qotd: Some Covered California patients involuntary transferred to Medi-Cal

KCRA.com/AP
September 9, 2014
Income checks throw Californians off health plans

Some Californians who purchased individual health coverage through the
state's insurance exchange are suddenly being dropped or transferred to
Medi-Cal, the program for the poor that fewer doctors and providers accept.

The changes are occurring as incomes are checked to verify the
policyholders can purchase insurance through the exchange.

Officials at Covered California acknowledged that a number of people are
being shifted around during income checks and eligibility updates.

"It will happen continually," spokesman Dana Howard said.

This year, he said, the exchange adjusted its income eligibility scale
when the federal government updated the poverty scale. As a result,
Howard said, people near the thresholds are sometimes moved between
private health plans and Medi-Cal. The checks might also determine that
some people make too much money to receive a subsidy.

Evette Tsang, a Sacramento insurance agent, said some of her clients
unexpectedly received Medi-Cal cards even though they were content with
the plan they purchased through the exchange.

"There's a lot of people who have never been on Medi-Cal, and they don't
want to. You hear the service is not as good, providers are not easy to
find," Tsang said.

http://www.kcra.com/news/income-checks-throw-californians-off-health-plans/27962242

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Los Angeles Times
September 9, 2014
Editorial
A California solution for a Medicaid quirk

The 2010 federal healthcare reform law required virtually all adult
Americans to carry insurance, starting this year. And to help make
policies affordable, it offered subsidies to lower-income households
while expanding the Medicaid insurance program to more of the poorest
residents. But there's a key difference between those two groups: Only
those in the Medicaid program may find their estates billed after they
die to pay back some of the aid.

Most troubling, the new requirement to obtain coverage is prompting
millions of Californians to sign up for Medi-Cal, where they are put in
Medi-Cal's version of an HMO. Only after they enrolled are they told
that, if they are 55 or older, the state will seek to recover the value
of the coverage from their estates. They could be in perfect health,
receiving no medical care at all, but still be running up a bill that
their estate will have to pay.

The California Legislature responded by passing a bill (SB 1124) that
would stop Medi-Cal, the state's version of Medicaid, from trying to
collect repayment for routine medical care and insurance premiums. The
measure now awaits action by Gov. Jerry Brown, whose Department of
Finance opposes the bill because it would cost Medi-Cal an estimated $30
million a year.

http://www.latimes.com/opinion/editorials/la-ed-medi-cal-20140910-story.html

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Los Angeles Times
September 8, 2014
Editorial
What can be done about Covered California's doctor gap?

A separate study of three rural counties by the California Health Report
found that more than half of the doctors listed by Medi-Cal in those
counties either were turning away new patients or couldn't be reached by
phone.

A related issue is whether the networks offered by health plans can
actually deliver the coverage the plans promise.

Insurers say they're taking the problem seriously, which should help
both those who shop for individual policies and the growing ranks
enrolled in managed-care plans through Medi-Cal.

http://www.latimes.com/opinion/editorials/la-ed-health-insurance-networks-20140908-story.html

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Comment by Don McCanne

At the beginning of the health care reform process, we complained that
the various factors in the proposed multi-payer model that would
determine what health care coverage a person would have would be highly
variable and would result in instability of health care coverage. The
current experience in California provides an inkling of the extent of
this problem.

Some who purchased plans through California's ACA insurance exchange -
Covered California - are losing that coverage when auditing demonstrates
that income levels were not confirmed, income levels changed, or income
eligibility levels changed because of updates in the federal poverty
thresholds. Regardless, people were losing the coverage which they had
selected, and became uninsured or moved to other private plans, or, in
some cases, were involuntarily enrolled in Medi-Cal - California's
Medicaid program.

The latter is a particular problem. First, many of these people pride
themselves on their self-sufficiency, even though they need to accept
government subsidies so that they could afford the exchange plans. They
understand that these subsidies are necessary, not for their own
personal failings but simply because health care has become so expensive
that the average worker can no longer bear the full costs. For these
people, being forced into a welfare program - Medi-Cal - can be humiliating.

But what is even worse, the Medi-Cal ticket doesn't automatically grant
them admission to the health care system. Although there was already a
shortage of physicians who would accept Medi-Cal patients, the lists of
providers currently contain names of many physicians who are now turning
away new Medi-Cal patients. Also, most of the newly eligible are being
enrolled in Medi-Cal managed care plans when preliminary reports
indicate that these plans do not have the capacity to carry the load.

Just to add further insult, those moved into Medi-Cal may have their
estates billed to recover Medi-Cal costs, when there is no recovery
process for subsidies provided for the Covered California exchange plans.

There are thousands of other reasons that coverage is unstable under the
Affordable Care Act. In contrast, a single payer system provides the
same comprehensive national health program for life. You can't get much
better stability than that.