CARTOON: Medi-Cal Mess

Medi-Cal Cartoon

California could offer state-subsidized health care to 170,000 undocumented children

As reported by the Associated Press:

SANTA ANA >> In a move that adds momentum to efforts to integrate immigrants, California is on the cusp of becoming the largest state in the nation to extend state-subsidized health care coverage to children from low-income families who are in the country illegally.

Democrats, immigration groups and health care advocates celebrated the announcement as both a cost-saving move and social progress for the state’s estimated 2.5 million immigrants who are in the country illegally. Critics, however, worry that the overburdened state-funded health program can’t handle another 170,000 children.

Gov. Jerry Brown and legislative leaders announced a $115.4 billion budget agreement that for the first time includes state funding to cover low-income children under 19 regardless of their legal status in Medi-Cal, the state’s health care program for the poor.

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Special Tax Sessions Announced by Gov. Brown

taxesIn announcing the budget deal with the Legislature, Governor Jerry Brown announced two special sessions to deal with transportation and Medi-Cal funding. Call them the Special Tax Sessions.

In the press release announcing the sessions, the governor stated that the sessions were to “find more adequate funding for our roads and health care programs.”

The governor asked for “permanent and sustainable funding to maintain and repair the state’s transportation and critical infrastructure.” He also wants “permanent and sustainable funding to provide at least $1.1 billion annually to stabilize the state’s General Fund costs for Medi-Cal,” some of which would be used to meet the demands of programs Democratic legislators sought funds for in the current budget such as In-Home Supportive Services.

At the governor’s press conference announcing the budget deal, reporters asked Brown about his first term (third term?) campaign pledge to only seek tax increases with approval of voters. Brown brushed aside the old pledge indicating the pledge only applied to his first term.

Add it all up and there will be a push for tax or fee increases to support the governor’s call for “permanent and sustainable funding.” Discussions will revolve around gas taxes and a higher car tax or maybe a mileage fee for transportation; perhaps an increased cigarette tax and other healthcare taxes for Medi-Cal.

Brown might hope for support from the business community for the transportation and infrastructure fix. Those issues have been of on-going concern to business.

Still, the large influx of dollars in the current budget and the talk of tax proposals that may end up on next year’s ballot will only increase the anxiety of businesses and taxpayers alike and could result in stalemated special sessions.

Originally published by Fox and Hounds Daily

Nearly One-Third of Californians Dependent on Medi-Cal

Healthcare costsWith Medicaid eligibility expanded nationwide under the Affordable Care Act, Medi-Cal enrollees have discovered that care in California is not keeping up with increased demand.

“Today, more than 12 million Californians, nearly one-third of the state’s total population, are enrolled in the government’s health insurance plan for low-income, disabled and disadvantaged residents,” U-T San Diego reported.

Wrangling reimbursements

The sharply increased burden has driven stark divides into statewide politics. The dispute has centered around reimbursement rates, which have fallen low enough to discourage many doctors from accepting Medi-Cal.

Even for those who do, low caps on Medi-Cal patients have become the norm. “According to the California Medical Association, Medi-Cal pays an average of $41.48 for an office visit, less than half the $102.45 that Medicare pays for the same service,” according to U-T San Diego.

Part of the problem traced back to 2011, when the state Legislature, deep in the red, passed Assembly Bill 97 — a bill cutting Medi-Cal reimbursements by 10 percent. As the San Jose Mercury News reported, a court injunction forestalled the cut until this fiscal year, but did not prevent it from staying in effect each year after that. In opposing the cut, Medi-Cal providers have beenjoined by the California Hospital Association and representatives in California’s rural counties, where doctors accepting Medi-Cal can be especially difficult to find without traveling long distances.

Gov. Brown’s administration has anticipated that the reimbursement cut will yield a first-year savings of over $214 million. But as state coffers have swelled with a big taxation windfall, Sacramento Democrats have pushed Brown to take a more liberal approach to budgeting.

For now, with the state deadline for budgeting looming, the governor’s office has refused to budge. Finance Department spokesman H.D. Palmer told the Mercury News that more specifics are needed on how reimbursement increases will expand access to care before the old rates are restored. Meanwhile, finance officials “have pointed out that the $91.3 billion Medi-Cal budget for 2015-16 is almost $10 billion more than the current fiscal year. More than half of the cost comes from the federal government, but the state increased its contribution from the general fund by $700 million for the next fiscal year, up to $18.2 billion.”

Competing priorities

Adding to the sense of chaos, activists have begun a new push to increase health care access for unlawful immigrants. That effort has come at an awkward time. As the Los Angeles Times observed, “reductions made in county health program funding to help finance Obamacare have made it more difficult for some local officials to add — and in some cases maintain — medical care for the poor and residents living here illegally.” California pulled about $900 million in funding for local health programs “to help pay for expanded insurance coverage for those eligible to receive Medi-Cal,” according to the Times.

Lawmakers have also targeted another way Gov. Brown has clawed back some health care outlays. In a unanimous vote, the state Senate sent legislation to the Assembly that would crack down on California’s so-called Medi-Cal recovery program. That regulatory approach that allows the state to reclaim Medi-Cal money from the estates of deceased beneficiaries, even going after the value of their homes. Under the law governing Medicaid, the federal government has been authorized to recover funds in a more narrow way.

For many Californians affected by the rules, the takings come as an shock. As Emily Bazar noted at the Sacramento Bee, beneficiaries can be targeted even if they never went to a doctor. In a particularly counter-intuitive twist, Obamacare enrollees placed into Medi-Cal based on their low income will be required to pay back their health subsidies — while higher-income Covered California enrollees will not have to repay the ones they receive.

Originally published by CalWatchdog.com

The Medi-Cal Mess

Pills health careCalifornia’s health program for the poor and disabled, Medi-Cal, has presented state lawmakers with quite a perplexing paradox. More and more people fall under the protection of Medi-Cal and need a doctor but fewer and fewer doctors are accepting the low fees associated with the program. While a simple solution may appear to be increasing the size of the Medi-Cal budget, Medi-Cal is already stretching the state budget and squeezing other programs. Thus, dealing with the Medi-Cal mess has become a real problem for state lawmakers and the governor.

As former Gov. Schwarzenegger economic advisor David Crane pointed out in a Sacramento Bee op-ed, “Medi-Cal’s share of spending has grown 35 percent since Brown took office and now consumes one-sixth of the budget.”

Yet, while the Medi-Cal costs surged upward with new patients coming into the system, especially because of the Affordable Care Act, fees were cut for health care providers during the recent recession and have not been restored. Many providers have decided not to accept Medi-Cal patients because of the low reimbursement rate.

So, more patients seek doctors and other health care providers while fewer health care providers are available to see them. And raising the cost of the program jeopardizes the cautious fiscal management of the Brown Administration that is concerned about what happens when there is another economic downturn.

Recently, Brown’s Director of Finance, Michael Cohen, told the press that the administration was willing to discuss boosting Medi-Cal reimbursement rates if that would guarantee greater access to doctors. How that guarantee is made to work is not certain.

There is no question that the health care providers should be more fairly compensated for their services and that all patients should be able to see a doctor. Given the increase in state revenues it is anticipated that some relief to the Medi-Cal program is in the offing. Yet, Brown is right to be concerned about an expanding budget.

While there seems no simple solution, not just the health care providers and the budget dollars should be considered. Another focus should be on the users of the system, their participation in the program and the opportunity for them to rise up and get free of the need for Medi-Cal assistance.

That California has nearly a third of its residents in need of Medi-Cal to provide health care is a sad commentary on the opportunity for the people to improve their circumstances. Obstacles should be removed so that the private sector can increase well-paying jobs. Then many of the people and their families using Medi-Cal can move away from the state sponsored health care and get company or individual health insurance.

Reducing obstacles to good job creation would go a long way toward relieving the burden on the Medi-Cal program.

In addition, Medi-Cal’s value must be brought home to patients. Health care providers have told me that they sometimes have to double and triple book Medi-Cal patients because they don’t appear for their appointments. The reason often suggested is that many patients are not required to pay anything for the appointment and thus put little value on the service. A nominal co-pay by all patients would add value to the service and change the character of the program.

Californians should receive health care due them and health care providers should be justly compensated for their work. However, there appears to be no Alexander’s sword to cut through the Gordian knot that is Medi-Cal so the fix must be a more holistic approach.

Joel Fox is editor of Fox & Hounds and President of the Small Business Action Committee

Democratic Immigrant Protection Bills Don’t Solve Poverty Problem

Legislative Democrats heralded a package of bills they purport to aid and protect undocumented immigrants. Acknowledging the humanitarian concern behind the package, the plan will do little to help immigrants achieve the American Dream if something isn’t done to provide middle class jobs. Without them, many immigrants here and those attracted by California ‘s largesse are subject to a life of poverty.

Immigration reform is a Federal issue but California’s Democratic legislative leadership chooses to take the issue on to the extent that they can with this package of bills. There are many concerns associated with the bills worthy of serious questions and doubt, not the least of which is the immediate cost. Leading the cost concern is Senator Ricardo Lara’s SB 4 that would add 1.5 million undocumented immigrants to the already stressed Medi-Cal roles.

Putting the cost question aside for the moment, as well as the implication that the laws likely would serve as a magnet to draw even more undocumented immigrants to California, an important question is if these proposals become law will the immigrants the laws are designed to assist continue to be prisoners of California’s poverty prison?

California leads the nation in the number of people trapped in poverty. Many are immigrants in the country illegally. Without creation of good paying jobs many likely will remain victims of poverty.

The push for minimum wage increases is not the real answer to the poverty problem. Modifying regulations and cutting taxes to promote small business is one solution. Offering incentives to encourage the capital investment needed to create manufacturing jobs that pay middle class wages is another.

Taking the major step to encourage middle class jobs is the best thing the state can do for all California’s residents.

Joel Fox is Editor of Fox & Hounds and President of the Small Business Action Committee

Originally published by Fox and Hounds Daily

Medi-Cal Struggles Leave Politicians Worried, Patients Hurting

A victim of its own success, California’s popular Medi-Cal program has rapidly swelled to a large enough size to malfunction. It’s known as Medicaid in the rest of the country and provides medical care to poor people.

Mounting woes — from applicant backlogs to outdated regulations — have raised serious concerns among analysts and policymakers.

In part, the challenges facing the Medi-Cal system came about because of administrative changes triggered by the federal Affordable Care Act, or Obamacare. Here it’s called Covered California. As CalWatchdog.com reported, a combination of cuts in federal and state budgetary subsidies boosted provider costs.

“A provision of Obamacare hiked the rates for primary care doctors to the substantially higher Medicare rates for two years, but those increases ended on Dec. 31,” reported the San Jose Mercury News. “A second blow came last month when the state cut the Medi-Cal reimbursement rate by another 10 percent, a reduction approved by California lawmakers in 2011 but delayed in a court battle that doctors ultimately lost.”

But the ACA has made an even greater impact on California’s health care challenges by ballooning the population accessing Medi-Cal benefits. As the Mercury News reported, Obamacare opened the floodgates in Jan. 2014, resulting in 2.7 million more recipients to date.

California’s expanded recipient group now makes up 17 percent of total national Obamacare enrollment, even though California’s overall population is just 12 percent of the U.S. total.

State health officials, according to the Mercury News, have concluded that by the middle of 2016, “more than 12.2 million people — nearly a third of all Californians — will be on Medi-Cal.” Meanwhile, the program already consumes about two-thirds of California state-government spending on health and human services overall.

Budgetary fears

For both Gov. Jerry Brown and Sacramento legislators, these trend lines have raised sharp worries, as McKnight’s news servicereported:

“State lawmakers this week said the latest enrollment news is alarming, and that even if a new pending rate request hike goes through, there is concern the state will run out of funding to care for its Medicaid recipients. State Medicaid costs are up 4.3 percent this year while federal share of costs for new enrollees will begin dropping in 2016, according to Gov. Jerry Brown.”

Brown has made an effort to head some costs off at the pass in his budget plan. According to State of Reform, a health-care think tank, “Brown has earmarked $2 billion in total funds ($943.2 million General Fund dollars) to cover mandatory Medi-Cal expansion.”

But pressure to change the budgetary calculus in California’s favor has intensified.

Reducing access

The big picture for Medi-Cal has officeholders and policymakers so nervous because of the ripple effects of increased costs and recipient rolls. State of Reform observed:

“In addition to Medi-Cal primary cuts making it potentially impossible for new patients to find physicians, President Barack Obama’s executive action will make approximately 1 million undocumented immigrants in California eligible for health insurance tax subsidies.”

That has critics warning access to doctors could decrease sharply. In a sobering report issued by the Legislative Analyst’s Office, the impact of the president’s actions was incalculable:

“The benefits received by undocumented immigrants through these programs are almost entirely funded by the state and would therefore result in additional General Fund costs of an unknown amount. The General Fund costs to provide state–funded benefits to this population are unknown at this time.”

With the federal government putting the squeeze on California’s budget, state doctors have become increasingly scarce.

“There are mounting concerns there will not be enough plan doctors to accommodate the enrollment surge,” according to McKnight’s. “One recent study found that only 57 percent of the state’s primary care doctors accept new Medi-Cal patients.”

As a result, increasing numbers of recipients have been winding up in the ER. As the Fresno Bee observed, that transfer of burdens has undermined the claim advanced by Obamacare proponents “that patients with insurance would have primary care doctors to take care of them and less reason to use expensive and overcrowded hospital emergency rooms.”

Although experts have not determined the likely extent of doctors’ unwillingness to treat Medi-Cal patients, California lawmakers have begun to brace for the worst: a substantial budgetary increase that will not be covered by the federal government.

Instead, the higher health tab may have to be absorbed by increased taxes, cuts in other budget areas, or both.

Originally published at CalWatchdog.com

Open-enrollment headache again strikes Covered CA

If you thought the rollout of Obamacare was problematic last year, this year could be worse — including its implementation here, called Covered California.

State officials are still struggling to clear a huge backlog of Medi-Cal applications from the past year, while legislators field numerous complaints from frustrated constituents, insurance premiums are increasing and Medi-Cal renewals are down. The open enrollment period for 2015 begins Nov. 15.

“As much as the first year of enrollment was big and rocky, on some levels the second year is going to be harder,” said Covered California Executive Director Peter Lee at a recent Senate Health Committee informational hearing.

Both Lee and Department of Health Care Services Director Toby Douglas are proud of their progress in implementing Obamacare in California.

“We reduced the number of uninsured by 3.4 million people in this state, from 22 to 11 percent,” said Lee. “That’s the largest reduction by percentage in the entire nation. We can feel proud of California serving as an example for the nation how to do this right.”

“[We] have had tremendous success with the implementation of the Affordable Care Act,” agreed Douglas. “We have within our Medi-Cal program dramatically changed the perception. The perception overall is positive and it gets high marks.

“That being said, we’ve had challenges, many challenges with the process. We know our implementation has not been without problems. We have to continue to learn from those challenges, continue to improve it and make it a better experience for all of those, whether applying for Covered California or enrolling into our Medi-Cal program.”

Backlog

One of DHCS’s biggest challenges has been clearing the Medi-Cal application backlog. It had reached 487,000 pending applications in July, which were whittled down to 171,681 by Oct. 15. Nearly 1,400 applicants have been waiting a year to find out whether they’ll receive coverage.

This has not only been an embarrassment for state health officials, but it’s also illegal. State law requires that health insurance applications either be accepted or denied within 90 days. Several social advocacy organizations have filed a lawsuit to get the state to abide by its own law.

“There has been an increase recently,” acknowledged Douglas. “Covered California has been going through administrative renewals, and that has pushed populations over to Medi-Cal. And we know that there’s at least 40,000 that are duplicates that need to be denied within the system of 171,000. And there’s 20,000 where we’re looking at our administrative strategies that are eligible.

“We have been going through a lot of different enhancements to try to reduce the pending cases and bring it down. Our ultimate goal is we want all applications determined eligible in the required time frame. And we might still always have pending cases, because counties might be waiting for verification information. But we want to make sure that there is no one out there stuck and pending because of system problems.”

Renewal

Another challenge for Douglas is getting Medi-Cal recipients to renew their coverage. The renewal rate in 2013 was 60-70 percent in many of the state’s larger counties. But that range has dropped to 50-70 percent in 2014, with some counties below 50 percent.

That decrease concerns Sen. Holly Mitchell, D-Los Angeles. “This is deeply troubling,” she said. “We spend all this energy talking about congratulating ourselves about our enrollment numbers and that number will be a moment in time because we get to re-enrollment and we lose them.

“And the Legislature will have kneejerk reactions like, ‘Get rid of the status reports, get rid of this, get rid of that’ to try to fix that number. That’s why I ask what the problem is so we can be a partner rather than kneejerk to try to plug this hemorrhage – because that’s huge and a problem.”

Douglas responded, “We’re not sure. We delayed the actual disenrollments to get more outreach. We would have thought it would be the same. This is not what we wanted. We think it’s because it’s a new process. There’s been concern from community groups that … thought it was confusing. It’s going to take a lot of grass roots work to break down and understand this new process and why it’s different.”

Mitchell said the confusion is inherent in the way government does things.

“Government does a horrible job in communicating,” she said. “At first I thought it’s because we really don’t want to enroll people. And I don’t think that’s the case. We are bitten by the IRS bug. Every form we create we have to make it as complicated, use as many words and make it look as academic and unfriendly as possible. It’s not just you, it’s government across the board. I’m not sure why that is. We have a bad habit of making the process as difficult and complicated unnecessarily as possible.”

Lee disagreed: “We certainly don’t, as either a matter of habit or purpose, try to make things complex, as you know.”

That prompted Mitchell to laugh, saying, “It’s government – we can’t help ourselves.”

Outreach

She also criticized the state’s education and outreach efforts to blacks.

“The effort in the first go around was lackluster,” she said. “And we need to have a clear conversation and commitment around who is engaged and contracted to do the advertising and outreach to this very specific and targeted community.

“I sponsored a [Covered California] storefront [in the Crenshaw mall] because I happened to think it was a great idea when I was approached by community-based organizations. But I have to say, I was quite disappointed at the outcome. We had five kazillion touches, but our enrollment numbers were nowhere near what I anticipated.”

Lee responded, “The Crenshaw mall enrolled not as many people as you thought it would and we thought it would. But a lot of people came and asked questions. And one of the things we learned is that it’s not a one-touch-and-done enrollment process. So the fact of having a storefront where people can come in, ask questions, take material home, come in again and then maybe go enroll with an insurance agent at that storefront we say, ‘Hallelujah, wherever you are enrolling is OK.’”

Calls

Committee Chairman Sen. Ed Hernandez, D-West Covina, voiced a complaint made by legislators at an Assembly Health Committee hearing on Obamacare in September.

“My office on a regular basis is getting calls,” he said. “They get funneled up to Sacramento. These are people who are in support of the Affordable Care Act. And they are just really upset. It can be anything from [a lack of] network adequacy to call time to wait time to length of time in Medi-Cal to get enrolled.

“So I want to make sure that not only California continues to be the leader, but absolutely most important that we address as many if not all of the concerns that the consumers of the state of California have.”

Sen. Bill Monning, D-Monterey, has also received numerous complaints from constituents.

“I represent rural areas where in much of my district there is no competition” among health insurance providers, he said. “Our phones are ringing off the hook with people who have coverage and can’t find a [health care] provider who will accept that coverage. So, coverage without access is not real coverage.

“We have a health care plan in Monterey County advising providers at a local hospital that diabetes prevention is not covered. It’s wrong. They are giving disinformation, turning people away. A major health plan that is our only health plan in the region of Monterey County is advising providers it will not cover preventing for diabetes.”

Lee said preventive care is covered, and insurance companies are reviewed annually to make sure they are providing adequate coverage.

“When we sit down with health plans, we don’t say the first question is: What’s the cost?” he said. “The first question is: Are there adequate networks of doctors, hospitals to make sure people get the necessary care? Not all, but in a number of cases there were areas where we specifically said there appear to be shortfalls in networks. And part of what plans came in with was expanded networks of hospitals or of doctors.”

Lee and Douglas assured the committee that they are working to fix the problems and improve service, but acknowledged that will take time.

This article was originally posted on CalWatchdog.com.

Quarter-million applicants still waiting for Medi-Cal

Originally published on CalWatchdog.com:

A quarter-million Medi-Cal applicants have been waiting more than 45 days, and in some cases nearly a year, either to receive coverage or find out why their application has been denied.

That’s an improvement from the 900,000 applicants who were languishing in early summer without coverage or word from Medi-Cal. But it will take another six weeks for most of the remaining 250,000 residents to receive or be denied coverage, according to Department of Health Care Services Director Toby Douglas.

At a Sept. 23 Assembly Health Committeeoversight hearing, Douglas touted the Medi-Cal expansion as a “tremendous success,” but cautioned the enrollment backlog may never be totally cleared.

Legislators expressed frustration that their constituents are being dropped from coverage without notice, getting the run-around when they try to find out what’s happening with their applications or never being informed about the potential for Medi-Cal coverage in the first place.

“It’s taking months – months – to check on the status of cases,” said Assemblyman Jim Patterson, R-Fresno. “We are completely unable to help constituents in a timely manner. And it’s happening over and over again.”

Patterson said applicants seeking information are getting caught in what he called a referral loop. “They are told the state is just a billing agency and they need to contact the county,” he said. “The county says, ‘It’s not our job, you have to go talk to the state.’ This is a loop that’s going on and on. We get the concerns that they are bounced from person to person, and everyone saying they can’t address the issue and they need to call somebody else.”

Covered California

Two million patients have been added to the Medi-Cal rolls the past year through the new Covered California exchange, part of the federal Affordable Care Act, or Obamacare. Medi-Cal now covers 11 million Californians – about 29 percent of state residents. The Medi-Cal budget is more than $90 billion, an 80 percent increase from just four years ago, according to committee ChairmanAssemblyman Richard Pan, D-Sacramento.

The application-processing delays have been due to the unexpectedly large increase in applications, technical snafus and administrative decisions to delay coverage until residency and income are verified, according to Cathy Senderling, deputy executive director of the County Welfare Directors Association.

“We are in a situation where it’s been incredibly exciting to have the Affordable Care Act after so much planning,” she said. “But it’s also been very frustrating for our workers and we know for our customers as well.”

Most of the 250,000 cases remaining in the backlog are in some stage of being worked on, she said. “Many of them actually need to be denied. And the capacity of the system has not yet been brought up to be able to do that because of the way it was programmed and the confusion that would be created for our customers.”

Patterson argued that these kinds of snafus are inherent in “a state-run and sort of a command-and-control approach to health care.”

“We asked for this,” he said. “By doing the things we have done, by taking this Affordable Care Act, putting a California overlay on it and the 2 million additional, all of the things that we have done, we should have understood that this would be the result, that we were going to end up with significant bureaucratic problems, that we were inviting these very kinds of problems.

“So I think to suggest that we are the victims of success doesn’t sit well with the people that are trying to be the examples of the success. And so the backlogs, the payment, the notifications, the dropping of individuals, all of this is really creating a serious matter of an urgent level. And I hope that you can take that back to your organization and the governor and others in charge.”

Backlog

Elizabeth Landsberg, director of legislative advocacy for the Western Center on Law and Poverty, pointed out that many of the hundreds of thousands of people stuck in the Medi-Cal backlog have suffered as a result.

“Some people are going without health care and having terrible health consequences,” she said. “Some can’t get care tests because they can’t pay out of pocket for them. And some are going into medical debt and facing collections because of it. This is a story about real people, our neighbors, our friends, our fellow Californians.

“It’s a story about a woman with severe pain from diverticulitis who has been using the emergency room when her pain is severe. The doctor said she needs to get non-urgent treatment of the condition to prevent the severe pain and the trips to the emergency room. We have patients going to the emergency room, but they cannot get on Medi-Cal and get the care that they need. Emergency rooms don’t provide that.

“This is story of a woman who applied through the Covered California portal in December, was told she should be eligible for Medi-Cal. She has medical bills from May 2014 and she has a hospital threatening her with collection actions against her. This is the story of a man who also applied nine months ago and has to pay out of pocket for insulin pump supplies and was hospitalized for diabetes complications affecting his heart.”

Landsberg said the state is not informing applicants of “their right to file for a fair hearing if they don’t have a timely eligibility determination. State law is clear, we have to make these decisions within 45 days.”

Her organization, along with several other advocacy groups, filed a lawsuit in Alameda County Superior Court on Sept. 17, Rivera vs. Toby Douglas, seeking to force the state to comply with its own law.

“Consumers simply don’t know that something’s going wrong if they don’t get an answer,” said Landsberg. “They get one notice from Medi-Cal saying, ‘We think you’re eligible for Medi-Cal, you’ll hear if you are.’ Many people still are familiar with the old rules where childless couples weren’t eligible for Medi-Cal. They don’t know that something’s wrong.”

Access

Assemblyman Roger Hernandez, D-West Covina, is also concerned that his constituents are being left in the dark.

“People are asking how we get folks connected with access to health care,” he said. “I’m concerned representing a community … where we see a high level of immigrant, working class, Latino and minority populations that are not having the same access to registration and information about how to sign up as other non-Latino groups are. That’s a problem in terms of outreach.”

Douglas assured the committee that improvements are being made. “Everyone is working around the clock,” he said. “What I want to report to you, and where we will get soon, is that every individual that applies and is providing all the information necessary will get enrolled in the program in the appropriate timeframes. And that’s what we need to get to. And we’re not there yet.

“The system continues to get a lot better. This continues to be a work in progress. We were quick in implementing health care reform. And it’s going to take next year still to work through some of these final system stages.”

He cautioned, though, that as his department works to get things right with the first year of Medi-Cal applications through the Covered California exchange, those applications will soon be coming up for renewal, potentially creating new challenges.