Over 930,000 Californians Lost Medi-Cal Coverage This Year Due to ‘Procedural Reasons’

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Florinda Miguel took her 6-year-old daughter for a routine dentist appointment in early December, only to find out that her Medi-Cal coverage had lapsed.

It took her by surprise. She hadn’t needed to renew her kids’ Medi-Cal coverage in almost four years. The Los Angeles resident said she doesn’t recall getting any notices or renewal paperwork in the mail this year.

“I don’t know if they sent it, if it was lost. I don’t know, but I didn’t get it,” Miguel said.

Without coverage, her daughter’s dental exam would cost $60, plus the cost of any additional work that needed to be done, so Miguel postponed it until she could get her Medi-Cal reinstated.

This spring, states restarted their annual eligibility reviews for lower-income people enrolled in Medicaid — better known as Medi-Cal in California — after the federal government paused them in 2020 so recipients could automatically maintain their health benefits during the COVID-19 pandemic.

Now, six months into the renewed eligibility process, thousands of eligible Californians are finding out, often during doctor’s visits, that they’ve lost their coverage due to missing or incomplete paperwork.

More than 930,000 people have had their Medi-Cal coverage terminated this year, according to state data. The vast majority of them — close to 90% — lost coverage because of so-called “procedural reasons,” often entailing problems with paperwork. California has the country’s fourth highest rate of terminations linked to procedural issues, according to the health policy research organization KFF (formerly known as the Kaiser Family Foundation).

Among Californians eligible for Medi-Cal renewals, 47% retained coverage, 15% were kicked off for paperwork problems, 2% no longer qualified and 35% are still under review, the KFF tracker shows.

People who lose their Medi-Cal coverage but are still eligible can hop back on within a 90-day grace period as long as they submit any missing information through the mail or online. As of October, the program covered 15.1 million people in California.

“During COVID, the message was ignore, ignore, don’t worry. For close to four years, we told people not to worry, and then all of a sudden, they had to worry,” said Celia Valdez, director of outreach and education at the Los Angeles nonprofit Maternal and Child Health Access. Her organization helped Miguel reinstate her kids’ Medi-Cal. But experiences like Miguel’s are common, she said.

“Many [enrollees] are saying, ‘I couldn’t fill my prescription, I went to the doctor and they told me I have no coverage,’” Valdez said.

People who are being disenrolled for “procedural reasons” tend to fall into several buckets, including those who are new to the program and may not understand that they now have to respond to yearly reviews, said Yingjia Huang, assistant deputy director at the California Department of Health Care Services, the state agency that oversees the Medi-Cal program.

Other people may now have health insurance through an employer and are not filling out their paperwork because they no longer need Medi-Cal nor would they qualify, Huang said. And some who moved during the pandemic may not have received the renewal alert this year because they neglected to report their new address to their county Medi-Cal office.

And in some cases, advocates add, county offices may not be processing paperwork on time that was submitted close to the deadline.

The Children’s Partnership, a nonprofit children’s advocacy organization, last week published a report about parents’ and guardians’ experiences with renewing their families’ Medi-Cal. The report noted several obstacles that parents said contributed to their children losing coverage, including unreturned phone calls, long call wait times, confusing instructions, limited access to translators, feelings of discrimination, and lack of awareness.

According to the report, gaps in coverage led to delays in care, missed medications and out-of-pocket costs for families.

Huang, with the Department of Health Care Services, said the state is working to increase the number of people whose coverage can be renewed automatically using state electronic databases that can verify an enrollee’s income and eligibility.

“Our [automatic renewal] rates historically have been lower than many of the other states — they probably have more electronic sources and databases that they can use,” Huang said. She noted the state has been receiving automation tips and technical assistance from the federal government to increase the number of cases that can be renewed automatically.

“That just eases the administrative burden on our members as well as our counties,” Huang said.

Valdez and other health advocates said there are significant gaps in support for people who have questions or need assistance. She said that calling county Medi-Cal offices can result in hours-long waits, and organizations like hers have limited capacity to fill in the gaps. People who are not connected to an advocate or an enrollment counselor could get lost in the process.

Among the top questions and comments from people seeking assistance is that the paperwork is too much or too confusing, said Kimberley Graham, director of patient access at AltaMed Health Services, a clinic system in Los Angeles and Orange counties that provides enrollment services.

“And they don’t know what to do. So often, the packets are opened, but they’re completely blank,” Graham said. “The next question is, ‘Do I have to do this every year?’”

The answer, she said, is “yes.”

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.