"Governor’s plan would cut Medi–Cal rolls"
San Francisco Chronicle
Tom Chorneau, Chronicle Sacramento Bureau
Monday, February 25, 2008
(02-25) 04:00 PST Sacramento --
Less than a month ago, Gov. Arnold Schwarzenegger was pushing lawmakers to pass a landmark program aimed at bringing health care coverage to 6.8 million uninsured Californians.
Now, with his health care expansion on the rocks and the state facing a multibillion-dollar budget gap next year, Schwarzenegger has proposed a plan to make most enrollees of state-sponsored medical care fill out more eligibility paperwork as a means of saving money - a move that critics say is insidious.
Administration officials expect the rule will result in 122,000 people being dropped from the rolls next year, saving the state $92 million - money that the governor's staff has already counted against the state's deficit.
The plan calls for about 4.5 million of the 6.5 million enrollees of the Medi-Cal program to file eligibility forms with the state four times a year. Under existing law, children, some disabled people and pregnant women must reapply once a year, while parents are required to report twice annually.
The chore of filling out a form and sending it to regulators might sound simple enough, but for Medi-Cal recipients such as Ernie Campbell of Novato, who has hemophilia, the danger of losing coverage because of an unanticipated problem, such as a form being lost or delayed in the mail, is a serious one.
"The renewal process is already a lot of paperwork and they warn you if you don't get everything in on time you could lose your coverage," said Campbell, 31. "I think this could probably affect me pretty negatively."
The governor's idea is not new: It was last proposed by then-Gov. Gray Davis during the budget crisis of 2003, although the Legislature eventually rejected the move.
Critics of Schwarzenegger's plan called it a cynical approach to saving money.
"When people fall off of Medi-Cal because they can't keep up with the red tape, they'll get referred back to the counties to reapply," said Lucy Quacinella, a San Francisco attorney who is an advocate for the poor.
"All we would be doing is creating this huge paper mill, increasing the administrative burden on counties and not saving the taxpayers anything - in fact costing more."
Anthony Wright, executive director of Health Access, a coalition of grassroots health care consumer groups, said the idea is a way of reducing the Medi-Cal rolls without actually imposing a budget cut.
"This is a cynical way to do business," he said. "They are intentionally making it more difficult for people to stay in the program with the express purpose of hoping they will drop out."
Not so, said Toby Douglas, deputy director of the state Department of Health Care Services. He said the idea is to simply get people who are not eligible for state services out of the system sooner.
"We are not doing this to create barriers to enrollment," Douglas said. "We are doing this as a way to ensure that those who are no longer eligible are no longer enrolled in the program."
Still, the proposal could have significant impact on San Francisco's plans to become the first city in the nation to provide insurance to all residents because the city is relying on the state to maintain coverage to existing Medi-Cal patients.
Tangerine Brigham, director of the San Francisco program, said her office has not had a chance to study the governor's plan but any barrier to coverage will increase the number of uninsured residents in the city and complicate the efforts of officials.
The new reporting proposal, along with a list of other cost-saving ideas included in the governor's budget, stand in stark contrast to the goals of the health care plan Schwarzenegger had aggressively pushed in the past year.
Legislation, which died before a state Senate committee last month, was aimed at expanding coverage to virtually all Californians by broadening government programs, mandating employers to provide insurance to employees and setting up a system where uninsured residents could purchase policies from a state-sponsored pool.
Although Schwarzenegger has said he has not given up on the health care expansion, his budget released last month would suggest otherwise.
In an effort to close a spending gap that stood at $16 billion at the beginning of the year but has since been cut in half by legislation approved last week, the governor has proposed cutting $1.1 billion from the Medi-Cal program. He would cut some benefits and impose a 10 percent reduction in reimbursements to doctors and hospitals that provide services to Medi-Cal enrollees.
Wright said that if the governor's budget plans are enacted, the number of uninsured residents will increase and impose more burdens on hospital emergency rooms where most of those without insurance will be forced to seek care.
"This is a major step backward in terms of getting access to care for Californians," he said. "More than 100,000 people will lose coverage, millions will lose access to some providers and it will also mean less federal matching funds will be coming into the state for the health care system we all rely on."
How to get involved
To comment on the governor's proposal to require Medi-Cal enrollees to file more eligibility paperwork, contact:
-- Gov. Arnold Schwarzenegger: Sacramento office (916) 445-2841, San Francisco office (415) 703-2218; e-mail by going to www.gov.ca.gov.
-- Assembly Speaker Fabian Nuñez, D-Los Angeles: Sacramento office (916) 319-2046; e-mail firstname.lastname@example.org.
-- Senate President Pro Tem Don Perata, D-Oakland: Sacramento office (916) 651-4009, Oakland office (510) 286-1333; e-mail email@example.com.
-- Senate Republican leader Dick Ackerman of Irvine: Sacramento office (916) 651-4033; e-mail firstname.lastname@example.org.
-- Assembly Republican Leader Mike Villines of Clovis: Sacramento office (916) 319-2029; e-mail assemblymember.vil email@example.com.