Millions at risk of losing Medi-Cal
The requirement that Medi-Cal keeps people continuously enrolled through the COVID-19 public health emergency (PHE) comes to an end on April 1, 2023. California’s 58 counties will have to review eligibility of the approximately 14.5 million people currently enrolled on Medi-Cal.
“Through COVID legislation, states have mostly kept people covered through Medicaid without interruption in exchange for an increase in their Medicaid federal matching funds,” said Farah Erzouki, Senior Policy Analyst, Center on Budget and Policy Priorities (CBPP) at a Jan 27 Ethnic Media Services briefing co-sponsored by CBPP. Medi-Cal is California’s Medicaid health care program which pays medical services for children and adults with limited income and resources.
During the COVID-19 pandemic, millions of Californians stayed on Medi-Cal during the public health emergency, because regular Medi-Cal renewal processes were paused.
The Unwinding Period
The California Legislative Analyst’s Office projects that during this “unwinding period, approximately two to three million Californians may no longer be eligible for Medi-Cal. The Department of Health and Human Services (DHHS) estimates that nationwide as many as 15 million people will be disenrolled from Medicare.
Starting April 2023, California will redetermine eligibility for Medi-Cal enrollees. Many Med-Cal recipients will need help transitioning to other types of coverage, while the process must ensure that those who remain eligible keep their Medi-Cal coverage.
States are required to maintain up to date contact information, and attempt to contact enrollees prior to disenrollment. Erzouki said that people who have moved during the pandemic, potentially changing their address and contact information, may not receive their renewal notice in the mail.
Renewals take 60 to 90 days
The “continuous coverage policy has meant that most Medi-Cal (Medicaid) enrollees probably have not had contact with their Medi-Cal agencies in three years, and in some cases, even longer,” added Erzouki. It would take additional paperwork to ensure that recipents kept their medical coverage, a renewal that could take “anywhere from 60 to 90 days to process.”
Eligible individuals are at risk for losing coverage if enrollees do not receive or understand notices or forms requesting additional information to verify eligibility, or do not respond to requests within required timeframes. Communities of color and children are at higher risk of losing coverage, said Erzouki.
Requirements for Medi-Cal Enrollees
Once the federal continuous coverage requirement ends, Covered California will begin automatically notifying and completing plan selection for Californians who could lose Medi-Cal coverage, if they are eligible for a subsidized plan on Covered California. A toolkit will provide more information for consumers and enrollment partners.
Medicaid agencies are going to be overwhelmed processing cases and documents, in the coming months, Erzouki said. She estimated seven million people could lose their coverage due to paperwork issues, although they are still eligible.
Medi-Cal enrollees must make sure:
- their county Medi-Cal office has their most current contact information.
- Call the Medi-Cal Member Helpline at (800) 541-5555.
- Be on the lookout for mail from Medi-Cal in the coming months and respond promptly.
- Call the Health Consumer Alliance If they have questions or concerns
“Medi-Cal enrollees need to make sure that their agency has updated contact information for them,” said Laura Guerra-Cardus, CBPP’s Director of State Medicaid Strategy. “ Enrollees have limited time after they lose coverage to transition to the Affordable Care Act plans. So the concern there is that people won’t have enough time to enroll in the marketplace after they lose Medi-cal coverage without experiencing some sort of gap in coverage,” she said.
Who Is Eligible for Medi-Cal?
All Medicaid enrollees will have to reapply to renew their eligibility, said Erzouki. In most states, Medicaid beneficiaries need to renew every year by proving they still meet the qualifying requirements to receive Medicaid benefits.
In California, eligibility for no cost Medi-Cal (California’s Medicare plan), requires that a single adult individual must have an annual income lower than 138 percent of the federal poverty level. For families, the income limit may be higher, as it depends on the number of individuals in the household.
Medi-Cal offers free or low-cost medical and dental services for eligible children and adults. Recipients of cash assistance under SSI/SSP (Supplemental Security Income/State Supplemental Program), CalWORKs (California Work Opportunity and Responsibility to Kids), Refugee Assistance or Foster Care or Adoption Assistance Program are automatically eligible for Medi-Cal.
The following individuals may be eligible for Medi-Cal if they are:
- Adult with or without children
- Diagnosed with breast or cervical cancer
- In a skilled nursing or intermediate care facility
- Refugee status during a limited period of eligibility. Adult refugees may or may not be eligible depending upon how long they have been in the U.S.
- Parent or caretaker relative of a child under 21
Undocumented In California Have Access To Medi-Cal
In July 2021, undocumented Californians aged 50 and older received full-scope, comprehensive Medi-Cal health coverage. Children under 19 years of age as well as young adults ages 19 through 25, regardless of immigration status, are eligible. Effective January 1, 2024 coverage will be extended to ages 26 through 49l.
The Department of Homeland Security recently published a regulation that makes it clear that immigrants can access health care, food and housing support, and other public benefits without fear of immigration consequences. CalHHS released a guide (available in multiple languages) that provides more information and community resources.
An undocumented person must meet the same eligibility requirements as any other beneficiary such as income limits and California residency in 2014.
Transitioning to a paid plan
California will move some people to a subsidized private plan on the state’s marketplace, Covered California. Enrollees will have to agree and pay a premium if they don’t qualify for a free plan. However, the premium could be as low as $10 a month, said Jessica Altman, executive director of Covered California.
During the yearlong unwinding, current enrollees could still qualify if the databases show their income is no more than 20% above the thresholds for Medi-Cal eligibility, said Tony Cava, a Department of Health Care Services spokesperson.
Medi-Cal members who aren’t renewed automatically will be sent a form requesting updated information, due within 60 days. People who do not complete the process will have their coverage terminated.
Medi-Cal members will have 90 days to appeal after being disenrolled.