Consumer advocates take Medi-Cal backlog fight to the feds

A coalition of health advocates Friday asked the federal government to force California to do more to reduce its huge backlog of pending Medi-Cal applications. The state has rejected the key elements of a plan proposed by the advocates last month.

In July, the Health Consumer Alliance sent a letter to California's Department of Health Care Services laying out seven recommendations for cutting the backlog of several hundred thousand Medi-Cal applications. The Department of Health Care Services, which oversees the Medi-Cal program, subsequently sent a letter to the federal government outlining its plan for reducing the backlog. 

The plan the state presented to the federal government did not include the Consumer Alliance's key recommendations; instead, it focused on fixing glitches in the state's computer systems.

In its letter Friday, the Consumer Alliance asked the Centers for Medicare and Medicaid Services to force the state to adopt the advocates' recommendations. Alliance members consider two of their proposals to be key: that the state grant conditional eligibility to all Medi-Cal applicants who have been waiting more than 45 days, and that it impose a moratorium on all annual renewals for existing beneficiaries, so that officials might focus on clearing the backlog of pending applications.

The Consumer Alliance urged the Centers for Medicare and Medicaid Services to "exert its influence on the state to implement these actions as soon as possible," arguing that "it is untenable that seven months into the year there are still nearly half a million applications simply waiting to be processed."

A spokeswoman for the Centers for Medicare and Medicaid Services told KPCC that her agency cannot comment on the advocates' letter until officials there have had a chance to review it.

The politicking around the backlog became somewhat confused on Friday, when the Consumer Alliance discovered that the state had responded to its recommendations back on July 24. It turns out that on that day, the state's Health Care Services department sent a letter to two Consumer Alliance members responding to the advocates' proposals. However those members have been on vacation, and the response was only discovered on Friday.

In its July 24 letter to the Consumer Alliance, the state said it was adopting several of the coalition's minor recommendations, but it was rejecting the two key proposals regarding conditional eligibility for applicants waiting more than 45 days and a moratorium on annual renewals for existing beneficiaries.

The Health Care Services letter expressed "serious concerns" that granting conditional eligibility to those stuck in the pipeline could compromise the overall program's "integrity," since the agency did not know how many of the applicants might ultimately be denied for one reason or another.

The state noted that it did delay annual Medi-Cal renewals for the first five months of this year, but it has refused to delay them any further.

The Consumer Alliance's letter to the federal government still stands, because the state's July 24 letter did not accept the advocates' key recommendations, according to Jen Flory, an attorney with the Western Center on Law and Poverty, which is a coalition member. 

A spokesman for the state said Friday that California has been making progress clearing its backlog, which he said now stands at about 490,000.

Health Consumer Alliance letter to Centers for Medicare and Medicaid Services

California Department of Health Care Services letter to Health Consumer Alliance