A year ago, with the end of the federal COVID-19 emergency, California started redetermining eligibility for the one out of three of its residents on Medi-Cal, its version of Medicaid.
At a time when many states are using this process to drop Medicaid members from the rolls en masse — Texas, for instance, has removed over two million members since the pandemic-era protections were lifted, while Florida has removed nearly one million — California is on the front line of efforts not only to retain but expand health coverage.
At an Ethnic Media Services Briefing, a state Department of Health Care Services (DHCS) official, community health care enrollment workers and Medi-Cal enrollees shared how redetermination has impacted enrollment, efforts to keep eligible members enrolled and the importance of keeping Medi-Cal services.
An overview of the unwinding
The nationwide redetermination of Medicaid, known as “the great unwinding,” is “one of the biggest healthcare events after the Affordable Care Act,” said Yingjia Huang, DHCS Assistant Deputy Director of Health Care Benefits and Eligibility. “It ends next month, in May 2024. California was able to renew and is continuing to renew nearly 15 million Medi-Cal members — and we’ve learned quite a bit.”
In November 2023, with 1 million Californians up for renewal that month, the state had a 21 percent disenrollment rate, whether due to ineligibility or errors with returning paperwork.
In December, however, DHCS automated much of the online enrollment process, “reducing that 21 percent disenrollment to about 9 percent,” said Huang. “Our January and February data shows that it continues to decrease, and those who are disenrolled for procedural reasons have 90 days to re-enroll with no gap in coverage.”
“One of the major obstacles was filling out that hefty redetermination packet. Many of our members came onto the program during the pandemic, and never did redetermination before, as the annual process was paused,” she explained. “Alongside automating the process to help members, we’ve created how-to videos and outreach to enroll over the phone or online, translated into 19 languages.”
In January 2024, DHCS also expanded Medi-Cal to eligible undocumented individuals of all ages adding about 700,000 people to full-scope benefits, she continued. “We did all that as we were going through the unwinding, and we’re very proud of where we are.”
“Now that Medi-Cal has expanded to everyone regardless of citizenship and immigration status, it’s ever-more vital for the health of the communities we serve and gets us closer to health care for all,” said Vilma Champion, Director of Managed Care and Enrollment at Northeast Valley Health Corporation (NEVHC) in the San Fernando and Santa Clarita Valleys.
With the expansion, NEVHC expects to provide primary and preventive services to over 6,000 newly eligible patients. With the unwinding, its clinics have helped over 5,000 patients re-enroll, the bulk of whom were monolingual Spanish speakers from immigrant backgrounds.
Champion suggested that, “to meet our patients where they are with access to care before they need it when they’re sick,” DHCS have culturally-tailored outreach for those with public charge or immigration status concerns, and reintroduce Saturday hours to increase accessibility and reduce wait times for those with conflicting work schedules.
Firsthand stories
“As the mother of three children, I’m very thankful that the workers at my clinic in Sun Valley made re-enrollment so smooth,” said Griselda, a Spanish-speaking NEVHC patient, through a translator. “Good health ensures the future for our children. I hope Medi-Cal is always there for them.”
She said she was especially grateful to be able to take her children to yearly physicals, and have them access normally expensive dental care: “My 15 year old daughter had a problem where she couldn’t close her teeth, and she was aware that kids who have this get bullied in school. She was very happy to get braces and prevent that from happening.”
“Last August, near San Diego, my mother, from Yucatan, had her first seizure,” said Dara M., daughter of a new enrollee. “She was undocumented and I didn’t know much about Medi-Cal at the time; I thought she was dying. Even when I was calling the ambulance, in the back of my mind, I thought, ‘How much will the bill be?’ and when the EMTs came, we decided to take her in my dad’s car. I wasn’t feeling safe, but it felt like the only option.”
“That was last August,” she continued. “As of January, Medi-Cal has now opened its arms to her and I’m not scared of telling her to go to the emergency room whenever she feels bad, because I know we won’t get a bill of thousands of dollars, or over $100 for each bottle of her monthly prescriptions. It’s really nice not having to worry about that anymore.”
Although Medi-Cal is expanding and improving, some still fear accessibility gaps and stigma.
“When my daughter got pregnant, she didn’t know how to navigate Medi-Cal. I helped get her enrolled, but we kept having to go to different clinics and doctors,” said Fitzgerald Graves, an enrollee with the African American Network of Kern County. “There was no rapport or consistent diagnosis … it turned out the baby had encephalitis, but the doctor told us the heartbeat was fine, and actually cursed us.”
“At a second hospital, they told us there was no heartbeat. The baby had passed in the womb,” he continued.
“I’m happy to say that all of our family is now on Medi-Cal,” Graves said. “My daughter and her fiancee are now expecting a little girl and I’ve tried to get her to use this new enrollment as a tool to get therapy and advocate for herself in finding physicians … I’m now scheduled for knee surgery due to a car accident. I’m confident in my surgeon and relieved to have the coverage.”
“What the state’s doing to keep people on Medi-Cal is the right way to go, and it’s only getting better,” he added. “My hope for the future of health care in California is that people have support in navigating the benefits they now have access to.”
