What's Up With Medi-Cal Redeterminations?

Medi-Cal

One in three Californians is enrolled in Medi-Cal or Medicaid [1 ]. Today, 15 million are enrolled in Medi-Cal, but millions stand to lose coverage as counties begin their annual eligibility renewals after a three-year hiatus.?

Medi-Cal is a public health insurance program funded by the federal and state government to provide critical health coverage to low-income adults below the 138% federal poverty level [2 ]. The unique benefit of Medi-Cal is that it expands access to healthcare services, including preventative wellness, chronic disease management, mental health, maternity, and prescription drugs for vulnerable populations [3 ]. Besides low-income households qualifying for Medi-Cal, California expanded access to children, adults under 26, and individuals 50 and over, regardless of immigration status [4 ]. Prior to the COVID-19 pandemic, 13 million Californians were enrolled in Medi-Cal, but as the pandemic continued, enrollment steadily increased by 16% [5 ; 6 ]. The increase in enrollment was a result of states, including California, providing continuous coverage to receive the federal government's increased funding for the health insurance program [7 ; 8 ].?

Redeterminations and Growing Problem

In December 2022, the U.S. Congress passed the Consolidated Appropriations Act of 2023, which untethered Medi-Cal continuous coverage from the public health emergency [9 ]. This law allowed annual Medi-Cal eligibility renewals, also known as redeterminations, to begin on April 1, 2023 [10 ].?

The California Department of Health Care Services (DHCS) estimates about 2 - 3 million Medi-Cal enrollees may lose their coverage during the redeterminations process that will span 14 months due to administrative discrepancies [11 ]. For instance, an individual may lose their coverage stemming from a change in their job, address, or income that may impact their eligibility [12 ]. Those who lose their Medi-Cal coverage will likely transition to employer-based coverage, but over half will be uninsured [13 ]. Renewal notices will be sent out from April 2023 to July 2023 via postal mail or email. Thus, it is important that enrollees ensure the following information with their local Medi-Cal agencies is updated, including:

1. Address
2. Phone Number
3. Any other contact information??

Updating the information listed above will help local county offices contact enrollees and inform them if they still qualify for Medi-Cal or need to send additional information. If the contact information is not up-to-date, enrollees risk losing their Medi-Cal coverage due to administrative discrepancies. California state law requires individuals who lose their Medi-Cal coverage to be automatically transitioned to a Covered California plan; however, the new plan they are placed into will likely come with a monthly premium, which Medi-Cal enrollees are not accustomed to paying. Although nearly half of the individuals enrolled in Covered California usually pay less than $50 a month, the new premium cost and deductibles may deter people from staying insured [14 ].?

Concerns in L.A. County & NEVHC’s Response

Besides losing Medi-Cal coverage due to administrative discrepancies, a second emerging issue surrounding Medi-Cal redeterminations is the agency’s capacity to handle the caseload of individuals being reviewed. Locally, Cal Matters estimates 20% of? Los Angeles County Medi-Cal enrollees will lose their coverage despite being qualified for the insurance program [15 ]. NEVHC's enrollment teams are prepared to respond and assist the community to navigate changes introduced by State, County, or local agencies.

The community NEVHC serves faces many challenges regarding their healthcare coverage, with one of the major barriers being language. As English is not the primary language for most of the population NEVHC serves, having language-appropriate communication is key to ensuring all messaging is received and understood as it is intended. NEVHC’s mission has always been to provide care that is sensitive to the economic, social, cultural, and linguistic needs of our community, and it is why patients recognize they can rely on NEVHC’s enrollment team to understand forms sent by the L.A. County Department of Public Social Services (DPSS). Besides language barriers, state or county materials may still be confusing since they are occasionally written in technical jargon not easily understood. No matter how much communication and messaging are done for a program launch, success is measured by partnerships to help the community understand the intended message.

In an effort to combat confusion and misinformation, NEVHC has prepared a variety of communication strategies for patients. First, informational materials will be posted across NEVHC’s health centers, company website, and social media platforms to mirror California’s Department of Health Care Service’s messaging. NEVHC is also simplifying communications and providing them in various languages to ensure there is no confusion among our patients.

Secondly, NEVHC will also begin sending mass text messages this spring to Medi-Cal beneficiaries in their preferred language and a phone line dedicated to assisting patients on the reinstatement of redeterminations. Finally, this summer, NEVHC will host a series of enrollment events at its health centers to invite patients and community members to meet with a Certified Enrollment Counselor for any assistance with their Medi-Cal renewals, health plans and/or assigned clinic/provider. All of these efforts are coordinated by? NEVHC’s patient advocacy teams. To learn more, visit NEVHC’s website .

NEVHC’s Advocacy Efforts

NEVHC participated in several opportunities for advocacy relating to Medi-Cal redeterminations. For example, our Outreach and Enrollment team provided written public comments in April to the Los Angeles County Board of Supervisors to support the Department of Public Social Services’ efforts toward the redetermination process. NEVHC shared their experience with helping patients navigate their Medi-Cal renewals, including how processes can be improved to better serve our community. At the state level, NEVHC, along with our partners at the Community Clinic Association of Los Angeles County and California Primary Care Association, is asking the California legislature to include a $60 million one-time budget augmentation to enhance the Medi-Cal Health Enrollment Navigators Project. Previously, this project received $60 million over four state fiscal years to provide counties and community-based organizations like NEVHC the ability to conduct enrollment outreach to hard-to-reach populations [16 ]. Regrettably, not enough of that original funding has reached community health centers. Thus, we are requesting this $60 million augmentation to help expand outreach, enrollment, assistance with troubleshooting, and, most importantly, redeterminations. CHCs are a trusted and close pillar of the community we serve. Our Enrollment and Outreach teams will continue to be our patients’ advocates, but resources are necessary to continue these efforts into 2024 when Medi-Cal eligibility expands to adults ages 26-49, regardless of their immigration status.?

If you want to support NEVHC’s advocacy efforts, contact your state elected official to let them know you support funding for Medi-Cal Health Enrollment Navigators. Not sure who your California State Senator or Assemblymember is? Visit findyourrep.legislature.ca.gov/ ?

To stay up-to-date on NEVHC advocacy efforts, join our Advocacy Network at? nevhc.org/advocacy/

Written by Julie Leyba, Government & Community Relations Manager, and Jiovanni Perez, Senior Program Manager, Outreach and Enrollment at NEVHC.

Sources

[1] Finocchio, L., Paci, J., Newman, M. & Blue Sky Consulting Group. (2021). Medi-Cal Facts and Figures - 2021 Edition. California Health Care Foundation. https://www.chcf.org/publication/2021-edition-medi-cal-facts-figures/#related-links-and-downloads

[2] Do You Qualify for Medi-Cal Benefits? California Department of Health Care Services (DHCS). (2023). https://www.dhcs.ca.gov/services/medi-cal/Pages/DoYouQualifyForMedi-Cal.aspx

[3] Medi-Cal Eligibility & Covered California - FAQ’s. (2023). DHCS. https://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/Medi-CalFAQs2014a.aspx

[4] Finocchio et al., 2021.

[5] Ibid, 2021.

[6] Farzan, Y. (2023 Feb. 27). Thousands in Southern California are expected to lose out on Medi-Cal after April. The Orange County Register.https://www.ocregister.com/2023/02/27/thousands-in-southern-california-are-expected-to-lose-out-on-medi-cal-in-april/??

[7] Brooks, T., Gardner, A., Yee, P., Tolbert, J., Corallo, B., Moreno, S., & M. Ammula. (2023). Medicaid and CHIP Eligibility, Enrollment, and Renewal Policies as States Prepare for the Unwinding of the Pandemic-Era Continuous Enrollment Provision. Kaiser Family Foundation. https://www.kff.org/medicaid/report/medicaid-and-chip-eligibility-enrollment-and-renewal-policies-as-states-prepare-for-the-unwinding-of-the-pandemic-era-continuous-enrollment-provision/?

[8] Cha, P. (2023 Mar 1). As a Pandemic Medi-Cal Policy Ends, Some Californians Will Fall Through the Cracks. Public Policy Institute of California. https://www.ppic.org/blog/as-a-pandemic-medi-cal-policy-ends-some-californians-will-fall-through-the-cracks/?

[9] Medi-Cal and the End of the Federal Continuous Coverage Requirement. (2023). California Health Care Foundation. https://www.chcf.org/collection/medi-cal-end-public-health-emergency/?

[10] Ibid.?

[11] Ibid.

[12] Pradhan, R. (2022 Feb 14). Why millions on Medicaid are at risk of losing coverage in the months ahead. National Public Radio. https://www.npr.org/sections/health-shots/2022/02/14/1080295015/why-millions-on-medicaid-are-at-risk-of-losing-coverage-in-the-months-ahead

[13] Danielson, C. & S. McConville. (2023 Apr 11). As Medi-Cal Enters a Post-Pandemic Phas, Keeping Eligible Californians Enrolled Is a Key Concern. Public Policy Institute of California. https://www.ppic.org/blog/as-medi-cal-enters-a-post-pandemic-phase-keeping-eligible-californians-enrolled-is-a-key-concern/

[14] Ibarra, A. (2023 Mar 3). After a pandemic pause, the state will restart checking Medi-Cal eligibility. Cal Matters. https://calmatters.org/health/2023/03/medi-cal-eligibility-2/?

[15] Looming Medi-Cal changes could swamp local agencies and disrupt coverage. (2023 Mar 28). Cal Matters. https://calmatters.org/commentary/2023/03/medical-change-health-care-disrupt/?

[16] Medi-Cal and the End of the Federal Continuous Coverage Requirement, 2023.