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Medi-Cal Coverage Under Review

California has begun reviewing over 15 million residents’ eligibility to continue their Medi-Cal coverage, a process known as the “great unwinding.” Medi-Cal is California’s insurance program for residents with low incomes.

Because of the COVID-19 pandemic, the federal government declared a Public Health Emergency, stopping all the annual eligibility processing, which is part of the normal medical renewal process, to continue your Medi-Cal every year. Three years later, the Department of Health Care Services (DHCS) is beginning the process again. This means that starting in mid-April, residents enrolled in Medi-Cal will receive renewal notices in the mail. This Unwinding Operational Plan is designed to inform Medi-Cal beneficiaries and other valued stakeholders, of what changes to expect.

On April 12, at a joint Ethnic Media Services/California Black Media news briefing in partnership with the California Department of Health Care Services, speakers broke down the steps involved in the redetermination process. The session shared who is at risk for being disenrolled, what people can do to get ready, and how to get information in 19 languages on the DHCS website.

The Great Unwinding

It will spread the process over 14 months and may automatically re-enroll some people. But most people will have to fill out a renewal packet with information about their income and household size. People who no longer qualify or who cannot fill out the paperwork will lose their free or low-cost coverage. 

“This dis-enrollment might also include IHSS (In Home Support Services) for a loved one,” said Arnold Becker, a counselor at HICAP (the Health Insurance Counseling & Advocacy Program) in Fremont. This might mean no cooking, cleaning support, or support for the activities of daily living such as toileting, etc. It could mean that someone dies for lack of these services.” This is a free service anyone can avail of, regardless of where you live in California. “There are HICAP offices and volunteers who can help but most people do not even know these resources exist,” added Becker.

So it’s critical to watch out for notifications from your local Medi-Cal office and respond by the due date printed on the correspondence. If you receive a yellow envelope in the mail, your information needs to be updated, and you must respond right away to avoid a coverage gap. If the local office does not get your updated address, phone number and email by the due date, you are at risk of getting disenrolled. The easiest way to respond is online, advised Yingjia Huang, Assistant Deputy Director, Department of Health Care Services.

Medi-Cal Enrollment

Currently, 15.4 million people are enrolled in the Medi-Cal program, the most ever, because of lost jobs which meant the loss of insurance. To qualify for Medi-Cal, people can earn up to 138% of the federal poverty level — that is $20,121 a year for an individual or $41,400 for a family of four. Some Californians, such as pregnant women and people with disabilities, may qualify with slightly higher incomes.

California’s renewal process restarted on April 1 and should be completed by June 2024. That means people can receive their renewal notices and paperwork anytime during this time period. It will not re-determine everyone at the same time. Members can have different medical renewal months. So, depending on your renewal month, you might get auto-renewed and get a letter in the mail from your local medical county office with this statement. “Congratulations, your medical coverage has been renewed for one year.” If you are not renewed automatically, “…the local Medi-Cal office will need to send out a packet in the mail and the packet will come in a yellow envelope,” said Huang.

Pandemic-related risks

The Department of Health Care Services estimates that about 12% of enrollees may have moved during the pandemic and are at risk of not receiving their renewal packets. People who have moved during the pandemic should update their address via the state’s website: or by contacting their local county office

Some people who were eligible for Medi-Cal during the pandemic, but may no longer qualify “because you may have made more money over the course of the pandemic.” The county will automatically send your information to Covered California, which is the state’s exchange for you to purchase insurance with a premium tax credit. “That process is automatic,” said Huang. “We’re trying to make sure that process is seamless and streamlined.”

Helping children thrive

Raising awareness that the renewal process is starting is critical so that everyone has access to care that is essential to be healthy and thriving. This is especially true for 5.7 million children who depend on Medi-Cal for their care, the pandemic having exacerbated mental health issues for children and youth across the state.

“Overwhelmingly, the people that are enrolled in Medi-Cal are people of color. Over half of all of our kids in California depend on Medi-Cal. In fact, almost 70% of children enrolled in Medi-Cal are children of color. It is a lifeline for so many in our communities, and it’s a program that continues to be available for the millions enrolled,” said Mayra Alvarez, Executive Director, Children’s Partnership.

“Even before the pandemic, long-standing, structurally racist policies and practices have created an environment where families of color experience significantly greater degrees of instability,” added Alvarez.

Citizenship status not affected

All the experts in this briefing confirmed that enrolling in Medi-Cal will not affect your citizenship status and help is available at your local offices—in person, on the phone and online.

California is also preparing for some key expansions and program changes. Starting in 2024, more people will qualify for full-scope Medi-Cal benefits as the state opens enrollment to income-eligible undocumented people ages 26 to 49. About 700,000 people are expected to gain benefits through that expansion. Children 0-5 years of age will also get continuous coverage starting in 2025.

“The problem is that seniors and those with disabilities do not understand what is happening and they are not computer literate enough to reapply online and they cannot get transportation to their social services office or even be able to fill out the forms if they get and understand them. What is happening is really a disaster in the making not only here in California but nationwide,” states Becker. It is important to take the steps highlighted above to ensure your coverage continues and you are proactive about steps you need to take to secure adequate coverage and avoid a coverage gap.

This article was published as part of a series – the Desi Golden Years Project – on aging in the South Asian Community, made possible with funding from the Silicon Valley Community Foundation (SVCF). The views expressed on this website and other materials produced by India Currents do not necessarily reflect the official policies of SVCF.

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