May 14--The surge begins in October. Each month, 740 phone calls are expected to be transferred from the new California health care exchange that is a linchpin of federal health care overhaul to the Ventura County Human Services Agency.
Once answered, many calls could take an hour to complete.
The callers will be previously uninsured people who may be eligible for an expanding Medi-Cal health insurance system. The already challenging job of enrolling them in a program that will start delivering care Jan. 1 will be more complicated because county employees may have to enter the same data in two systems.
"We don't know what to expect. We're trying to plan for every contingency," said Human Services Agency Director Barry Zimmerman. "We know for certain there's going to be activity."
Called a warm handoff, the telephone waltz is a small but revealing part of the task of implementing the health overhaul. It shows the preparations, concerns and uncertainty that accompany insurance changes expected to cover at least 1.8 million uninsured Californians, including 30,000 or more in Ventura County.
The handoffs will begin when preliminary enrollment starts in the Covered California exchange, the new insurance marketplace designed to cover at last 980,000 people in its first year. People who call the exchange but may fit under Medi-Cal's rising eligibility bar will be transferred immediately to county offices.
An exchange representative will stay on the phone until a county employee answers the call. Exchange officials say the goal is that at least eight of 10 phone calls are answered in 30 seconds. In one phone call, they will try to figure out whether people qualify for Medi-Cal and attempt to enroll them.
"We're trying to make it very simple for people," said Dana Howard, spokesman for the exchange.
The numbers aren't simple. Howard said about 29,000 phone calls will be transferred to counties across the state from October to December, according to exchange projections. But officials with the Los Angeles County Department of Public Social Services say they have been told their agency could receive a total of 30,000 phone calls during the three months.
Officials with the Ventura County Human Services Agency say they have been told to expect about 740 phone calls a month. If people have all the information available, enrolling them in Medi-Cal on the phone could take up to an hour.
"We need about 17 workers to handle that workload," said Curtis Updike, a deputy director in the agency, adding that the increased staff has been approved by the Ventura County Board of Supervisors. "If we get excessively more phone calls, that could be problematic."
If county employees are unavailable, the call could be transferred elsewhere in a group of 18 counties banding together.
Human services officials say they're not worried about the warm handoffs, adding that it's only one part of their preparations for the Affordable Care Act. They also expect as many as 1,000 more walk-in visits a month for people enrolling in Medi-Cal or the health exchange. They're dealing with the elimination of the state's Health Families insurance program, which means about 20,000 more children will be covered by Medi-Cal beginning in August.
But while having county employees immediately available to answer phone calls from Covered California is admirable, it also carries the potential for problems, said Ventura County Supervisor Steve Bennett.
The cost of the extra employees will be covered by Medi-Cal, not the county. But there's a potential for unnecessary costs no matter who's paying, Bennett said.
"Given the fact that a warm handoff may result in that staff person being tied up for an hour, I question how expensive that will be," he said, noting the exact number of calls is unknown. "How many people do you have to have? If you don't know, there will be some potential wasting of funds."
A computer interface is being designed to help with the handoffs. It will allow the exchange's online enrollment system to communicate with a statewide automated welfare system used to place people in Medi-Cal.
But the complexity of designing a system that can exchange data with counties means the interface won't be ready when enrollment begins in October. That delay means county employees will have to find a workaround or enter information separately into two systems.
"I don't think it will make the eligibility more difficult," Zimmerman said. "I think it will cause an extra workload."
Exchange officials and many people involved in Medi-Cal enrollment say the complexities won't be felt by the people enrolling and that the process should still be seamless.
Some observers aren't convinced.
"The promise of this enrollment system is: You can enroll, and it's going to be easy," said Sonya Vasquez of Community Health Councils, a Los Angeles health advocacy group. But she worries the enrollment process for people new to Medi-Cal will become long and overly complicated.
"Here we are potentially making things more complicated than what we have today," Vasquez said.
Howard said the complexity of enrollment reflects the enormity of the change coming in the next year. While counties enroll people in Medi-Cal, Covered California will provide a marketplace that expects to insure 980,000 to 1.38 million people in its first year. For many, the cost of premiums will be cushioned by federal subsidies.
"In California, we're on time," he said, adding that the Oct. 1 enrollment date won't be delayed. "There are going to problems. We know that. This is a landmark build. ... But it's going to be ready."
The complications will come in part because the changes are new not only to the uninsured people enrolling in health plans but also the people doing the enrolling, said Charles Rosen, president of the California Association of Health Underwriters.
"It's brand-new to everybody," he said. "I think in the best of worlds, it's going to be really complicated."
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