Medi-Cal Mess

Riverside County's deficient handling of health care for the poor is unacceptable. County supervisors should be asking tough questions about why the county cannot meet federal standards for handling Medi-Cal claims promptly, and demanding solutions that will improve the county's performance.

Riverside County is the only county in the state that has missed federal deadlines for Medi-Cal enrollment every year since 2004, when the current monitoring system began. Federal law requires counties to process 90 percent of applications for Medi-Cal coverage within 45 to 90 days, depending on the type of application. Medi-Cal is California's version of Medicaid. That joint state-federal program provides public health coverage for people at or below the federal poverty line, which now stands at $22,050 in annual income for a family of four.

Riverside County's 2010 audit shows the county processed only 70 percent of regular Medi-Cal enrollments on time -- a failure rate three times higher than the law allows. And the county's record on disabled Medi-Cal applicants was even worse.

Supervisors, however, have the power to reverse that course. County officials need to find out just why the county misses the same deadlines other California counties routinely meet. And supervisors then have to follow through with solutions.

Doing nothing is not a viable option. A slow and confusing process for gaining coverage discourages people already struggling with health ailments, and hardly improves medical outcomes. And ignoring the concerns of people who may have no other option for health care is neither humane nor fair.

The county also cannot afford to postpone improvements until some later date. Current federal law calls for a huge expansion of Medi-Cal coverage by 2014, by raising eligibility to 133 percent of the poverty level, or $29,327 in yearly income for a family of four under today's guidelines. That step would nearly double the county's current caseload of more than 118,000 patients. How would a system that barely works now cope with that kind of growth?

Congress might alter the law, of course, but the county could face an influx of new Medi-Cal clients anyway. Federal officials approved a $10 billion grant for California last week, to help the state phase in the Medi-Cal expansion before 2014.

County officials say the latest poor showing was the result of incorrect data submitted to the state -- an explanation that hardly inspires confidence in county management of Medi-Cal services. That perception is not helped by county supervisors' flat surprise at the county's poor performance.

Granted, Riverside County has seen a dramatic increase in the Medi-Cal population since the economic downturn began. But that factor does not explain why the county was missing deadlines well before the economy tanked. And the application process is complicated and confusing, yet other counties manage to process enrollments promptly.

Riverside County should be able to manage that feat, as well. County officials have no excuse for accepting anything less.

More Stories from This Project

No penalties for failed Medi-Cal performance

What is the penalty for failing to meet federal requirements for timely processing of Medi-Cal applications? Apparently, there is no penalty.

Riverside County: Worst Medi-Cal record in state

Pregnant and diagnosed with thyroid cancer, Karina Hernandez went to a Riverside County social services office late last summer desperate for medical care. Then she waited.

Seeking ways to improve Medi-Cal application process

If Riverside County is to make progress in enrolling Medi-Cal applicants in a timely way, it might consider the role played by Marie Padrone.

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Lauren M. Whaley

Freelance journalist Lauren M. Whaley is a photographer, radio producer and print reporter specializing in topics related to mental illness, reproductive health care and health disparities. She is also a childbirth photographer.This year, She is working on a series about how low-income parents access care for perinatal mental illnesses. The project is funded in part by the Rosalynn Carter Fellowships for Mental Health Journalism.She was a 2016-17 Knight Science Journalism Fellow at the Massachusetts Institute for Technology.Her work has been recognized by the Association of Health Care Journalists, the Scripps Howard Foundation and the Public Radio Exchange (PRX) STEM story project. She has contributed radio, video, photography and written stories to KQED Public Radio, Southern California Public Radio, the San Jose Mercury News, the New York Times and other media outlets. For six years, she worked as the Center for Health Reporting's multimedia journalist. She is a past president of the national organizationJournalism and Women Symposium (JAWS) and spent her early 20s leading canoe expeditions for young women, including a solo-led 45-trip in the Canadian Arctic. She is based in Los Angeles.

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