12 Jun ‘Too Much Protocol’: Advocate Helps Medi-Cal Members Navigate Renewal

Some people whose Medi-Cal is not renewed do not discover their coverage has lapsed until they try to visit a doctor. (Photo by Online Marketing on Unsplash)

By Joe Porrello

Due to a COVID-19 compromise, three years passed before the California Department of Health Care Services restarted its annual review process for Medi-Cal member eligibility in 2023 — when almost 1 million Californians lost coverage. Since then, more of the roughly 13 million Medi-Cal members continue to lose or have lapses in their active health insurance status.

Nora Vigil, a patient service advocate who has worked over 11 years at LifeLong Brookside San Pablo Health Center, says she encounters patients who are caught off guard by their lack of coverage almost daily.

“When they’re going to an appointment for any reason, they discover they don’t have Medi-Cal,” she said.

The issue of inactive coverage, according to Vigil, stems from mailed renewal packets that must be filled out and returned. She says many patients return their completed forms and hear no response for sometimes over a month — if at all. Others may not even receive their packet for a number of reasons, like if it is sent to an old address on file.

For those anxious they made a mistake due to a lack of acknowledgement, or in the dark about their inactive coverage, Vigil provides needed assistance and reassurance by guiding them through the Medi-Cal forms and dropping them off on-site.

“I prefer they do it twice because you never know,” she said. “I feel responsible because they turned in their papers on time and didn’t receive any response, and they’ve been coming to our clinic and want to see a doctor.”

And the problem does not end at office visits.

“They want to pick up prescriptions that are not active; that’s my concern, when they need to pick up medication for a health condition,” said Vigil.

Aside from the renewal packets, she noted other bureaucratic hurdles and shortcomings negatively affecting Medi-Cal members’ coverage.

“Sometimes I call, and they say it’s active in the state but not in the county or vice versa; it’s confusing,” Vigil said. “I don’t know how to control that — I can’t; it’s something internal with Medi-Cal.”

Furthermore, many people wrongly lose coverage due to incorrectly being found to be above the salary limit, she said, citing a divorced and remarried woman whose first husband was still marked as part of her household income.

Wait times on the phone regularly being over an hour for those with coverage questions also does not help, Vigil said.

“That’s something I don’t understand. There’s too much protocol, which is terrible,” she said.

Even when patients do get someone on the phone that can help them with the renewal process, there is often a language barrier and Vigil requests an interpreter.

“I let them use the telephone and they’ll be afraid to speak with Medi-Cal… I let them know they have the power to speak in their language,” she said. “Medi-Cal is there to help them and the eligibility person needs to be able to hear the whole story.”

Opening more direct phone lines for members to develop familiarity with employees, Vigil says, is critical so that “people could call and feel comfortable and confident talking about their cases.”

With Medi-Cal status often boiling down to minor confusions with relatively simple fixes, Vigil noted the fulfillment of helping someone regain their coverage.

“Sometimes, it’s a little stressful, but I feel happy when I get things resolved,” she said, adding that even then, keeping one’s case number on hand for further questions is a wise decision.

When their case comes up for review, those on Medi-Cal can lose coverage for failing to respond, but there is a 90-day grace period after the due date to provide required documents and reinstate coverage. Once coverage is reinstated, bills paid out-of-pocket can be reimbursed from the date of discontinuance.

According to Yingjia Huang, assistant deputy director of Health Care Benefits and Eligibility at the California Department of Health Care Services, the number of Medi-Cal members is expected to grow because of recent strides in the program like the addition of health enrollment navigators to assist with bureaucratic hurdles, streamlined renewal processes, informational online toolkits in 19 languages, and the expansion of coverage to income-eligible undocumented immigrants.

Those who have applied for or received benefits from Medi-Cal and have a complaint about how services were handled or had services denied or modified can discuss the complaint with a county welfare representative, file a discrimination complaint, or request a hearing.

Renewals may be completed in person with assistance from others like Vigil at varying Medi-Cal Care locations, or online at www.benefitscal.com or www.coveredca.com.

Contra Costa County residents can get enrollment assistance for Medi-Cal, Covered California or CalFresh food assistance at LifeLong Brookside San Pablo Health Center and William Jenkins Health Center in Richmond by calling (510) 830-3333 to schedule an appointment.