The impact of the COVID-19 public health crisis is being felt across the nation. Given the serious illness and risk of mortality faced by people who contract COVID-19, which is higher for people of color, having health insurance coverage is more critical than ever. Due to rising unemployment and an anticipated spike in Medi-Cal applications, county workers are confronted with a potentially high volume of applications to process while complying with shelter in place orders.
Medi-Cal county offices have temporarily closed posing challenges for vulnerable people
As a result, many county Medi-Cal agencies have temporarily closed their offices. Office closures present major barriers for already vulnerable applicants who need health coverage, particularly those who have a disability, have Limited English Proficiency, seniors, and people without access to the internet to submit online applications (such as rural communities). While CMS has not released data on race and the impacts of COVID-19, the data available reveals significant racial disparities related to the financial and health risks the pandemic has amplified for communities of color. It is crucial for county agencies to recognize these disparities to ensure marginalized communities who are harder hit by this pandemic can apply for Medi-Cal.
Social service agencies ensure Medi-Cal applications
So, how can people still access their local county agencies to get onto Medi-Cal? Federal Medicaid rules require that social service agencies ensure Medi-Cal applications be made available without delay, which agencies have done through a variety of options. These agencies must also timely process submitted Medi-Cal applications. In order to ensure people can get on Medi-Cal, agencies are required to provide options to apply by internet, telephone, in person, and by U.S. mail. Eligibility workers have an obligation to provide assistance to any applicant that requests help with the application. In California, the existing online single streamlined application is also available to apply for a range of health coverage options, including Medi-Cal and Covered California
Outstation locations to receive and process Medicaid applications
The COVID-19 public health crisis highlights the importance of preparing for disasters or public health crises to ensure people can still enroll in Medicaid. For example, states have authority to prepare outstation locations to receive and process Medicaid applications when offices are closed or exceed capacity during a disaster or a public health crisis. Federal rules also provide states with authority to relax eligibility rules for Medicaid enrollment due to office closures or barriers to accessing paper or online applications or if telephone lines are down. For example, states may allow self-attestation for all eligibility criteria other than citizenship or immigration status; states can also ease requirements to verify information required to qualify such as suspending periodic data checks; and states can expand presumptive eligibility for eligible populations so people can get on quickly with a simplified process. All of these options make it easier for people to get onto Medicaid when they cannot access a state or county office or do not have access to the internet.
Relaxed eligibility requirements
California has adopted relaxed eligibility requirements during the public health crisis, some of which was put into place during prior public health emergencies. The state has directed counties to accept telephonic signatures for applications, including use of signed and dated sworn statements called “affidavits” to attest to residency, income, and assets when applicants are unable to provide the necessary verification documents due to the pandemic. California also allows for expedited transfer of Medi-Cal for beneficiaries who have had to relocate to another county during the pandemic. In order to streamline new or continued enrollment onto Medi-Cal, the state has outlined an order of priorities for local agency eligibility workers to mitigate widespread loss of coverage.
People should be able to get coverage
Given the state guidelines during this pandemic, people newly eligible for Medi-Cal should be able to get on and stay on coverage, even if county Medi-Cal offices are closed. More outreach and education is needed to ensure people know how to get on Medi-Cal during these unprecedented times. County Medi-Cal offices must have the needed capacity to adapt to office closures and disaster-related barriers and meet the growing needs of millions of Californians who have lost their jobs and their health insurance due to COVID-19.