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Thousands dropped from Medi-Cal in first eligibility check since the start of the pandemic

, By Kate Wolffe, Capital Public Radio

New data shows Sacramento County disenrolled 9,650 people from Medi-Cal in June. It was the first time in three years it and all other California counties have checked for eligibility.

The majority of people who were dropped did not return the renewal packets that were sent to the last address the county had on file. The same is true on the state level. Of the 225,000 California residents who were disenrolled in June, almost 9 in 10 were dropped because they didn’t complete the renewal paperwork.

“It’s extremely troubling,” said David Kane, senior attorney at Western Center on Law and Poverty. “Nobody looked at their cases and said, ‘you’re over income or you no longer qualify.’ They were cut off merely for paperwork reasons.”

Kane said many people have changed their addresses in the past three years, and may have never received the packet. Meanwhile, in Sacramento, community health workers say long wait times and a lack of communication from the county make it difficult to help people renew their coverage.

Medi-Cal, California’s low-to-no-cost insurance program for people with very low incomes, is in the first month of a yearlong renewal process.

Throughout the COVID-19 public health emergency, a federal policy called “continuous coverage” ensured that people could join Medi-Cal but could not be taken off. When the public health emergency ended this spring, counties began checking whether people were still eligible for the first time since 2020.

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‘A disaster waiting to happen’: Do staff shortages threaten Medi-Cal plans for renewing recipients

, By Cathie Anderson, Sacramento Bee, 

In one report after another earlier this year, counties from Los Angeles to Sacramento warned Medi-Cal officials that they don’t have enough trained staff — or simply don’t know whether they do — to process the millions of Californians whose cases come up for renewal starting in June.

For three years now, ever since federal officials declared a public health emergency in March 2020, U.S. law has prohibited Medi-Cal from kicking millions of Californians off its rolls, even if their incomes pushed past eligibility limits.

The end of so-called continuous coverage will come over a rolling 12-month period, based on the last date when a Medi-Cal enrollee’s eligibility was determined. If enrollees don’t submit the proper documentation by time their eligibility month ends, they will lose their benefits.

State officials estimate that 2 million to 3 million Medi-Cal enrollees could lose coverage because counties can’t manage the volume of cases or they don’t have the right addresses for enrollees or they can’t get critical information in time.

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Accessing Health Care During a Disaster

, By Western Center's Health Team

California is home to some of the most beautiful landscapes in the world, but it’s also home to disasters that will likely increase as our climate changes. Disasters often cause immediate chaos and create significant burdens in the aftermath, including obtaining health care.

Survivors of disasters have a right to get health care when, where, and how they need it. Unfortunately, they might have to fight for it. Western Center’s health care advocates created a practice tip for accessing health care after a disaster.

Due to ongoing wildfires and future disasters, survivors may need extra assistance to access health care. Fortunately, several protections help survivors access the services, supplies, and care that they need.

Read the full tip for detailed information about special rights and remedies available to survivors seeking prescription drugs, medical supplies and equipment, physician and specialist care, eligibility and coverage, health plan enrollment changes, and more. In the meantime, here are a few important points to know when trying to access health care in the wake of disaster:

Whether survivors are insured or uninsured, rights and resources exist to help replace prescription drugs, as well as medical supplies and equipment lost or destroyed during disasters. 

  • Uninsured survivors can access prescription drugs and supplies via the Emergency Prescription Assistance Program, which provides free refills with a prescription at participating pharmacies. To locate a participating pharmacy, call 855-793-7470 or click here.
  • Insured survivors can contact their prescribing providers, pharmacies, and/or managed care plans to request refills and replacements.
  • Medi-Cal Dental: Removable dental appliances may be replaced under special expedited procedures (i.e. retainers, space maintainers, partial and full dentures, and joint appliances). Claims for these appliances, exams, and radiographs should not require prior authorization, and limitations should not apply.
  • FEMA Other Needs Assistance provides grants for “necessary expenses and serious needs” caused by the disaster including medical and dental expenses not covered by primary health insurance, including if insurance denies or excludes coverage, or the survivor is uninsured. Apply for FEMA benefits at Disaster Recovery Centers, (800) 621-3362, or online. Contact the California Disaster Legal Assistance Collaborative for more information.

Survivors may need access to care and medical appointments urgently during and after a disaster. Several protections require health plans and providers to make care available.

  • Emergency care: Federal law prohibits hospitals from turning away pregnant people in labor and patients facing emergency medical conditions—no matter their insurance status.
  • Dialysis: Patients should first contact their regular dialysis center for help locating a replacement center.
  • If contracted providers are unavailable after a disaster, Medi-Cal managed care plans must still provide adequate provider networks, including by authorizing out-of-network care if no providers are available in network.
  • Medicare Advantage Plans must allow members to access out-of-network care after “a Presidential emergency declaration, a Presidential (major) disaster declaration, a declaration of emergency or disaster by a Governor, or an announcement of a public health emergency by the Secretary of Health and Human Services.”

During and after a disaster, survivors may need help applying for Medi-Cal and Covered California, or just keeping their existing coverage.

  • Many disaster survivors may be newly eligible for Medi-Cal due to job loss and/or reduction in earnings. They may obtain expedited Medi-Cal.
  • Starting July 1, 2021, many people can get immediate full coverage when they apply for Medi-Cal at CoveredCA.com or by phone at (800) 300-1506. After a disaster, Medi-Cal application requirements are less restrictive. You can apply for Medi-Cal at any time.
  • County welfare offices must continue to provide Medi-Cal eligibility services during and after disasters “without delay.” This includes in-person assistance during regular business hours, plus telephonic and internet access for Medi-Cal applications and renewals.
  • A declared state of emergency in California gives affected individuals a special enrollment period to enroll in Covered California for 60 days after the date of the declaration of state of emergency.

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Note: This resource is for current and future disasters in 2021 and beyond. For the latest rules on the ongoing COVID-19 pandemic, please visit the Health Consumer Alliance’s website, which is kept current with evolving pandemic rules. If you or someone you know needs assistance accessing any of these benefits, please call the Health Consumer Alliance at 888-804-3536 for free, confidential assistance.

JOINT STATEMENT: Overturning Affordable Care Act Would Have Devastating Consequences for Millions of Californians

The stakes have never been higher for the millions of Californians who rely on the Affordable Care Act (ACA) for access to the vital health care services they and their loved ones count on every day. As the U.S. Supreme Court weighs the future of the ACA, one point is clear: this momentous law has become part of the fabric of our entire health care system.

So many things we all count on could be upended if the ACA is overturned:

  • Guaranteed coverage for people with pre-existing conditions, including almost 950,000 people who have contracted COVID-19.
  • The ability of 2 million young adults under age 26 to remain on their parents’ health plans.
  • The expansion of Medi-Cal to nearly 4 million low-income Californians, including single childless adults between 19-25 with incomes up to 138% of the Federal Poverty Level.
  • Subsidies through Covered California to make individual health insurance more affordable.
  • Enhanced Medicare payments to hospitals, doctors and other providers that help ensure seniors have access to the care they need, when they need it.

Cutting through all the partisanship, politics, and legal arguments, the ACA is really about one thing: people. Without the ACA, millions of Californians who rely on its protections will be sicker, their ability to provide for their families will be at risk, and they will face an uncertain future.

With so much at stake, we hope the Supreme Court rules to protect the health of all Californians.

 

‘Extremely frustrating:’ How tech breakdowns are hurting Gavin Newsom’s coronavirus response

, The Sacramento Bee

“Lawyers who work with low-income clients continue to hear from people who have lost coverage even after the counties were notified, said David Kane, a lawyer who works for the Western Center on Law and Poverty. The state should be working harder to fix the problem, which is leaving vulnerable people without coverage in the middle of the pandemic, Kane said.

“It’s August, and they still haven’t completely fixed it,” Kane said.”

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California Lawmakers Block Health Care Cuts

, California Healthline

“A lot of these benefits are benefits provided in the private market,” said Linda Nguy, a policy advocate at the Western Center on Law & Poverty. “Having a lower standard for public programs for low income and communities of color is problematic, especially in a public health crisis.”

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