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11,000 Stuck In Fresno County's Medi-Cal Backlog


California’s poor continue to face month long waits in getting state health coverage. FM 89’s Diana Aguilera reports how a young couple in Fresno County is dealing with the backlog.

Paola Martinez and her husband Irving Toscano thought they had done everything right to get health care coverage.

They made sure they met the Medi-Cal eligibility requirements, they filled out the paperwork and signed up through the Covered California website at the end of March.

But ever since then, they’ve been waiting.

"As time passed it was from excited like yay we’re going to be covered to like what the heck when are we going to be covered?" Martinez says.

The young couple is not alone. As of this week there are still more than 11,000 people in Fresno County waiting to hear the status of their Medi-Cal applications.

Two weeks ago Toscano thought his wait might finally be over when he received a letter from the county. The news? His application still hadn't been processed.   

He says it’s frustrating. "I'll just keep waiting then, that’s pretty much all I can do."

The expansion of coverage under the Affordable Care Act was meant to help people like Toscano and Martinez. The couple has a limited income and would seem to meet the requirements for Medi-Cal. He works as a security guard and she’s unemployed. For the past three years, they’ve been living at his parent's house in Clovis.

Norman Williams, a spokesman for the state's department of health care services, says that statewide there’s about 600,000 people like Toscano and Martinez whose applications are still pending.

"We enroll people into coverage each day and more people apply each day," he adds.

"It makes me nervous because, what if we don't get covered, what are we going to do?" -Paola Martinez

So, what's causing this backlog?

Deborah Martinez with Fresno County's department of social services says there's two main factors. First, when enrollment opened the state’s computer systems didn’t communicate properly with the county’s computers.

"It was meant to be instantaneous and it hasn’t been instantaneous at all," she says.  

The county says that miscommunication stalled the approval process and helped create the backlog.

The other reason: Fresno County has been flooded with applicants. That's put a strain on resources both at the county and the state.

"It's a very comprehensive and detailed process but we are like 20 times better than where we were in January." - Deborah Martinez with Fresno County.

Still Martinez says the process is now running much more smoothly than it was months ago.

"It's a very comprehensive and detailed process but we are like 20 times better than where we were in January."

She says as of this week, the county has approved about 64,000 Medi-Cal applications. And Williams says things are also improving statewide.

"The 600,000 is a considerable decrease since the roughly 900,000 who were pending at the end of March."

But if things are looking a lot better, why is the backlog still a problem?

Well, unlike Covered California -- the state’s health insurance exchange -- where the signup deadline was March 31, Medi-Cal accepts enrollments year round.

And that means as the applications submitted earlier in the year are being finalized, new ones are coming in adding to the backlog.

"Applications are being taken by the date that they were submitted so our workers know to look at date of application and work those first," Debrah Martinez with Fresno County says.

Paola Martinez says she was excited when they signed up in March. But now, she's losing hope.

That comes as little consolation to Toscano and his wife Martinez. They say it's been a troubling process, and if a health emergency were to happen, they’re not sure where to turn for help, or how they'd pay for it.

"In a serious case I would have to go to emergency and find a way to how to pay my bills later on," he says. "I don’t have money saved up for any of those kind of bills.”

Back at Toscano’s home in Clovis, they’re getting ready to fire up the grill for dinner. The family is cooking steak fajitas while Toscano and Martinez play with their little nephew Elias who likes to honk the horn of his toy car.

It’s a happy time for the young couple but concern about their health care looms large.

"It makes me nervous because, what if we don’t get covered, what are we going to do?” Martinez says. "Hopefully we do because we need it, everyone needs it."

With any luck, their wait may soon be over. County officials say they’ve made tremendous progress in processing Medi-Cal applications and expect to eliminate the the backlog by September 1.

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