Leave No Californian Behind: California’s Efforts to Ease Access to Medi-Cal During the Pandemic

Leave No Californian Behind: California’s Efforts to Ease Access to Medi-Cal During the Pandemic

As the number of COVID-19 cases across the country continue to steadily rise, many of us here in California are thankful that Governor Newsom imposed a “shelter in place” order early on. As a result of swift action and a prolonged period of social distancing, California has managed to keep our death toll comparatively low. Still, we are not out of the woods and the pandemic is highlighting the grave need for every American to have comprehensive health insurance coverage. Even the Trump Administration has been forced to limit relentless efforts to restrict access to Medicaid.

Increase in enrollment in Covered California

California is taking proactive steps to enroll people in coverage so that all Californians are protected from the virus. The public support for health insurance is evidenced by the fact that 84,000 consumers enrolled in Covered California coverage within the first five weeks of rolling out a special enrollment period (SEP) in response to the COVID-19 pandemic. The state is also diligently working to increase Medi-Cal coverage to ensure that those most vulnerable to the virus – essential workers like grocery store workers, home health aides, and California farmworkers, as well as the elderly, homeless individuals and those with underlying medical conditions – are protected. In the last month, California’s Medicaid agency, Department of Health Care Services (DHCS), has taken steps to obtain emergency authority through federal waivers and to make changes to the state’s Medicaid plan in an effort to expand and streamline access to Medi-Cal.

COVID-19 Presumptive Eligibility Program

While DHCS awaits approval from the federal Medicaid agency (CMS) on various Medi-Cal flexibilities, the state has already implemented eligibility and enrollment flexibilities. Effective April 8, 2020, California implemented a COVID-19 Presumptive Eligibility Program. The program provides access to COVID-19 diagnostic testing, testing-related services, and treatment services, including all medically necessary care at no cost to the individual, for Californians who are uninsured or who currently have private insurance that does not cover COVID-19 testing and treatment.

This Presumptive Eligibility (PE) program is available to individuals regardless of immigration status, income or resources. PE providers enroll individuals in this time-limited program if the individual doesn’t qualify for other existing PE programs. Separately, California’s 1135 waiver and State Plan Amendment (SPA) seek to expand the existing Hospital Presumptive Eligibility (HPE) Program to get individuals who are 65 and older, blind, or disabled under 138% FPL on to Medi-Cal quickly. Through these eligibility and enrollment flexibilities, California is seeking to provide a “no wrong door approach” so that all Californians have access to free health insurance even if they are not able to sign up for coverage through a county welfare office or online.

Flexible approach supports telephone enrollment

In recognition of the physical distancing requirements of “shelter-in-place,” DHCS has implemented enrollment flexibilities that support telephonic enrollment, as discussed in this recent blog. DHCS has also been proactive in issuing guidance that permits applicants to telephonically enroll in Medi-Cal through various options such as the Hospital PE Program, Every Woman Counts, FPACT, CHDP, and the Breast & Cervical Cancer Treatment Program (BCCTP). These policies are critical in a time when Californians are being told to stay at home, and wear masks and stand six feet apart if they go out.

There is still more that should be done to get people health coverage during and after this public health crisis but these are important steps forward to ease Medi-Cal eligibility criteria, remove enrollment hurdles, and ensure more Californians have coverage when they need it most. California’s strong stance on expanding coverage will also help prepare our state for any potential surge in COVID-19 cases or second waive later in the year.

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