Many Californians Lose Medi-Cal Coverage in Benefits Reviews

Florinda Miguel took her 6-year-old daughter for a routine dentist appointment in early December only to find out that her Medi-Cal coverage had lapsed.

It took her by surprise. She hadn’t had to renew her kids’ Medi-Cal coverage in almost four years. The Los Angeles resident said she doesn’t recall getting any notices or renewal paperwork in the mail this year. “I don’t know if they sent it, if it was lost, I don’t know but I didn’t get it” she said.

Her daughter’s dental exam would cost $60, plus the cost of any work that needed to be done. She had to postpone the dental visit until she could get her Medi-Cal reinstated.

This spring, states restarted eligibility reviews for low-income people enrolled in Medicaid, better known as Medi-Cal in California. These check-ups usually happen every year, but the federal government paused them in 2020 so that people would maintain health benefits during the COVID-19 pandemic.

Now six months into the renewed eligibility process, thousands of Californians are finding that they are losing their coverage due to missing or incomplete paperwork. Many, like Miguel’s children, are still eligible, but don’t learn they’re going without coverage until they seek medical care.

More than 928,000 people had their Medi-Cal terminated between June and October, according to state data. The vast majority of them — close to 90% — lost Medi-Cal coverage because of so-called “procedural reasons,” often meaning problems with paperwork. California has the fourth worst rate of terminations linked to procedural issues in the nation, according to the health policy research organization KFF (formerly known as the Kaiser Family Foundation).

Among Californians who have been due for Medi-Cal renewals, 47% retained coverage, 15% were kicked off for paperwork problems, 2% no longer qualified and 35% are still under review, the KFF tracker shows.

People who lose their Medi-Cal but are still eligible can hop back on within a 90-day grace period as long as they submit any missing information through the mail or online. As of October, the program covered 15.1 million people.

Advocates say there are a number of reasons people may be losing coverage even though they are eligible for it. Many people were simply unprepared or unaware this verification process had restarted.

“During COVID the message was ignore, ignore, don’t worry. For close to four years we told people not to worry and then all of sudden they had to worry,” said Celia Valdez, director of outreach and education at the Los Angeles nonprofit Maternal and Child Health Access. Her organization helped Miguel reinstate her kids’ Medi-Cal. But experiences like Miguel’s are common, she said.

“Many [enrollees] are saying ‘I couldn’t fill my prescription, I went to the doctor and they told me I have no coverage,’” Valdez said.

People who are being disenrolled under “procedural reasons” tend to fall under several buckets, said Yingjia Huang, assistant deputy director at the California Department of Health Care Services, the state agency that oversees the Medi-Cal program. For example, some people may now have health insurance through an employer and are not filling out the paperwork because they no longer need Medi-Cal nor would they qualify.

Others moved during the pandemic and didn’t report their new address to their county Medi-Cal office, so they did  not receive the renewal alerts. Other enrollees, especially those who are new to the program, may not understand that yearly reviews are the norm.

Health advocates add that some people may be submitting their paperwork close to their deadline and county offices may not be processing them on time.

More automatic Medi-Cal renewals

The Children’s Partnership, a nonprofit children’s advocacy organization, last week published a report about parents’ and guardians’ experiences with renewing their families’ Medi-Cal. The report noted several obstacles that parents say contributed to their children losing coverage, including: unreturned phone calls, long call wait times, confusing instructions, limited access to translators, feelings of discrimination and lack of awareness.

According to the report, gaps in coverage led to delays in care, missed medications and out-of-pocket costs for families.

Huang with the department of health care services said the state is working to increase the number of people whose coverage can be renewed automatically using state electronic databases that can verify an enrollee’s income and eligibility.

“Our [automatic renewal] rates historically have been lower than many of the other states, they probably have more electronic sources and databases that they can use,” Huang said. The state has been receiving automation tips and technical assistance from the federal government to increase the number of cases that can be renewed automatically, Huang said.

“That just eases the administrative burden on our members as well as our counties,” Huang said.

Valdez and other health advocates say there are significant gaps in support for people with questions or in need of assistance. Calling county Medi-Cal offices can result in hours-long waits and organizations like hers have limited capacity, she said. People who are not connected to an advocate or an enrollment counselor could get lost in the process.

Among the top questions and comments from people seeking assistance is that the paperwork is too much or too confusing, said Kimberley Graham, director of patient access at AltaMed Health Services, a clinic system in Los Angeles and Orange counties that provides enrollment services.

“And they don’t know what to do. So often the packets are opened, but they’re completely blank,” Graham said. “The next question is ‘Do I have to do this every year?'”

The answer is yes, Graham said.

Ana B. Ibarra is a reporter with CalMatters.

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