibility of new applicants like Clarke.

And while the period to apply for private insurance through the state has ended, enrollment in Medi-Cal remains open. About 800,000 applications for that coverage are pending approval statewide, according to the Department of Health Care Services in Sacramento.

In L.A. County, officials said, more than 200,000 Medi-Cal applications filed between Oct. 1 and Dec. 31 were trapped in the state’s computer enrollment system until February. Today, the county’s Department of Public Social Services can link up to the state system, but workers still face a daunting backlog of applications — and new software glitches have exacerbated the problem.

Uncertain about their Medi-Cal coverage status, some patients are putting off trips to the doctor and drugstore — or paying full price for care they can’t delay.

A software problem upended Benjamin Lazcano’s Medi-Cal coverage, according to a lawyer working with the 48-year-old’s family to fix a number of healthcare application woes. While waiting for county and state workers to resolve the problem, the South L.A. resident drove to Tijuana, Mexico, to refill his blood pressure medication.

San Gabriel Valley resident Ed Rampell, 59, said that he submitted his application in October but wound up paying full price for his medications in January.

One patient wrote The Times to say she has a worrisome growth behind an ovary. She submitted an application in October. County health clinics informed her she won’t be able to keep her appointments for blood tests and ultrasound scans until her Medi-Cal coverage is confirmed, she said. Or she can pay full price for the services.

As of Thursday, she was still waiting.

“A lot of good, smart people with good intentions in the state and county are working really hard to fix these problems,” said Katie Murphy, managing attorney at Neighborhood Legal Services of Los Angeles County, which has a grant from the state to provide legal assistance to patients with Obamacare enrollment cases. “But until they do, people will fall through the cracks.”

Overall, healthcare advocates view the expansion of Medi-Cal as a success.

Before the healthcare overhaul, childless adults like Clarke had been excluded from the free or low-cost healthcare program for the poor. But on Jan. 1, any legal resident earning less than 138% of the poverty level — or $15,856, for a household of one — became eligible.

Norman Williams, a spokesman for the state’s Department of Health Care Services, said the federal Affordable Care Act has added 1.9 million new people to Medi-Cal rolls so far, bringing the total in California to nearly 10 million. That’s more than eight times the total number who have purchased private insurance through the Covered California program.

Williams said the volume of Medi-Cal applications, combined with challenges of new computer systems, hampered the state’s ability to complete eligibility reviews in a timely and accurate manner.

“We’re pleased with the success, but we know that there are problems to be resolved,” he said. “We’re committed to doing better.”

On Tuesday, Sheryl Spiller, director of L.A. County’s Department of Public Social Services, told the Board of Supervisors that delays in Medi-Cal verification were the result of “a lack of state readiness.” Retraining of county health agency staff and “lots of overtime” were overcoming the technical obstacles, she said.

“We’re getting the job done,” Spiller said.

The county expects to be processing applications within the required 45 days by the end of May, Anjetta Venters-Bowles, the department’s assistant director, said in an interview.

In the meantime, officials are trying to get the word out about alternatives for MediCal-eligible patients who need immediate medical treatment.

Patients with pending applications who require care or prescriptions can request a temporary Medi-Cal card from county social services agencies that they can bring to a participating doctor.

Some doctors and medical care providers are reluctant to take on patients before their application process is complete, fearing they may not get reimbursed for services if eligibility is not confirmed, said Lynn Kersey, executive director of Maternal and Child Health Access, an advocacy group that took part in Covered California enrollments.

“I understand where they’re coming from,” Kersey said of wary medical care providers. “There isn’t that guarantee.”

At Valley Community Clinic in North Hollywood, Olga Duran, director of health outreach services, said that physicians there had been treating Medi-Cal applicants whose paperwork was still pending.

She’s confident patient care will improve overall once the current technical problems are resolved.

“The infrastructure needed a lot more support,” she said. “We tried to get the Titanic moving quicker than it could.”

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