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Covered California News & Commentary

Topics of interest to both consumers and agents related to Covered California and the ACA biased in favor of the successful implementation of the Exchange and deliberately apolitical.

February 2011 Archives

In 2014, up to two-thirds of California's 7 million uninsured residents will will likely be eligible for new coverage options in the California Health Benefit Exchange either via Medi-Cal expansion or federally subsidized private health insurance, according to a new policy brief from the UCLA Center for Health Policy Research.

The brief presents county-by-county estimates of the number of Californians who had employer-based, public or individual health insurance in 2009, as well as those who were uninsured for all or part of that year. Based on the CHIS 2009 data, 3 million uninsured Californians will gain coverage through health reform's Medi-Cal expansion and 1.7 million will be eligible for federal subsidies through the Exchange. Additionally, 1.2 million will become eligible to purchase non-subsidized coverage through the exchange.

Most Helpful to the Working Poor

Reform may particularly help those struggling in the economic downturn by expanding the definition of those who are eligible for Medi-Cal to include adults without dependent children who earn up to 133 percent of the federal poverty level ($10,956 for one person in 2009). With this newly eligible population added to those who are uninsured but eligible for Medi-Cal under existing regulations, approximately 3 million of the lowest-income nonelderly adults and children will be eligible for coverage through Medi-Cal.

Number of Uninsured Californians Probably Higher Now

California, with its 7 million uninsured, has the largest total number of uninsured residents in the nation, a situation exacerbated by the economic downturn and rising unemployment. That number might have been even higher without a federal subsidy offered around the time the 2009 CHIS data was collected that enabled laid-off Californians to retain their employer-provided health insurance through COBRA. That subsidy has since expired. Larger increases in public program participation, as well as a decline in California's overall population (largely due to undocumented residents leaving the state), also may have kept the total uninsured rate from rising.

California lost millions of dollars in federal funding to provide health care to uninsured kids because it didn't enroll enough eligible children into its government health plans.

In response to a federal incentive program that awarded extra money to states that met certain enrollment numbers, California set a goal of signing up 352,000 new kids in its Medi-Cal or Healthy Families programs. It fell short by about 24,000 kids, which left the state ineligible for the federal funds.

It wasn't that there weren't enough eligible kids in the state. This happened, let's remember, during a year when unemployment in California peaked at 12%. Researchers at the Urban Institute estimated in October that the state was home to nearly 700,000 uninsured children who qualified for state or federal programs but hadn't been enrolled. So why couldn't the state meet its enrollment goals? Because California has a cumbersome system that acts as a roadblock to enrolling eligible children.

One problem is that in 2009, to save money, Gov. Arnold Schwarzenegger cut funding to pay certified application assistants, who help enroll those qualifying for Medicaid.

A second problem is that it has become increasingly difficult to find physicians willing to accept the artificially low payments -- as low as 9 cents on the dollar for some kinds of care -- that have been set by the Medi-Cal program.

A third reason involves the hoops hospitals must jump through to get reimbursed for treating uninsured children who qualify for state or federal programs. If a family without insurance brings a child with a serious medical problem to the hospital, for example, the emergency room staff provides care with the expectation of being reimbursed by the state under a process called retroactive enrollment. But submitting such claims has become increasingly difficult. Delays and denials are commonplace. Some hospitals have grown so wary of participating in this hard-to-win system that they have opted to absorb the loss and chalk up the cost of treating such children to unreimbursed care.

In an effort to get more people signed up for coverage, our nonprofit organization, the San Jose-based Foundation for Health Coverage Education, launched a 24-hour help line for the uninsured in 2005. Through our live call-in center and our coverageforall.org website, we have been able to help more than 2 million uninsured Americans who seek help.

The process is simple. First, we ask five eligibility questions. Then we identify public programs for which the inquirer might be eligible and provide applications for the programs and a list of documentation that will be required. It doesn't have to be an obstacle course.

California needs to simplify its process. One step in that direction would be to allow people eligible for Medi-Cal to sign up for it at the "point of service" -- when they receive medical care. California employs 26,500 state workers who are responsible for enrolling people in public programs, including welfare, Medi-Cal and food stamps. This number could be reduced if Medi-Cal enrollment could be done online at a clinic, doctor's office or hospital where care is delivered.

California lost out this year, and that should never happen again. By revamping its antiquated and inefficient enrollment system, the state need never again leave federal grant money on the table while children go without healthcare.

By Phil Lebherz

Mr. Lebherz is executive director of the Foundation for Health Coverage Education, which operates the U.S. Uninsured Help Line (800-234-1317) and http://www.coverageforall.org.

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