Education for Medi-Cal Enrollees Leads to Better Health Care
 s Medi-Cal
switches to a managed care system, health advocates across the state are concerned that
recipients do not have the information they need to obtain quality health care.
One of these advocacy organizations, Maternal and Child Health Access (MCHA) in Los
Angeles, has received funding from TCWF in the hope that, with appropriate education
efforts, the mandated move to managed care will improve access to health services for the
1.2 million Medi-Cal beneficiaries in Los Angeles County.
   TCWF awarded MCHA a two-year grant of $561,000 in 1996
and another two-year grant of $400,000 in 1998 to assist the agency in helping low-income
families and individuals understand and navigate the often murky waters of managed care.
“Although Los Angeles County has nearly completed the transition to managed care,
there is an ongoing need to educate low-income consumers about their rights and options
and to assist new and existing Medi-Cal enrollees in making informed decisions,” said
Tom David, TCWF executive vice president.
While the State funded many consumer-oriented efforts to ease the transition, these
efforts tended to emphasize the enrollment aspects of managed care. MCHA, on the other
hand, provides comprehensive education and information to consumers.
“Medi-Cal is a pretty convoluted system, and there are consumer issues that go
well beyond enrolling in one of the two major managed care health plans being offered to
beneficiaries in L.A. County,” said MCHA Executive Director Lynn Kersey. “There
are actually 10 smaller plans under the two major ones, as well as huge post-enrollment
problems such as delays and access to specialists.”
Kersey pointed out that problems also arise when people move from county to county,
lose their Medi-Cal eligibility or are part of families where some members are eligible
for Medi-Cal and others are not. To add to the confusion, not all Medi-Cal recipients are
mandated to enroll in managed care.
 One of
MCHA’s key strengths is its use of a “train-the-trainer” approach to help
consumers understand what it means to be in a managed care plan, how to make intelligent
choices, how to exercise their rights and how to assess the quality of their managed care
program.
Cindy Doorn, MCHA’s director of training and education, estimates that the agency
to date has trained about 5,000 people on the intricacies of managed care at 113 community
sites. Approximately 3,433 of those trained are front-line staff from 66 health care
organizations who are training others in their agencies and communities.
“This approach has a real ripple effect, enabling us to reach larger numbers of
people than those we work with directly,” Doorn said. “As a result, we feel
we’re making inroads in bridging the gap of understanding between patients and their
providers and in ensuring patient rights.”
The trainings are part of an overall education plan that includes culturally
appropriate informational materials, workshops for Medi-Cal beneficiaries, an information
phone line for consumers and efforts to educate policymakers on key issues. Despite the
work of MCHA and others, Kersey said that many people with low incomes are still falling
through the cracks.
“The system is probably fine for people who are well or able to stay with the same
health care provider, but we still don’t have a good mechanism to determine if people
are getting the level and quality of care they’re supposed to have,” she said.
|
