With Medi-Cal redeterminations underway following the end of the federal public health emergency, the Western Center on Law and Poverty (WCLP) is concerned about recently released data from the state, which shows that 225,231 individuals have been disenrolled from the program so far.
For the renewal period beginning in April, a total of 1,052,030 individuals underwent a renewal, of which 199,852 were terminated due to procedural reasons. Procedural reasons may include being unable to complete renewal packets, and the state not having up-to-date contact information for beneficiaries. David Kane, senior attorney at WCLP, spoke with State of Reform about his concerns with the high level of terminations.
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“We’ve heard a lot of concern that it’s an unacceptably large number of people who are suffering Medi-Cal coverage cut-offs for paperwork reasons. The latest numbers from the state are that one in four people who are asked to do something to keep their Medi-Cal see their Medi-Cal terminated—not because they are ineligible for Medi-Cal, but simply because there isn’t information available to keep them covered.”
WCLP has been working with California’s Department of Health Care Services for over three years to prepare for this redetermination process. WCLP meets with the agency twice per month and reports challenges they hear about from the community. The Center also advocates for policy changes that will make it easier for Californians to renew and maintain coverage.
The state says procedural errors occur when individuals fail to turn information in, but Kane said many are attempting to renew their Medi-Cal but run into roadblocks. Bumps occur when individuals attempt their annual renewal through the phone—which is critical for those who don’t have a physical address—need to conduct the renewal during their lunch break, or don’t receive paperwork in the language they speak. Phone wait times have also increased, with LA County having average hold times of 45 minutes.
Kane told State of Reform that when individuals call their county, some counties relay that they don’t conduct renewals over the phone. Some individuals who have attempted their renewals online also run into barriers.
“They are scanning and uploading their renewal forms and putting them through there, and there’s some disconnect where the counties are not picking them up and processing them, so they terminate on eligibility when their Medi-Cal ends,” Kane said.
The state has translated Medi-Cal renewal mailers in the nineteen threshold languages, but Kane has heard that individuals are receiving these forms in languages that they don’t speak. An individual’s eligibility file should have that person’s preferred language listed, and if it isn’t listed, then they receive mailers in English.
“We also see it on the other side, strangely. English-speaking people receive [packets] in language they have never spoken, so there’s mix-ups like that that happen,” Kane said.
If individuals run into these barriers while doing all within their power to retain their Medi-Cal coverage, they still may face—and have faced—termination. The impact of losing Medi-Cal coverage, however, is far-reaching.
“How it unfortunately plays out for too many people is the first time they learn that their Medi-Cal has ended is when they try to access medical care, and they need it. They will go to the pharmacy, and the pharmacist is doing their job and will say, ‘Oh, you don’t have insurance, and that drug actually costs thousands of dollars.” We receive reports just like that.'”
Having to pay out-of-pocket for medical expenses due to termination of coverage means people are rationing their medications—or skipping them altogether—or being forced to choose between purchasing costly medications or paying for food or rent.
Since Medi-Cal is tied to non-traditional medical services, individuals are running into additional challenges. Medi-Cal covers transport services, allowing individuals to travel to and from doctor’s appointments, yet vendors of transport services are running into the same issue: if people don’t have insurance, they won’t receive services and are left waiting at the curb for a ride that doesn’t show up, which Kane said can be painful for those in dialysis.
Individuals are being impacted by surgeries they have scheduled in advance. Kane said healthcare workers check insurance during surgery prep one to two days prior to the procedure, and if an individual had their insurance terminated, their care is delayed for months, or altogether.
Kane also believes California has made improvements to close coverage gaps. If individuals no longer qualify for Medi-Cal but meet requirements for Covered California, then they will be moved to a matching plan with no gap in coverage. At the same time, if individuals don’t qualify for Covered California, they are simply left without insurance coverage. Kane said outreach efforts for Medi-Cal are shifting to ensure individuals are aware of the fact that they have 90 days to turn in any missing information to get their Medi-Cal benefits turned back on, with no appeal needed.
The state has been conducting outreach with educational materials on redeterminations, in addition to running a statewide advertising campaign, which Kane said he has heard on the radio and believes is beneficial for raising awareness. Medi-Cal managed care plans have also been conducting outreach among their members.
“What is needed, and what is clear is needed more of is support for navigators, is what they’re called. They’re in the community. They are sitting down with people and their renewal forms and helping fill them out,” Kane said.
The need for navigators comes from the need to assist those for whom the current system doesn’t adequately serve, including individuals who don’t speak any of the threshold languages or English, or those who can’t get through to the counties because phone wait times are extensive. Kane said the state has provided funding for navigators for the past several years, but more is needed.
“Let’s just keep their Medi-Cal on while we do more to try to reach them,” Kane said. “We should explore all ways to try to help the 199,000 people.”
A tactic that nine other states have taken on is pausing disenrollments for those who are experiencing procedural issues. So far, Delaware, Idaho, Iowa, Maine, Minnesota, Mississippi, New York, West Virginia, and Wyoming have taken this route.
“We’d like to see the state hit pause on that—at least nine other states across the country have done that because they’ve seen their discontinuance rates be higher than before—this is also true in California. So, that’s a sign we need to pay special attention to this group, and figure out how to help them.”
With about 40 percent of Californians covered by Medi-Cal, Kane said it’s important for Californians to speak with friends and family members about the redetermination process, including how renewals are restarting, that they should check their mail for a yellow envelope from the state, and to complete the information in that envelope and return it.
“Be ready to help people with that because it’s not easy for everybody. Some people might need help understanding the forms, turning them in, [and] following up with the county to make sure it’s processed. Those are some good things that people can do. I think we should also be ready to help people who say, ‘Oh, my Medi-Cal ended,’” Kane said.