Advocacy Group Calls for More Action To Reduce Medi-Cal Backlog

On Friday, the Health Consumer Alliance sent a letter asking CMS to force California officials to take additional steps to reduce the backlog of unprocessed Medi-Cal applications, KPCC's "KPCC News" reports (Florido/Glickman, "KPCC News," KPCC, 8/1).

Medi-Cal is California's Medicaid program.

Background

In July, California Department of Health Care Services spokesperson Anthony Cava said that the number of Medi-Cal applications awaiting verification fell from 900,000 in May to 600,000 -- about a 33% reduction (Gorn, California Healthline, 7/16).

Last month, HCA sent a letter to DHCS that included seven recommendations for reducing the backlog.

However, DHCS then sent a letter to CMS outlining its own strategy, which did not include HCA's key recommendations. The agency instead said it plans to repair technological glitches in the state's computer systems to reduce the backlog.

A spokesman for the state said Friday that California has been making progress clearing its backlog, which now stands at about 490,000.

Details of HCA Letter

In its letter sent Friday, HCA highlighted two key recommendations that CMS should require California to implement:

• Granting conditional eligibility to all Medi-Cal applicants whose applications have been pending for more than 45 days; and
• Delaying all yearly reviews for current beneficiaries so that state officials can focus on pending applications.

HCA urged CMS to "exert its influence on the state to implement these actions as soon as possible," noting that "it is untenable that seven months into the year there are still nearly half a million applications simply waiting to be processed."

After sending the letter to CMS, HCA found that DHCS had responded to the advocates' original letter, but had contacted two group members who were on vacation. In the response, the state said it was rejecting HCA's recommendations related to conditional eligibility and delaying reviews because of "serious concerns" that such changes could compromise the program's overall "integrity."

However, attorney and HCA member Jen Flory said the advocacy group's letter to CMS still stands because the organization's two key recommendations were not adopted.

A CMS spokesperson said that the agency has not yet reviewed HCA's letter and would not comment until it had done so ("KPCC News," KPCC, 8/1).