Valley counties making progress on Medi-Cal backlog

Sept. 21--County officials in the central San Joaquin Valley say they are chipping away at a backlog of unprocessed Medi-Cal applications that prompted individuals and advocacy organizations to sue the state last week.

Tulare County workers are putting in overtime to clear 2,100 applications that are months old.

"Our staffs are working Saturdays and Sundays to work those backlog applications," said Donna Ortiz, deputy director of TulareWorks, which signs up residents for Medi-Cal along with other social service programs.

On Wednesday, a Visalia mother joined with advocacy organizations to force the state to enroll applicants within 45 days, or at a minimum, send a notice to applicants that they have the right to go to a hearing and have their eligibility determined.

Frances Rivera, 68, said her son, Robert Cribbs, waited five months to get a Medi-Cal card that did not arrive until two months after his death in April of a pulmonary embolism.

Rivera said she watched her son's health deteriorate. "It's amazing, heartbreaking to watch someone, anyone, but especially someone in your family suffering and nobody doing anything," she said.

She hopes the lawsuit, which was filed Wednesday in Alameda County Superior Court, will fix the backlog. "If their problem is not enough workers, they need to get more workers," she said.

Ortiz said Tulare County continues to "work as fast as we can and as much as necessary to get these applications processed and people to get the health care they need." When asked about Rivera's case, Ortiz said: "We in Tulare County have sympathy for anyone who has been caught in the state system of glitches."

Tulare County, like others across the state, was swamped when thousands of people rushed to enroll in Medi-Cal beginning last October, the start of an expanded program that lets poor, childless adults in California qualify for the first time for low-income state-federal insurance.

The avalanche of new Medi-Cal applicants coincided with thousands of people enrolling in health plans through Covered California, the state's insurance exchange under the Affordable Care Act. They had until April 1 to be covered by insurance to avoid a tax penalty.

During the enrollment crush, Fresno County got 23,040 applications in January alone. In a typical month, it gets about 3,500 applications.

And Medi-Cal and Covered California applications all filtered through the state's new computer system, called CalHEERS, which had problems from the get-go. By April, the statewide backlog of Medi-Cal applications had reached 900,000. That has been reduced now to about 350,000.

Fresno County expects to be done with backlogged applications by next week, said Sanja K. Bugay, deputy director of the Department of Social Services.

A system issue between CalHEERs and the county's computer system has been fixed, and "we're taking care of the people waiting longer than 45 days," Bugay said.

Ortiz said she expects Tulare County to clear its old applications by Oct. 31. "We are going to try our darndest."

But anyone with a serious health issue or an emergency should call the department or visit a district office or outstations that are located in rural areas, she said. "We will absolutely expedite and process that case immediately."

Rivera wants the state and counties to do whatever it takes to process Medi-Cal applications quickly.

Before her son died, he told her no one was taking his medical problems seriously because he didn't have insurance, Rivera said. "He believed if he had insurance of some kind -- any kind -- they would help him."

The reporter can be reached at (559) 441-6310, [email protected] or @beehealthwriter on Twitter.

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