225,000 Medi-Cal enrollees lost coverage in June; here’s how that compares with prior years [The 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 free or low-cost 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.

Historically, during that 90-day period, California has reinstated 4% of those whose coverage wasn’t renewed on time, Cooper said, and if that holds, it would mean that Medi-Cal would beat its typical disenrollment rates of 18% to 20%.

“We are very happy with our current June numbers,” Cooper said. “However, we know that we want to do more to keep people covered and to ensure that they have what they need. So we will continue to partner with our managed care plans, our PACE organizations, our navigators. We are proactively sending them lists of Medi-Cal members who have been disenrolled so they can do direct outreach to those individuals within the 90-day period.”

While PACE organizations provide medical services and everyday living needs to elderly Americans, the state put $140 million toward funding health navigators to get the word out to individuals so that they can remain covered.

The Bee asked consumer advocate David Kane, a senior attorney with the Western Center on Law & Poverty, to review data that Cooper shared with the media Thursday. He said that, while the overall percentage of disenrollments may be about the same or better than pre-pandemic numbers, he is troubled by the proportion of enrollees who are not responding to Medi-Cal’s requests for information.

In the Medi-Cal enrollment process, beneficiaries can be qualified in one of two ways. First, a state computer system attempts to renew coverage automatically by scouring federal and state databases for data that proves eligibility. About 26% of enrollees were renewed this way last month

The other roughly 74% were sent questionnaires, and they had to return them by June 30. Their answers are used to determine their eligibility.

But almost 200,000 people, or about 25.7% of those who were sent questionnaires, didn’t respond for some reason, Kane said. Many Medi-Cal enrollees frequently suffer financial upheavals and have a number of health challenges, Kane and other advocates have told The Bee, so they don’t always have stable housing situations. Over the three years of the pandemic, they said, enrollees may have changed addresses multiple times. Enrollees also report having to hang up to take care of other business after waiting hours on hold to speak with someone in their county Medi-Cal office, Kane said.

A report from the US Department of Health and Human Services noted that enrollees sound common themes when asked about the re-enrollment process: “I never got the notice,” “I couldn’t get through to the call center” or “I sent in the paperwork but it got lost.”

Whatever the reason, Kane said, June’s failure-to-respond rate is higher than the 18.9% that Medi-Cal saw in June 2019. Even if the most recent rate drops by 4% over the 90-day period, Kane said, it will still be higher than it was in the comparable month prior to the pandemic.

“Based on the limited comparison to June 2019, that’s concerning,” Kane said, “and that means we have to do more to make sure people are able to respond and that counties process whatever responses come in. ... We still have work to do to keep people covered.”

How DHCS is stepping up outreach to Medi-Cal enrollees

The Department of Health Care Services, which oversees Medi-Cal, has been planning for this moment since late 2021 and already has put in place a number of measures to reach enrollees, Cooper said, but more is planned.

In addition to recruiting health navigators and partnering with organizations that directly serve enrollees, DHCS has invited volunteers to sign up as coverage ambassadors to spread the word that continuous Medi-Cal coverage is ending. Between ambassadors and navigators, there are roughly 3,500 people on the ground doing this work, Cooper said.

The department also is funding a communications campaign in 19 languages, and if enrollees no longer meet income eligibility requirements, Medi-Cal is working with Covered California to make them aware of health insurance plans available on the state-based marketplace. Many Californians are eligible for coverage that costs $10 or less each month.

For the first time ever, Cooper said, DHCS began sending out emails, more than 7 million so far, as well as text messages, 1 million of those, to enrollees to let them know they needed to sign up.

DHCS is also rolling out other efforts soon, Cooper said, sending out toolkits to schools in the fall and working with the California Department of Social Services to get toolkits both to vulnerable individuals who get in-home supportive services and to their providers.

Number of Medi-Cal disenrollments could far exceed past years

While the percentage of people losing coverage could be about the same as historical figures, the sheer number of people affected by disenrollment has risen dramatically because states couldn’t drop anyone’s coverage.

In California, a third of state residents or more than 15.5 million people were on Medi-Cal by the time federal officials approved restarting the Medicaid renewal process. That was up from 12.5 million in March 2020.

Cooper said that DHCS has estimated that 1.8 million to 2.8 million Californians could lose their Medi-Cal coverage over the next 12 months. The number would be at the high end of that range if 17% of Medi-Cal enrollees lose coverage.

An analysis by the US Department of Health and Human Services found that 72.2% of children risk losing their Medicaid coverage despite being eligible. Latinos and families making below 100% of the federal poverty limit are also disproportionately at risk of losing Medi-Cal coverage.

Medi-Cal enrollees with June renewal dates were the first to go through the process since early 2020. If you look back at June 2019, Medi-Cal had a disenrollment rate of about 17%, but it affected far fewer people — 133,800 individuals — than the roughly 225,000 people whose coverage was cut off June 30.

“We too often see that, when Medi-Cal is cut off, that’s when somebody cannot pick up a prescription drug at the pharmacy,” Kane said. “It’s when their transportation to take them to dialysis does not arrive. It’s when their surgery is canceled. Those kinds of things happen. ... Unfortunately for too many people, they actually don’t get access to needed medical care when their Medi-Cal is inactive.”

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