Medi-Cal Archives – Western Center on Law & Poverty

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

August 14, 2023, By David Kane, California Health Report

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.

DHCS official discusses Medi-Cal unwinding data

August 9, 2023, By Hannah Saunders, State of Reform

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.

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

July 27, 2023, By Hannah Saunders, State of Reform

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.

Tens of thousands lose Medical eligibility

July 25, 2023July 25, 2023, By Mariel Mallare Jimenez, KALW

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.

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

July 25, 2023July 25, 2023, 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.

People are losing their Medi-Cal coverage, what can be done?

July 24, 2023July 25, 2023, By Jennifer Hodges, KCBS

More than 200,000 people have lost their Medi-Cal health coverage, mostly because they didn’t return paperwork.

Those preliminary numbers come after the state brought back a renewal process that had been suspended during the pandemic.

For more on the implications, Jennifer Hodges spoke with David Kane, a senior attorney with the Western Center on Law and Poverty.

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

July 21, 2023July 25, 2023, By Cathie Anderson, Sacramento Bee

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.

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

July 21, 2023July 25, 2023, By Ana Ibarra, CalMatters

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.”

Tens of thousands of L.A. County residents could soon lose Medi-Cal coverage. Here’s why

July 3, 2023July 25, 2023, By Emily Alpert Reyes, Los Angeles Times

Tens of thousands of people in Los Angeles County could lose their Medi-Cal coverage in July, according to preliminary data provided to a health plan that serves Angelenos on the public program.

L.A. Care, a publicly operated health plan in L.A. County, said that early data provided by the state indicate that roughly 40,000 of its members enrolled in Medi-Cal could lose their coverage this month, although final numbers are still pending.

Those figures do not include Medi-Cal recipients who are not covered by L.A. Care, which serves roughly 2.7 million of the nearly 4.7 million people in L.A. County who were enrolled in Medi-Cal as of this spring, according to state figures. The numbers are expected to keep shifting as more people return paperwork that was due Friday to renew their coverage in California’s Medicaid program, the beginning of a process that will play out over the next year.

But the tentative figures are an early sign of the serious shift underway as the federal government has rolled back rules that helped people stay on Medicaid, one that has troubled health providers and advocates who fear many patients will unnecessarily lose medical coverage for which they qualify.

“Losing Medi-Cal coverage is not a mere inconvenience or annoyance,” said David Kane, an attorney at the Western Center on Law & Poverty. “For far too many it can be life-threatening. It can mean that transportation to dialysis does not show up. Surgery is canceled. You cannot pick up your prescription drugs.”

Analysis Of Governor Newsom’s 2023-2024 May Revision Budget

May 12, 2023May 15, 2023, By WCLP Policy Team

The Newsom Administration released its 2023-24 May Revision budget, projecting a $31.5 billion deficit. After years of a budget surplus, California is forecasting a downturn in funding due to a combination of capital gains losses and delayed tax filings due to natural disasters, but California remains strong. The May Revision reflects a $37.2 billion in total budgetary reserves and additional funds from the Managed Care Organization tax.

Governor Newsom maintains many of the Administration’s and legislature’s previous commitments and proposes no new trigger cuts. He also proposes no new corporate or personal taxes, despite calls from the Senate and advocates to increase taxes on wealthy corporations and the state’s highest earners.

We appreciate that the May Revision maintains past budget agreements including expansion of Medi-Cal to all regardless of immigration status, reforming the Medi-Cal share-of-cost, and on-time implementation of food assistance for Californians 55 years of age or older, regardless of immigration status.

As the fourth largest economy in the world, California has made great strides in addressing poverty and systemic inequities, but there is more work to be done. We look forward to working with the legislature and Administration to protect low-income Californians as the State enters more uncertain fiscal circumstances.

Below are our initial reactions to the proposed budget by issue area, with a focus on changes from the January budget proposal.

HEALTH CARE

Health4All: The May Revision maintains full funding to expand full-scope Medi-Cal eligibility to all income eligible adults ages 26-49 regardless of immigration status on January 1, 2024. The May Revision includes increases for previous expansions for adults 50 and older and ages 26-49 due updated managed care rates, higher share of state-only costs, higher caseloads, and higher acuity members.

Managed Care Organization (MCO) Tax: The May Revision proposes a bigger MCO tax with an earlier start date (April 2023 through end of 2026). This results in $19.4 billion in total funding, including $3.4 billion for 2023-24. $8.3 billion is proposed to offset General Fund and $11.1 billion is proposed to support Medi-Cal investments that improve access, quality, and equity over an 8- to10-year period. These investments include rate increases to at least 87.5% of Medicare for primary care, birthing care, and non-specialty mental health providers and the remainder will be put into a special fund reserve for future consideration.

Covered California Affordability Sweep: The May Revision maintains proposal to sweep Covered California reserve fund to General Fund totaling $333.4 million.

Distressed Hospital Loan Program: The May Revision includes up to $150 million one-time General Fund to provide interest-free cashflow loans to not-for-profit and public hospitals in significant financial distress or to governmental entities representing a closed hospital, for purposes of preventing the closure of, or facilitating the reopening of, those hospitals.

Home and Community-Based Services Spending Plan Extension: The May Revision includes a six-month extension until September 30, 2024 for specified programs such as the IHSS Career Pathways Program and the Senior Nutrition Infrastructure Program to fully spend allocated funding based on critical programmatic needs.

Doula Services Implementation Evaluation: To align with later implementation date, TBL is proposed to extend the timeline of the Doula Stakeholder Workgroup (from April 1, 2022 until December 31, 2023) and to extend the evaluation of the doula benefit implementation in the Medi-Cal program (from April 1, 2023 until June 30, 2025).

Medical Interpreter Pilot Program: Through TBL, the May Revision proposes to extend the expenditure authority of the Medical Interpreter Pilot Project for 12 months, from June 30, 2024 to June 30, 2025.

988 Update: The May Revision includes a one-time augmentation of $15 million for a total of $19 million, from the 988 State Suicide and Behavioral Health Crisis Services Fund for California’s 988 centers. This increase will support workforce expansion to handle increased answered call volume, extensions of service hours, and the availability of chat and text options for callers utilizing the 988 services.

BH-CONNECT Demonstration (formerly referred to as CalBH-CBC Demonstration): The May Revision includes an update to the BH-CONNECT Demonstration to include a new Workforce Initiative and includes $480 million in funding for each year of the five-year demonstration period ($2.4 billion total funding and no General Fund).

CalRX and Reproductive Health: The May Revision includes TBL and $2 million one-time General Fund reappropriation from the Capital Infrastructure Security Program and allows the use of these funds for reproductive health care if necessary.

Community Assistance, Recovery, and Empowerment (CARE) Act: The May Revision includes additional funding to support the implementation of the CARE Act. Compared to the Governor’s Budget, the annual increase is between $43 million and $54.5 million to account for refined county behavioral health department cost assumptions, additional one-time $15 million General Fund for Los Angeles County start-up funding. The May Revision also includes an additional $16.8 million in 2023-24, $29.8 million in 2024-25, and $32.9 million ongoing to double the number of hours per participant for legal services from 20 hours to 40 hours.

HOMELESSNESS

The May Revision preserves the full $3.7 billion in funding for homelessness programs, as committed in previous budgets, including $1 billion for the Homeless Housing, Assistance and Prevention grant program.

May Revision Adjustments:

Behavioral Health Bridge Housing Program: $500 million one-time Mental Health Services Fund in 2023-24 in lieu of General Fund. This investment eliminates the January Budget proposed delay of $250 million General Fund to 2024-25 and restores the $1.5 billion commitment funded in the 2022 Budget Act for the program.

HOUSING

While the May Revision reflects a steady commitment to Homelessness investments, the May Revision also culminated in a weakening of housing investments totaling $17.5 million in General Fund reductions and $345 million in deferrals related to housing programs. Funding for housing programs remains at approximately 88% of the allocations made in 2022-23 and proposed for 2023-24 ($2.85 billion). This outlook could change if there are sufficient General Fund dollars in January 2024. If that occurs, the Governor has committed to restoring $350 million of these reductions. Overall, the proposal includes $500 million continued annual investment in the state Low-Income Housing Tax Credit program, $225 million for the Multifamily Housing Program, and $100 million for the Portfolio Reinvestment Program. These programs have a proven track-record of addressing housing affordability and homelessness across California.

May Revision Adjustments:

Foreclosure Intervention Housing Prevention Program: Provides funds to various non-profit organizations to acquire foreclosed property and operate as affordable housing. Deferral of $345 million of the $500 million one-time General Fund over four fiscal years—for a revised allocation of: $50 million in 2023-24, $100 million in 2024-25, $100 million in 2025-26, and $95 million in 2026-27

Downtown Rebound Program: Funds adaptive reuse of commercial and industrial structures to residential housing. Reverts $17.5 million in unexpended funding that remained in this program after the Notice of Funding Availability.

In contrast, the Senate’s Budget Plan, which was released two weeks ago, both prevents funding cuts and delays, and builds on our progress by including ongoing investment in homelessness and resources for key housing production programs. Notably, that Plan provides $1 billion in ongoing funds to support the Homeless Housing Assistance, and Prevention Program, $1 billion towards the state Low-Income Housing Tax Credit Program, and an additional $300 million flexible allocation towards affordable housing programs.

Western Center is a proud member of a coalition of California’s leading affordable housing, homelessness, and housing justice advocacy organizations championing a comprehensive coalition investment strategy for affordable housing production, preservation, and tenant stability. While the May Revision falls short of our requests to meet the housing and homelessness crisis at scale, we look forward to continuing our budget advocacy and encourage the Governor and Legislative leadership to finalize a budget that includes ongoing, significant resources like those included in the Senate budget plan and our coordinated housing budget letter.

PUBLIC BENEFITS AND ACCESS TO JUSTICE

CalWORKs Grant Increase: The May Revision reflects a 3.6-percent increase ($111.2 million in 2023-24) to CalWORKs Maximum Aid Payment levels, effective October 1, 2023. These increased grant costs are funded through the Child Poverty and Family Supplemental Support Subaccount.

Supplemental Security Income/State Supplementary Payment (SSI/SSP): The May Revision continues to include an 8.6% increase in funding for the SSI/SSP and Cash Assistance for Immigrants (CAPI) program providing a $3.6 billion from the general fund. This allocation provides recipients with an increase in grant levels to $1,134 per month and $1,928 per month for couples.

California Food Assistance Program (CFAP) Expansion Update: The May Revision moves up the issuance of food benefits for older undocumented immigrants to start October 2025, instead of the January Proposal that delayed it until 2027, which we appreciate but we still need Food4All regardless of age and immigration status.

Summer Electronic Benefit Transfer (EBT) Program: The May Revision includes $47 million ($23.5 million General Fund) for outreach and automation costs to phase in a new federal Summer EBT program for children who qualify for free or reduced-price school meals beginning summer 2024.

Safety Net Reserve: The May Revision withdraws $450 million (half of $900 million) from the Safety Net Reserve. The reserve is intended to maintain existing Medi-Cal and CalWORKs program benefits and services when program cost may increase due to economic conditions, which may occur if recession occurs, so we argue it is prudent to not draw from Safety Net Reserve until those conditions are met.

Services for Survivors and Victims of Hate Crimes Augmentation: The May Revision includes an additional $10 million General Fund to support services for victims and survivors of hate crimes and their families and facilitate hate crime prevention measures in consultation with the Commission on Asian and Pacific Islander American Affairs.

For questions, contact:

Health:  Linda Nguy, Senior Policy Advocate – lnguy[at]wclp.org; Sandra Poole, Policy Advocate – spoole[at]wclp.org
Housing and Homelessness: Cynthia Castillo, Policy Advocate – ccastillo[at]wclp.org; Tina Rosales, Policy Advocate – trosales[at]wclp.org

Public Benefits/ Access to Justice: Christopher Sanchez, Policy Advocate – csanchez[at]wclp.org

Tag: Medi-Cal