May 01, 2023
On April 1, 2023, California began the process of redetermining eligibility for about 15 million Medi-Cal enrollees. This large, complex effort was triggered by the official end of the COVID-19 public health emergency and the end of the federal Medicaid continuous coverage requirement that was implemented as part of the Families First Coronavirus Response Act.
The redeterminations are based on the beneficiaries’ next annual renewal date (done on a rolling basis and not all at once). On April 1, counties resumed their normal redetermination process for beneficiaries with a June 2023 renewal date. The first disenrollments for those deemed no longer eligible will begin in July.
As a result of the redetermination process, two to three million beneficiaries could no longer be eligible for Medi-Cal. Those no longer eligible may, however, qualify for tax subsidies that allow them to buy affordable coverage through Covered California.
DHCS is in the process of creating a provider outreach toolkit to help providers assist and inform Medi-Cal patients on the redetermination effort and the easiest ways to their contact information is up to date and they are responding to renewal letters. The toolkit will include an FAQ, patient flyer for physician offices, along with social media, text message and email campaign text that can be utilized.
In the meantime, practices can =encouraging beneficiaries to update their contact information by visiting KeepMedicalCoverage or MantengaSuMediCal, signing up for updates via email and SMS text message, and being on the lookout for renewal packets that may come through regular mail for cases that could not be renewed using information the local county office has available.
With the first disenrollments beginning in July, it will be extremely important that physician practices verify eligibility for their Medi-Cal/Medi-Cal managed care patients each month. Failure to do so may result in non-payment for out-of-network services. Additionally, physician practices that are on capitated contracts are encouraged to review their monthly capitated payments and the affiliated enrollee reports carefully to identify any decreases in payment due to disenrollment.
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Contact: CMA’s Center for Economic Services at email@example.com or (800) 786-4262.