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Millions of Californians in Jeopardy of Losing Medi-Cal Coverage

Millions of Californians in Jeopardy of Losing Medi-Cal Coverage 

The Protecting Medi-Cal Coverage for Californians Act (AB 2956), aimed at helping millions of low-income Californians keep their Medi-Cal coverage, held back from progressing through the Legislature 

(Sacramento, CA) May 20, 2024 – The Protecting Medi-Cal Coverage for Californians Act (AB 2956) introduced by Assemblymember Tasha Boerner (D-Encinitas) has died in Assembly Appropriations. The bill, aimed at protecting the most vulnerable by allowing adults enrolled in Medi-Cal to keep their coverage for a full 12 months and by making the federal Medi-Cal renewal flexibilities permanent, was intended to decrease the number of wrongful Medi-Cal disenrollments Californians are currently experiencing.

As of April 2023, California restarted the process of reviewing and renewing Medi-Cal eligibility for the first time since Medi-Cal renewals were paused in March 2020, referred to as Medi-Cal “unwinding.” Over 1.6 million Californians have lost their Medi-Cal coverage in the first 10 months of this unwinding period – the overwhelming majority being people of color, with about half of all disenrolled people being Latines. The overwhelming majority (80%) of Medi-Cal disenrollments have been for procedural or ‘paperwork’ reasons, meaning they have been disenrolled by no fault of their own, even when they were likely still eligible.

Most notably, California had adopted several federal flexibilities to streamline the renewal process and reduce the number of wrongful disenrollments. In other words, without these flexibilities, far more eligible Medi-Cal enrollees would have lost their coverage. AB 2956 would continue those flexibilities that otherwise would expire. The federal agency has extended those flexibilities through June 2025. But without AB 2956, it is unclear that California will extend these flexibilities beyond December 2024.

Advocates have been sounding the alarm that the unwinding process would come down on the backs of poor Californians, particularly communities of color. Although the state is approaching the end of this process, redeterminations are an annual procedure for the Medi-Cal program – meaning that unless protections are put in place, these wrongful disenrollments will continue and be far worse without continuing existing flexibilities. AB 2956 was one last effort to put protections in place. However, today the Legislature held this bill on suspense in the Assembly Appropriations Committee. Coupled with the proposed cuts in the state budget to enrollment navigators, California leaves millions more at risk of wrongfully losing coverage, potentially increasing poverty and negative health outcomes in the state.

“I am disappointed that AB 2956, a bill that would have helped many Californians retain health coverage, did not get the necessary approval to move forward. I remain committed to ensuring that those eligible for Medi-Cal are not routinely disenrolled due to bureaucratic red tape. It is unconscionable to think that over a million people each year are not able to get the care that they need due to something as simple as missing a single piece of paper,” stated Assemblymember Tasha Boerner. 

The bill is co-sponsored by the Western Center for Law and Poverty (WCLP)The Children’s Partnership (TCP), and The Latino Coalition for a Healthy California (LCHC),

“Since Medi-Cal redeterminations began nearly a year ago, 1.6 million low-income Californians, including well over 300,000 children, have lost Medi-Cal coverage, all through no fault of their own. The vast majority of disenrollments are the result of procedural reasons, not eligibility – placing children at risk of losing coverage due to barriers like submitted renewal forms not being received and long call wait times to get questions answered. Even relatively short gaps in Medi-Cal coverage can mean the difference between getting the timely early developmental intervention that growing children and their families need to lead healthy lives and falling dangerously behind in healthy childhood development. Putting families’ coverage in jeopardy, especially our BIPOC communities that are more likely to rely on Medi-Cal for coverage, exacerbates existing racial disparities and undermines Californians’ investments in coverage for all.” – Mayra E. Alvarez, President, The Children’s Partnership

“This important legislation was an intentional fight for justice. The health of Latines is in a fragile state: our community is still facing acute cases of COVID-19, long-COVID and the socio-economic repercussions of the pandemic. This means that now more than ever, Medi-Cal coverage is essential to our well-being. Unfortunately, in the wake of post-pandemic public health emergency flexibilities, Medi-Cal redetermination disenrollments have disproportionately affected Latinos. In 2023, of those who were disenrolled, 49.5% were Latino – that’s 613,280 Latine community members who lost life-saving coverage. We find ourselves at a unique nexus of time. California has led the nation in expanding access to Medi-Cal for ALL, regardless of immigration status. And these disenrollments are an antithesis to the decades of hard work we, as a state, have put in. To truly reach health equity for all Californians, we have to ensure that there are intentional processes that take into account the realities that our communities are facing. The loss of AB 2956  will unfortunately have a dire impact on the health and economy of our state.” – Dr. Seciah Aquino, Executive Director, Latino Coalition for a Healthy California

“We are deeply disappointed that AB 2956 is not moving forward. The failure to permanently extend temporary, innovative fixes that eliminate burdensome administrative barriers means California is turning back the clock and resuscitating a bureaucratic process that stripped health coverage from thousands of people every month.” – Linda Nguy, Associate Director of Policy Advocacy, Western Center for Law and Poverty

“Failing to move forward with AB 2956 is a failure to better protect the most underserved Californians. The restart of the renewals process in the state has provided an incredible opportunity to improve our Medi-Cal eligibility and enrollment systems at a crucial time when millions of residents’ coverage has not been renewed for several years since the start of the Public Health Emergency. Preventing further efforts to enact stronger and improved policies amidst the current momentum on improving Medi-Cal eligibility processes is a huge missed opportunity to mitigate loss of coverage and prevent deeper inequities among underserved communities in California.” – Skyler M. Rosellini, Assistant Director of California Policy, National Health Law Program

CONTACT: 

Robert Nunez

Latino Coalition for a Healthy California

[email protected]

(805) 815-7730

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Assemblymember Tasha Boerner represents the 77th District, which encompasses Carlsbad, Encinitas, Solana Beach, Del Mar, and the coastal communities of La Jolla south to Downtown and Coronado. You can learn more about Assemblymember Boerner at a77.asmdc.org.

Latino Coalition for a Healthy California (LCHC)— is the leading statewide policy organization with a specific emphasis on Latine health. For over 30 years, LCHC has worked on transforming systems to achieve Latinx health justice. We pride ourselves in translating community solutions into equitable policy and lasting systemic change.

The Children’s Partnership is a California advocacy organization advancing child health equity through research, policy, and community engagement. For 30 years, TCP has championed policies that help create a California where all children have the resources and opportunities they need to be healthy and thrive.

Through the lens of economic and racial justice, Western Center on Law & Poverty  litigates, educates, and advocates in courts, cities, counties, the State Capital, and the public arena to secure just housing, health care, economy, and legal systems for  Californians with low incomes.

Newsom’s proposed spending cuts spur backlash from affected California groups

Just minutes after Gov. Gavin Newsom unveiled a revised state budget with billions of dollars in spending reductions on Friday, advocates for affected programs began showering reporters with statements of dismay.

The gist of the complaints was that after Newsom and the Legislature had devoted attention and money to expanded health care coverage, prekindergarten education, income supports for the poor, undocumented immigrant assistance, homelessness, climate change and a myriad other left-of-center causes, the new budget would punish their recipients.

Building the California Dream Alliance, a consortium of nearly 60 groups, was among those disappointed with Newsom’s budget, issuing a compendium of comments from its members, including the Western Center on Law and Poverty.

“Although we appreciate the governor maintaining previous expansions and grants, his approach balances the budget on the backs of low-income Californians through over $3 billion in cuts,” Linda Nguy, an associate director of the organization, said. “Instead of considering additional revenue solutions, the governor proposes to cut in-home supportive services for people who were previously excluded from Medi-Cal due to their immigration status, deeper CalWORKs cuts, and continued cuts to housing and homelessness prevention programs.”

New eligibility rules mean nearly 2 million on Medi-Cal can now save for a rainy day.

FEB. 14, 2024 3 AM PT

Millions of Medi-Cal beneficiaries can now save for a rainy day, keep an inheritance, or hold on to a modest nest egg without losing coverage, thanks to an eligibility change phased in over the past year and a half.

The change also has opened the door for thousands who previously did not qualify for Medi-Cal, the health insurance program for low-income residents that covers over one-third of California’s population.

Until Jan. 1, 3 million Medi-Cal beneficiaries — mainly those who are aged, blind, disabled, in long-term care or in the federal Supplemental Security Income program — faced limits on the value of financial accounts and personal property they could hold and still qualify for coverage. Now, nearly 2 million of them will no longer face these restrictions, putting them on par with the roughly 12 million other Medi-Cal beneficiaries who don’t have asset limits.

They still must be below Medi-Cal’s income threshold, which for most enrollees is currently $1,677 a month for a single adult and $3,450 for a family of four. However, the change will eliminate a lot of paperwork for applicants and the county workers who verify their eligibility.

For a long time, this group of Medi-Cal beneficiaries could have no more than $2,000 in the bank — $3,000 for a married couple — though the home they lived in, as well as one car and certain types of other personal property, were exempt.

“If you had $5,000 in assets, you would have to spend $3,000 on something to prove that you were beneath the limit to qualify,” said Tiffany Huyenh-Cho, a senior attorney at the advocacy group Justice in Aging. “We had people who prepaid rent, spent money on car repairs, bought a new couch or appliances — things to reduce their assets in order to get to the $2,000 limit.”

Now, Huyenh-Cho adds, “you don’t have to remain in deep poverty. You can save for an emergency; you can save for retirement or for a security deposit if you want to move.”

And those who have hoped to leave a little something for their children when they die can now do so, even if they need expensive long-term care.

The first phase of the rule change was implemented in July 2022, when the threshold was raised dramatically to $130,000 for an individual and $195,000 for a two-person household. That was a nonfactor for the vast majority of those concerned; after all, most people with incomes low enough to qualify for Medi-Cal would not have that much saved. For this reason, the total elimination of the so-called asset test ushered in this year is expected to help fewer people financially than the first change did.

Still, there are some people with more than $130,000 in the bank whose savings would have been wiped out in shockingly short order had they needed long-term care in a nursing facility or at home. Now, they can qualify to have Medi-Cal pick up that cost.

Dr. Joanne Shinozaki, a resident of Granada Hills, hired private full-time caregiving last year for her mother, Fujiko, who has dementia. But it cost nearly $11,000 a month, which Shinozaki quickly realized would burn fast through the roughly $200,000 in savings her father had left when he died early last year. Reluctantly, she put her mom in a memory care home, which was less expensive. But after a 10% increase in January, it is now costing $9,000 a month, although that includes food and utilities.

Fujiko Shinozaki, who has dementia, at a memory care home in Agoura Hills.
Fujiko Shinozaki, who has dementia, is currently in a memory care home in Agoura Hills. Thanks to a change in eligibility rules that took effect Jan. 1, she may now qualify for Medi-Cal despite a nest egg her husband left when he died last year.
(Joanne Shinozaki)

Because of the money Shinozaki’s dad left, her mom did not qualify for Medi-Cal under the old rules. Now that money no longer counts against her.

Shinozaki, a veterinarian who quit her job to coordinate her mother’s care, needs to return to work soon. She has applied for Medi-Cal for her mom and is waiting for it to be approved.

“It would mean being able to bring her back to the house where she’s lived since 1988, if she’s well enough to come home,” Shinozaki says. To do that, she will need to get her mom access to caregivers via Medi-Cal’s In-Home Supportive Services program.

Indeed, another benefit of the change in eligibility rules is that it supports the caregiver economy, says Kim Selfon, a Medi-Cal and IHSS policy specialist at Bet Tzedek Legal Services, which provides free legal assistance to people in Los Angeles County.

Advocates who work with Medi-Cal enrollees and applicants say they often have to explain the difference between assets and income.

“I think a lot of people are confused,” says Stephanie Fajuri, program director at the Center for Health Care Rights, an L.A.-based nonprofit that helps people navigate Medi-Cal and Medicare. “They say, ‘What do you mean? I could be making $1 million a year?’ And we say, ‘No, that’s income.’”

So, let’s be clear: Under the new rules, yes, you can have a second house. But if you are renting it out, that’s income — and given today’s rental prices, it will probably disqualify you from full Medi-Cal benefits. You can also keep an investment account regardless of the balance, but distributions from it as well as any interest, dividends and capital gains it generates are also income.

Again, most beneficiaries are unlikely to have a large pool of assets and still have income low enough to qualify for Medi-Cal. But if you suddenly inherit a modest sum — or even a large one — now you can keep it, though it may briefly affect your coverage.

Unfortunately, the 1.1 million Medi-Cal beneficiaries receiving Supplemental Security Income are still subject to an asset test, because different rules apply to them.

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).

‘Worse Than People Can Imagine’: Medicaid ‘Unwinding’ Breeds Chaos in States

In California, staffing shortages at county agencies that administer Medi-Cal, the state’s Medicaid program, are making it more difficult for people to renew their coverage.

In Missouri and Florida, callers waited on hold for more than two hours on hotlines to renew their Medicaid coverage.

In Tennessee, the parents of a disabled man who had been on Medicaid for three decades fought with the state this summer to keep him enrolled as he lay dying from pneumonia in a hospital.

Seven months into what was predicted to be the biggest upheaval in the 58-year history of the government health insurance program for people with low incomes and disabilities, states have reviewed the eligibility of more than 28 million people and terminated coverage for over 10 million of them. Millions more are expected to lose Medicaid in the coming months.

The unprecedented enrollment drop comes after federal protections ended this spring that had prohibited states from removing people from Medicaid during the three pandemic years. Since March 2020, enrollment in Medicaid and the related Children’s Health Insurance Program had surged by more than 22 million to reach 94 million people.

The process of reviewing all recipients’ eligibility has been anything but smooth for many Medicaid enrollees. Some are losing coverage without understanding why. Some are struggling to prove they’re still eligible. Recipients and patient advocates say Medicaid officials sent mandatory renewal forms to outdated addresses, miscalculated income levels, and offered clumsy translations of the documents. Attempting to process the cases of tens of millions of people at the same time also has exacerbated long-standing weaknesses in the bureaucratic system. Some suspect particular states have used the confusing system to discourage enrollment.

“It’s not just bad, but worse than people can imagine,” said Camille Richoux, health policy director for the nonprofit Arkansas Advocates for Children and Families. “This unwinding has not been about determining who is eligible by all possible means, but how we can kick people off by all possible means.”

To be sure, some of the Medicaid recipients who signed on to the program when the U.S. unemployment rate soared amid covid-19 lockdowns have since gotten health insurance through new jobs as unemployment dropped back to pre-pandemic lows.

And some of the disenrolled are signing up for Affordable Care Act marketplace plans. Centene CEO Sarah London, for example, told investors on Oct. 24 that the health care giant expected as many as 2.4 million of its 15 million Medicaid managed care members to lose coverage from the unwinding, but more than 1 million customers had joined its exchange plans since the same time last year.

Still, it’s anyone’s guess how many former Medicaid beneficiaries remain uninsured. States don’t track what happens to everyone after they’re disenrolled. And the final tallies likely won’t be known until 2025, after the unwinding finishes by next summer and federal officials survey Americans’ insurance status.

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CalFresh and other public aid in Sacramento County move to new system

If you get help from Sacramento County to pay for food, health care or housing — and almost half of all residents receive some kind of public assistance — you likely have visited MyBenefits CalWIN to apply for, renew or manage your benefits.

Well, that access point changes this week.

On Monday, the MyBenefits CalWIN site, mybenefitscalwin.org, began redirecting thousands of users to a brand new online portal, BenefitsCAL.com, where they will be directed to create new accounts and link to the personal information already in their files.

“We do have a large percentage of our customers who utilize our online services with our current system,” said Roselee Ramirez, manager of the human services division in the county’s Department of Human Assistance.

Ramirez said the team has been meeting with community-based organizations and advocates to encourage users to create new accounts.

“We want to make sure all our customers are aware of that, so we can help them with getting up on the new online system,” Ramirez said.

BenefitsCal has gone through several years of testing and includes updates that take advantage of 21st century technology, like using cell phones to scan and upload documents, said consumer advocate David Kane of the Western Center on Law & Poverty.

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Western Center Roundup – August 2023


Commemorating the 60th Anniversary of the March on Washington, Black August, and Black Philanthropy Month

This month, we commemorated the 60th anniversary of the March on Washington, led by Rev. Dr. Martin Luther King Jr. and other giants of the civil rights movement. The march and King’s remarks that day are lodged in Americans’ collective memory as a turning point in the struggle for civil rights. Last Saturday, more than half a century later, a multiracial coalition of thousands of people gathered once again on the steps of the Lincoln Memorial to demand social, racial, and economic justice and decry the people and systems that are trying to undo the progress we’ve made over the past 60 years. We recognize that all of our struggles are interconnected, and that liberation requires all of us to play a role in fighting oppression. Black August is a commemoration of the fallen freedom fighters of the Black Liberation Movement, a call for the release of political prisoners, a condemnation of the conditions in prisons, and a continued fight for Black liberation. This month is also Black Philanthropy Month, founded by Dr. Jackie Bouvier Copeland in 2011, as a global celebration and intentional campaign to elevate giving and funding equity. The theme of this year is “Love in Action,” inspired by the writings of bell hooks on love as a driver of true social change. She wrote, “But love is really more of an interactive process. It’s about what we do, not just what we feel. It’s a verb, not a noun.” Our development team continues to intentionally uplift the practice of putting love into action by applying community-centric fundraising principles in their work with the support and guidance of our philanthropy consultant, April Walker from Philanthropy for the People



New Settlement: Affirming Access to Charity Care

Earlier this month, we announced our landmark settlement in a charity care case against Santa Clara Valley Healthcare with co-counsel Consumer Law Center, Inc., addressing the county’s failure to adequately inform patients with low and no incomes of the hospital’s charity care and discount payment policies. As a result, the County has updated their notices on how patients can qualify for free and discounted payments and expanded the number of languages notices are available in. An estimated 43,000 former patients of Santa Clara Valley Healthcare have received notice of possible billing corrections and refunds. “Medical debt, particularly hospital debt, burdens many Californians and forces them to forgo medically necessary care and other life necessities. We hope this lawsuit will give thousands of Santa Clara residents some financial relief,” said Helen Tran, Senior Attorney with the Western Center on Law and Poverty.

News coverage of the settlement can be viewed in Kaiser Health News and KTVU.

 

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9/19: Pasa La Voz and Meet the Advocates – Medi-Cal Renewals

For this next Meet the Advocates, we’re excited to partner with the Latino Coalition for a Healthy California. Their “Pasa La Voz” project aims to spread awareness and education about health, and to provide community resources to Latinx families and individuals in a culturally and community-informed manner. On Tuesday, September 19th from 12:00 PM to 1:00 PM, join Western Center senior attorneys David Kane and Helen Tran and Ana Tutila, a Promotora in Orange County with the Latino Coalition for a Healthy California as they discuss the importance of Medi-Cal renewals for California’s health and racial equity goals – and the current challenges facing those renewing their coverage. Millions of Californians who depend on Medi-Cal are going through the renewal process for the first time since before the start of the pandemic. We’ll be diving into the work advocates and community-based organizations are doing to support people enrolled in Medi-Cal to keep their coverage, highlighting on-the-ground challenges enrollees are facing, and discussing the policy changes needed to improve this process.

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Opinion: Achieving California’s Health Equity Goals Depends on Getting This Process Right

Imagine you receive a stack of papers in the mail, some 20 pages long. You need to read them, confirm and update your personal information, and then find and get copies of physical proof of your income and other household details. The clock is ticking: Your health insurance hinges on your ability or inability to take action in fewer than 60 days. Now imagine English isn’t your primary language, or you work full time, or you are the primary caretaker of your kids or other loved ones. Or imagine you, like thousands of people who are unhoused, do not have reliable access to mail.

For the first time since 2020, millions of Californians are renewing their Medi-Cal benefits. This is typically an annual process that was paused during the pandemic. The federal government sent states more money in exchange for keeping people enrolled during the public health emergency enacted due to the COVID-19 pandemic. Over 15.8 million people have Medi-Cal (California’s version of Medicaid), which provides health coverage for people with low incomes. They include families, people who are undocumented, seniors, children, single adults, people with disabilities and many others. According to the California Health Care Foundation, Medi-Cal covers more than 50 percent of all births, and more than 1 in 4 enrollees speaks a language other than English.

The California Department of Health Care Services (DHCS) just released June 2023 data. Alarmingly, the share of people whose Medi-Cal was terminated is higher than in 2019, the last time this process occurred. For people whose renewal papers were due last month, counties cut off Medi-Cal coverage for more than 25 percent of people simply for paperwork reasons — not because they were no longer eligible for coverage. Instead, their Medi-Cal coverage ended automatically because that is what the county’s computer system is programmed to do if the paperwork isn’t received or processed on time or is incomplete. In June 2019, the cutoff rate was just under 19 percent.

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DHCS official discusses Medi-Cal unwinding data

California began redetermining Medi-Cal eligibility of members in April, and has since disenrolled 225,231 individuals, while 499,093 individuals have maintained their Medi-Cal coverage, according to Yingjia Huang, assistant deputy director of Health Care Benefits and Eligibility at the Department of Health Care Services (DHCS).

This week, Huang hosted a webinar with stakeholders to go over Medi-Cal unwinding information, and shared the state’s interactive dashboard to explain June data.

The diversity and volume of individuals in California make Medi-Cal redeterminations an extraordinary task for all involved, Huang said, adding that over 15 million Californians will undergo the process. DHCS began preparing for the unwinding several years ago when the federal public health emergency was put in place because they were unsure of when the emergency order would end.

The data on DHCS’s dashboard helps the department develop strategies and investments for supporting the Medi-Cal population, and helps the department decide whether it needs to alter messaging to members.

“This is the first time the department has ever posted something so early, which is 45 days after the actual last day of the coverage month of June,” Huang said, adding that DHCS usually reports data 90 days after June, or in October. “This is in the spirit of full transparency in the unwinding journey.”

Total Medi-Cal enrollment for June was 15,568,357 individuals statewide, with the first set of disenrollments taking place on July 1st. While the state continues to conduct redeterminations, individuals are continuing to sign up for coverage. In June, DHCS received 143,069 applications in total, 125,145 of which were determined to be eligible for Medi-Cal coverage or the Children’s Health Insurance Program.

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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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