‘They told me I have no coverage’: Californians surprised by loss of Medi-Cal insurance


Summary

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

This is an Espaol article.

Florinda Miguel took her 6-year-old daughter to her regular dentist in early December, but there she learned her Medi-Cal coverage had ended.

This 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. He said, I don’t know if they sent it or not, if it’s lost I don’t know but I didn’t get it.

Her daughter’s dental exam will cost $60, plus the cost of any necessary workup. She had to postpone dental visits until she could reestablish her Medi-Cal.

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

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

More than 928,000 people had their Medi-Cal exhausted between June and October, according to state data. The vast majority of them, about 90%, lost Medi-Cal coverage for so-called procedural reasons, which often means problems with paperwork. According to the health policy research organization KFF (formerly known as the Kaiser Family Foundation), California’s rate of terminations related to procedural issues is the fourth worst in the nation.

The KFF tracker shows that 47% of Californians due for Medi-Cal renewal retained coverage, 15% were dropped due to paperwork problems, 2% are no longer eligible and 35% are still under review. Are.

People who lose their Medi-Cal but are still eligible can return within the 90-day grace period, provided they submit any missing information via mail or online. As of October, the program covered 15.1 million people.

Californians aren’t ready to renew insurance

Advocates say there are many reasons why people are losing coverage, even if they are eligible for it. Many people were not prepared for this or were unaware that this verification process had started again.

The message during Covid was ignore, ignore, don’t worry. “For about four years we told people not to worry, and then suddenly they have to worry,” said Celia Valdez, director of outreach and education at the Los Angeles nonprofit Maternal and Child Health Outreach. His organization helped Miguel get his children’s Medi-Cal reinstated. But experiences like Miguel’s are common, he said.

many [enrollees] They’re saying I couldn’t get my prescription filled, I went to the doctor and they told me I don’t have any coverage,” Valdez said.

People who are being disenrolled for procedural reasons fall under several buckets, said Yingjia Huang, assistant deputy director of 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 or would qualify for Medi-Cal.

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

Health advocates say some people may be submitting their paperwork close to their deadlines and county offices may not be processing them in time.

More automatic Medi-Cal renewals

The Children’s Partnership, a nonprofit children’s advocacy organization, published a report last week about the experiences of parents and guardians renewing their family Medi-Cal. The report cites several barriers that parents say contribute to their children losing coverage, including: phone calls not being returned, long wait times for calls, confusing instructions, limited access to translators, feelings of discrimination and lack of awareness.

Gaps in coverage led to delayed care, missed medications and out-of-pocket expenses for families, according to the report.

Huang, with the Department of Health Care Services, said the state is working to increase the number of people whose coverage can be automatically renewed using a state electronic database that verifies an enrollee’s income and eligibility. Can.

Our [automatic renewal] Rates have historically been lower than many other states, Huang said, adding they likely have more electronic sources and databases they can use. 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.

This reduces 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 who need help. Calling county Medi-Cal offices can result in hours-long wait times, she said, and organizations like hers have limited capacity. Those who are not connected to an attorney or enrollment consultant may get lost in the process.

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

And they don’t know what to do. Often the packets are opened, Graham said, but they are completely empty. The next question is, do I have to do this every year?

The answer is yes, Graham said.

Supported by the California Health Care Foundation (CHCF), which works to ensure People get access to the care they need, when they need it, at a price they can afford. visit www.chcf.org to find out more.


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