There is no doubt that the coronavirus pandemic has impacted every part of our lives. As COVID-19 tears through communities across the country, the number of Americans filing unemployment claims continues to rise at a historic pace, and 30-40 million Americans are at risk of eviction. Access to affordable health care through Medicaid is more important now than ever.
Enrollment in Medicaid is steadily rising across the country as a result of the pandemic, with one recent analysis finding it increased by 8.4% across 30 states between February and July 2020. Given Medicaid enrollment is closely tied to the economic decline of the country, it is anticipated that the numbers will continue to climb, as Medicaid enrollment tends to lag behind unemployment and food assistance.
Despite this national upward trend, California has seen no significant uptick in Medi-Cal enrollment. Despite initial projections that roughly 2.6 million California workers and dependents are at risk of losing job-based coverage, enrollment numbers have not accelerated. In fact, as of July 2020, total Medi-Cal enrollment numbers hovered at 12.7 million. Some data suggests this is a slower growth rate than most every other state. We are also seeing a marked drop in new Medi-Cal enrollments for individuals whose primary language is Spanish.
While California has taken significant steps to respond to the pandemic, including by providing Medi-Cal for COVID testing and treatment for those who are uninsured or underinsured, low-income Californians have been struggling to navigate county office closures, application-processing delays, and other obstacles to obtaining or keeping their Medi-Cal. For example, despite federal guidance and Governor Newsom’s moratorium on negative actions, roughly 200,000 Medi-Cal beneficiaries were erroneously terminated from Medi-Cal.
This is particularly troubling given the federal coronavirus response law enacted on March 18, 2020 requires states to continue coverage for those on Medicaid in exchange for more federal funds. Although the state continues to work diligently to restore coverage for these beneficiaries, the damage has already been done. These unlawful coverage lapses interrupt medical care and can cause lasting financial medical debt.
There is more the state can do to get eligible individuals enrolled in Medi-Cal quickly. We and other advocates have pushed for changes that help Californians, many of whom are struggling with both a public health emergency and some of the most destructive wildfires the state has ever seen. One such change is to expand the Accelerated Enrollment program that currently allows children to get their Medi-Cal quickly through the state’s marketplace website (“CalHEERS”), while the county follows up to verify information.
An expansion of this option was implemented for adults in 2014 when the state had a significant backlog of applications. This federal presumptive eligibility option for adults was made available under the Affordable Care Act but has not been adopted in California. Additionally, the state should adopt policies that support real time enrollment and allow for verification of income or other requirements after the individual is enrolled in Medi-Cal.
This “post-enrollment verification” rule would allow individuals to be determined immediately eligible based on their attestation of income or other needed information and use their Medi-Cal health insurance while the state determines eligibility and matches information to electronic data sources after the person is enrolled.
Medi-Cal is a lifeline that ensures access to preventive care, medically necessary behavioral health and medical services, medications, and other critical services for low-income Californians as they navigate the stresses of living through the COVID-19 pandemic. More can and should be done to get that coverage in place as quickly as possible during this unprecedented health care and wildfire crisis.