California is facing a substantial budget deficit and there is tremendous pressure on state and county governments to reduce costs, including public health insurance programs. This comes at a time when there are nearly six million uninsured Californians, 820,000 of whom are eligible, but not enrolled, in the state's Medi-Cal program. Any efforts to improve Medi-Cal's enrollment among those who are eligible must account for the fiscal crisis at the state and local levels.

The California HealthCare Foundation's (CHCF) Medi-Cal Policy Institute (MCPI) commissioned The Lewin Group to assess the cost implications, enrollment impacts, and policy considerations of several strategies for simplifying Medi-Cal eligibility determination for families. The research found that each of the strategies considered would result in an increase in Medi-Cal enrollment while reducing administrative costs. The strategies would also increase the flow of federal dollars into the state at a time when state and local resources are shrinking.

According to Nalini Pande, CHCF program officer and co-author of the reports, "There are currently 165 categories of coverage in the Medi-Cal program, each with its own eligibility and documentation criteria. This is confusing and frustrating for both applicants and eligibility workers."

Additional detail on the assessment is contained in three documents.

Simplifying Medi-Cal Enrollment: Opportunities and Challenges in Tight Fiscal Times, discusses the complexity of the current Medi-Cal enrollment process and the importance of simplifying this process; describes California's recent improvements to the process; and examines options for further simplification. This issue brief also includes summary findings from the two other reports.

1. Eliminate the assets test;
2. Simplify the assets test by counting only liquid assets; or
3. Streamline the documentation requirements for the assets test by allowing self-certification of assets. Each of these three options would increase enrollment and reduce administrative costs. Eliminating or simplifying the assets test would permit currently ineligible low-income adults to avoid depleting certain assets such as retirement accounts in order to qualify for coverage. These simplification measures would also create time-savings for applicants and eligibility workers. Furthermore, allowing Medi-Cal applicants to self-certify the value of their assets would result in net savings to the Medi-Cal program without changing the current eligibility standard.
   Simplifying Medi-Cal Enrollment: Options for the Income Test discusses three strategies for simplifying the income portion of the eligibility determination process for families. These include:
4. Allowing applicants to self-certify their income (instead of providing documentation);
5. Allowing applicants to self-certify their income deductions; or
6. Changing the methodology used to count income from a net income methodology to a gross income methodology. The findings presented in this report suggest that self-certification of income would have the greatest potential benefit to applicants and eligibility workers.

   Pande stated, "California has considerable flexibility in determining both the eligibility standards and required documentation for the Medi-Cal eligibility process. As we struggle with record budget shortfalls, simplification strategies that reduce the costs of program administration while improving Medi-Cal enrollment are important to explore."

   The issue brief and income and assets reports, along with a summary presentation and a technical report detailing the cost-modeling methodology, are available online through the link below.