Medi-Cal enrollees in California: Here’s how to verify your eligibility

If you are enrolled in Medi-Cal, as more than one-third of Californians are, make sure your county knows how to reach you, or you could lose your health coverage unnecessarily.

You will likely hear and see public messages over the coming weeks urging you to update your contact information. Heed them.

Then, sometime between now and next spring, you'll probably receive mail from the agency that administers Medi-Cal in your county telling you if you are still eligible for the safety-net health insurance program or asking for more information about your employment status, income, and household size. An information request would likely come in a bright-yellow envelope containing a roughly 20-page form about six weeks before the start of your renewal month.

Be on the alert: Medi-Cal is warning about scammers who have been contacting enrollees and requesting a fee to help people renew coverage. Don't fall for it. No payment is required to renew your coverage.

But be sure to open your mail and respond to any official request for personal information. And be aware that updating your information could push you off Medi-Cal if your income has risen or if you have access to other insurance.

If you need help with any of this, especially that daunting renewal form, keep reading.

Medi-Cal, the state's version of the Medicaid health insurance program for low-income residents, has embarked on a 14-month effort to reexamine the eligibility of its nearly 15.8 million members. It is part of the massive "unwinding" being undertaken by all state Medicaid programs after three pandemic years during which their rolls swelled. States had agreed, in exchange for extra funding from the feds, not to boot anyone except in cases such as fraud, death, or a move out of state.

On April 1, Medicaid restarted the annual eligibility checks that had been the norm before the pandemic. It will be the biggest shake-up in U.S. health coverage since the Affordable Care Act, though it cuts the opposite way: Between 8 million and 24 million people will likely be bounced from Medicaid nationally, including an estimated 2 million to 3 million in California.

To minimize the number of enrollees dropped unnecessarily, California's Department of Health Care Services, which runs Medi-Cal, has launched a $25 million advertising and outreach campaign that will send messages in 19 languages. The department is enlisting the assistance of nearly everyone who has contact with Medi-Cal enrollees: county offices, health plans, medical providers, advocacy groups, and volunteers. And it got $146 million in supplemental funding to help counties cope with the unprecedented number of renewal decisions.

But some patient advocates, health plan executives, and community clinic administrators worry it will not be enough to help all enrollees who could lose coverage if they can't be reached or don't respond — especially transient and homeless people and those with language or cultural barriers.

Less than two months before the start of the unwinding, multiple counties, including Fresno and Sacramento, reported staffing shortages and the need to train eligibility workers.

Laura Sheckler, deputy director of policy at the California Primary Care Association, which represents about 1,300 community clinics statewide, says the nearly $60 million in state funds earmarked for "navigators" to assist Medi-Cal enrollees is not enough for her group's members to provide all the help that will be needed. The association has asked lawmakers for another $60 million.

Some Medi-Cal members already know where they stand. Anthony Kelley, a 53-year-old single dad, is one of them. Kelley, who lives with his 14-year-old son, Nicholas, in Pacifica, California, temporarily lost his job as a driver for a concrete company in the early days of the pandemic and signed up for Medi-Cal. He got his job back about a month later, along with access to employer-sponsored health coverage, but he has stayed on Medi-Cal for the past three years. His son has been on Medi-Cal since he was born.

When San Mateo County sent Kelley a renewal form, he called and was told his $58,000 annual income likely meant he and his son would lose Medi-Cal coverage. Now, he's waiting for that to happen.

"It sucks for my son," Kelley says, adding that he fears Nicholas could lose his doctors. "But we'll deal with it."

If you are anxious or uncertain about what you need to do, don't fret. Help is available.

You can call or visit your local Medi-Cal office to update your personal information or ask for assistance. The Department of Health Care Services (www.dhcs.ca.gov) lists on its website all county Medi-Cal agencies, with addresses, phone numbers, and links. You can also call Medi-Cal's help line (800-541-5555).

If you want to avoid potentially long lines or telephone hold times, consider signing up for an account at www.benefitscal.com or www.mybenefitscalwin.org. Doing so will allow you to update your personal and financial information online and find your renewal date.

Another great resource is the Health Consumer Alliance (888‑804‑3536 or www.healthconsumer.org), which can help you navigate the complexities of renewal, or contest a termination decision you think is unwarranted. Community clinics, which provide care for nearly one-third of Medi-Cal enrollees, often have navigators on-site who can help fill out forms and answer questions. L.A. Care, the largest Medi-Cal health plan, has 11 centers across Los Angeles County that will offer help to anyone who needs it, not just its members. Fresno County has 14 such centers. Check with your health plan for similar resources.

Under a state law, SB 260, if you are bumped off Medi-Cal but still have income low enough to qualify for an insurance subsidy through Covered California, the state's insurance marketplace, you will be auto-enrolled in a plan the exchange deems to be the best value at the lowest cost. Once notified of the plan selection, you will have 30 days to accept it, choose another plan, or decline coverage altogether.

"This doesn't need to be all doom and gloom for people who have Medi-Cal," says David Kane, a senior attorney at the Western Center on Law & Poverty.

This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.