A child learns to walk
The Children’s Partnership estimates that up to 1 million children will lose their MediCal coverage as California reviews eligibility re-determined as part of the great unwinding of Medicare. (image credit: Unsplash)

MediCal Members Could Lose Healthcare Coverage

Between June 2023 and May 2020, more than 15 million MediCal members – a third of the state’s residents – will have their eligibility re-determined as part of the great unwinding of Medicare. So California is taking steps to ensure all eligible Californians have continuous coverage by completing their redetermination packets before September 30.

Department of Health Care Services (DHCS) is investing in health enrollment navigators, and coverage ambassadors and utilizing its managed care plans to help enrollees navigate the redetermination process and return their ‘yellow medical packet’ by the given deadline. DHCS is sponsoring a series of briefings to get that message out.

On August 15, leaders of healthcare nonprofits shared information about the approaches they are taking to amplify the DHCS message. The briefing was sponsored by the California Department of Health Care Services, and hosted by Ethnic Media Services, and California Black Media.

The ‘Great Unwinding’ puts healthcare at risk

 In June alone, DHCS disenrolled 21% of MediCal members of over 1 million members that were up for the redetermination said Yingjia Huang, the Assistant Deputy Director of Health Care Benefits and Eligibility with the DHCS. She anticipates a similar volume of people will be dropped from MediCal each month into May 2024.

However, DHCS is also ensuring enrollees get resources to transition into alternate programs if found ineligible for MediCal. It’s reviewing changes to make it easier for members to get and stay covered in the next few years.

Huang explained that a large portion of the 21%, ( 225,000 individuals) were disenrolled because they did not return their yellow medical packets in time. She urged members to return their packets by September 30 to get reinstated or avail of ways to find coverage if ineligible for MediCal.

Complete redetermination packets

The DHCS outreach plan will include 3,500 coverage ambassadors across the state to urge the completion of redetermination packets. Funding is provided for over 150 health enrollment navigators -community-based organizations – to help members navigate the complex redetermination process. DHCS is also launching back-to-school toolkits in partnership with 220 local educational agencies, to provide FAQs for teachers and letters for students, in order to reach parents with reminders about redetermination. Its managed care plans will use calls and postcards to remind members to act.  

“We are all together taking an unprecedented set of actions to keep our members in coverage,” said Huang. “We really hope that in the next 11 months, as we’re going through the remaining parts of the unwinding, we continue to keep our members on coverage.”

Healthcare transitions

A program started in June will provide eligible Californians with a seamless transition from MediCal to a health insurance plan offered by Covered California.

California is well-positioned to support consumers through this process and help them keep coverage, said Covered California CEO Jessica Altman. California already reduced its uninsured rate from 17 and a half percent before the Affordable Care Act passed, to just seven and a half percent. It’s “the largest reduction of any state in the nation,” said Altman.

However people lose Medicare eligibility due to changes in income and employment, she added, and Covered California could help provide continuous coverage to people transitioning from MediCal through quality health plans and robust financial assistance, that will help pay for monthly premiums, often at little or no cost to them.

“Most Californians who lose medical coverage but qualify for Covered California will be able to get coverage at either no or low cost each month,” added Altman.

Assistance for enrollees

Data from Covered California showed that nearly 90% of enrollees received financial help. Two-thirds of enrollees were eligible to pay $10 or less per month for their health insurance.

Starting January 2024, a new program supported by California’s legislature and the governor will help eliminate deductibles for over 650,000 enrollees and anyone under 250% of the Federal Poverty Level covered through Covered California.

In addition, Covered California is reaching out to all communities across the state in their preferred languages to make sure they understand their options during this process. Media campaigns about the MediCal transition are available in Spanish, Mandarin, Cantonese, Korean, and Vietnamese.

“Covered California has created radio, digital, and social media ads, as well as educational videos that walk consumers through the process of how to create an account, review their coverage options, and learn how to sign up for coverage,” explained Altman.

Health Enrollment Navigators

Louise McCarthy, the President & CEO of the Community Clinic Association in Los Angeles County, said that the governor’s $10 million increase in funding for health enrollment navigators this fiscal year, in addition to ongoing funding, is making a difference in their re-enrollment program.

Los Angeles County health centers and nonprofit private community health centers serve 1.89 million Angelenos. The county is investing in human, financial, and technical resources to support clients in maintaining continuous coverage. It’s funding enrollers at community health centers to assist clients with paperwork and navigate benefits. Assistance with language access is being provided at local community health centers.

Children at risk of falling thorough healthcare gaps

After the public health emergency that disproportionately affected communities of color, families and children need to keep their coverage, said Mayra E. Alvarez, President of The Children’s Partnership. She pointed out that “5.7 million children, almost 60% of the kids in California rely on MediCal, and those are overwhelmingly kids of color. Almost 70% of kids enrolled in Medicare are children of color.”

The Children’s Partnership estimates that up to 1 million children will lose their MediCal coverage. They are seriously concerned that families aren’t able to access renewal, with close to 90% procedurally disenrolled.

“That’s higher than the national average,” said Alvarez.

Last year, the legislature and the administration included multiyear continuous coverage for children zero to five, a policy that eliminates application hurdles for families. Unfortunately, that policy won’t start until 2025. The Childrens Partnership is urging the legislature and administration to implement the policy as soon as possible to ensure that families and children don’t fall through the cracks.

The Medicare application process is complex and confusing. Using various approaches – health centers, navigator organizations, and enrollers – to help people keep or get their coverage is important.

“I have a master’s in health care administration. Walking my uncle through the Medicare application took me more time than I care to admit.”

Photo by Priscilla Du Preez on Unsplash

Meera Kymal is the Managing Editor at India Currents and Founder/Producer at desicollective.media. She produces multi-platform content on the South Asian diaspora through the lens of social justice,...