Challenges with Medi-Cal Enrollment in California
California will soon restart annual eligibility reviews of people enrolled in Medi-Cal, the state’s public health insurance program. These enrollees could lose coverage if they are no longer eligible or unaware that their status needs to be updated. States have taken various steps to prevent unnecessary coverage loss, including ensuring up-to-date contact information, monitoring rates of returned mail, and working with insurers to disenroll those who no longer qualify for the program.
Lack of Knowledge About Medi-Cal Benefits
Various state and federal policies have dramatically increased the number of Californians with comprehensive health coverage. These include the Patient Protection and Affordable Care Act, which expanded eligibility for Medi-Cal (the state’s Medicaid program) and created health benefit exchanges like Covered California that offer federally subsidized private health insurance to individuals with incomes at or below certain levels. Counties are sending notices to current enrollees who must apply to re-enroll in Medi-Cal or submit new application information. In some cases, these enrollees may have a life change that makes them no longer eligible for the program, or their contact information is outdated, and they need to update it.
Lack of Knowledge About Eligibility Criteria
People may need help understanding the eligibility criteria, how they change over time, or when they might need to reapply. They might need to know how much their income counts toward their Riverside County Medi-Cal services benefits and whether they can pursue other coverage outside the program. They might not be aware that there are different ways to apply for the program (medium-term, long-term, and permanent) or that they could simultaneously qualify for both Medicare and Medi-Cal. The state will soon resume its annual eligibility review process for people enrolled in Medi-Cal, and many of these residents will be expected to reapply or choose a new plan. The state will rely on outreach and education, including radio, TV ads, billboards, and social media, to help people navigate the enrollment or reapply. But many of these residents also will be facing the prospect of paying a premium for their health plan, even though some will receive generous subsidies from Covered California that make the premium very affordable. The state needs to ensure that the reapply or re-enrollment processes are as smooth as possible and that the underlying systems for verifying eligibility work properly. It should also provide a clear and timely mechanism for escalating eligibility determinations that need more accurate or clear.
Lack of Knowledge About the Enrollment Process
The millions of Californians enrolled in Medi-Cal, the state’s public health insurance program for low-income residents, may not realize their enrollment is about to end. As protections implemented during the covid-19 pandemic expire, millions of low-income people risk losing coverage and potentially facing large medical bills. The state is launching a massive outreach campaign via radio and social media to alert people that their enrollment is ending this month and they will need to reapply. It also enlists federally funded navigators and other community workers to help people reapply or shepherd them into new coverage.
State officials typically conduct regular eligibility checks to identify people no longer qualify for Medicaid. Those disenrolled from the program usually face periods of uninsurance, as they must redo paperwork and wait for their new coverage to start. CHCF recently conducted virtual focus groups and in-depth interviews with 91 Californians to explore their knowledge, attitudes and experiences related to Medi-Cal and other coverage options. Results indicate that most participants needed more understanding of their Medi-Cal benefits and how to access them.
Lack of Knowledge About Other Coverage Options
In California, Medi-Cal is a healthcare program for low-income families with children, adults, seniors and people with disabilities. It is financed equally by the state and federal governments.
The program provides health coverage for people whose income is up to 138% of the poverty level ($20,121 per year for an individual and $41,168 for a family of three) and who meet other criteria. County human services departments are responsible for delivering the program to eligible residents. While the pandemic pause allowed many Medi-Cal enrollees to stay on their current plans, that protection will expire next month. The state will begin sending renewal notices and unwinding the policy that froze regular eligibility reviews. The state is launching a massive outreach campaign using radio, social media and billboards to inform people that the renewal process is coming. It will also enlist federally funded navigators to help people update their contact information and shepherd them into new coverage through Covered California if their income has increased and they no longer qualify for Medi-Cal.
Lack of Knowledge About the Eligibility Review Process
In April, California will resume its annual eligibility review process for Medi-Cal students. It could cause some enrollees to lose their coverage if they are unaware of the process or unable to provide the information needed. The state has launched a massive outreach campaign via radio, social media, and billboards to remind people that they must reapply for Medi-Cal this year. It also enlists federally funded navigators to help people navigate the process and shepherd them into Covered California if they still need to renew their existing coverage. During our fieldwork, many participants reported limited knowledge about the annual renewal process for Medi-Cal and other ACA-related health insurance programs. It is not surprising given that most of our study participants self-identified as Latino, and many rely on media sources—particularly television, radio, and newspapers—for health care information. Adding to this mix is that most of the state’s eligibility system vendors use a “reasonable compatibility” policy when reviewing enrollment data, which can result in inaccurate eligibility determinations for some individuals.