LOS ANGELES – It’s one of the next big hurdles for the Obamacare rollout: What will happen when hundreds of thousands of low-income Californians shift from county health plans to the state’s huge Medi-Cal system on Jan. 1?
Judging from a similar surge in 2011, patients and physicians could see plenty of problems.
Starting on New Year’s Day — Wednesday — as many as a million formerly uninsured or underinsured people will begin moving onto Medi-Cal rolls and reporting to clinics and hospitals that have agreed to provide treatment at set rates.
Also for the first time, childless and healthy low-income adults will be eligible, and benefits will include mental health and substance abuse treatment.
Healthcare advocates are overjoyed about the expansion of services, which is subsidized by the federal government under the Affordable Care Act. At the same time, they recognize that this is the kind of influx that can leave patients and doctors in a lurch — confused about such things as whether a long-planned surgery is still authorized or where patients should go for prescription refills.
When 380,000 senior and disabled Medi-Cal members were gradually switched into managed care in 2011, advocates reported numerous cases in which patients suffered as doctors and health plans didn’t coordinate properly to deliver necessary ongoing medications and treatments for ailments as serious as cancer, schizophrenia and diabetes. Healthcare providers struggled as well; many were assigned new patients with no way to review their medical histories.
This time, officials and healthcare providers say they hope to avoid such disruptions.
“We’re using the same system we would use in an earthquake,” said Louise McCarthy, chief executive of the Community Clinic Assn. of Los Angeles County, comparing the planning effort to a disaster drill. “This is going to be seismic. We have to approach it as such.”
The first step in getting ahead of potential problems: making sure computer systems align.
According to the state Department of Health Services, about 400,000 Californians are likely to wind up in Medi-Cal — a $70-billion program — after applying for the first time through Covered California, the state healthcare insurance marketplace; 195,000 others have tried to sign up through county human services agencies. Those new members won’t join a Medi-Cal managed care plan right away.
But more than 600,000 new Medi-Cal participants will roll over immediately from special county-based health programs formed to ease the transition to Obamacare. Using money from the Affordable Care Act, some California counties opted to start providing medical services for Medi-Cal expansion eligible patients early in 2010 so those patients could be cued up to move automatically into Medi-Cal this week. Los Angeles County’s Healthy Way LA program represents more than half of this population, with 315,000 people signed up as of Nov. 30.
Planners are attempting to make sure that the state and county records for these patients match up with the enrollment rosters at the health plans contracted by Medi-Cal — giving providers at least some idea about which patients are headed their way and what their needs may be.