Americas Community Health

California Medi-Cal coverage expanded despite redetermination

By Caesar Antonio Nucum Jr

SAN FRANCISCO – In its continuing goal to keep as many people enrolled as possible at a time when many other states were using “the great unwinding” to purge their Medicaid lists, California’s Department of Health Care Services (DHCS) launched last year a federally mandated annual initiative to redetermine Medicaid eligibility (called Medi-Cal in California) as one out of three residents in the Golden State is on Medi-Cal.

At the April 16 California Ethnic Media News Briefing titled “Medi-Cal’s Impact After Redetermination – How Californians Can Renew Coverage” jointly presented by Ethnic Media Services and California Black Media, a DHCS expert shared the data on how redetermination has impacted Medi-Cal enrollment numbers, and plans for Medi-Cal moving forward while a director of one health clinic in LA County that has the most Medi-Cal enrollees in California, discussed its ongoing efforts to assist eligible recipients to stay on Medi-Cal and re-enroll if they were dropped.

Three storytellers discussed the importance of Medi-Cal to their families and share their experience getting or keeping it.

The same briefing was attended by Assistant Deputy Director, Health Care Benefits and Eligibility  (HCBE), California Department of Health Care Services Yingjia Huang, Director, Managed Care and Enrollment, Northeast Valley  Health Corporation (NEVHC) Vilma Champion, Medi-Cal enrollee Griselda, Medi-Cal enrollee at African American Network of Kern County Fitzgerald Graves and daughter of newly enrolled undocumented mother Dara Montejo.

The start of California’s redetermination with the end of the federal COVID-19 emergency a year ago, came at a time when many states used the process to drop Medicaid members from the rolls in large number with Texas removing over two million members since the pandemic-era protections were lifted, while Florida removed nearly one million. California, on the other hand, is on the front line of efforts not only to retain but expand health coverage.

Huang referred to the nationwide redetermination of Medicaid as “the great unwinding, one of the biggest healthcare events after the Affordable Care Act.”

“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,” Huang revealed. “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.”

Huang continued that their January and February 2024 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,” Huang 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.”

Huang also reported that in January 2024, DHCS also expanded Medi-Cal to eligible undocumented individuals of all ages adding about 700,000 people to full-scope benefits and did it through the unwinding, and they are very proud of where they are.

Managed Care and Enrollment at Northeast Valley Health Corporation (NEVHC) in the San Fernando and Santa Clarita Valleys Director Champion confirmed that Medi-Cal has expanded to everyone regardless of citizenship and immigration status and it’s ever-more vital for the health of the communities they serve and gets them closer to health care for all.

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 “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.  

Griselda, a Spanish-speaking NEVHC patient, through a translator, is happy as a mother of three children is very thankful that the workers at her clinic in Sun Valley made re-enrollment so smooth.

“Good health ensures the future for our children. I hope Medi-Cal is always there for them. I am 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,” Griselda narrated.

Montejo, a daughter of a new enrollee, recounted the time last August when her undocumented mother from Yucatan had her first seizure and was thought to be dying. Montejo called the ambulance just the same being the last option she had but was continuously bothered by how much they will be billed on top of what her mother’s condition would be like.

“That was last August,” Montejo 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,” recounted 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,” Kern sadly continued.

“I’m happy to say that all of our family is now on Medi-Cal,” Graves is relieved. “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,” Kern 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.”