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 categorizes this group of 1 in 4 people who have lost Medi-Cal coverage as “failure to respond,” but really that means anything from people not returning renewal information, returning incomplete renewal information, or the county not processing renewal information. Before the pandemic, consumer advocates routinely saw that some people with Medi-Cal never received renewal mailings, and even when people turned in information, their coverage would sometimes end anyway without the county determining them ineligible. This year, people have reported submitting renewal information on the new statewide website, but their Medi-Cal is still cut off.
Alarmingly, Californians ages 65 and over and people with disabilities fare even worse in this renewal process. Years ago, the government decided to treat them differently when designing its computer system. Now that decision has led to preventable age and disability disparities in renewals. These Californians enrolled in Medi-Cal are automatically renewed at a dismal rate of 0.77 percent, compared to an auto-renewal rate of 30.5 percent for everyone else.
We must do better. People having their Medi-Cal coverage automatically terminated is not inevitable. It’s a flawed policy that the state and counties decided to implement before the pandemic — and now is the time to bid it farewell. Since the health of approximately 40 percent of Californians depends on Medi-Cal coverage, the state and counties must look at everybody’s files — and find ways to contact them and evaluate them for ongoing coverage — before cutting off Medi-Cal. Community-based organizations are ready to support counties and the administration to help address cultural and linguistic competency, broadband issues, county staffing shortages and overall outreach.
The pandemic underscored the importance of keeping people healthy and insured. Millions were able to access free testing and free vaccinations thanks to federal and state guidelines. Medi-Cal covers physical, oral and mental health, and improves both community health and the economic security of enrollees. Having access to a primary-care provider leads to higher patient satisfaction, more equitable health outcomes, better quality of care and lower mortality.
When Medi-Cal coverage ends, people can get their Medi-Cal back. They can turn in missing information within 90 days after the discontinuance. If the information shows they meet Medi-Cal’s requirements, their coverage will be restored.
The pandemic taught us many things, including that we are all responsible for making sure everyone can be healthy. It is important we get this process right for the millions whose lives depend on Medi-Cal. Automatically cutting Medi-Cal coverage violates our values and the work we’ve done to create a California for all.
David Kane is a senior attorney at the Western Center on Law and Poverty, advocating for health, racial and economic justice.