Medicaid redeterminations require better outreach


As the CEO of a large public health plan that serves 1.6 million people in Southern California, I always welcome feedback from our members. When Maria, a friend and community partner, invited me to join her and listen to some of our most vulnerable residents describe their challenges with the public healthcare system, I jumped at the chance.

It was a blistering-hot spring day last April as I made my way into the backyard of a modest San Bernardino home. Twenty-five people were there, but they did not know who I was, other than a guy who knows Maria and might be able to help them with what they were going through.

Related: CMS’ Jonathan Blum – Redeterminations will make Medicaid stronger

So the residents spoke freely about their experiences and frustrations.

One mother described how a simple communication error prevented her premature infant from being signed up for Medi-Cal, California’s Medicaid program. I also met a young couple who ended up homeless while waiting 12 months for Medi-Cal to cover their HIV medications. Others described long wait times on the phone, dropped calls and difficulties of finding a live voice to help them.

Their stories rocked me to the core. Employees at my organization, Inland Empire Health Plan, and our provider partners work hard to advocate and care for each member. But clearly, we needed to do more.

The faces and the stories from that afternoon a year ago will always stay with me. And they are top of mind as I think about the real possibility of a new public health crisis emerging now that COVID-19 public health emergency protections have ended for Medicaid programs across the country. What is happening in California will be happening in other states across the country.

Since March 2020, the PHE had allowed Medicaid beneficiaries to skip the annual eligibility determination process. During the pandemic, our Medi-Cal members were not required to take any action to maintain their benefits.

But on April 1, that changed. Once again, the state resumed contacting members by mail for information to help determine continued Medi-Cal program eligibility.

Now, you may be thinking, “So, what is the big deal?” What public health plans across California and the rest of the country are concerned about is that one overlooked piece of mail could have catastrophic consequences. Everything hinges on the member receiving the packet, completing the requested information, and submitting it by a certain deadline. Those who do not respond in time will be dropped from the program and lose all their public healthcare benefits. Members could start losing coverage as early as July 1.

Consider how an interruption of coverage could impact members undergoing treatment for a serious illness or chronic condition. And even for healthy people, the out-of-pocket medical costs for just one illness or injury could quickly deplete savings.

In my health plan’s coverage area alone, which encompasses Riverside and San Bernardino counties, nearly 300,000 could lose their Medi-Cal benefits because of a simple oversight. That is unacceptable.

With so much at stake, health plans can and must do more to make sure their members do not fall through the cracks at this critical time. We must reach members individually and provide hands-on assistance.

To prepare, our health plan has hired more than 50 new employees and trained hundreds specifically for the Medi-Cal redetermination process. Our members live within two large Southern California counties encompassing more than 27,000 square miles. Much of it is rural, so strategic partnerships with community-based organizations are allowing us to better reach our members wherever they are, whether that is at church or on the street.

We have also partnered with state and local county Medi-Cal agencies to help raise awareness, share data and coordinate strategic messaging, as California and other states ring the alarm about the massive number of projected coverage losses.

And that may prove to be the most critical piece. Without this leadership and support from our county Medi-Cal agencies, our member outreach efforts would be limited. Inland Empire was an early pioneer of this type of partnership, and now California highly encourages other county agencies to do the same with the health plans in their region.

We are receiving a monthly list of our members up for renewal, along with updated and verified contact information. Our team will immediately call or text the member to alert them that an important packet is coming in the mail. Once the packet is received, we will assist the member in completing and submitting the required information.

Time is critical, so it is important to continually check in until the member has submitted the information by mail, phone, online or at a local county Medi-Cal office.

Inevitably, some may lose their Medi-Cal benefits because their household income now exceeds eligibility requirements. But they will not fall through the cracks and will still be part of the healthcare system. These members will be automatically enrolled in Covered California, the state health insurance marketplace established by the Affordable Care Act. There, they may be eligible for a federally subsidized health plan.

If it sounds like we are going to extraordinary lengths to help our members fill out simple paperwork, consider the alternative: Up to 3 million Californians could lose their Medi-Cal benefits if they do not complete this process in a timely manner. Nationally, the Centers for Medicare and Medicaid Services estimates that up to 15 million people could lose their current coverage.

These are people just like those I met in that San Bernardino backyard: hard-working individuals of modest means doing their best to deal with some of life’s toughest challenges. In an era of stagnant wages, rising inflation and high housing costs, they depend on this critical safety net more than ever. How could we possibly do anything less?


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