During the COVID-19 public health emergency, 5.7 million California children on Medi-Cal were protected from losing health coverage. Now that Medi-Cal redeterminations are underway, the California Children’s Partnership is urging the Department of Health Care Services (DHCS) to enact continuous Medi-Cal coverage from birth to five years to minimize coverage losses for children resulting from redeterminations.
In 2022, California adopted a permanent policy of multi-year continuous coverage for children from birth to age five, which will allow children enrolled in Medi-Cal to remain enrolled without having to face administrative hurdles. However, this policy is not slated to begin until January 2025.
“Even short gaps in coverage, let’s say you’re off coverage for three months, four months, in the early stages of their life, that may mean they missed an important screening that could have identified something, and had it addressed immediately,” Kristen Golden Testa, policy director at the Children’s Partnership, told State of Reform. “For healthy childhood development, they really need to have all of those well-child visits to catch all the milestones, as there’s so much development happening in that period of their life.”
Prior to the COVID-19 pandemic, about 90,000 Californian children on Medi-Cal who were five years or younger would lose their healthcare coverage primarily due to procedural reasons, only to hop back on within the same year—a process known as “churning.” For all children on Medi-Cal, 400,000 children were churning in total, but during the federal public health emergency, the churning rate for all children on Medi-Cal dropped down to 15.
“These are young children, zero to five. When you look at all children [on Medi-Cal], it was closer to 400,000,” Testa said.
Testa told State of Reform that children will lose coverage only to return within the same year, which is an indicator that the child is eligible, but most likely experienced procedural issues. She said only a small portion of children who lose Medi-Cal coverage are due to ineligibility, and said most coverage losses are due to various administrative reasons, including housing insecurity which may prevent individuals from receiving or completing eligibility paperwork.
The Children’s Partnership has been hosting focus groups related to gaps in coverage and their causes, and spoke with parents of color and parents of children of color. The organization found that a primary issue was language access and issues with over-the-phone renewals.
“The wait times have been very long to get through, and for people who need interpretation services, it’s exceptionally long.”
— Testa
While the state and counties are required to translate and mail out eligibility renewal forms, Testa has heard that the translations are unclear, and members are uncertain of what they’re being asked to do.
While the continuous coverage policy focuses on children from birth to age five, Testa said continuous coverage for all children is important and has been shown to improve health outcomes. Last month, the US Department of Health and Human Services announced that states must provide 12 months of continuous coverage for children under the age of 19 who are on Medicaid beginning in 2024.
The Children’s Partnership is focusing its advocacy on children up to age five, since 90 percent of brain development occurs within those first five years. The American Academy of Pediatrics recommends 15 well-child visits during this developmental period. Testa said if these appointments are missed due to coverage loss, for example, they cannot be made up since there are so many around the corner. Even with the required 12-month continuous coverage period, children within this sensitive age range would need to have their coverage renewed each year.
Additional healthcare coverage concerns relate to children with special health needs or conditions. Testa said she has seen families desperately trying to locate medication, which can cost up to thousands of dollars without health insurance.
“Families are desperate to try and find how to make up for missed medications if they run out. Same with treatments. If there are certain procedures that are scheduled, that would have to be postponed, and it ends up being that folks are going to the emergency room when they really shouldn’t have to.”
— Testa
Lapses in coverage for young children also affect the mental health of parents and families by increasing their stress levels.
“Just the stress that you hear from families, as well as the financial debt, because ostensibly, Medi-Cal will reimburse you, but in the meantime, you can’t get into a visit until you pay. We’ve heard families say that’s thousands of dollars that they are now on the hook for and trying to get reimbursement for,” Testa told State of Reform.
The Children’s Partnership is urging DHCS to move forward on this continuous coverage initiative, while also asking Gov. Gavin Newsom to prioritize this effort in his January budget.