This Family Says No To Medi-Cal, But A Computer Won’t Listen

For many people, it’s a relief to finally qualify for Medi-Cal. But Christopher Bundros can’t seem to get his two kids off of it.

The Clovis accountant and his wife qualify for federally subsidized health coverage through Covered California, the state’s insurance exchange. He wants his two children on the same plan so they can see the doctors they want.

The problem is that his kids are eligible for Medi-Cal, the state’s low-income insurance program, which has a higher family income cutoff for children than for adults. Thus, according to federal law, they cannot be enrolled in any other subsidized insurance plan.

So Bundros tried to enroll his kids in the same plan he and his wife had on a private basis, without accepting any subsidies. No dice. The Covered California computer repeatedly flagged the kids as being on their parent’s plan and pushed them back into Medi-Cal, he said.

“I tried 10 times to take my kids off Medi-Cal,” he said. “I went down to the office, I called, I wrote letters.” He said he has two fistfuls of faxes to insurers and state agencies that show how long and hard he’s worked to “disenroll” his children from Medi-Cal.

“They kept saying the kids were in Medi-Cal,” Bundros said with a deep sigh. “This has been a nightmare for us.”

A bill to address problems like the Bundros family’s was rejected in the Assembly Health committee earlier this week. Assembly member Jim Patterson (R-Fresno), who  wrote the legislation, proposed to fix the computer system so that kids could join their parents in a single marketplace plan — even when the kids were eligible for Medi-Cal and thus not for other government subsidies. In those cases, parents would have to pay the full price of the coverage for their children.

“Parents who want better care for their kids just had the door slammed in their face again,” he said. “If they can afford to buy a better health care plan for their kids, the system should be able to accommodate them.”

He vowed to introduce another similar bill.

But some health care advocates strongly oppose his efforts, saying they fought for years to have people eligible for Medi-Cal be more smoothly enrolled in it.

Beth Capell, spokeswoman for Health Access California, a Sacramento-based consumer advocacy group, said the “fix” Patterson is proposing would create more problems than it could ever solve.

“It’s an attack on Medi-Cal that adds barriers and roadblocks to coverage,” she said.

She explained that the bill would have complicated the enrollment process, created confusion among parents about their choices and possibly created other computer snafus.

She said it wouldn’t help kids but would serve insurance brokers, who stand to make money when more people sign up for unsubsidized coverage instead of Medi-Cal.

According to the Western Center on Law and Poverty, a family of four making $39,000 a year would pay roughly $13 a month to cover their two children under Medi-Cal. Unsubsidized premiums could cost up to $599 a month, with additional costs for deductibles and out-of-pocket maximums.

Bundros said he’s willing to pay the extra money and should have a choice. And getting his children off Medi-Cal actually would save the state money, he said.

Patterson said that was the reasoning behind his legislation.

“It’s a bill to help people who are being boxed into a system that denies them a reasonable choice and puts their kids in some degree of risk,” Patterson said.

Shann Conner, president of Lumen Insurance Solutions, an insurance broker in Fresno, said she has dozens of clients in the same boat.

“Sometimes people just don’t want to be on Medi-Cal,” she said.

Patterson said he’s been told repeatedly by Covered California officials that they’re aware of the computer problem that kicks kids back into Medi-Cal and are working on it. But he doesn’t believe them.

“‘We’ve been working on it?’ Then give me a date when it’s going to be fixed,” he demanded.

In an email, Lizelda Lopez, a spokeswoman for Covered California, said her agency is open to addressing computer issues and doesn’t need a new law to make that happen.

“We are always looking for ways to improve the customer experience and are open to suggested changes to the enrollment website to accomplish that,” she said.

Lopez said Covered California officials don’t know how many families might have the Bundross’ problem. In any case, she said, the exchange can’t do anything about the federal rule that doesn’t allow Medi-Cal-eligible children to be on other subsidized plans.

Patterson said he has talked to sympathetic Democrat legislators willing to carry a new bill, and a revised version of his original proposal should appear within the next month.

Related Topics

Capitol Desk Insurance Medi-Cal