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Getting Medical: Signing Up and the Benefits

by admin on 7th-May-2015

By Manny Otiko, CBM

Theresa Jenkins, 49, of Los Angeles is being treated by Dr. Derrick Butler at a Southern California medical center (T.H.E. La Brea Center)

Theresa Jenkins, 49, of Los Angeles is being treated by Dr. Derrick Butler at a Southern California medical center (T.H.E. La Brea Center)

When LaRita Reed graduated from the University of California, Los Angeles, she was excited about earning her degree and all the possibilities that lay ahead. But soon she found herself facing a new challenge. The mother of two young children who had previously been covered under the college’s insurance program was suddenly uninsured, still unemployed, and being phased out of her UCLA health care coverage.

Worried mostly about the welfare of her kids, she reached out to her local social services office. While applying for health coverage for her children there, Reed discovered she was eligible for Medi-Cal, a health insurance program for low-income families that she hadn’t heard about before. With Medi-Cal, her health insurance problem was resolved. But for new applicants to the program, she says, the application process can be confusing. In addition to doing the research to find out if she was eligible or not, waiting through the four-week approval period was a time of high anxiety.

The California Department of Health Care Services has taken a number of steps to ease the anxiety and uncertainty felt by many Californians like Reed who apply. Medi-Cal is providing much more information online about the application process, benefits and who gets covered. It is also expanding its reach to cover more people. A number of health advocacy organizations across the state, like the Root Community Health Center in Oakland, are also helping people to navigate the application process and determine if they are eligible or not.

Adam Weintraub, a spokesman for the California Department of Health Care Services (DHCS), says the most common reason new applicants are rejected is because they make too much money. Another reason is that applicants may not be able to prove their place of residency.

DHCS says Medi-Cal is now available to low-income families and individuals of all ages who are eligible. Also, the enactment of the federal Affordable Care Act – commonly called “Obamacare” – means more people qualify for Medi-Cal. To be eligible for the program, families have to make a certain amount of money every year based on poverty levels set by the DCHS and informed by guidelines given by the U.S. Department of Health and Human Services. Weintraub said that works out to be $32,913 or less in annual income for a family of four. For an individual that number is $16,105 and $21,708 for a family of two.

Having family members with disabilities can also be a factor that helps with Medi-Cal qualification, he added.

Reed says once she was approved, she received a California Medi-Cal card in the mail and she had to choose from three programs: LA Care, Blue Cross or Health Net.

“If you don’t choose, they choose for you,” Reed said. She also advises applicants to do their research before selecting a plan, so they can choose a program that best fits their needs.

Reed says Medi-Cal has been a huge benefit for her because she doesn’t have to pay a monthly premium. If you are employed, Medi-Cal fees are set on a sliding scale based on income. Reed said another major benefit to Medi-Cal is not having to pay for prescription medications at participating pharmacies. People who are approved are often enrolled in the managed care program, Reed said. A Medi-Cal Managed Health Care plan offers all the same benefits as a standard Medi-Cal plan. The main difference is that the enrollee in the managed care program is assigned a primary doctor who coordinates care for that patient within a network of doctors to ensure the patient stays healthy. The plan is designed for patients who are aged, blind, disabled and receiving Social Security Income (SSI) or State Supplementary Payments (SSP) or other state-provided financial assistance.

According to Weintraub, there are some steps applicants can take to speed up the application process. He recommends:

• Applicants have certain paperwork, such as their social security card and household income and tax information, ready when they are filing applications.

• Applicants should also ensure they fill in the forms as accurately as possible and use the correct contact information. Weintraub added applicants should make sure the name used on the forms matches the name on the applicant’s social security card.

“The more information on the application, the less likely it is to be kicked out,” Weintraub said.

Reed says applying for Medi-Cal can be frustrating, but there are some ways to speed up the process. If applicants run into

roadblocks, they can request a hearing, which usually speeds things up.

For more information about Medi-Cal go to: www.dhcs.ca.gov/services/medi-cal/Pages/ MediBen_Svcs.aspx

For information about county social services offices go to: www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx

The article above is brought to you by California Black Media, a coalition of Black -owned media outlets committed to making a difference in our communities. It is made possible via a grant for public outreach from The California Endowment. We share the common goal in reaching as many residents as possible with useful information that will help expand access to affordable, quality healthcare to all Californians. 

Category: Healthy Living.
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