California Health Report: Huge Increase in Cases Handled by Medi-Cal Complaint Office This Year

By Hannah Guzik

The California office that handles complaints from people in the state’s low-income health program has seen its monthly caseload increase by 82 percent this year compared to 2013.

The Department of Health Care Services operates Medi-Cal, the state’s Medicaid program. The department’s Managed Care Ombudsman Office responds to complaints from Medi-Cal enrollees. The office helps people access services that should be covered by their plan.

The Ombudsman Office looked into an average of 9,466 cases monthly through June this year, according to the department.

Last year the office handled an average of 5,205 cases monthly.

California expanded Medi-Cal under the federal Affordable Care Act this year, making more people eligible for the insurance plan. About 2.2 million people have signed up since the expansion. A quarter of the state’s population, or 10.9 million people, are now enrolled in the program.

An additional 490,000 are still waiting for their applications to be processed.

While the increase in enrollment has been touted as a sign of the expansion’s success, the application backlog and the significant increase in the number of cases the Ombudsman Office is investigating show that implementation has been rocky for many.

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