‘They told me I didn’t have coverage’: Californians shocked by loss of Medi-Cal insurance

In summary

The federal government has suspended an annual Medicaid renewal requirement during COVID-19. Now that it has continued, many Californians are losing coverage for procedural reasons.

Read this article in Spanish.

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 surprised him. She hasn’t had to renew her children’s Medi-Cal coverage in nearly four years. The Los Angeles resident said he doesn’t recall receiving 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 daughters dental exam cost $60, plus the cost of any work that needed to be done. He had to postpone a dental visit until he got his Medi-Cal back.

This spring, the state restarted eligibility checks for low-income people enrolled in Medicaid, better known as Medi-Cal in California. These check-ups usually occur annually, but the federal government stopped them in 2020 so people could maintain health benefits during the COVID-19 pandemic.

Now, six months into the revamped eligibility process, thousands of Californians are finding out they’re losing coverage because of missing or incomplete paperwork. Many, like Miguel’s children, are still eligible, but don’t learn they don’t have 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, about 90%, lose Medi-Cal coverage for so-called procedural reasons, often meaning problems with paperwork. California has the fourth-worst rate of terminations related to procedural issues in the nation, according to the health policy research organization KFF (formerly known as the Kaiser Family Foundation).

Of Californians scheduled to renew Medi-Cal, 47% maintained coverage, 15% were initiated for paperwork problems, 2% were no longer eligible and 35% were still under review, the KFF tracker shows.

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

Californians are not ready for insurance renewals

Advocates say there are several reasons why people may lose coverage even when they are eligible for it. Many people are unprepared or unaware that this verification process has started all over again.

In the time of COVID the message is ignore it, ignore it, don’t worry. For about four years we told people not to worry and then all of a sudden they worry, said Celia Valdez, director of outreach and education at the Los Angeles nonprofit Maternal and Child Health Access. His organization helped Miguel get his children’s Medi-Cal back. But experiences like Miguel’s are common, he said.

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

People who are disenrolled for 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 not fill out the paperwork because they no longer need Medi-Cal and are not eligible.

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

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

More automatic Medi-Cal renewals

The Childrens Partnership, a nonprofit children’s advocacy organization, published a report last week about the experiences of parents and caregivers in renewing their families’ Medi-Cal. The report cited several obstacles that parents say contributed to their children’s loss of 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, coverage gaps lead to delays in care, missed medications and out-of-pocket costs for families.

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

Our [automatic renewal] Historically rates have been lower than many of the other states, likely because they have more electronic resources and databases at their disposal, Huang said. The state is receiving automation tips and technical assistance from the federal government to increase the number of cases that can be automatically renewed, 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 huge gaps in support for people who have questions or need help. Calling county Medi-Cal offices can result in long wait times and organizations like hers have limited capacity, she said. People who are not connected to an advocate or an enrollment counselor may be lost in the process.

Among the top questions and comments from people seeking help 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 county providing registry 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 it every year?’”

The answer is yes, says Graham.

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.

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