Navigating Changes in Medi-Cal Coverage: What You Need to Know

Navigating Changes in Medi-Cal Coverage: What You Need to Know
Photo by CDC / Unsplash

As California resumes eligibility checks for Medi-Cal, tens of thousands of residents face the risk of losing their health insurance each month. The state, which temporarily suspended eligibility reviews during the COVID-19 pandemic, is now evaluating approximately 16 million people from June 2023 to May 2024. This process has resulted in more than 300,000 individuals losing their Medi-Cal coverage since July 1, with reasons ranging from procedural issues to changes in personal circumstances.

Understanding the Impact

The majority of coverage losses in June and July were attributed to procedural reasons, such as individuals not returning renewal forms or providing incorrect information. While some experience coverage lapses due to changes in employment or income, others may be affected by paperwork errors or missing notifications.

Cary Sanders, Senior Policy Director at the California Pan-Ethnic Health Network, highlights the potential challenge, stating, "It's because it's been such a long period where folks have not had to renew their health coverage. 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."

What to Do If You Lose Coverage

1. Notification and Verification

If you suspect disenrollment, check your mail for notifications or contact your local Medi-Cal office for eligibility verification. Clinics and hospitals can also assist in checking your coverage status.

2. Appeal Process

If disenrolled despite qualifying, a 90-day appeal period allows you to challenge the decision. Complete the renewal packet promptly or provide missing information to your county Medi-Cal office. Accessibility issues should be communicated to facilitate electronic or phone document submission.

3. Future Prevention

To prevent disenrollment, update your address promptly, renew and update Medi-Cal coverage annually, and keep essential documents, such as tax returns and health records, readily available. Sign up for renewal reminders through keepmedicalcoverage.org.

Exploring Alternative Coverage Options

1. Covered California

If no longer eligible for Medi-Cal, explore low-cost health insurance through Covered California. Those earning up to 250% of the federal poverty level may qualify for low-premium plans.

2. Medicare

Individuals over 65 or with disabilities may qualify for Medicare, assisting with hospital costs, medical care, and prescription medication.

Seeking Assistance

Several resources can provide assistance:

  • Contact local Medi-Cal offices for eligibility inquiries.
  • Call the Office of the Medi-Cal Ombudsman at (888) 452-8609 for issue resolution.
  • Utilize third-party services like Health Consumer Alliance and BenefitsCal for Medi-Cal re-enrollment support.

Special Assistance for Vulnerable Populations

Seniors and individuals with disabilities experiencing disenrollment can reach out to state-supported enrollment navigators for assistance. The Department of Health Care Services provides a social media toolkit in 19 languages to raise awareness about redeterminations.

In navigating these changes, staying informed, proactive, and seeking assistance can help Californians maintain access to essential healthcare services.

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