Thousands of Californians are losing Medi-Cal every month. What to do if you lose coverage

BY SHREYA AGRAWAL | CalMatters

Tens of thousands of Californians are losing health insurance every month as the state resumes checking people’s eligibility for Medi-Cal, which it suspended during the COVID-19 public health emergency.

About 16 million people in California will be evaluated for eligibility from June 2023 to May 2024. About half of those up for a review were automatically renewed because officials were able to verify their information in the system. Others were sent yellow renewal packets that they were supposed to fill out and send back to their county Medi-Cal office.

More than 300,000 Californians have lost their Medi-Cal eligibility since July 1. The majority of lost coverage in June and July due to procedural reasons, such as not sending their renewal forms back or having incorrect information in their forms, according to state data.

Some people losing coverage are no longer eligible because of changes in their personal lives, such as starting a job with higher pay. But some might see their coverage lapse because of paperwork mistakes or simply missing a notice in the mail.

“It’s because it’s been such a long period where folks have not had to renew their health coverage,” said Cary Sanders, senior policy director at the California Pan-Ethnic Health Network. “There could be up to 2 to 3 million Californians who could lose their health coverage just by virtue of this change, because there would be people who wouldn’t know what to do.”

Here are some answers to questions about what you can do if you lose coverage, including how to appeal.

How do I know if I got disenrolled from Medi-Cal?

You will get notified through mail. If you didn’t receive a notification but still believe you might have lost coverage, you can call your local Medi-Cal office to check eligibility or go to your regular clinic or hospital where they can look this information up for you.

For any questions about Medi-Cal eligibility, you can contact the state Department of Health Care Services, which manages the Medi-Cal program. Their Medi-Cal Eligibility Division can be contacted at (916) 552-9200.

I qualify for Medi-Cal but still got disenrolled. What should I do?

Your next step depends on how much time has lapsed since you lost your coverage, as stated on the official notification letter.

The state has instituted a 90-day appeal period in case you lost coverage even though you qualify.

If you are within the 90-day period, you should immediately fill out the yellow renewal packet, or supply any missing information, and send it to your county Medi-Cal office. If you lost the packet or sent the packet but still got disenrolled, call your local Medi-Cal office or go to your regular clinic or hospital to figure out the next steps.

If you are unable to send your information to your local Medi-Cal office due to accessibility issues and are running out of time, ask the office staff to accept your documents electronically or through the phone.

If you are past the 90-day period, you will be required to reapply for Medi-Cal benefits. This means starting a new application entirely.

How can I appeal?

Tatiana Fassieux, training and education specialist at Medicare advocacy nonprofit California Health Advocates, said people should remember that they have appeal rights.

If you received a notification about disenrollment, you can request a Fair Hearing and appeal the loss of coverage. This will ensure that your benefits continue until the hearing is resolved.

“Many people take the letter verbatim and they don’t read it and they don’t appeal,” she said.

According to the state Department of Health Care Services, adults under the age of 26 can qualify for Medi-Cal regardless of immigration status. Medi-Cal does not share information with the immigration office, so undocumented Californians should not be afraid to seek help. Starting Jan. 1.  Californians of all ages will be able to qualify for Medi-Cal irrespective of immigration status.

I got disenrolled because I no longer qualify. How can I get health insurance?

If you no longer qualify for Medi-Cal, you may still be able to get low-cost health insurance through Covered California, which is the state’s marketplace for health insurance plans.

Those who earn up to 250% of the federal poverty level – or $33,975 for an individual or $69,375 for a family of four – would qualify for low-premium plans through Covered California. You may also be eligible for additional health insurance subsidies through the Affordable Care Act (ACA), including the Advance Premium Tax Credit and Cost-Sharing Reduction plans.

If you are over the age of 65 or have disabilities, you may also qualify for Medicare, which can help pay for hospital costs, medical care and even prescription medication.

How can I make sure I don’t get disenrolled in the future?

Keep an eye out for any mail sent to you from your county Medi-Cal office. If you recently moved, make sure to update your address on the Medi-Cal website or by calling your local office.

You will be expected to renew and update your Medi-Cal coverage every year, so keep all your important information in an accessible place.

“You should have your documents like tax returns and health records handy,” Fassieux said.

You can sign up for renewal reminders through the state’s renewal website:  keepmedicalcoverage.org. That resource also is available from the state in Spanish.

Are there any other resources I can use for help?

The state’s Department of Health Care Services has several resources to help, including contact information for your local Medi-Cal office, schedules of community events and health fairs where you can get information in person, and guides on what to do if you lost Medi-Cal coverage.

For assistance with Medi-Cal re-enrollment, you also can  call the Office of the Medi-Cal Ombudsman. The office is a neutral resource that can help you deal with any issues you may have with the program. You can contact the Office of the Ombudsman at (888) ​452-8609.

There are also several third-party services that can help you get back on Medi-Cal.

Health Consumer Alliance is a free assistance program funded by The California Endowment, Covered California, the state Department of Managed Health Care, and the Blue Shield Foundation. It provides legal services and can help you renew your Medi-Cal coverage. To get in touch, you can read their guide on renewing Medi-Cal or call their toll-free number, 888‑804‑3536.

You can contact BenefitsCal which also provides assistance with Medi-Cal. The website has translations in 20 languages.

Will seniors and other vulnerable populations get special assistance?

According to health policy organization Justice in Aging, seniors and those with disabilities have experienced higher rates of disenrollment from Medi-Cal. Seniors, pregnant women, and certain children under 21 experienced a disenrollment rate of 26.7% in June 2023, compared to the overall average rate of 21%, according to the Department of Health Care Services.

Tiffany Huyenh-Cho, a health attorney at Justice in Aging, said seniors and people with disabilities are dual-eligible, which means they qualify for both Medicare and Medi-Cal.

“Dual-eligibles are a very diverse group with really high chronic needs, and they are more likely to be a person of color,” she said. “Their health disparities and chronic conditions are exacerbated by the loss of Medicaid.”

Often seniors and other dual-eligibles use their Medi-Cal benefits to cover their Medicare premiums as well as any wraparound services not included in Medicare. The loss of Medi-Cal means they may lose these additional benefits and face the deduction of Medicare premiums from their Social Security checks, said Huyenh-Cho.

“That puts people at risk of not being able to pay for rent and other needs, like clothing, food  and utilities,” she said. “One of the big concerns that we have is it puts people at risk of economic insecurity and potentially at risk of homelessness because of that loss of income.”

Those who require additional assistance can reach out to state-supported enrollment navigators, which are community-based organizations and social service agencies that help vulnerable populations through the process.

The Department of Health Care Services has also released a social media toolkit to spread awareness about redeterminations, so people can renew their coverage before they get disenrolled. This kit is available in 19 languages.