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Delay of game: Counties say they need more help with Medi-Cal expansion from distracted state health officials 

Delay of game

The most populous state in the Union plans to become among the first to implement Congress’s 2010 Affordable Care Act—assuming California can make its own deadlines.

Gov. Jerry Brown scheduled the health-care exchange Covered California to go live for enrollment on Oct. 1, with coverage beginning Jan. 1, 2014. Brown and state Democrats intended for an expanded Medi-Cal system to go into effect along the same timeline. The state plans to add 1.2 million Californians to its roll of public health care recipients.

However, as the Covered California launch date rapidly approaches, some local officials charged with administering Medi-Cal wonder if the agency that oversees the system can make the date.

San Luis Obispo County social services director Lee Collins suspects Oct. 1 may come and go without new Medi-Cal enrollment because of poor communication between state administrators and the counties. Collins told New Times the state Department of Healthcare Services (DHS) has been slow to answer questions and provide specific directions on how counties should administer Medi-Cal under the new regime.

“Sometimes people are incompetent, and you can deal with that,” Collins remarked. “I think this is different. It’s something much more akin to neglect. … I’ve never seen anything like it.”

On Aug. 13, SLO County spent $2.2 million in state grant funds to hire 24 full-time employees to deal with the anticipated influx of new Medi-Cal recipients. The county ended up creating its own program to train the new hires after the state reportedly provided few instructions. Collins expects more than 9,000 additional county residents to apply.

The more populous Santa Barbara County expects three to four times as many new Medi-Cal applicants. Deputy social services director Maria Gardner agreed with Collins’ assessment of the situation.

“I think that’s consistent with our experience,” she said. “We’re just now beginning to train our staff because the materials from the state have been late to arrive.”

DHS spokesman Anthony Cava replied that the agency is providing training to county staff on administering the Medi-Cal expansion. He listed several—highly technical—examples.

“Both DHS and Covered California, in concert with the California Welfare Directors Association (the lobby that represents county administrators like Collins and Gardner), are working collaboratively with counties to meet their operational needs by Oct. 1,” Cava said.

The reported cause of the problem is also highly technical. Enrollment for California welfare programs happens with the aid of automated systems. Covered California boasts that its new website will provide a single application for the insurance exchange and Medi-Cal eligibility. Yet county welfare administrators report they still need to enter data from the Covered California system into the old Medi-Cal database.

That’s a problem, but one the counties can live with. Collins says DHS keeps screwing around with the automated enrollment system for Medi-Cal instead of telling the counties how to prepare for the Oct. 1 launch.

“They’re distracted from the task at hand,” Collins said. “I don’t think they have their eyes on the prize.”

DHS referred New Times’ questions about the automated system to Covered California, which then referred the reporter back to DHS. The two agencies eventually sent over a combined statement explaining that the state recently began testing the new system. DHS and Covered California expect all systems to connect electronically by Jan. 1, 2014.

“It must be stressed that system testing continues, as planned, and that all of our work is geared to ensuring the best possible consumer experience,” the statement reads.

Rep. Lois Capps (D-California) arrived in SLO to talk about Affordable Care Act implementation three days after the county spent the state grant funds on personnel. She came to address the Medicare changes in front of the SLO County Commission on Aging.

Capps appeared unaware of the counties’ complaints when asked about local difficulties in implementing Medi-Cal expansion. However, she predicted that problems experienced early in implementation would eventually smooth over.

“Nothing the government ever sponsors, initially, is perfect,” she said. “We’re all in this together as we roll this out.”

Still, will it roll out on time? Covered California spokesperson Anne Gonzalez said a possible Medi-Cal delay wouldn’t affect the launch date of the state’s insurance exchange. Covered California began training staff at its customer service call centers in early August.

Cava explained that existing state programs would bridge the gap if Medi-Cal implementation lags behind the public exchange.

“However, we do expect Covered California and Medi-Cal to be ready to enroll simultaneously,” he said.

Collins, once again, spoke less optimistically.

“It’s like I told the Board of Supervisors: We’ll be ready. I don’t think the state is going to be ready,” he said. “I think what’s ultimately going to happen is the Legislature is going to hold hearings and they’re going to ask, ‘What the hell is going on?’”

Staff Writer Patrick M. Klemz can be reached at

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