Medi-Cal seen as relief for some, confusing burden for others
The majority of patients who have enrolled in the Affordable Care Act were assigned to Medi-caid. Most feel some ecstasy and relieve that they have health insurance. On Jan. 21, Covered California reported that 584,000 had been "determined likely eligible" for Medi-Cal after visiting CoveredCa.com and an additional 630,000 transitioned into Medi-Cal from separate low-income health programs run by counties. Patients signing on for Medi-Cal join a health plan and receive their care from networks of participating doctors, clinics, hospitals and pharmacies, much like other managed care patients who have private insurance.
There are however many gaps and questions about just what that means. We reported these deficits several months ago. I became aware of these when a member of my family who had been disabled for ten years and had several pre-existing conditions. They did not qualify for SSDI because she had not worked enough in the past 10 years to qualify...largely because she was not able due to her permanent disability.
The Los Angeles Times reports several scenarios that will disappoint those assigned to Medi-caid. Supporters of national healthcare reform tout the expansion of Medicaid — called Medi-Cal in California — as one of the great successes of the Affordable Care Act.
For many needy people, learning they're eligible for the usually free program has been a tremendous relief — assurance that, after decades of forgoing care or worrying about medical expenses, they'll now be able to afford medications, see a doctor or seek emergency care without worrying about ending up broke.
But the news isn't wholly welcome for others, who find the complexities of signing up with Medi-Cal bewildering and onerous. And some, like Golden, who don't consider themselves low-income and don't know how Medi-Cal works, also fret over being placed on state healthcare rolls — "on the dole" — and would rather just pay for insurance.
Medi-caid and Medi- Cal (California's Medicaid program) has a significant 'stigma' for patients and for hospitals. Some hospitals have contracted with medicaid, and providers must apply and be eligible as a provider. Many providers do not accept Medi-caid. Patients without a share of cost (another story) are elibible and encouraged to join a managed care Medi-Cal program. (a prefarable alternative to fee for service.)
Low-priced insurance policies aren't available for Medi-Cal-eligible Californians, who are welcome to buy insurance through the exchange only if they give up any subsidy.
Another hidden glitch is for families with children, and despite the Affordable Care Act's promise of guarranteeing coverage to children until age 26 under the parent's policy California dances to its own set of rules. Martin Gross, a self-employed lawyer and Obamacare proponent in Mar Vista, bought Kaiser Permanente policies for himself and his wife through Covered California.
But when his 16-year-old son qualified for Medi-Cal, it gave him pause.
"I said, 'Wait a minute — I'm not that poor. Why is my son on Medi-Cal?' " he recalled. "I wasn't crazy about it. It was a hit to my ego."
Gross said he would have liked to have had the option of paying what he used to for his son's coverage.
"I just didn't want to pay double," he said, referring to what would have been the unsubsidized Covered California cost.
Edward Chavez, co-chairman of the health enrollment team at One L.A., a community group that works through religious congregations, said that he and other advocates had encountered similar resistance to Medi-Cal among the mainly Latino and working-class clients he has in the northeast San Fernando Valley.
Little-known Medicaid provision allows states to seek repayment from enrolleesA little-known wrinkle in the decades-old Medicaid law may be prompting some Americans ages 55 to 64 to shy away from the health plan of last resort -- called Medi-Cal in California -- after learning there's a catch: Once they die, their estates may have to reimburse the government for the cost of their medical care. There are significant waivers and exemptions to this law.
MEDICAID ESTATE RECOVERY PROGRAM
From fiscal year 1993-94 to 2013-14, California's Medi-Cal Estate Recovery Program recouped $978.5 million. Of that, 50 percent was returned to the federal government. Over the same period, California's Medi-Cal budget was $621 billion.
California is typically ranked at the top of the list of states in Medicaid estate recovery.
The average estate claim amount in California is $95,000. The average recovery amount is $15,000. This amounts to a paltry amount of less than .000000005 % of the Medi-Cal budget.
Source: California Department of Health Care Services
