An unprecedented number of Californians are facing the challenge of renewing their eligibility for Medi-Cal, the state's Medicaid health insurance program for people with low incomes and disabilities. The program's enrollees were given an annual re-enrollment process because the federal government prohibited states from removing people from the Medicaid program during the coronavirus pandemic. This temporary policy allowed millions of people to remain insured, but now that the public health emergency is over, his local Medi-Cal office We are re-evaluating the qualifications of the above members. The major “unwinding” of the federal government's Continuing Coverage policy is scheduled to begin on April 1, 2023 and be completed on May 31, 2024.
This is the second in a series of CHCF blog posts aimed at elevating the perspectives of government agencies, community-based organizations, and other key groups on the front lines of mitigation in California. In this series, we ask: Where are Medi-Cal members in the process? What is working well and what can be improved? What are we learning that can be used to streamline the Medi-Cal enrollment and retention process, even after the process is complete?
I recently posed these questions about mitigation to Injia Huang, Deputy Director of Health Benefits and Eligibility at the California Department of Health Services (DHCS). Our interview has been edited for length and clarity.
Q: What are some of the challenges DHCS faces with updates?
answer: One of the big challenges is that there is a large amount of redetermination. After the Affordable Care Act expansion in 2014, we added millions of people overnight, but we never reached the 16 million mark. During the pandemic, many of our members also moved around the state while the renewal process was paused, so we had little to no contact with them. We sent out a large amount of mailings in 2021, and about 10% of our mailings were returned to his DHCS because we didn't have up-to-date contact information. This means that many people did not receive their renewal packet and were unable to fill it out and send it back.
County social services offices facilitate the Medi-Cal eligibility process and have lost many county employees during the pandemic. They have become burnt out as caseloads have increased significantly in public assistance programs and COVID-19 has created personal challenges outside of the work environment. This has resulted in many retirements over the past few years, leaving fewer experienced county-qualified employees working in Medi-Cal. Approximately 40% to 50% of the eligible workforce was vacant at the start of mitigation, and many employees were eligible for Medi-Cal redetermination because they were hired during the pandemic when redetermination was suspended. It was never completed. Less than two years later, the state increased county budgets by $146 million to hire more redetermination workers, but finding enough people to fill the positions has been difficult.
Separate from mitigation, the U.S. Centers for Medicare and Medicaid Services directed us to integrate two electronic eligibility and enrollment systems used by county officials to manage Medi-Cal caseloads. Converting two systems into one requires additional training to help staff learn how to use the new system.
Q: What changes can improve the renewal process in the remaining months?
answer: The federal government has approved several “flexibilities” for states at the beginning of mitigation to smooth the process, and it would help if these were made permanent. For example, many people in the “elderly and disabled” category have stable incomes because they collect pension or retirement income, but workers who qualify for benefits are They often have trouble verifying these amounts through the electronic databases where their information is stored. This means it cannot be updated automatically. As a result, after you send update packets to these members, you must submit additional information for approval.
However, due to the federal government's flexibility waiver, employees no longer need to verify these members' income from other sources if the amount is stable from year to year. Approximately 2 million to 3 million people fall into this category, and these cases tend to be more complex and time-consuming to renew without the federal government's “flexibility.”
Another change that will help going forward is the continuation of the public awareness and support campaigns launched during the mitigation period. As part of the campaign, for the first time we began sending members reminders to update their contact information via text. Previously, we sent these reminders by mail or online through our membership. Welfare calculation But many people don't have online accounts. According to DHCS data, an average of 55% to 60% of Medi-Cal members have opened a text reminder. Our community partners let us know that people are coming in to renew their Medi-Cal because their members are receiving texts.
We are also spreading the message that even if you receive a notice that you have been disenrolled on a specific date, you will be reinstated if you submit a renewal packet within 90 days of disenrollment and your eligibility is verified by the county. Many people are not aware that there is a 90-day grace period.
Q: What bright spots have you seen in this process?
answer: Our local Medi-Cal office has done an exceptional job dealing with the redetermination volume. Our partnership with county officials is the closest we have ever experienced because of our mutual understanding that this is an unprecedented event. One of the ways we work together is to DHCS Coverage Ambassador ProgramThis allows community advocates, community-based organizations, health plan representatives, and others to receive training from DHCS on how to help Medi-Cal members stay covered.
Through this program, we educate our ambassadors about the renewal process. To date, we have trained over 5,000 ambassadors for him. The program is important because it is a new concept for his DHCS and ambassadors are considered reliable messengers on the ground. We know that government agencies can be intimidating for members, and ambassadors may have a stronger sense of cultural competency.
We also recently received federal approval for a new policy that allows Medi-Cal members to provide reasonable explanations for discrepancies in their income data. For example, a member's current income may be lower than previous year's income data reported by the IRS. Members are typically required to provide documentation proving they currently earn a lower amount, which can be a barrier to completing a renewal. The new policy bypasses the documentation requirement and instead allows for a brief written explanation of the discrepancy. For example, seasonal workers can describe their work and salary for this season. This change is a bright spot as it will be an ongoing policy.
Q: What happens to Medi-Cal after the rollback?
answer: Through this process of unwinding, we have developed many creative ways to understand who we cover, how we cover them, and how we meet the needs of our members.I created something interactive Dashboard This provides up-to-date information about the number of updates, number of aborted redeterminations, reason for abort, and other data, allowing for transparent progress during unwinding. Dashboard data revealed that many members were experiencing “procedural terminations” for not returning packets, prompting DHCS to extend its Outreach campaign.
We look forward to continuing to leverage these strategies to better understand what our members need. Effective January 1, Medi-Cal will no longer bar income-eligible Californians between the ages of 26 and 49 from entering the country based on their immigration status. This will result in a significant increase in enrollment for the program, so we must continue to find ways to engage people and work with each county to successfully implement these changes.
heather stringer
Heather Stringer is a freelance health science journalist based in San Jose. She studied civil engineering at Stanford University and began her journalism career at a Fremont daily newspaper. Heather began covering health care as a staff writer and editor for a nursing magazine, and she began her freelance career in 2003. Her work has appeared in Scientific American, Monitor on Psychology, Cure, Proto, and Nurse.com.
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Andri Tambunan
Andri Tambunan is a documentary photographer and videographer based in Sacramento. He specializes in photojournalism and long-term storytelling. His documentary work focuses on social justice, health, environmental protection, and identity, and he is passionate about using visual storytelling to inform, engage, and influence social change. .read more
