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California becomes first state to offer health insurance to all eligible undocumented adults But many remain uninsured because of a range of enrollment barriers

California became the first state to offer full health insurance to undocumented immigrants. (Getty Images)

By: Brenda Verano
Jan 8, 2024

On Monday, California became the first state in the nation to offer health insurance to all eligible undocumented immigrants. Beginning January 1, immigrants of all ages will be eligible for the state’s health insurance program for low-income people, known as Medi-Cal.

Throughout the years, Granados has developed a list of chronic and degenerative diseases.

Full-scope Medi-Cal will allow immigrants like Granados, living in the Golden State to seek free dental, vision (eye) care, specialist appointments, mental health care, substance use disorder services, prescription drugs and medical supplies, and in-home care if they meet all Medi-Cal eligibility rules, including income limits.

Immigrants ages 26-49 are the last group to join the ongoing Medi-Cal program expansion, which is part of the “Healthy California for All” initiative, which took effect in 2015. Nine years ago, former Gov. Jerry Brown signed a law making undocumented children (1-18 years old) eligible for state insurance.

What followed was the Young Adult Expansion, which was signed into law in 2019 and provided full-scope Medi-Cal to young adults 19 through 25. In 2023, the Older Adult Expansion, which provided full-scope Medi-Cal to adults 50 or older, was signed into law.

Adults can apply to Medi-Cal online, in person through Medi-Cal enrollment centers and thousands of certified enrollers and over the phone. For California immigrants to qualify for Medi-Cal, adults must submit proof of income that proves their household earns less than 138% of the federal poverty level (FPL), along with additional details like age, marital status, tax information and identification.

Granado’s first health issue began as a kid in Mexico when she was diagnosed with epilepsy, a neurological condition involving the brain that makes people more susceptible to having recurrent, unprovoked seizures. “We didn’t grow up with much, but my mom always cared for me, even when she didn’t know what exactly was wrong,” she said.

Granados grew up in a small town in Guanajuato, Mexico, where her parents and grandparents lived off the land as farmers. “My parents taught me to value everything—every meal, every day that we get to wake up and although my health has not been the best in the last few years, I remain grateful,” she said.

She immigrated to the United States in 1998 and shortly after she was diagnosed with Sjögren’s syndrome, a chronic (long-lasting) autoimmune disorder caused when the immune system attacks the glands, which causes the eyes, mouth, and other parts of the body to retain moisture. Granados said that for her, it causes her mouth to feel very dry, a symptom that has required her to visit the dentist more frequently than most people.

She began noticing the ways that not having insurance played a key role in the type of care she would receive. “When I first started going to the clinic because of my severe migraines, they would prescribe me Tylenol and other people would be offered medical tests and examinations to find the exact cause of the headaches,” Granados said.

But the chronic disease that first sent Granados to the hospital for days was fibromyalgia, a chronic (long-lasting) disorder that causes pain and tenderness throughout the body, as well as fatigue and trouble sleeping. “It’s the type of pain that you cannot control or get rid of; it’s very scary,” Granados said.

She was first diagnosed with fibromyalgia about 5 years ago when the pain was so severe that her husband decided to take her to the emergency room and ask for her to be admitted to the hospital, a decision that would leave them financially struggling. “The doctors explained that they did not know what caused it, but that it explained my heightened sensitivity to pain in my back. I could not walk,” she said. “ We spent all of our savings on being in the hospital and seeing a specialist. “

After years of experiencing severe symptoms of fibromyalgia, Granado’s feet and entire body are not as strong. She uses a cane to support herself; she cannot walk or stand for long periods or carry heavy equipment; and she gets very cold easily, all of which affect her daily life, her job and her ability to perform regular tasks.

For those like Granados who already have an active restricted or emergency Medi-Cal insurance plan, they will not need to submit their application or apply again. “Those people will be automatically switched over to full-scope coverage beginning January 1st, 2024,” Jose Torres Casillas, Policy and Legislative Advocate at Health Access California, said.

He said that Health Access California had been actively recommending community members and other community organizations to enroll qualified immigrants into emergency-scope Medi-Cal before the beginning of the year, so the transition would be seamless.

Medi-Cal will cover an additional 700,000 Californians

In the United States, one in five (20%) immigrant adults reported having problems when it came to paying for health care in the past year and (22%) said they skipped or postponed care in the past year because of their inability to pay, according to a  2023 survey by the LA Times and the Kaiser Family Foundation (KFF).

meical photo 4

Timeline of the Medi-Cal expansions that took effect throughout the year. Graph by Brenda Verano

Previously, many undocumented immigrants like Granados only qualified for restricted Medi-Cal, which allowed immigrants to receive emergency and pregnancy-related services as long as they met eligibility criteria like economic requirements and had proof of California residency in 2014.

Medi-Cal provides services to over 13 million Californians (or one in three who rely on the program for health coverage). Granados is excited to begin receiving full-scope comprehensive health insurance, which will help her see a doctor for her chronic pain regularly and can ultimately cover at-home assistance and care, all while not having to worry about the cost.

The California Department of Health Care Services (DHCS), which administers Medi-Cal, estimates that with this new expansion, an additional 700,000 Californians will now be enrolled, but Torres Casillas, said the number of new enrollees will most likely be a lot greater.

“When the 50-year adult expansion was approved, our original estimates were that about 250, 000 people were going to enroll. We’re now over 300,000 people over the age of 50 who have enrolled,“ he said. “We’re expecting a similar situation with that of the 26 to 49, where we are currently estimating 700,000 people will be eligible, but we’re expecting a lot more people to enroll.”

#Health4All campaign

Torres Casillas has become a policy expert at Health Access California, which serves as the co-chair, along with the California Immigrant Policy Center, of the #Health4All campaign, which has driven the efforts of all the Medi-Cal expansions throughout the years. The Health4All campaign began in 2013 when immigrant rights activists, healthcare advocates, and community members came together to call for expanding health care to all immigrants living in California.

“We’re ensuring that we, along with other organizations advocating for immigrants, are at the decision-making table to be able to speak on and address a lot of the issues that exist within the implementation of these Medi-Cal expansions,“ he said. “We want to make sure that the state is able to use a lot of the lessons learned from our prior expansions and apply those to the new expansions.”

The January 1 expansion will cost the California Health and Human Services Agency $835.6 million in funding between 2023 and 2024 and $2.6 billion annually, but Torres Casillas believes these costs are worth the well-being of immigrants. “We need to invest in our immigrant community’s well being, and this is a huge step for them to feel supported and part of our country’s health care system,” he said.

Existing flaws in Medi-Cal’s Application Process

However, according to David Kane, senior attorney at Westen Center for Law and Poverty, an organization that has worked closely with DHCS to ensure the implementation of the expansion, the Medi-Cal applications and the application process still have flaws.

“We convene meetings with partners, advocates, stakeholders and the Department of Healthcare Services to make sure that they are implementing this in a way that will meet the needs of the community,“ he said.

For Kane, aside from complaints of Medi-Cal applications that take long to process, adults not being able to reach the county by phone or not being able to get help in their language, one of the biggest flaws in the Medi-Cal application is the section that asks people for their social security number. Although skiing for an SSN is something that is a federal requirement, it is not something undocumented immigrants do not have.

“That’s something that should have been fixed a long time ago. We do not want people to feel discouraged when they see this in the application. We need to find a way to let people know they can still get full-scope care even if they don’t have a social security number,” Kane said.

Enrollment barriers

The KFF also found that among immigrants who are eligible for health coverage, many remain uninsured because of a range of enrollment barriers, including fear, confusion about eligibility policies, difficulty navigating the enrollment process, and language and literacy challenges.

For Maria Hernandez, 23, who has had Medi-Cal insurance for over 5 years and speaks fluent English, navigating Medi-Cal is still a challenge. She was born in Puebla, Mexico and immigrated to the U.S. when she was only six months old. “We never really got any assistance or help [from the government] before. My mom was scared of telling people she was an immigrant,” she said.

Hernandez got severely ill during the COVID-19 pandemic, and being able to go to the hospital or clinic to get the appropriate care made her appreciate having health insurance. “It has helped me a lot, just by the fact that I was able to be seen,” she said.

As a former personal translator for her mom, she realized the way language plays a part in health coverage. “I did not live too far from a hospital and being able to go without having to think of the cost or if [doctors] were going to speak English is something I did not have to worry about, but many did,” Hernandez said.

Andrew Kazakes, senior attorney at the Legal Aid Foundation of Los Angeles (LAFLA), has provided free, high-quality legal services to those seeking government benefits, including Medi-Cal.  “Part of our work at LAFLA is that we hold clinics set up in L.A. County hospitals, where social workers will refer patients to our clinic if they have any legal issues that might have prevented them from getting approved for the services they need, such as Medi-Cal.”

 Although federal funding restrictions limit the assistance LAFLA can provide to undocumented immigrants, with exceptions that depend on individual circumstances, the organization aims to assist uncovered Californians who are eligible for their services, and to provide high-quality referrals to those who they cannot serve directly.

During his time hosting legal aid clinics at Rancho Los Amigos National Rehabilitation Center, located in Downey, he worked with many patients who were unfamiliar with the healthcare system of California and who wrestled with navigating Medi-Cal and the application process.

“There was definitely a high volume of undocumented folks who got referred our way. It’s really confusing for a lot of people to navigate these different administrative systems and it’s not their fault,” Kazakes said. “The system itself is really confusing. Doctors will struggle, social workers will struggle, and even attorneys will have to struggle to figure out, based on somebody’s status, what sort of assistance they can get.”

According to Kazakes, because a hospital does not turn away anyone who does not have health insurance or cannot pay, the patient would often obtain presumptive eligibility for Medi-Cal.

“If you have someone who’s showing up from a car crash, the hospital doesn’t want to pause care; therefore, the patient would get presumptive eligibility, but after the patient receives the care needed, like, for example, a surgery, they are left to transition off Medi-Cal unless they can establish their eligibility,” he said. “It creates this situation where people have already been through trauma, and now they’re put in this position of not knowing if the care is going to be there to help them with the aftermath of the accident and fully recover beyond the immediate emergency.”

Kane and Torres believe that the hardest part, other than implementing the Medical 26-49 Adult Expansion, will be modifying the Medi-Cal health system to make immigrants feel welcomed and seen. “It’s not as simple as saying: “OK, immigration status doesn’t matter anymore.” That’s what the law says. It’s super clear; it’s super simple, but the Department of Health Care Services has historically excluded this group of people. The State Department of Health Care Services needs to break down the systemic barriers that they have had in the design of their program,” Kane said.

Supporting New Medi-Cal Patients

Katie Rodriguez, vice president of Policy and Government Relations at the California Association of Public Hospitals and Health Systems (CAPH), said their members are excited to welcome new full-scope Medi-Cal patients and wants them to feel supported in the clinics and hospitals where they will be seeking care.

According to Rodriguez, 21 public hospitals and their clinics in the state, such as Los Angeles General Medical Center and  UCLA Medical Center, already see many of the patients that have recently become eligible for full-scope Medi-Cal. “The majority of our patient population at our public hospitals and healthcare systems are already Medi-Cal or Medicare patients or uninsured,“ she said. “We are very proud of this.”

Rodriguez said public hospitals and clinics do not turn anyone away because of a lack of insurance and are excited to continue to foster the patient-relationship practices that make new full-scope MediCal-eligible patients feel included and seen. “Public hospitals and their clinics regularly communicate with any new and existing patients. that come in and make sure that they’re aware of all coverage options, in case they’re eligible for full-scope Medi-Cal or other services as well,” Rodriguez said.

Rodriguez said she is aware of how filling out new applications can be overwhelming and difficult for people who are doing this for the first time. One of the things that the public hospitals and their clinics have done to ease some of these nerves and assist new Medi-Cal patients is to have people solely designated to help fill out applications and determine eligibility. “Many of our hospitals and clinics have what we call enrollment counselors onsite that help individuals apply,” she said. “Most importantly, the enrollment counselors, tell them what Medi-Cal is, the documentation they need, and what the application looks like. Whenever possible, they go through it with them in the language they feel most comfortable with,” she said.

Public Charge

In August 2019, former president Donald Trump announced a public charge policy that, at that time, could result in the rejection of many immigrants applying for an immigrant visa (e.g. green card) if they had previously accessed or were deemed likely to rely on certain forms of public assistance, such as Medi-Cal. The unenrollment and decreased participation in government assistance programs contributed to more uninsured individuals and negatively affected the health and financial stability of families.

Even as the former public charge rule is no longer in effect and the government has stopped following the Trump-era rule on March 9, 2021, the narrative continues, and according to Torres Casillas, immigrants continue to be afraid of taking advantage of programs like Medi-Cal.

“That rule is no longer in effect, but we’re still dealing with the remnants in the sense that people may not know that it’s no longer in effect. And if that information spreads, then other people are confused and therefore hesitant to apply to Medi-Cal” he said.

Kane said that the Western Center for Law and Poverty and other immigrant rights advocates, including the Health4All Coalition, continue to push DHCS to educate people on the way public charge is not something they should worry about.

 “For some time, DHCS would not want to say anything about public charge because they said it was like giving immigration legal advice, but it’s not if you are just educating people,” Kane said. “We’ve been pushing DHCS to tell people very basic things about public charge, and we’ve made some great progress.”

Today, DHCS’s website contains basic information on public charge and assures people that the U.S. Department of Homeland Security (DHS) and U.S. Citizenship and Immigration Services (USCIS) do not consider health, food, and housing services as part of the public charge determination. “DHS strongly encourages these populations to access any and all services and benefits available to them without fear of a future negative impact,” states the DHCS website.

For Granados, a flawed Medi-Cal program is better than not having any insurance at all. “I’m still grateful and even if flawed, I’m excited to be able to have Medi-Cal,” she said.

Torres Casillas believes outreach, marketing and informing community members of their eligibility are the most crucial steps after January 1. “People may not know that they’re eligible; people may not know that coverage was expanded, and we all need to work hard to make sure the information gets to the right people,” he said.

Kane said it’s important to emphasize the journey that it took for all immigrants in California to be eligible for Medi-Cal. “We know that this is a community-led, community-driven effort. That’s the only reason we’re doing this because people stood up and advocated for their family members and themselves,” Kane said.

You can apply for Medi-Cal at any time of the year. To learn when you can apply, go to www.coveredca.com or call 1-800-300-1506 (TTY 1-888-889-4500).

Black Midwifery in the US

Since the inception of the United States, midwifery has been the most customary practice for pregnancy care and childbirth. Today, the primary care for pregnant people in most developed European countries is facilitated by midwives. However, in the United States a divide began to take root in the 1800’s, when white male physicians began to explore childbirth with greater interest. Their approach was based on a patriarchal and colonial framework that was highly experimental and racist, often times using enslaved African to test explicit drug therapies, shock treatments, and surgeries without any anesthesia.

Prior to the creation of formalized medical education in obstetrics and gynecology, midwives were the sole experts in birth work and medicine relied heavily on Native American and African American knowledge of plants and indigenous healing modalities. For millennia, birth work was considered a female occupation or “woman’s work” (Hoch-Smith and Spring, 1978; Leavitt, 1983; Rooks, 1997; Donegan, 1978; Litoff, 1990). The midwifery model of education was a indigenous model of apprenticeship under more experienced midwives that were often grandmothers who also learned from their grandmothers. In the United States midwifery was largely practiced by enslaved Africans who were responsible for women’s healthcare of all enslaved women on the plantation as well as the white women who owned them. A large part of midwifery apprenticeship on the plantation included various forms of training such as herbalism, procedures for dealing with birth complications, perinatal care, and serving as traditional healing.

Once the field of medicine became “professionalized” and legitimized by the legal system with the invention of the American Board of Obstetrics and Gynecology in 1927, physicians sought to dominate the field of birth work as its primary practitioners. Their claim to jurisdiction spurred racist propaganda campaigns depicting Black midwives as caricatures falsely accusing midwives of being “incompetent”, “witches”, “unclean”, “savages”, and “untrustworthy”. These physicians also lured white women to trust them because they offered “innovative” pain relief options such as opioid tampons, and mercury. In addition to the propaganda, because pregnancy began to be viewed as a pathological condition beginning in the late 1800s and continuing into the 1900s, physicians claimed that only legally trained individuals could “treat” this “condition”. Such assertions/claims served as manipulative tools that “pushed the scales” in favor of physician-assisted births versus granny midwife assisted births.

The public perception of midwives began to shift as the midwives who had for centuries in the Americas served as the primary maternal and infant healthcare providers were essentially deemed illegitimate. These smear campaigns were supported by the white male physicians who were founders and members of State Boards of Health which controlled who was able to care for and treat women in childbirth. By the 1900s white male physicians attended approximately half of births, despite having little to no training in obstetrics.

In rural America, however, Black midwives continued to attend births especially for Black folks who lived in the segregated south and had no access to hospitals in their communities. In the Southern states, Black midwives, sometimes called “granny” midwives, attended up to 75% of births until the 1940’s.

Racist laws, educational restrictions, and campaigns against midwifery care led to the dismantling of the practice especially for Black women, for example:

  • The 1910 Flexner Report recommended hospital deliveries and the abolition of midwifery. The study has since been recognized for its racist, sexist, and classist approach to medical education.
  • “Twilight sleep” was introduced in 1914, an amnesiac given to women by white physicians preventing any memories of giving birth.
  • In 1915, Dr. Joseph DeLee – a prominent obstetrician – called pregnancy and childbirth “dangerous” and “evil.” Dr. DeLee promoted the use of forceps, sedatives, ether, and other interventions that needed hospital-level care. He argued that midwives were incompetent.
  • The Department of Indian Affairs passed legislation that moved births from the home to the hospital.
  • The Shepphard-Tower Infancy and Protection Act became a federal law in 1921. It encouraged states to develop their own maternal and child health legislation. Before these changes, lay midwives practiced mostly without restrictions. The new laws severely reduced their practice in many states. For example, Alabama began requiring all midwives to obtain a license, then later required nurse-midwives to practice only in hospitals. These changes prevented 150 “granny midwives” from practicing across the state practically overnight.
  • Public health nurse Mary Breckenridge founded Frontier Nursing Service (FNS) in rural Kentucky in 1925 which led to the more formalized field of nurse-midwifery also developed at this time. Breckenridge’s racist rhetoric impacted Black midwives’ entry into the nurse midwifery route though Breckenridge has been for “creating a pathway for midwifery education and certification.”

The formalization of education and certification ultimately delegitimized apprentice-trained midwives in every community. Today, less than 5% of midwives in the United States are people of color. Disparities in maternal morbidity and mortality rates are striking; Black mothers are 2-3 times more likely to die in childbirth than white mothers. This impact reflects the powers and forces that disconnected midwives from their communities.

Black Midwives that Birthed Communities

Mary Coley was born in Baker County, Georgia. She began training as a midwife under the tutelage of Onnie Lee Logan. She became an advocate for the health of Georgia’s black population and was known for her willingness to work with women regardless of race in a time of segregation. It is estimated that she delivered over 3,000 babies in her career.

Ms. Arilla Smiley was trained by the local Health Department in Brunswick Georgia and apprenticed with her mother-in-law. She received her license to perform midwifery in 1963 and retired in 1987. During her career as a midwife, Ms. Smiley delivered over 1,000 babies in Mitchell County.

Maude Callen was a nurse-midwife in the South Carolina Low country for over 60 years. Her work was brought to national attention in W. Eugene Smith’s photo essay, “Nurse Midwife,” published in Life on December 3, 1951.

Margaret Charles Smith delivered more than 3,000 babies. In 1949, she became one of the first official midwives in Green County, Alabama, and she was still practicing in 1976 when the state passed a law outlawing traditional midwifery. In the 1990s, she cowrote a book about her career, Listen to Me Good: The Life Story of an Alabama Midwife, and in 2010 she was inducted into the Alabama Women’s Hall of Fame.

Bibliography
Abbott, Andrew. 1988 The System of Professions. Chicago: University of Chicago Press.
Donnegan, Jane B. 1978 Women and Men Midwives: Medicine, Morality, and Misogyny in Early America. Westport: Greenwood Press.
Fraser, Gertrude Jacinta. 1998 African American Midwifery in the South: Dialogues of Birth, Race, and Memory. Cambridge: Harvard University Press.
Hoch-Smith, Judith and Anita Spring. 1978 Women in Ritual and Symbolic Roles. New York: Plenum Press.
Leavitt, Judith Walzer. 1987 “The Growth of Medical Authority: Technology and Morals in Turn-of-the-Century Obstetrics.” Medical Anthropology Quarterly 1(3). September. 230-255.
Leavitt, Judith Walzer. 1983 “Science Enters the Birthing Room: Obstetrics in America Since the Eighteenth Century.” The Journal of American History. 70(2). 281-304.
Litoff, Judy Barrett. 1996 “Forgotten Women: American Midwives at the Turn of the Twentieth Century.” Pp. 425-441 in Childbirth: Changing Ideas and Practices in Britain and America 1600 to the Present, edited by Phillip K. Wilson, Ann Dally, and Charles R. King. New York: Garland Publishing.
Pringle, Rosemary 1998 Sex and Medicine: Gender, Power, and Authority in the Medical Profession. Cambridge: Cambridge University Press.
Radcliffe, Walter. 1989 Milestones in Midwifery and the Secret Instrument: The Birth of the Midwifery Forceps. San Francisco: Norman Publishing.
Rooks, Judith Pence. 1985 Midwifery and Childbirth in America. Philadelphia: Temple University Press.

Western Center Roundup – December 2023


Settlement Finalized in Katie A. v. LA County Mental Health Lawsuit
After more than 20 years of litigation, the U.S. District Court for the Central District of California, Western Division, has given final approval to a settlement in the longstanding case Katie A. v. Los Angeles County. The Court’s action ends a federal class action lawsuit that, over time, led to significantly improved mental health services for children and young adults in foster care or who face imminent risk of placement in foster care.

Filed in 2002, the suit alleged the county and state agencies failed to provide legally mandated health care services to youth in its custody. The lack of mental health services harmed foster youth by increasing the likelihood they would be removed from their homes.  Removals compound trauma for foster youth, making the lack of appropriate care even harder for children already struggling with mental illness.

“In the beginning of this lawsuit, we saw many youth have multiple moves due to behaviors that weren’t being addressed with treatment, and they were losing important connections to family and community,” said Antionette Dozier, one of Western Center’s lead attorneys on the case.


Tis the Season to Donate (Unspoiled) Food
One in five Californians suffers from chronic hunger, but a growing food rescue effort is poised to shrink that number.

About two years ago, one of the most significant waste reduction mandates went into effect across the state. SB 1383 ambitiously seeks to reduce organic waste  by 75% by 2025.  This means that around 20 million tons of potential waste may soon be diverted from landfills to kitchen tables.

Throughout California, municipalities  are setting up  programs to  ensure that grocery stores, produce marts, corporate kitchens, schools,  and other commercial food generators  set protocols to inspect leftover food before it spoils and see that it reaches those who are hungry as fresh as possible. For years prior to SB 1383, many food generators resisted donating food. Now with legislation, a robust network of waste reduction programs and streamlined donation processes,  support is growing.

For example, Food Finders, which has a network of over 470 partners across five counties in Southern California, has been helping food generators comply with the mandate. In particular, they facilitate same-day, donor-to-recipient delivery of edible foods.

FULL BLOG

Patients in California County May See Refunds, Debt Relief From Charity Care Settlement

California’s largest public hospital plans to start notifying 43,000 former patients Monday that they may be eligible for refunds or billing corrections, part of what advocates called a major legal settlement that will help force the hospital to fulfill its charity care obligations.

Santa Clara Valley Medical Center, along with other units of county-owned Santa Clara Valley Healthcare, will also adopt procedures to ensure patients are informed of their eligibility for charity care, which nonprofit and public hospitals must provide.

“This is huge,” said Helen Tran, a senior attorney with Western Center on Law & Poverty, which joined another California-based legal group, the Consumer Law Center, in a lawsuit against the hospital. “It’s so important that the hospital is stepping up to take corrective action. That’s something we haven’t seen many hospitals do.”

Filed in 2019 and settled in June, the lawsuit alleged that Santa Clara Valley Medical Center billed patients and sent them to collections for charges they should not have been required to pay. Emily Hepner, one of the plaintiffs, was a full-time student, raising two children alone,and uninsured in 2014 when she needed urgent surgery, according to the lawsuit. The hospital never followed up after telling her she might be eligible for charity care and, nearly a year later, she received a $34,884 bill. The hospital later sued her for that amount plus attorney fees.

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Western Center on Law and Poverty suggests California pauses Medi-Cal disenrollments that are due to procedural reasons

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.

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 hold times of 45 minutes to one hour.

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Tens of thousands lose Medical eligibility

About 225,000 Californians lost their free or low-cost health coverage as of July 1st in the first round of a Medi-Cal renewal process – which had been suspended since early in the COVID-19 pandemic.

The number makes up more than 20 percent of the 1 million or more people who were due to reapply for coverage in June.

Less than three percent of those who lost coverage lost it because their incomes now exceed program limits. Most lost it because they didn’t submit a renewal packet and could not have their incomes verified.

Staff attorney David Kane told CalMatters “I don’t think today’s preliminary numbers mean we can all sit back and think things are OK, these disenrollments are not inevitable.” He added that the lack of responses could be due to not receiving the packets or not getting the packets in their language.

Anthony Cava of the California Dept. of Public Health told KALW that it’s not too late for some residents to hold on to their Medi-Cal coverage. If you’ve lost your insurance, Cava advised Californians to: return packets to their county office; notify them if you’ve moved; and to return any yellow envelopes promptly.

The state will review eligibility for about 16 million people over the next year. Those who were dropped from Medi-Cal on July 1st have 90 days to re-apply for reinstatement.

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225,000 Medi-Cal enrollees lost coverage in June; here’s how that compares with prior years

A three-year hiatus ended in June for more than 1 million California Medi-Cal enrollees. They once again had to prove they were eligible for the government-funded health care coverage, and roughly eight out of 10 got their paperwork in by the June 30 deadline, California Medicaid Director Jacey Cooper said Thursday.

That was about the same proportion of enrollees who successfully completed monthly re-enrollment in California before Congress enacted the Families First Coronavirus Response Act in the early days of the COVID-19 pandemic, requiring states to continue covering anyone who was approved for Medi-Cal or any other Medicaid program around the country.

Beginning in June and continuing through May of next year, Medi-Cal enrollees have to re-apply for coverage by the end of the month in which their eligibility dates fall.

Medi-Cal discontinued coverage for about 225,000 individuals, or roughly 21% of people whose coverage came up for renewal in June, Cooper said, but those who lost coverage have 90 days to provide the necessary documentation and restore their coverage retroactive to the cut-off date.

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More than 220K people kicked off Medi-Cal in its first checkup since COVID

About 225,0000 Californians lost their free or low-cost health coverage as of July 1, in the first round a Medi-Cal renewal process that had been suspended since early in the COVID-19 pandemic.

That’s approximately 21% of the over 1 million people who were due to reapply for coverage in June, according to preliminary numbers released by state health officials on Thursday.

Medi-Cal, the state’s health insurance program for low-income people, typically reviews enrollees’ eligibility every year. The state paused that process during the pandemic at the orders of the federal government, but resumed in the spring.

Less than 3% of the people who lost coverage no longer qualify for Medi-Cal because their household income now exceeds the program’s limits.

That means the majority of people were kicked off because they didn’t return a renewal packet and county Medi-Cal offices couldn’t verify an enrollee’s income. Cooper said the counties and state are trying to reach enrollees in multiple ways — email, mail and texts.

David Kane, a senior attorney with the Western Center on Law and Poverty, said it is concerning that tens of thousands of people could be  without insurance even though they are eligible. They may have failed to respond for a number of reasons, such as not receiving the packet or not getting the packet in their language.

“I don’t think today’s preliminary numbers mean we can all sit back and think things are OK,” Kane said. “These disenrollments are not inevitable. The state, counties, advocates, and community groups together have the power to help more people keep their Medi-Cal.”

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Over 34,000 L.A. County households lost Medi-Cal in July amid rollback of COVID rules

More than 34,000 households in Los Angeles County have had their Medi-Cal coverage discontinued this month as California joins other states in beginning to cut off people from Medicaid programs who no longer meet income requirements or whose paperwork was not submitted in time.

The latest numbers were shared by L.A. County officials at a public meeting Wednesday. Health officials and legal advocates are closely eyeing such early figures to see how a major shift in health coverage is playing out in L.A. County and across California, amid concerns that people who legally qualify for Medicaid could end up losing it unnecessarily or suffering interruptions in their coverage.

Earlier in the pandemic, federal rules had allowed people to hang on to Medicaid coverage without turning in annual paperwork to prove they were still eligible. Now states have started ejecting people from their programs again after the federal government rolled back those pandemic rules.

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California Steps up to Stop Big Tobacco From Maliciously Targeting Black Communities

Every year, over 45,000 Black lives are lost in the United States to tobacco-induced illnesses like lung cancer, heart disease, and strokes. Tobacco corporations for decades have been intentional about their predatory targeting of Black communities. Black, Indigenous, and communities of color are already denied equitable access to social, political, and economic systems which produce inequitable and preventable negative health outcomes. 

This is an industry rooted in racism, white supremacy, and nefarious capitalism. The colonialist and extractive production models used by tobacco producers had detrimental effects on Black, Brown, and Indigenous people at its origins. Today, Big Tobacco actively continues to disrupt community health initiatives meant to improve health outcomes for profit.  

In 1964, after a report by the U.S. Surgeon General about the hazardous health impacts of smoking and subsequent federal laws limiting smoking and tobacco advertising, tobacco companies shifted their marketing to target Black communities across the country. Big Tobacco had lost their biggest youth demographic, as they were banned from advertising in colleges or from handing out loose cigarettes on campus to students under 21.  

The industry thrives due to strategic co-optation of community leadership whenever it can. Tobacco industries deployed a multi-pronged effort to prey on Black communities by working with Black influencers, handing out free cigarettes through bellhops or barber shops, and funding political campaigns or supporting Black causes. Tobacco businesses have for years tried to create fake cultural affinities like the advertising campaigns for Kool Jazz Festivals with icons such as Dizzy Gillespie.  

Tobacco companies went as far as appropriating #BlackLivesMatter, Juneteenth, and used Dr. Martin Luther King Jr. quotes in their product advertising a couple of years back. Their marketing has been a shallow and peformative public relations strategy to buy good will and actively undermine or discredit the systematic harm tobacco perpetuates. 

In 2009 the U.S. Food and Drug Administration (FDA) banned flavored cigarettes, yet menthol cigarettes slipped by due to a split in the Congressional Black Caucus (CBC). A recent survey found that 85% of Black smokers preferred menthol cigarettes. Many in congressional leadership at the time received support and donations from tobacco companies.  

States like California have been taking strong steps to disrupt Big Tobacco’s assault on Black communities. This past November, Californians voted to support Proposition 31 and uphold Senate Bill 793, authored by former Senator Jerry Hill. Once SB 793, a bill to ban the sale of flavored tobacco products and tobacco product flavor enhancers, was signed into law, Big Tobacco immediately jumped into action to delay the implementation of the law by referendum. California voters saw through this self serving and dangerous ploy and voted in favor of keeping the law, with 63.42% voting to do so. In California, flavored tobacco including menthol flavors remain banned. The industry immediately shifted to introduce new cooling non-menthol tastes.  

In response, the African American Tobacco Control Leadership Council (AATCLC) and California Attorney General, Rob Bonta sent warning letters to RJ Reynolds and Imperial Tobacco Group Brands to stop these new products from harming Black communities.  

AATCLC Co-Chair Dr. Phillip Gardiner proclaimed that this violated the state’s law prohibiting the sale of flavored tobacco, “we will not sit by as tobacco companies work to continue their assault on the health of Black people.” 

Big Tobacco is just one example of an issue at the intersection of public health and racial justice. Thankfully, lawmakers, advocates, community groups, and voters came together to call out their predatory and harmful practices. When we come together, we can stop special interests and protect the health and well-being of Californians.