As you probably know, California suspended its annual requirement for Medi-Cal enrollees to verify their program eligibility during the Public Health Emergency (PHE).  The continuous coverage requirement ended on March 31, 2023, and normal verification protocols resumed on April 1, 2023.  This allows the County Department of Public Social Services (DPSS) 14 months to redetermine eligibility for over 15 million existing enrollees.

According to preliminary reporting from State health officials, approximately 225,000 Californians lost their Medi-Cal coverage as of July 1^st during the first redetermination round, representing approximately 21% of those who were required to reapply in June of 2023.

Only 3% of those who lost coverage due to their household income rising above program limits.  The majority were disenrolled because they didn’t return their renewal packet and Medi-Cal offices were unable to verify their income and eligibility in other ways.

At this rate, an estimated total of two to three million people could lose their coverage within the next 11 months.  This could be catastrophic for the disenrolled and the health system in general.

Fortunately, the news isn’t all bad.  Californians who were dropped from Medi-Cal in July or August have a 90-day window from their disenrollment date to request reinstatement of coverage.  However, taking a proactive approach to eligibility verification can vastly reduce the chances of avoidable disenrollment and ensure continuity of coverage for their enrollment year.

The key is for enrollees not to wait to be notified or hope to be automatically requalified.  Acting now can make all the difference.

Here are some helpful links that patients and providers can use to better understand and navigate the redetermination process.

For Providers 

Click here for a PDF compiled by MedPOINT experts that provides:

• A highly detailed overview of the redetermination process from start to finish
• Steps you can take to help your patients with their renewal efforts
• Updates on MedPOINT efforts to help at the IPA level
• A list of health plan communication tools for both providers and members

For Patients

• Visit the California Department of Health Care Services (CA DHCS) Keep Your Medi-Cal Action page for help updating your contact information or completing your renewal form and guidance on what to do if you’re notified that your Medi-Cal coverage has ended.
• Visit the LA County Department of Social Services (DPSS) Office Locations Page to find a local office for in-person help and resources for applying for Medi-Cal online or over the phone.
• For further help, or if you become stuck at any part of the process, visit the Health Consumer Alliance website, or call them at 888-804-3536.