Advocates, State Officials Wrangle Over California’s Medi-Cal Renewal Backlog

Consumer advocates this week sent a letter to CMS asking for federal intervention in the struggle to eliminate a huge backlog in processing Medi-Cal renewal applications, primarily due to computer-related issues.

State officials said the backlog has been reduced to about 490,000 applications, down from a peak of about 900,000 in March.

Almost half a million pending applications is about half a million too many, given the 45-day federal deadline for processing applications, consumer health advocates said.

They want CMS to grant presumptive eligibility to all applicants who have waited longer than 45 days.

“I wouldn’t say [state officials] are trying to do a bad job at renewals to get people off Medi-Cal,” said Jen Flory, senior attorney in the Sacramento office of the Western Center on Law and Poverty. “But I do think there’s some financial driver at work here.”

While the backlog remains, the state does not have to pay for Medi-Cal services for those hundreds of thousands of potential beneficiaries, Flory said.

Financial motivation has nothing to do with it, according to Norman Williams, deputy director of public affairs for the Department of Health Care Services.

“We have implemented a number of suggestions from both advocates and CMS to reduce the number of pending individuals as quickly as possible,” Williams said in a written statement. “Our pending individual number has been reduced to nearly 490,000 due to the continued efforts of county eligibility workers, the batch processing of Medi-Cal applications, and technology improvements made to our web portal. We work continuously to develop solutions that are effective, but don’t cause issues that would compromise the process and lead to larger problems occurring.”

Williams said the department hopes to have the backlog down to 350,000 by the end of August.

“Currently, we are using language that was given to us by advocates to inform beneficiaries about our efforts and how they can get health care services now,” he said. “We will be meeting with advocates immediately to provide clarity on our actions and gain their input, and we will discuss how we can work together to implement improvements.”

The state’s response to advocates’ concerns in a July 24 letter did not answer some basic questions, Flory said.

Part of the long-term problem, Flory said, is the computer issues that are plaguing the renewals process now won’t be fixed till sometime next year — so it doesn’t make sense to pretend the backlog will magically disappear, she said.

Flory said the state granting presumptive eligibility would buy more time to fix the IT problems and at the same time not hurt people who qualify for Medi-Cal services but are not receiving them.

“Why not ask for further time?” Flory asked. “They haven’t told us why they wouldn’t want more time. They’ve hinted that’s because of CMS. It’s almost insulting because we all know CMS would be willing to change the timeline.”

Related Topics

Capitol Desk Medi-Cal