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California and the West

New Health Plan for Needy Is Criticized

Medi-Cal: Complex registration process and short deadline may mean few enroll, advocates say.


SACRAMENTO — Thousands of poor families who moved from welfare to work could lose medical coverage because a new program to provide them health care is being rushed into service and is too complicated, advocates for the poor complained Wednesday.

State officials have given counties until April 30 to enroll nearly 250,000 former aid recipients in the new program--a deadline so short that many will drop into the ranks of the uninsured, advocates said.

"It's a bungled, missed opportunity to preserve coverage for low-wage workers who have turned down welfare checks," said Lucy Quacinella, staff attorney for the National Center for Youth Law. "We have placed 250,000 individuals at risk of losing their medical coverage . . . and they are predominantly children."

The new program, which grew out of the 1996 national welfare reform act, extends Medi-Cal benefits to former aid recipients who leave welfare to take jobs, most of them low-paying. In the past, welfare recipients were entitled to Medi-Cal only as long as they were receiving government assistance.

Financed with equal shares of federal and state money, the extended care arrangement was created to ensure that recipients who comply with the dictates of welfare reform by going to work are not penalized. Most low-wage jobs do not come with health care benefits.

But Quacinella said the combination of an enrollment process laden with bureaucratic hoops, county workers who are still unfamiliar with the new rules and a short deadline are all ingredients for disaster in most California counties. Enrollment forms are long and require complicated financial information.

She said Los Angeles may be an exception, because it uses simpler procedures and has initiated a strong outreach effort designed to keep poor families from losing Medi-Cal benefits.

State officials acknowledged that the deadline is tight. But they said they created enough safeguards to protect poor families. Those most at risk left welfare in the last year and have remained on the Medi-Cal rolls until the state completed regulations for enrollment in the new program.

Losing recipients is "'something we are worried about," said Stan Rosenstein, the Department of Health Services' assistant deputy director of medical care services. "[But] I don't see this catastrophe happening--at least in Los Angeles--that the advocates are talking about."

The Davis administration has tried to soften the impact of the impending deadline by announcing that it will not penalize those who fail to make it, he said.

"Counties should do the best they can to meet these deadlines," he said. "We don't expect all the counties to make them."

The program, which eases Medi-Cal requirements by allowing poor workers formerly on welfare to earn more and still qualify for benefits, comes at a critical time: when the numbers of people without health insurance is skyrocketing.

In California, one in five people, or 7 million, are uninsured, according to federal surveys. Of these, 1.8 million are under 19. Nearly half of those children--an estimated 788,000--are qualified for Medi-Cal but their parents have not enrolled them.

At the same time, California's track record on new medical programs has been poor. A complicated and cumbersome application process discouraged many parents from enrolling their children in Healthy Families, which was created to provide medical insurance for children of the working poor.

Enrollment, which began July 1, 1998, fell well below expectations. State officials simplified the application form last week.

Quacinella said the enrollment process for the new Medi-Cal program is equally daunting, and she fears that when families get the enrollment packets in the mail they will find them too difficult and throw them away. "The packet itself would be complicated for any college-educated person to fill out," she said.

With the April 30 deadline looming, she said, she feared many counties would then drop from the rolls anyone who didn't send in the forms.

Frank Mecca, executive director of the County Welfare Directors Assn. of California, advised state health officials in November when the Wilson administration established the deadline that "the timeline . . . is unreasonable. . . . Counties will be unable to meet the time frames."

In Los Angeles County, Sheryl Spiller, chief of the welfare department's medical and food stamp division, said her agency's approach has been to take whatever time is necessary to ensure that no eligible recipient is dropped from Medi-Cal. As a result, she said, Los Angeles will be one of the counties that will not meet the deadline.

"We want to make sure we don't lose people," she said.

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