Last week saw an emergency room full of healthcare-related IT problems, issues and challenges being reported. We chose to concentrate this week’s edition of IT Hiccups on one which resembles a healthcare version of Hotel California where hundreds of thousands of California Medi-Cal health insurance applications have been checked in, but can’t seem to leave the confines of California government offices.
A bit of background to this story is useful to its understanding: As part of the Affordable Care Act (ACA), California decided to loosen the eligibility of state residents who could qualify for Medi-Cal, the state’s Medicaid health insurance program for low-income state residents. Some 8 million Californians were already enrolled in Medi-Cal last year, and a 2013 University of California Berkeley and Los Angeles joint study estimated (pdf) that another 1.4 million more residents would now qualify under the new eligibility rules. Of those 1.4 million, it was expected that some 750,000 to 910,000 individuals would enroll in Medi-Cal by the year 2019.
The state's plan was for the newly eligible Medi-Cal applicants to apply for benefits beginning 1 October 2013 using the freshly implemented US $450 million Covered California state health insurance exchange website and supporting infrastructure systems developed to implement the ACA. After the application is processed and the information provided with it vetted, the plan called for the applicants' Medi-Cal insurance to come into effect on 1 January.
While Covered California experienced its share of problems, generally it fared better than most of the other state-developed health insurance exchange websites. About 1.4 million Californians enrolled for private insurance plans through Covered California; however, what took California by surprise was that another 1.9 million residents—some 2.5 times more than originally expected—enrolled for Medi-Cal health insurance coverage. The unexpected number of Medi-Cal applicants coupled with several Cover California technical troubles and Medi-Cal application issues have conspired to create a situation where over 900 000 Medi-Cal enrollees are still waiting to get their insurance cards.
For example, one factor causing the hold-up was that the state-run Covered California exchange computer system was supposed to interfacewith the 58 individual county social services computer systems by 1 October 2013. The interface was intended to corroborate an applicant’s eligibility as well as to confirm the county managed care plan the applicant selected. However, the Covered California to counties’ interface wasn’t fully operational until 21 January 2014, according to the Fresno Bee story. Given that the state is expected to take no longer than 45 days to process an application, the delay created an instant backlog of approved applications.
A Sacramento CBS television station report quoted California Department of Health Care Services (DHCS) spokesperson Norman Williams as saying (in a bit of an understatement):
With the state’s computer system, and the counties’ computer systems, we’ve worked together for years, decades… Covered California is new, [however], so we have to have those computer systems talking to each other and exchanging information, and that’s proven to be kind of a difficult task.
Further exacerbating the delay was that there was a programming flaw in the Covered California website that “caused applications to be wrongly denied and put on hold,” Frank Mecca, executive director of the County Welfare Directors Association of California told the Fresno Bee.
Adding to the chaos, the Bee stated, was that an unspecified number of Medi-Cal applicants did not provide all the documents needed to verify their eligibility, which is troublesome but not unexpected. For example, according to an AP story last week, nearly 25 percent of all ACA applications requesting health insurance subsidies have been found to have some type of data “discrepancies.”
There is no official timetable for when the Medi-Cal backlog will be whittled down to just applications requiring more eligibility information. Last month, the state indicated that this could be accomplished by the end of June, but this date now looks highly doubtful. California DHCS spokesperson Williams says that the state is “devoting all the resources we can to make this work and to get them into coverage.” He added that, “It’s our top priority right now.”
Medi-Cal applicants who still have not received their insurance cards after 45 days are being told by DHCS to contact their county human services office. However, according to both the Fresno Bee and the Sacramento CBS television station stories, Medi-Cal applicants who do inquire about their missing insurance cards complain that they are being given the run around.
The mess, which has been described as a “jaw-dropping fiasco” by advocates of low-income Californians, may get worse in the near future. According to California Healthline.org, the advocates claim the revised eligibility renewal forms for 8 million Medi-Cal beneficiaries that need to be returned by the end of June are going to cause confusion and lead to a large number of incomplete applications being submitted.
DHCS strongly disputes this claim. It also indicated, however, even if true, it wasn't a big deal because DHCS social services personnel would contact those who submitted incomplete forms. Of course, that might not happen until after DHCS personnel work through the current Medi-Cal application backlog.
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Robert N. Charette is a Contributing Editor to IEEE Spectrum and an acknowledged international authority on information technology and systems risk management. A self-described “risk ecologist,” he is interested in the intersections of business, political, technological, and societal risks. Charette is an award-winning author of multiple books and numerous articles on the subjects of risk management, project and program management, innovation, and entrepreneurship. A Life Senior Member of the IEEE, Charette was a recipient of the IEEE Computer Society’s Golden Core Award in 2008.