As July 1st hits, a budget fix for California is apparently nowhere in sight. So how is this year different from years past?
Besides the alarming $24 billion hole in California’s budget, we seem to have a different Governor. As recently as 2007-08, Gov. Schwarzenegger was actively advocating for health reform. Now he proposes to endanger the intergrity of the very programs on which health reform would be built.
The “Year of Reform” governor sought to expand and improve Medi-Cal. Today, our public health programs seem to be a prime place he goes to find “savings” in the state budget. While, on one hand, he’s demanding big-picture solutions from legislative leaders, with the other hand he’s passing around a new package of proposals that could, in effect, make Medi-Cal coverage less accessible.
Under the guise of modernizing the system and “bringing California into the 21st Century,” Schwarzenegger would eliminate 27,000 county workers who currently help Medi-Cal recipients with complex enrollment procedures. He calls person-to-person interaction an “antiquated process…relying on slow and time-consuming face-to-face and mail-in processes that are only available between 9-5 and lack uniformity across counties.”
Moving the process online, he says, will be “taking advantage of the latest technologies to allow people to apply and enroll in state programs faster and with fewer hassles — all while reducing costs.” It almost sounds too good to be true.
Advocacy groups like the Western Center on Law & Poverty find this alarming.
People need the help of those county workers — their face-to-face interaction, and step-by-step assistance — to successfully enroll in Medi-Cal or determine their eligibility. Medi-Cal is an exceedingly complex program.
Advocacy groups also know that a process to apply for Medi-Cal online is already underway, and believe this should be but one of several options for people to sign up for Medi-Cal. The online project is being carefully monitored by stakeholders who want to make sure it’s fair, accessible and works well as it proceeds.
Yet the Governor’s proposal is something else–a wholesale privatization, turning enrollment into a for-profit private vendor like Maximus. Such privatization makes government programs less transparent and accountable — and can lead to time lags in enrolling patients (thus saving the state money). Other states have tried privatizing the management of health care eligibility and enrollment with little success.
Even Texas cut the cord on its privatization effort, finding itself without the promised savings and short on workers who previously administered the program. The Fort-Worth Star Telegram reported that, in the end, offices were understaffed, calls went unanswered and Texas was left with “fallout from a major experiment in state government that nearly everyone called a disaster.”
To be clear, Schwarzenegger’s proposal isn’t intended to simplify and eliminate the various enrollment barriers, like the asset test or regular redeterminations. It’s meant to undo the network of people that help low-income families navigate this complex and confusing system.
This could result in fewer people enrolling in Medi-Cal, especially since the least likely population to have online access at home include low-income seniors and people with disabilities. Those are the people who Medi-Cal is responsible for serving — and California already spends less on their care than other states.
So what may seem logical — taking advantage of online capabilities — may turn into a barrier, a barrier that results in fewer people receiving Medi-Cal health insurance. But that may be the point.