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It’s Time to Simplify

Thanks to passage of federal health reform, on January 1, 2014, nearly 1.7 million Californians will be newly eligible for Medi-Cal, a program that is critically important to our state and of tremendous value to the people who use it.

However, in its current form, the Medi-Cal program is large, complex, and slow moving. For beneficiaries, county eligibility workers, and state administrators alike, the system is burdened by excessive bureaucracy and unnecessary complexity that oftentimes lead to significant barriers to coverage.

For instance, there are currently some 35 eligibility categories within Medi-Cal, a product of the addition of different mini-programs over time. Once in the program, Medi-Cal enrollees are tagged with and tracked by more than 160 aid codes, and oftentimes more than one aid code is assigned to an individual enrollee. There are redundant and inadequate verification standards, upon which multiple agencies and all 58 counties must rely. State and county communication mechanisms and automation systems do not take full advantage of technology to create a seamless link between Medi-Cal and other health programs. The application of internet technology is inadequate at best. For a description of much of the complexity in Medi-Cal, check out CHCF’s Guide to Medi-Cal Programs by Manju Kulkarni.

Over the past three months, ITUP has convened the Program Simplification Workgroup to address the ways in which the newly eligible, as well as the currently eligible but not enrolled, population will be enrolled into Medi-Cal and how we can begin to make the eligibility determination process and program administration easier and more understandable.

The Workgroup just produced this Simplification White Paper which analyzes the existing Medi-Cal program to identify areas ripe for simplification, and puts forth recommendations to help ensure that health reform implementation is an opportunity to dramatically streamline California’s health care programs’ administration, enrollment, and redetermination processes.

Among others, the paper covers:

  • The Culture of Coverage;
  • Possible Eligibility Simplifications;
  • Medi-Cal’s Relationship with Other Programs & The Exchange;
  • Continuous Eligibility;
  • The New Application;
  • Income Verification;
  • The New Website and Internet Portal;
  • Eligibility Processing;
  • Presumptive Eligibility;
  • Outreach & Education; and
  • Enrollment Assistance & Navigators.

Be sure to download and read the White Paper. If you have thoughts and/or suggestions, or if you’d like to join the Simplification Workgroup, please send an email my way (cliff@itup.org).

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