For Immediate Release:
Contact: Robert Nunez, rnunez@lchc.org@lchc.org
Dear Director Baass, Dir. Cooper and Ms. Rene Mollow,
On behalf of the undersigned organizations, we want to thank you for meeting with us last week to discuss concerns regarding California’s Medi-Cal renewal process and the disparate impacts of procedural terminations on communities of color and additional vulnerable communities who are at risk of losing life saving coverage.
We continue to urge DHCS to reconsider and to pause procedural disenrollment’s due to the systemic problems we have identified that are causing eligible Medi-Cal members to lose coverage.
We are deeply concerned by both the initial unwinding data shared by DHCS through the Medi-Cal Continuous Coverage Unwinding Dashboard and what we and service providers are learning and hearing from the experiences of clients and communities on the ground about the problems with the renewal process. The problems with the process are disproportionately impacting people of color, people whose primary language is other than English, unhoused individuals, children, seniors, and people with disabilities. The human impact of the failures of our systems cannot be understated with these populations already experiencing some of the greatest health inequities in our state.
Our communities are still recovering from a devastating pandemic, during the past three years we saw over 9 million cases and over 100K deaths and those families are still recovering from acute cases, long-COVID and the socioeconomic repercussions of the pandemic. We saw in action however, policy solutions that work! Millions of eligible Californians were able to receive care during a public health emergency because federal, state and local government worked together to expeditiously cover and protect individuals and families. Now, after a three-year pause in renewals, the data and community experiences are showing that Californians are losing coverage when they are still eligible because of procedural and systematic problems in part because of DHCS’s administration of the renewal process. System issues require a system fix, it is unfair to place the onus on individuals. Here are a few examples of current systemic concerns, that need to be addressed and are contributing to the large proportion of procedural disenrollment’s:
● Long county call wait times and erroneous call disconnects, particularly for those needing interpretation, many without call back options
● CalSAWS automatically discontinues Medi-Cal every month unless a renewal submission is marked as “received” – which due to county staffing shortages, does not always happen when it should
● BenefitsCal/CalSAWS documentation uploads not being processed and marked “received” by county eligibility workers before eligibility auto-terminates
● BenefitsCal/CalSAWS delays between setting up an account and renewal functionality being available to Medi-Cal members
● Counties are not auto-renewing (ex parte) people aged 65+ and people with disabilities who have fixed incomes and non-countable assets
● Not receiving renewal packets or notices of renewals in process, despite updated contact information
While we understand that annual Medi-Cal renewals are a required procedure, we urge DHCS to adopt the federal flexibility that allows pausing disenrollments for procedural reasons during renewals while the Department addresses the above noted systemic issues. In order to protect the recovering health, safety & well-being of Californians, DHCS should pause renewals and take appropriate and swift action to keep the most vulnerable populations covered. We know this pause step is systematically feasible as DHCS has instituted a delay for 160,000 disenrollment’s previously scheduled for disenrollment in July due to the failure by counties to issue timely notices of action (according to DHCS’ July report to CMS), and has taken similar protective action for hundreds of thousands of Medi-Cal members throughout the pandemic. Federal analysis estimates that most individuals facing procedural disenrollment’s remain eligible, particularly for children, three-fourths of whom remain eligible. Below please find a list of recommended policy and system actions to immediately address concerns related to California’s renewal process, especially for communities of color and additional vulnerable populations:
● Pause procedural terminations: The data shows that the overwhelming majority of June terminations (89%) were due to procedural reasons. The most effective way to avoid people from wrongfully losing coverage is to pause terminations due to procedural reasons because the renewal process is demonstrating deep flaws and is having a disparate impact on communities of color. Nearly 1 in 3 of terminations are for Latinxs beneficiaries, according to the data provided in the unwinding DHCS dashboard.
● Confirm Accuracy of Medi-Cal’s Ex Parte process: As noted in CMS’ August 30 letter to states, several states are inaccurately determining “ex parte.” States are required by federal law to make an “ex parte” determination of all individuals’ eligibility without requesting additional information from families that states already have access to. If a child’s ex parte determination is instead based upon their parents’ income eligibility standard, and a renewal packet is set but not submitted, the child is being incorrectly terminated. Similarly, if one household member must provide additional information that should not lead to other household members needing to provide information and be subsequently disenrolled if not provided. As directed by CMS, we hope DHCS will quickly confirm that all counties are complying with these rules and pause renewals while it determines that their ex parte processes are meeting federal law.
● Expand data sources to increase ex parte renewal: CMS has issued guidance that encourages states to increase the number of ex parte renewals by expanding the data sources they use to verify ongoing eligibility. We urge DHCS to implement this policy available to California to lessen the burden on individuals and maximize the benefit of procedural flexibility that can maintain coverage for populations such as older adults, children, seniors, individuals whose primary language is other than English, and persons
with disabilities. California’s June ex parte renewal rate for non-MAGI groups sits at 0.41%. Thousands of individuals, including older adults and children, are not being renewed ex parte. The loss of Medi-Cal leads to a cascade of negative effects for older adults and people with disabilities, including the sudden loss of income due to the loss of Medi-Cal payment of Medicare premiums and cost-sharing.
● Streamline and clean up online renewal system: System-wide glitches have already been reported within the BenefitsCal system. Because CalSAWS is programmed to automatically discontinue Medi-Cal eligibility during annual renewals, counties must take action to stop that pending action. But when somebody uploads a renewal or proof on BenefitsCal, that action alone does not stop the Medi-Cal cutoff. Instead, the uploads languish until a county worker can review them and mark them as “received.” This results in erroneous Medi-Cal cutoffs, because workers are not able to mark all submissions as received. To fix this problem, DHCS should instruct BenefitsCal to program the system to mark renewals as “received” when any upload is submitted on a case during its Medi-Cal annual renewal period.
● Ensure notices and materials are reaching families. As mentioned, we have evidence that families are not receiving renewal packets despite updating contact information. In addition, families have no confirmation that submitted renewal packets are received and being processed. Our recommendation to mark renewals as “received” in the CalSAWS/BenefitsCal system should be implemented and written notices should be sent to families letting them know their renewal packet was received and is being processed, and how to follow its status.
● Collect and share county call center data metrics and standards: We understand that currently DHCS is not required to collect or share county call center data per CMS
policy. However, this is an enormously missed opportunity for DHCS to better understand systemic barriers to renewals and what the issues are county by county and limits crucial information-sharing that can assist advocates and service providers to better assist local and state governments to address and resolve systemic gaps and provide appropriate local level interventions to keep people covered. For example, today people are suffering erroneous call disconnects and hour-long wait times – but those issues remain unaddressed because DHCS fails to collect tracking data. DHCS should collect county call center metrics in whatever ways that counties currently track those data, and share with the public those reports.
● Broader funding for navigators and community assistance. As community organizations are trying to assist families with their renewals, they are also asked to assist
the state with finding and notifying recently disenrolled individuals that there is time to be reinstated. In LA, that amounts to a call list of 48,000 in the month of June. While we greatly appreciate the data shared with navigators, health plans and schools, it would be important for DHCS to coordinate this massive outreach effort among these partners and
support those community organizations in that effort. Including language access to Indigenous Mesoamerican communities speaking Mixteco, Mayan, K’iche, Zapoteco and additional Indigenous Mesoamerican languages.
● Implement the multi-year continuous coverage for young children: Roughly 800,000 children, majority children of color, stand to wrongfully lose coverage through this year’s unwinding process. California has already adopted a policy to permanently continue coverage for young children from birth to age 5. Children ages 0-5 face lifelong
consequences in losing coverage as this period of early childhood development. As of now there is a delay in implementing this policy. DHCS could request that the Governor prioritize this policy in his January Budget, effectively giving the financial greenlight needed for DHCS to fully implement this policy. California has the opportunity to not
only allow young children to stay enrolled in Medi-Cal, but can also allow their families to stay enrolled by preventing them from having to jump through administrative hurdles to keep them enrolled.
We wholeheartedly share and welcome DHCS’ health equity goals of centering the needs of the individual served by Medi-Cal. We also recognize that DHCS has taken extraordinary actions to maximize continuity of Medi-Cal coverage, but more is needed. We see this Medi-Cal renewal response as an anti-racist health equity opportunity for DHCS to prioritize addressing the barriers facing Medi-Cal beneficiaries, particularly those facing language, disability, and other barriers, over the ease of the system procedures and the efficiency of its operation.
Please let us know when we can discuss the implementation of these solutions further and we stand ready to work with you on these solutions. We appreciate your attention to this letter regarding our concerns and recommended actions to ensure Californians remain protected and healthy.
Sincerely,
David Kane
Senior Attorney
Western Center on Law and Poverty
Kim Lewis
Managing Attorney
National Health Law Program
Kristen Golden Testa
Health Policy Director
The Children’s Partnership
Dr. Seciah Aquino
Executive Director
Latino Coalition for a Healthy California
Tiffany Huyenh-Cho
Senior Attorney
Justice in Aging
Kristen Golden Testa
Health Policy Director
The Children’s Partnership
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About LCHC:
Latino Coalition for a Healthy California (LCHC)— is the leading statewide policy organization with a specific emphasis on Latinx health. For over 30 years, LCHC has worked on transforming systems to achieve Latinx health justice. We pride ourselves in translating community solutions into equitable policy and lasting change.
