Communities of color face unique challenges when seeking health coverage. Community health workers say they often can’t get people to enroll in Medi-Cal because many fear the program will reveal their immigration status and lead to deportation. Others struggle to navigate common life transitions, like aging out of foster care or losing their employer’s insurance.
Unaffordable Coverage
The cost of private health insurance has skyrocketed since Obamacare passed, making it unaffordable for many families. The state spends billions a year on Medi-Cal, but more is needed. A recent study ranked California 40th for healthcare accessibility, indicating that the state is falling behind. The big problem is that too many people need help seeing a doctor with their managed care plans, which will likely worsen.
The number of doctors who accept Medi-Cal patients is dwindling. The state is trying to fix this issue, but it will take time and money. For many, the solution is to qualify for low-cost or Riverside County Medi-Cal services. But the eligibility rules are complicated, and some people need help determining eligibility for coverage.
Moreover, eligibility is determined based on household income – not family assets or other living costs, making it hard to understand how much a person needs to make to have affordable coverage. It is why you need help with consultation and qualifying for healthcare.
The problem is also magnified by the fact that most Medi-Cal beneficiaries are assigned to a managed-care plan based on their county of eligibility rather than their medical needs or preferences. Those with the highest demands are likelier to be placed in a high-cost plan. In addition, the managed-care system allows for “carve-out” payments to be made to the program that is not included in its capitation rates and contractual service obligations.
Lack of Information
Many people who rely on Medi-Cal do not have the information they need to stay covered. As a result, they need more certainty and clarity as their eligibility status changes and help to navigate the system to receive accurate, timely, and personalized support. A lack of clear and precise information is especially challenging for people who face common life transitions such as aging out of foster care, leaving a parent’s insurance, moving into a different housing unit or job, getting married, or changing jobs. People need help applying for coverage or reapplying during these events and may even be denied coverage because of mistakes in their application or misinterpreted rules.
In addition, many study respondents reported that new Section 1931 rules have made eligibility more complicated than ever before. These rules affect medically and non-medically needy beneficiaries, creating confusing requirements and processes. Respondents reported that the new rules are difficult to understand and that even experienced Medicaid staff have difficulty interpreting them.
Fear of Disclosure
The application process can be complex whether people seek health coverage through Medi-Cal or the state’s marketplace. Small income changes can cause eligibility to shift — but when inaccurate information is typed into the two programs’ shared computer system, or applicants receive conflicting advice, they can face frustrating roadblocks.
Even when enrollees do get help, they often need to receive the full benefit of the support that is available to them. For example, many people rely on phone assistance from local agencies, but their interactions can be frustrating. Frequently, callers are asked to repeat information already provided, and they need consistent answers about their status.
For instance, the state will resume its annual review of Medi-Cal enrollment – sometimes called a “redetermination” – later this year. As a result, many Californians could lose their insurance.
Many county officials and state staff have known that the unwinding process would eventually begin, but enrollees may need to be made aware. Those whose Medi-Cal eligibility is determined to end in June will receive renewal packets from the state. They will be disenrolled from coverage if they don’t provide the necessary new information. In some cases, the state will allow them to enroll in Covered California so that their premium subsidies will continue.
Getting Help
Insurance agents and legal aid attorneys say they regularly receive calls from people wrongly bounced between Covered California, the state marketplace for those buying their health insurance, and Medi-Cal, the state’s version of Medicaid. Sometimes small income changes can cause a computer system shared by the two programs to shift a person’s eligibility. Other times, human error can do the same thing.
The problems could worsen this year as the state restarts its annual eligibility reviews of people enrolled in Medi-Cal in April after a three-year pause that began during the COVID-19 pandemic. As a result, officials estimate that as many as 3 million Medi-Cal enrollees may lose coverage because they no longer qualify or need to realize they need to renew. Some will be able to regain coverage through a special enrollment period. Still, others may need to find new options — including buying more expensive private insurance, qualifying for the marketplace’s bare-bones plan or going without health care altogether.