Starting April 1, 2023, California returned to requiring enrollees to annually renew their Medi-Cal coverage. This came after a roughly three-year hiatus under federal policies designed to help people keep their health coverage during the pandemic. Over the course of a little over a year, California will need to redetermine Medi-Cal eligibility for over 15 million enrollees, an unprecedented undertaking.

July 1 marked the first day Californians could lose their Medi-Cal coverage through the restarted redetermination process. The California Department of Health Care Services (DHCS), which administers Medi-Cal, shares detailed monthly data on how this process is going, as well as reporting on metrics required by the federal Centers for Medicare & Medicaid Services.

We now have three months of Medi-Cal renewal data reflecting redeterminations completed or in process during June, July, and August. The analysis below examines what the data can tell us and explains some of the basic data points.

Data and Timing

Each monthly dashboard produced by DHCS reflects the universe of cases due for renewal in that month, with any disenrollments among those cases effective the first day of the following month. For example, the June data show renewals due, in process, or continued during June, and disenrollments that were effective July 1. Data are typically posted roughly six weeks after the end of each renewal month.

This article focuses on state-level data. California’s Medi-Cal eligibility system is county-based, so it is important to look at county-level data while also recognizing that population size and composition will affect the numbers. A county-level look may reveal important dynamics invisible at the state level; for example, substantially higher- or lower-than-average disenrollment rates or disproportionate disenrollments for certain groups. Detailed data by county are available on the DHCS interactive dashboard.

How many people have been disenrolled from Medi-Cal, and how many people have had their Medi-Cal coverage continued?

Almost 3.2 million Medi-Cal members have come up for an eligibility redetermination since the process restarted earlier this year. So far:

• 511,166 Californians, or 16%, have been disenrolled.
• 1,483,421 Californians, or 47%, have had their Medi-Cal renewed.
• About 1.2 million Californians, or 37%, are still going through the process.

When tracking these numbers, it is important to understand that, among the over half-million Californians disenrolled, some already have other health coverage or will transition to other coverage, such as Covered California, which automatically facilitates enrollment for those who are losing Medi-Cal coverage and are eligible for financial help through Covered California. (Data is available on Medi-Cal Transitioner Profiles.)

Also, some who are disenrolled will regain Medi-Cal coverage. People have 90 days from the date of their disenrollment to get their Medi-Cal coverage reinstated by providing requested information. In the months ahead, updated data will be posted to reflect this “settling” of the numbers.

Looking beyond the numbers, any break in coverage can be devastating to people who need care. Many of the barriers that prevented people from renewing in the first place may also prevent them from “curing” their coverage during the 90-day period.

What is the main reason Californians are being disenrolled from Medi-Cal?

A small portion of Medi-Cal disenrollments have been because enrollees were determined to no longer be eligible, for reasons such as higher household income. The vast majority (87%) of Medi-Cal disenrollments have been due to procedural reasons.

What are “procedural reasons”?

Procedural reasons refer to being disenrolled for reasons other than being determined ineligible. Examples of procedural reasons include paperwork not being received by the county Medi-Cal office on time or paperwork missing required information or proof.

Some people may not return their renewal paperwork because they already know they are ineligible or they don’t want Medi-Cal coverage; others may not have received the renewal packet, may not understand what is being requested, or may not be able to get the answers or support needed to complete the information by the deadline.

Californians who have been disenrolled for procedural reasons — some 440,000 to date — may still be Medi-Cal eligible.

Who is being disenrolled? Are any groups being disenrolled at disproportionate rates?

Some data are missing, but the available self-reported data on the age, race and ethnicity, and language of the Californians disenrolled to date are shown below. (The data are also available for download below.) A separate important question is whether any groups are being disenrolled at disproportionately high rates, compared to their representation among the renewals due each month. To date, the available statewide data suggest that:

• Nonsenior adults are being disenrolled at a somewhat disproportionately high rate.
• Californians 65 and older and those who qualify for Medi-Cal based on a disability or being over age 65 or both (called “non-MAGI”) are being disenrolled at a disproportionately high rate. The ex parte rate, explained below, sheds further light on this.

What is the ex parte rate, and why is it important?

To renew enrollees’ Medicaid coverage, states are required to first attempt to confirm ongoing eligibility using information they have available without requiring additional information from the enrollee (e.g., looking at wage data from state sources). This is called ex parte renewal and is designed to reduce the burden on the consumer and streamline the renewal process. The percentage of California’s redeterminations completed using ex parte over the last three months has increased from 27% to 35%, meaning a greater share of renewals due are being done via ex parte — a positive trend.

Data to date show that adults 65 years and older and those qualifying for Medi-Cal based on having a disability (non-MAGI) are less likely to be renewed via ex parte, meaning they are more likely to have the additional burden of submitting information to renew, potentially leading to procedural disenrollment. California has recently adopted new policies to further streamline redeterminations for this population and automate ex parte. The impact of these improvements is not yet reflected in the data but should show up in the months ahead.

Data also show ex parte renewals being disproportionately low among Spanish-speaking and Latino/x enrollees. This merits further investigation; one barrier may be that the process relies heavily on data sources that advantage those with established credit histories, thereby excluding many immigrants.

Going Forward

In the months ahead, it will be important to watch the key metrics identified here, as well as to monitor county-level data. The data to date point to the need for continued and more aggressive action to help Californians maintain coverage, including more targeted strategic outreach and support for groups being disproportionately disenrolled. Check back here for updates.

The author acknowledges the State Health Access Data Assistance Center for its analysis of the DHCS data.