Publication

Streamlining Children's Eligibility Processing for Medi-Cal

Diane Schweitzer and Kristen Putnam, Putnam Community Investment Consulting

Governor Schwarzenegger's 2005-06 budget included a plan to streamline Medi-Cal eligibility determination for children. Under the proposal, Medi-Cal applications for children received at the Single Point of Entry (SPE) would be processed by the SPE vendor instead of being sent to the county for final eligibility determination.

This issue brief provides important information on the issue of centralizing eligibility determination for Medi-Cal and describes how the Governor's streamlining proposal would have affected children, families, counties, and the state. While there was some opposition to this specific proposal, it managed to expose significant problems with the system that need to be addressed.

The implications of the proposal include:

• For children and families, SPE likely would mean a significant decrease in the amount of time it takes to determine children's final Medi-Cal eligibility. Some families may find the process more efficient, while the shortened time frame for completing applications may result in delays or failures to secure coverage for others. Some children could lose coverage prematurely by being considered only for children's no-cost Medi-Cal and not other Medi-Cal programs.
• For counties, the anticipated administrative savings would result in a reduction of enrollment funds. However, there are concerns that county workload may not decrease as much as the state has predicted, leaving already over-strapped counties to bear the burden of those costs.
• For the state, the proposed changes would necessitate a larger role in monitoring and oversight of the SPE vendor, and in hiring, training, and supervising state-level eligibility workers to finalize eligibility determination. Based on the available data, it is unclear whether or not the proposal would have resulted in savings or additional costs for the state.

Although the Governor's proposal was not adopted by the legislature, this issue brief identifies a series of issues that the California Department of Health Services, the legislature, and county officials should consider when thinking about ways to improve the eligibility determination process for families.