Almost 1M Lose Coverage: Medi-Cal's Procedural Struggles

Author’s note: This article is summarized from various sources, and attributions are linked within.

Sick child in hospitalPhoto byAlexander GreyonUnsplash

Thousands of Californians lost their Medi-Cal (Medicaid in California) coverage through no fault of their own, due to procedural issues during the renewed eligibility reviews.

Though during and after the pandemic, Medi-Cal was auto renewed for many, in the spring of 2023 states restarted eligibility reviews for low-income people. This resulted in over 928,000 people losing coverage between June and October. Approximately 90% lost coverage due to paperwork problems, making California the fourth-worst state in the nation for such terminations. Many eligible individuals discovered their coverage lapse only when seeking medical care.

Per Kimberly Graham, director of AltaMed Health Services, a clinic system in Los Angeles and Orange counties that provides enrollment services, those who need help state that “the paperwork is too much or too confusing.” Graham continues, “And they don’t know what to do. So often the packets are opened, but they’re completely blank. The next question is ‘Do I have to do this every year?' The answer is yes.”

The Kaiser Family Foundation tracker reveals that 47% of Californians due for Medi-Cal renewals retained coverage, 15% were removed for paperwork issues, 2% no longer qualified, and 35% are still under review. Advocates cite reasons for coverage loss, including unpreparedness and unawareness of the restarted verification process.

Medi-Cal allows re-enrollment within 90 days for those still eligible, but procedural hurdles persist. Health advocates point out gaps in support, such as unreturned calls, long wait times, confusing instructions, limited translator access, and lack of awareness. Gaps in coverage lead to delays in care, missed medications, and out-of-pocket costs for families.

Other causes of dropped coverage falling under the umbrella of procedural issues include individuals gaining employer-based insurance or not reporting address changes to Medi-Cal offices.

To address the many challenges and loss of healthcare, the state is working on increasing automatic renewals using electronic databases, but concerns persist over administrative burdens and limited support. Until that time, there’s a need for improved communication, awareness, and assistance to ensure eligible individuals maintain or renew their Medi-Cal insurance.