Approved but not Greenlit
In 2022, the California legislature approved multi-year continuous Medicaid coverage (known as Medi-Cal in California) for children aged 0-5. However, the funding for this coverage is yet to be greenlighted. As a result, around 284,000 children in California were disenrolled during the year-long eligibility renewal process required by the federal government for Medicaid beneficiaries. The main reason for this was administrative issues, and not because the children no longer met the eligibility criteria for the coverage.
At an Ethnic Media news briefing on April 5, 2024, speakers discussed the importance of covering children ages 0-5 under Medi-Cal, and how gaps in medical health coverage and issues with Medicaid renewals can affect families.
Tasha Boerner, an assembly member representing the 77th district, said that there are currently 14 million Californians who rely on medical coverage.
“And for perspective we have 40 million Californians. According to the California Department of Healthcare Services, 1.3 million are children. Despite the millions of Californians who qualify for Medi-Cal, hundreds of thousands are being disenrolled at an alarming rate over simple clerical errors or just a piece of paper,” she said.
Ensure continuous multi-year medical coverage for the youngest kids
Boerner further revealed that while the national average of dis-enrollment is 71%, California’s dis-enrollment due to these same errors is much worse.
“As of November 2023, 92% of Californians have been procedurally disenrolled. One-third of these affected individuals are children and youth who will no longer have access to essential healthcare services such as checkups and necessary medication.”
She added that many of these families only find out about their lack of coverage when seeking basic necessary services. These families are still eligible for Medi-Cal coverage but are often disenrolled without any fault of their own.
Boerner said that the reasons for dis-enrollment can vary from outdated contact information leading to missed renewal notices, inadequate language assistance, or challenges in gathering all required documentation, and submissions of timely renewal applications not marked as received due to staffing shortages.
While the legislature and Governor Gavin Newsom approved continuous Medi-Cal enrollment for children in budget cycle 2022, the funding still needs to be certified this funding by the Department of Finance.
“If the Department of Finance does not certify this, thousands of children in California, between the ages of 0 and 5 years will be without healthcare coverage,” she said.
A national crisis
It is interesting to note that half of the children in the United States get their coverage through Medicaid and the Children’s Health Insurance Program (CHIP) Elaborating more on this, Joan Alker, executive director at the Georgetown Center for Children and Families, shared that during the pandemic, the states got extra money from the federal government to support their budgets to cover everyone under their Medicaid programs. However, now that the public health emergency has lifted, states are checking everybody’s coverage.
“The states in many cases don’t have the best systems to handle this kind of workload. This is particularly true for those who are not politically invested in keeping families on coverage. Researchers at the Federal Government estimated that 3 out of 4 children who would lose their Medicaid during this time would still be eligible. That’s a much higher percentage than for adults Because children have higher income eligibility for Medicaid and CHIP.
While talking about the states in terms of children losing coverage, Alker shared that Texas topped the charts with 1.3 million fewer children on their Medicaid program, which means that 1 out of 4 children in the country losing coverage are in Texas alone. This is followed by Florida, Georgia and California.
“But the good news is that we are seeing a national breakthrough in policies that we know can work to solve these problems. The number one thing that we know can work is these longer periods of continuous eligibility, such as the one passed by California a couple of years ago. So, California was on the earlier side in passing this, but of course, the state has not implemented it,” Alker said.
At the same time, the three states that are already in the process of implementing longer medical coverage from birth to age 6 are Oregon, Washington, and New Mexico, she shared.
Recently, President Biden in his budget this year is proposing to Congress that states are offered an option to cover infants from birth through age 6.
“Right now, that is not allowed in the Medicaid program unless you go through the section 1115 waiver process, which is quite complicated. So, the President’s budget includes this option and then would also establish a period of 3 years of continuous eligibility after that,” Alker explained.
This would allow states to establish a system where they cover infants through age 6 and then check their eligibility again at age 9. “This would vastly reduce the number of red tape errors and churning that we see,” she said.
How gaps in coverage impact families
Talking about the gaps in health insurance coverage, Mayra Alvarez, president of The Children’s Partnership, explained how healthy childhood development requires frequent and timely visits and screenings.
“If any one of you is a parent, we know that baby sees a doctor up to 7 times in that first year of life alone. Even short gaps in coverage can disrupt that care. It is necessary to have preventive care to get our young children ready for school and on a strong path to adulthood,” she said.
Alvarez added that more than half of California’s 9 million children rely on Medi-Cal for coverage, and 3 out of 4 of those children are children of color.
“We also know that medical enrollees of color are more likely to bounce on and off coverage due to historic, systemic inequities impacting families of color, access to jobs, housing, and more.”
Last year, Alvarez’s organization held focus groups across the state where they heard directly from parents about the impact of gaps in their children’s coverage.
“One Spanish-speaking parent in Fresno, California described their confusion and concern about losing coverage, saying that when they took their sick daughter to the doctor’s office, they were told they weren’t covered and were in complete shock. Or other families saying that they that their daughter didn’t have any coverage for months and wasn’t able to be in the therapy,” said Alvarez.
During the pandemic, ‘the churn rate’ for California children dropped from 7.5% to 1%.
“I want to repeat that during a public health emergency, we did a better job at keeping kids covered because of protections like this. It is this demonstrable success of the continuous coverage protection that made California include as part of its 2022-23 budget,” she said.
Dr Ilan Shapiro, Chief Health Correspondent and Medical Affairs Officer at Alta Health, has also expressed his belief that every child who visits his clinic has the potential to become an amazing adult. However, gaps in medical coverage could have a significant impact on their lives by reducing their access to developmental screenings and medications.
“It is in our hands to make sure that we’re protecting the base of our community, the future of our community. And those are our children,” Dr Shapiro said.
How can children get re-enrolled?
Alvarez shared that people in California can call 1800 5415555 to know about enrollment which will help them identify their county medical office.
“But we do encourage folks to identify the many resources available to families to seek assistance. There are community organizations where families can receive additional information about enrollment,” she said.
Dr. Shapiro also encouraged parents to contact their clinics for enrollment information through community fairs or by phone. “We are also amplifying it on social media in both English and Spanish and making sure that in our clinics, we have proper information for them, so they know where to go,” he said.
