Medi-Cal Redeterminations: Putting the Data into Context

By Michelle Baass, Director, California Department of Health Care Services

Over the last few months, and in collaboration with our county partners, we have embarked on a journey to redetermine eligibility for Californians who are receiving health coverage through our Medi-Cal program. This federal requirement is an enormous task as California represents 17 percent of the nation’s Medicaid population, the largest of any state in the nation.

For context, in March of 2020, at the beginning of the COVID-19 pandemic, the federal government paused all Medi-Cal eligibility renewals. In California that pause ended on March 31, 2023, as did the continuous coverage requirement, and Medi-Cal redeterminations resumed in June 2023. Between June 2023 and May 2024, more than 15 million Medi-Cal members will have their eligibility redetermined.

We all have family, friends, and neighbors who get health coverage through Medi-Cal, which covers more than 33 percent of Californians, including 50 percent of all births, most school-aged children, and two-thirds of long-term care days in the state. It enables low-income children and adults, including parents, individuals with disabilities, and older individuals, to access doctor visits, screenings, prescriptions, mental health care, substance use treatment, and other vital health care services to get and stay healthy. And it provides access to new benefits and services that have launched as part of the CalAIM transformation, such as Community Supports services, which range from housing services to asthma remediation and medically-tailored meals.

Our priority is to make sure Californians remain covered. Keeping eligible Medi-Cal members enrolled in coverage provides them with access to comprehensive health care benefits; reduces pressure on emergency or urgent care services because people are empowered to seek care earlier; and ultimately helps support the overall productivity and success of our state’s economy.

We are working hard to use every tool we have to ensure we do just that. We are collecting a large amount of data to help us both understand how we are doing in redetermining eligibility and to ensure that we are addressing anomalies or disparities in the processes. These data are also helping us drive our outreach efforts to support our commitment of ensuring all those eligible can continue their coverage. These data are available on our website as part of a comprehensive dashboard that is designed to ensure that our partners and the public is able to continue to monitor progress with us.

Our first month (June 2023) of refreshed data is now available. In total, 1,021,460 Medi-Cal members were due for redetermination in the month of June. The good news is that 90 percent (923,282) of renewals have been processed with the remaining 10 percent at various stages of the renewal process. It is important to note that these remaining individuals continue to receive health coverage while they go through the renewal process.

There are a few important takeaways form the data for June. First, a majority of Medi-Cal members were able to seamlessly go through the renewal process. Roughly 35 percent were able to automatically renew based on our data matching efforts, while another 31 percent completed their information and returned it to our county partners. Second, our preliminary data releases do not capture the full scope of the number of active renewals processed after June. For example, in June, we preliminarily reported in July that 69 percent (724,324) of Medi-Cal members due to be redetermined completed the renewal process, after further data reporting and validation, this number jumped to 90 percent. The increase is attributed to the completion of the active renewals that were submitted to the counties for processing by Medi-Cal members after the Notice-of-Action cutoff that occurs ten days before the end of the month, which is a requirement for all Medicaid programs to ensure sufficient noticing for Medicaid members before an adverse action is taken. Third, Medi-Cal members who are discontinued can submit additional information to the county during the cure period and can be reinstated; in June, 4 percent (39,123) who were discontinued were able to be reinstated.

We have a lot more work ahead of us. Roughly 243,070 of the 923,282 individuals who went through the renewal process in June were discontinued from the Medi-Cal program. Some of these individuals were able to gain health insurance coverage through a new employer, while others were able to get coverage through California’s health insurance marketplace, Covered California. In fact, in July 2023, 35,051 Medi-Cal members were found eligible for coverage with Covered California. Of those, 9,415 (or 27 percent) were found eligible for subsidies and therefore received an automated plan selection. Our disenrollment rate for June of 24 percent is below the national average and below other states of our size and scale (Texas at 62 percent, Florida at 34 percent and New York at 31 percent). It also is not significantly different from the natural monthly disenrollment rate prior to the pandemic of 17–20 percent.

Additionally, we have learned a lot of significant lessons from our counties, our Medi-Cal members, and community partners since June 2023. We have taken up additional federal flexibilities that help reduce the administrative burden on our Medi-Cal members and increase efficiencies in our renewals processing. Specifically, we partnered with federal partners to increase our auto-renewal processes, allowing for a much more streamlined, no-touch process for our Medi-Cal members. We look forward to seeing these added efficiencies in our future data in the coming months as the unwinding journey continues.

As we look ahead, we will continue to iterate on our work to ensure that we address unmet needs and are responsive to the data. It also will be important to couple the quantitative data with qualitative information from our county partners and our members. Most importantly, we will double down on our outreach efforts to ensure that they are in language and culturally appropriate so to ensure that we meet our members where they are. In Fall 2023, we partnered with California Health Care Foundation to send out a survey to our disenrolled Medi-Cal members in their preferred language to understand the reasons why they did not return a Medi-Cal packet. The surveys were sent via phone, email, text, and regular mail, with the hopes of understanding qualitatively how we can improve processes to support our Medi-Cal families.

We cannot do this alone as government. It will require us working together across disciplines and siloes. So if you want to roll up your sleeves and help us, sign up to be a Coverage Ambassador.