Computer Problem Removes Infants From Medi-Cal

A software problem in the state's computer system for determining Medi-Cal eligibility is causing "[t]housands" of infants in California to lose coverage, the Orange County Register reports. In July, the Department of Health Services received a new software program to help doctors' offices immediately determine if walk-in patients are eligible for Medi-Cal. The program automatically approves health care benefits for 60 days for all children who visit a doctor's office or clinic. Within 60 days, a parent must submit an application for ongoing Medi-Cal coverage or the benefits expire. Newborns are supposed to be automatically granted Medi-Cal coverage from their first doctor's visit until they are 1 year old. However, the software was not created to recognize children younger than age 1 and automatically cancels Medi-Cal coverage for those children after 60 days. The problem was found "shortly after the system went online," the Register reports. Although the Legislature in August appropriated the $196,000 needed to fix the program, the state has not yet done so, according to the Register. Civil rights attorneys sued the state, and DHS was ordered to fix the software glitch by April 1. However, DHS is still involved in a "costly legal battle" over when the system will be fixed and has already spent $61,346 in legal fees related to the matter, the Register reports.

Stan Rosenstein, a DHS official, said he could not comment on the legal proceedings, but he said that "how the computer treats newborns was not contemplated at all" when the program was configured. Lucy Quacinella, a San Francisco attorney who is suing the state, said, "There doesn't seem to be the political will here to help these babies" because state employees are not working quickly enough to fix the problem. Assembly member Judy Chu (D-Monterey Park) called the delay of the software fix "outrageous." Rosenstein said that the software program has been changed to continuously extend the 60-day Medi-Cal coverage for infants until they reach age 1 as a temporary fix. However, that fix "isn't without its flaws" and can still cause infants to lose coverage, the Register reports. Lynn Kersey, executive director of the Los Angeles-based advocacy group Maternal and Child Health Access, said, "In this day and age, when you can do a lot with computers, it should be possible to continue this without parents having to stand on their heads and call phone numbers that aren't staffed. If any one of us had to do that to keep our health insurance coming, we wouldn't put up with it" (Kim Quach, Orange County Register, 2/9).