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Medi-Cal Simplification: Opportunities to Streamline Enrollment Processes

The Patient Protection and Affordable Care Act (PPACA) expands Medicaid coverage to 133% of the
Federal Poverty Level (FPL) starting in 2014. As a result, nearly 1.7 million Californians will be newly eligible on January 1, 2014.

In its current state, Medi-Cal operates inefficiently, bogged down by excessively complex eligibility requirements and barriers to enrollment, leaving health leaders worried that the system will not be able to handle the influx of newly eligibles once expansion is implemented. The eligibility system is lengthy, outdated, complex and replete with redundant verification standards that are a time-consuming drain on California’s already burdened budget.

While health reform expands Medicaid eligibility to millions of adults, the likelihood that they will enroll hinges partly on the Medicaid enrollment process. ACA provides an opportunity for states to simplify the enrollment process in order to fully embrace a new “Culture of Coverage.” Information technology is one way that a seamless enrollment link can be made between Medi-Cal, the newly formed California Health Benefit Exchange and other public programs. Ease of enrollment and transitions between programs will cut high administrative costs and reduce gaps in coverage. These systems must be in place prior to 2014 to ensure that the newly eligible have coverage.

With just over two years until expansion takes effect the time to implement change is now. This paper outlines steps that ACA and California have implemented in anticipation of expansion and further suggestions for enrollment reform implementation in California in preparation of 2014.

Medi-Cal Simplification Draft Medi-Cal Simplification Draft.pdf
Medi-Cal Aid Codes Medi-Cal Aid Codes.pdf

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