California prepares for Medi-Cal redeterminations as millions may lose coverage
Since the start of the COVID-19 pandemic, California received an increase in Medicaid funding under the condition that disenrollments would be postponed for as long as the federal COVID-19 public health emergency (PHE) remained active, which allowed millions of Californians to remain on Medi-Cal during the unprecedented health crisis.
But with the Federal Consolidated Appropriations Act of 2023, Medicaid continuous coverage requirements are no longer tied to the PHE, and continuous coverage terminates on March 31st.
On April 1st, Medi-Cal will resume its normal redetermination process, with first disenrollments from coverage occurring in July. The process will span the next 14 months and will redetermine eligibility for about 15 million current beneficiaries. California’s Department of Health Care Services (DHCS) estimates that two to three million beneficiaries may lose their Medi-Cal coverage, although the majority of this group will be eligible for other forms of healthcare coverage and that they may need assistance transitioning.
Individuals may be at risk of becoming disenrolled from Medi-Cal due to administrative and procedural barriers, like Medi-Cal eligibility officers not having beneficiaries’ current contact information, including phone numbers and addresses, after the last two years.
DHCS says in order to keep Medi-Cal coverage, beneficiaries need to login to their accounts to make sure that addresses, phone numbers, and email addresses are current. The department also recommends signing up for email and text messaging updates, and checking the mailbox since counties will mail a physical letter about eligibility, where beneficiaries may need to complete a renewal form.
California will have up to 14 months to initiate and complete redeterminations for nearly all Medi-Cal beneficiaries. Local county offices will conduct a full renewal process for all enrolled in Medi-Cal and CHIP, or the Children’s Health Insurance Program, through auto-renewals and requesting information when necessary.
DHCS assigned each beneficiary a specific renewal month to space out disenrollments, and members who have been enrolled in Medi-Cal for the longest will have the earliest renewal months.
Statewide Automated Welfare Systems, as well as local county offices, will initiate redeterminations starting at about 85 days prior to the last day of an individual’s redetermination month. For individuals with a June 2023 renewal month, processing will begin in April. During April, an ex-parte review will be initiated for renewals due in June and an annual renewal packet will be mailed. By June, a notice of action will be sent to individuals if the annual renewal remains incomplete, or if the beneficiary is no longer Medi-Cal eligible. June 30th will be the final day of Medi-Cal eligibility for this population of discontinued beneficiaries.
For individuals with an October renewal month, an ex-parte review will be initiated in August, during which annual renewal packets will also be mailed. In October, a notice of action will be sent if the annual renewal remains incomplete, or if the beneficiary is no longer Medi-Cal eligible. Oct. 31st is the final day of Medi-Cal eligibility for this population of discontinued beneficiaries.
Medi-Cal has seen a 16% increase in total enrollment since March of 2020, which is largely due to the continuous coverage requirements that were put in place. The most recent DHCS PHE outreach mailer to all Medi-Cal households went out in December 2021, and had a return rate of 12%.
While continuous coverage for Medi-Cal is ending, many Medi-Cal and CHIP beneficiaries may become eligible to move to Covered California, a service that connects Californians with brand-name health insurance at federally subsidized rates.
Senate Bill 260, which was approved by the governor in October of 2019, authorizes Covered California to enroll individuals in qualified health plans when they lose coverage from Medi-Cal, Medi-Cal Access Program, or County Children’s Health Initiative Program, and individuals may be eligible to receive financial assistance through Covered California.
Individuals who lose Medi-Cal will not experience a gap in coverage if they confirm their selection of a qualified health plan, and pay a premium only if required, for Covered California coverage within a month of their disenrollment from Medi-Cal, according to DHCS.
DHCS will report the number of people transitioning to Covered California to CMS. Of those who have transitioned, DHCS will report the number of individuals who enrolled into a qualified health plan.