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Medi-Cal Simplification

Medi-Cal Simplification Medi-Cal Simplification.pdf


In its current state, 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. [1] 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.[2] 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 technology, particularly information technology (IT), is inadequate at best. While the Medi-Cal program is very important and of tremendous value to the people who use it, its complexities come with high administrative costs, perpetuate gaps in coverage and impose unnecessary burdens on individuals and the state budget.

As required by the Patient Protection and Affordable Care Act (ACA)[3], nearly 1.7 million Californians will be newly eligible for Medi-Cal on January 1, 2014.  With less than three years before the program’s gates open to this new population, it is more than appropriate for us in California to ask some basic questions:

  • Where, how, and in what forms will the newly eligible, as well as the currently eligible but not enrolled, population be enrolled into Medi-Cal?
  • Will the Medi-Cal eligibility determination process be easy and understandable or will it remain a complex process that requires significant time and effort for the applicant
  • Can Medi-Cal administration be quick and simple while still being secure and accurate?

Over the past three months, ITUP has convened the Program Simplification Workgroup to (1) tackle these and other important questions, (2) analyze the existing Medi-Cal program to identify areas ripe for simplification, and (3) develop recommendations to help ensure that health reform implementation is an opportunity to dramatically streamline California’s health care programs’ administration, enrollment, and redetermination processes.

In this paper, we outline the ways federal reform compels simplification, summarize various opportunities to simplify Medi-Cal’s current web of complexities, and offer descriptions of various stakeholders’ positions on these alternatives.  We make recommendations on the myriad of ways the state and counties could help shed Medi-Cal’s unnecessary weight and help it become a streamlined and nimble program.

Ultimately, we believe that as all levels of government make changes to accommodate ACA reforms, this is the moment to simplify and streamline Medi-Cal.  If the state and counties incorporate many of the recommendations in this paper, we believe Medi-Cal will move beyond its reputation as a complex, Welfare-era program with significant documentation and verification requirements to become a model and central component in the new “Culture of Coverage.”

[1] Manjusha P. Kulkarni, J.D., “The Guide to Medi-Cal Programs:  A Description of Medi-Cal Programs, Aid Codes, and Eligibility Groups,” August 2006, p. 2, available at http://www.chcf.org/publications/2006/08/the-guide-to-medical-programs.

[2] Ibid. at p. 15.

[3] ACA § 2001.

To continue reading, download the full text .pdf file at the top of the post.