With the start of California health care reform in October, you will also hear a lot about changes to Medi-Cal. It is important to remember the following.
There are two types of Medi-Cal: Health Insurance Medi-Cal and Long-Term Care Medi-Cal (LTC Medi-Cal). The type of Medi-Cal that helps to pay for nursing home care is long-term care Medi-Cal. Health insurance Medi-Cal helps pay for doctors, hospitals and other medical care.
The administrative process for Health insurance Medi-Cal is changing dramatically. Because it is the safety net for those that will not be able to afford coverage under Covered California, initial eligibility is being simplified. Annual requalification is also being eliminated.
For those in a nursing home whose health insurance is first Medicare and then Medi-Cal as secondary, they must be enrolled in a Medi-Cal HMO beginning in April 2014 (this has already been pushed back many times).
Unlike Health Insurance Medi-Cal, the qualification standards for long-term care Medi-Cal don’t change. Eligibility will still be as difficult as it is now. Annual redeterminations will also still be mandated.
What happens if a person age 65 or older is on Health Insurance Medi-Cal and goes into a nursing home? Keep in mind that just because someone is already on Health Insurance Medi-Cal, they have to be approved by LTC Medi-Cal.
We have already experienced a huge problem in getting a case transferred from Health Insurance Medi-Cal to the LTC Medi-Cal department. The problem is that we couldn’t get in touch with anyone directly. We kept getting pushed from one phone number to the next.
California has created one phone number for both Health Insurance and LTC Medi-Cal. They call this the Customer Service desk. Contact phone numbers for LTC Medi-Cal workers have also been eliminated, so if we need to speak with the caseworker, we need to call the Customer Service number and leave a message for the worker to contact us.
This is also true now for facilities needing to speak with their assigned workers. The old adage of “don’t call us, we’ll call you” is now standard operating procedure for Medi-Cal.
The bottom line is that it now even more difficult, time-consuming and burdensome to qualify for LTC Medi-Cal even if you already have Health Insurance Medi-Cal.
It is now more important than ever for an initial application for LTC Medi-Cal to be submitted as accurately as possible. Processing and approval time is sure to be delayed as it is going to be harder to get through the bureaucracy.
So the next time you hear about changes to Medi-Cal, ask yourself if it is about Health Insurance Medi-Cal or LTC Medi-Cal. There is a huge difference.