Plan To Switch Eligibility IT Systems OK’d

The Senate Committee on Health last week approved a bill that would alter the computer system California uses to process eligibility claims for subsidized health coverage.

Under the requirements of SB 1341 by Sen. Holly Mitchell (D-Los Angeles), the California Healthcare Enrollment, Eligibility and Retention System — the program used by Covered California — would give way by January 2016 to the Statewide Automated Welfare System. SAWS is used by county welfare departments throughout the state.

“This codifies the agreement [to make] SAWS the system of record for Medi-Cal consumers,” Mitchell said.

“We hear a lot about technology problems in our state,” said Frank Mecca, executive director of the County Welfare Directors Association of California. “But one of the most successful displays of technology in our state’s history is the automation of welfare through SAWS.”

Elvia Malvido, an eligibility supervisor in Los Angeles County, said the SAWS program allows eligibility workers to do their jobs more efficiently.

“Each and every day my coworkers and I are having to deal with some very unnecessary frustrations,” Malvido said. “The frustrations of consumers who have not received eligibility determination notices, they don’t know what’s going on with their cases. The frustration of clients who have received incorrect eligibility determinations. And the frustration of confused clients who are filing into our county offices.”

CalHEERS can be confusing and sometimes provides the wrong information, which creates work overload in county offices, she said.

“Just this last weekend alone, one of our workers was greeted on Monday morning with 112 voicemails looking for the status of their applications,” Malvido said. “This is one worker, in one office.”

If recipients don’t know their eligibility status or receive incorrect information about that status, they often reapply — even when they’ve already been deemed eligible, Malvido said, “which is compounding the problem.”

Under the SAWS computer system, Malvido said, a lot of those issues would disappear.

“We’re asking you to provide us with the tools we need to do our jobs,” Malvido said, “so we can give the accurate and timely eligibility services these people deserve.”

Elizabeth Landsberg, director of legislative advocacy for the Western Center on Law and Poverty, said her organization supports the change.

“We’ve been reluctant to take a position on where notices of action should come out, but they’re critical to consumers,” Landsberg said. “We’re finally forced to say that it isn’t working to have the notices come out in CalHEERS.”

In some cases, applicants get “six or seven confusing and conflicting notices out of CalHEERS,” she said.

“We wish we could stay out of the IT fight,” Landsberg said. “But it has become so urgent, we think it’s necessary to fix the county system.” 

The committee agreed and the bill passed on a 7-0 vote. It now heads to the Senate Committee on Appropriations.