Healthcare leaders agree: Eligibility work to be done by counties

SEIU members at the HBEX in Sacramento
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Our campaign this summer to shine the spotlight on the critical decision-making process of the California Health Benefit Exchange (HBEX) showed how effective SEIU members can be when we join with allies to advocate for our work and for the clients we serve.

The five-member Exchange board met on Aug. 23 and publicly affirmed the critical role Eligibility Workers play as California moves forward with implementing the Affordable Care Act next year.

  • There will be NO PRIVATIZATION of eligibility determination work.
  • Only county Eligibility Workers will handle Medi-Cal eligibility determination.

“I want to thank and acknowledge the public employees who are here; I appreciate that. We need not just the generals and the captains, but we need Eligibility Workers as well.”
— Dr. Robert Ross, Exchange board member

This is exactly our message these past months. In our lobby visits with key state legislators, in our newspaper ad that appeared in the Sacramento Bee, in our Op-Ed in the San Jose Mercury News, and on our web site, SEIU members have been saying: Let us answer the call and help families get affordable health insurance coverage.

  • We are already trained and on the job
  • We are from the community
  • Our work keeps services local
  • We can provide better service at lower cost

The Exchange board directed staff to pursue a “Centralized Multi-Site Service Center Model Medi-Cal County Determination Hybrid.”

Many questions remain of what this hybrid will look like, when fully implemented:

  • We need to ensure that any initial screening of calls only asks a few questions such as income and county of residents so that the Medi-Cal eligibility determination is processed by qualified and experienced Eligibility Workers who can meet the needs of participants.
  • We need to ensure clients get the best service by having county Eligibility Workers handle continuing case management for “mixed-case” households, or families with people enrolled in both Medi-Cal and the Exchange.

“We are here today to tell you that county eligibility workers are passionate about our work, committed to our clients and ready to make health care reform a reality.”
— Gloria Carrillo, Eligibility Worker, Santa Clara County

What is clear is that county public employees need to be heard, and need to be at the table. And board members and Executive Director Peter Lee vowed “a public transparent process with robust public engagement” from all stakeholders.

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2 Responses to “Healthcare leaders agree: Eligibility work to be done by counties”

  1. wRen Bradley says:

    Congratulations, why did I know that you all would prevail? Because you are feisty, articulate and caring workers…Awesome…leading the way

  2. Theodora Ramirez says:

    Great work & thanks to all of you who made the trip for all of us!

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