This post is part 8 of our 12-part “Protect Medi-Cal Funding” series. Medi-Cal provides a long-term investment that helps Californians succeed. This blog highlights the importance of Medi-Cal enrollment and continuity of coverage protections are essential for enrolled populations, including children, parents, pregnant women, low-income workers, older adults and individuals with disabilities.
Medi-Cal enrollment rules are designed to protect low-income applicants who may have urgent health care needs and no other option to access services. Unlike Covered California coverage, Medi-Cal is not subject to an Open Enrollment Period and accepts applicants at any time during the year. State and federal law require that applicants be enrolled with “reasonable promptness” and retroactive coverage is available for the three months prior to the application month.
Special continuity provisions protect vulnerable enrollees, like automatic coverage for infants born to mothers on Medi-Cal for the first year of life and providing pregnant women Medi-Cal coverage for a post-partum period of at least 60 days. California also provides Hospital Presumptive Eligibility (HPE), temporary no-cost Medi-Cal for up to 60 days to individuals with an immediate medical need. All of these protections ensure that Californians have immediate access to care and ensure hospitals and physicians are paid for their services.
The Senate’s Better Care Reconciliation Act (BCRA) proposal threatens these enrollment and continuity protections by:
- Cutting federal Medicaid funding by $772 billion places an annual cost-shift onto California of nearly $3 billion in 2020, rising to $30.3 billion by 2027
- Forcing California to look at cutting coverage and benefits or impose more burdensome application and renewal procedures to decrease or discourage enrollment
- Decreasing enrollment in Medi-Cal by 38 percent in California from what it is today under the ACA
- Eliminating Hospital Presumptive Eligibility (PE), which currently provides coverage to 25,000 Californians each month
- Eliminating the three months of retroactive Medi-Cal coverage, making Californians more susceptible to medical debt and bankruptcy
Check out our Protect Medi-Cal Funding series, Issue Brief #8, for a “deeper dive” on the importance of Medi-Cal enrollment and continuity of coverage protections for low-income Californians and to learn how these protections are threatened by Medicaid funding cuts.
Why Medicaid Cuts Would Harm Health Care for California’s Children