SAN DIEGO: Local Barriers to Medi-Cal Cited
Overly aggressive fraud prevention tactics are keeping eligible San Diego residents from enrolling in Medi-Cal, the San Diego Union-Tribune reports. A recent study found that San Diego's poor are less likely to receive the federally funded health care benefits than residents elsewhere in the state. "We agree fraud is not acceptable, but if we're keeping 30% of the people who are eligible off Medi-Cal, it's hurting everybody," said Gary Stephany, president of the Healthcare Association of San Diego. In San Diego, only 52% of Medi-Cal applications are approved, compared with 80% in Los Angeles County and 86% in Riverside County. The exclusion of eligible residents from the program leads to increased costs in emergency medical services, which "must be borne by local hospitals and the county itself."
Fraud Prevention Gone Haywire
Several "highly publicized" fraud cases led the county to "clam[p] down on Medi-Cal fraud in 1993." Those efforts created an atmosphere where "county workers were encouraged to blow the whistle on any co-worker 'suspected of being gentle on fraud detection.'" Until recently, county eligibility offices hung posters "warning that applicants could be reported to the Immigration and Naturalization Services." Applications have been rejected if the "applicant wasn't home when an investigator visited." "When you scare a community enough," said Joni Halpern of the local American Civil Liberties Union, "people talk to each other and finally they just don't apply."
Reform En Route
The report recommends "reforming the eligibility process for Medi-Cal." County Director of Health and Human Services Dr. Robert Ross said the allegations of Medi-Cal enrollment barriers in the county were "a reasonably fair criticism," and noted that he is trying to alter the "attitude of 'rudeness and cynicism'" at county offices. The county has already "increased its efforts to find and sign up people eligible for Medi-Cal," he noted (Duerksen, 7/26).