After a roughly three-year hiatus under federal policies designed to help people keep their health coverage during the pandemic, California has returned to requiring enrollees to annually renew their Medi-Cal coverage. California will need to redetermine Medi-Cal eligibility for over 15 million enrollees, an unprecedented undertaking.

To understand how this process is going, CHCF is monitoring detailed monthly data provided by the California Department of Health Care Services (DHCS), which administers Medi-Cal. Scroll down to our first update, posted on November 4, for an explanation of data measures and an analysis of the first quarter of data. Subsequent updates will be provided on a rolling basis as new data become available.

Update: 90-Day Updated Redetermination Data June–October 2023

Posted April 15, 2024

Back in February, we examined the first release of 90-day updated Medi-Cal redetermination data (covering June–August). As we explained, the 90-day data can help provide a fuller picture of the impact of the unwinding than the data released monthly because people who have been disenrolled from Medi-Cal have 90 days to get reinstated and because the updated data may capture progress on renewals still in process when monthly data are reported.

DHCS has now released more of this 90-day updated data, adding data for September and October 2023, meaning there are now five months of this more “settled” data. The five months of 90-day data show a substantially more positive picture than the monthly (or “pre-90 day”) data on key measures:*

In addition, the 90-day data show that non-MAGI enrollees are not being disproportionately disenrolled compared to their representation among redeterminations due. This is important as, before full implementation of policy improvements, this group was being disenrolled at a disproportionately high rate. (For more on this topic, see previous posts.)

Looking across the five months of updated 90-day data, we see these trends:

• The disenrollment rate has been trending downward, from 24% to 20%. (We define disenrollment rate as the percentage of renewals due resulting in disenrollment.)
• The procedural disenrollment rate has dropped from 80% in June to 70% in October, a new low.
  • Although this substantial progress should be celebrated, note that this still means the majority of Californians losing their Medi-Cal coverage are being disenrolled for procedural reasons rather than being determined ineligible. We don’t know how many people procedurally disenrolled remain eligible for Medi-Cal.
  • The procedural disenrollment rate for non-MAGI enrollees has been declining but remains quite high, at 85% in October.
• Roughly 150,000 people have had their Medi-Cal coverage reinstated over the five months, or 16% of the original disenrollments. The percentage being reinstated was about 17% in June and has dropped to about 14% for September and October.
• Dramatic progress continues on the number of renewals in process (see above), although the pace may be slowing somewhat, landing at about 20% still in process in September and October.

The 90-day updated data do not include demographics, so we cannot report on whether the new data show differences by race, ethnicity, age, gender, or language.

Stay tuned for more analysis as updated data become available.

Explore more of the 90-day updated data, available under Document Downloads, below.

* As was the case with the previous 90-day data, updated data revise the number of renewals due each month for various reasons (see previous post). This impacts the number of renewals in process and the disenrollment and continuance rate. Note that in all redetermination data sets, the month of July appears to be an outlier, possibly due to a reporting or processing glitch.

Update: January Redetermination Data

Posted April 2, 2024

You may remember that December data showed dramatic improvements compared to previous months (see December post below). Most indicators show these gains holding. For older Californians and those qualifying for Medi-Cal because of a disability (an enrollment category called non-MAGI), the picture continues to substantially improve.

• After skyrocketing from 4% to 58% in December, the ex parte rate among the non-MAGI population continued to improve, climbing to 62%. (Ex parte is a process whereby Medi-Cal uses other sources of information to confirm eligibility without requiring additional information from the enrollee.)

Holding largely steady:

• The overall disenrollment rate was 8%, similar to December’s 9%.
• The share of disenrollments due to procedural reasons (e.g., paperwork issues, missing information) held steady at 81%.
• The statewide ex parte rate dropped from 66% in December to 60% in January, a decline but still notably improved from 36% in November.

What Conclusions Can We Draw at This Point?

This second month of data supports the case that these improvements are due to the key policies California implemented in the fall, perhaps most notably the expanded use of ex parte for non-MAGI enrollees, people experiencing homelessness, and folks with income at or below 100% of the federal poverty level. As we noted in our December post, ex parte not only removes burdensome paperwork for consumers but should also free up eligibility workers to focus on more complex cases. In the months ahead, we hope to see the ex parte rate increase and to see this translate into:

• Non-MAGI enrollees no longer being disenrolled at a disproportionate rate, compared to their representation among those with renewals due
• A shrinking portion of disenrollments due to procedural reasons
• A decline in the percentage of renewals still in process

Procedural Disenrollments

While January data show the portion of disenrollments due to procedural reasons down from its high of 92% in November, it remains extremely high at 81%. Most people being disenrolled are not being disenrolled due to a determination that they are no longer eligible but for reasons such as late or missing paperwork or information.

Stay tuned for future analyses as more data are released.

Explore more data, available under Document Downloads, to see breakdowns by age, race, and language.

Update: December Redetermination Data

Posted February 27, 2024

December data showed dramatic improvements compared to previous months. Most notably:

• The disenrollment rate plummeted from 19% to 9%.
• The share of disenrollments due to procedural reasons also dropped substantially, from 92% to 81%.
• The statewide ex parte rate increased from 36% to 66%. (Ex parte is a process whereby Medi-Cal uses other sources of information to confirm eligibility without requiring additional information from the enrollee.)

Also:

• The share of people who continued in Medi-Cal coverage increased from 47% to 72%.
• The portion of redeterminations still in process fell from 34% to 20%.
• Among the non-MAGI population, the ex parte rate skyrocketed from 4% to 58%. (Non-MAGI enrollees include adults age 65 and older and those qualifying for Medi-Cal because of a disability.)

These dramatic improvements may in large part be due to California’s implementation of federal flexibilities that allow more people to have their eligibility determined via ex parte, as explained below, as well as other beneficial policies and practices since the unwinding began. Some changes were implemented earlier this fall and so may not have been reflected in earlier data. However, it is important to remember that the December numbers here represent a single month of data. More months of data are needed to confirm this is a positive trend. We are hopeful it is!

More About Ex Parte

Ex parte not only removes burdensome paperwork from consumers but also should allow county eligibility workers to complete more redeterminations and focus attention on more complex cases.

In addition to other policy improvements, California expanded the use of ex parte for Medi-Cal eligible enrollees experiencing homelessness (and therefore unlikely to receive a renewal packet), people with income at or below 100% of the federal poverty level, and people with certain types of stable income such as social security payments and disability payments, which would include many non-MAGI enrollees.

The skyrocketing ex parte rate for non-MAGI enrollees is important, since this group has been disproportionately disenrolled, compared to their representation among renewals due, throughout the unwinding. If this much higher ex parte rate holds in the months ahead, we should see this disparity eliminated.

Stay tuned for future analyses as more data are released.

Explore more data, available under Document Downloads, to see breakdowns by age, race, and language.

As noted in our original post, people have 90 days from the date of their disenrollment to get their Medi-Cal coverage reinstated. Since my last post, DHCS has added another month of updated data reflecting this “settling” of the numbers for September.

Update: 90-Day Updated Redetermination Data for June–August 2023

Posted February 16, 2024

DHCS has begun releasing updated 90-day data about the Medi-Cal renewal process, in addition to the detailed monthly data it posts. The 90-day updated data can help provide a fuller picture of the impact of the unwinding for a couple reasons:

• After receiving a notice of disenrollment, people have 90 days (sometimes called the “cure” period) to get their Medi-Cal reinstated by supplying updated or missing information. The updated data should reflect these reinstatements, giving us a more “settled” idea of how many people are keeping their coverage.
• California has also seen the number of renewals remaining “in process” stack up. The updated data could show whether substantial progress is being made on these renewals in process.

The 90-day updated data for June–August 2023 is posted below under Document Downloads. We compared it to the original data for those three months to answer some key questions. (Note that in both data sets, July appears very different from June and August, possibly due to a reporting or processing glitch.)

Are people regaining their Medi-Cal coverage through the 90-day cure period? If so, how many?

Updated data show almost 93,000 people had their Medi-Cal coverage reinstated over the three months. This includes about 39,000 in June and almost 27,000 each for July and August. For the three months, that translates to 18% of the original disenrollments being reinstated.

Do the updated data show progress on the number of renewals in process?

The data show dramatic improvement, with 759,000 fewer renewals still in process for the three-month period. While the previous data for this same period showed about 37% of renewals due still in process, the updated data show only about 14% in process.

One important caveat here is the updated data revise the number of renewals due each month — showing 124,143 fewer renewals due over the three months. DHCS reports that this revised count reflects cases where people report a change of circumstance, which resets their renewal date to another month, as well as data clean up to address some earlier data issues related to recent changes in the county electronic eligibility system.

In addition to affecting the number of renewals in process, this reduction in renewals due impacts the disenrollment and continuance rates we describe below, since we measure those as a percentage of renewals due.

Do the updated data show more people getting disenrolled or more continuing? What do the data show about the disenrollment rate?

The new data show 443,020 additional people kept their Medi-Cal coverage. The updated data also show 192,000 additional disenrollments. With a smaller number of renewals due and a larger portion processed, the new data show both a higher continuance rate (63% compared to the earlier 47%) and a higher disenrollment rate than the earlier data (23% compared to 16%).

Do the updated data show any improvement on our high procedural disenrollment rate?

The “uncured” data for the June–August period showed 87% of all disenrollments were due to procedural reasons. The updated data show procedural disenrollments compose a smaller portion of disenrollments — 78% for the three months. This is positive news. August data show the most dramatic drop, from 89% to 74%.

What do the updated data show about disparities between groups? Are non-MAGI, who have been disenrolled at a disproportionate rate compared to redeterminations due?

Throughout the unwinding, non-MAGI enrollees (adults 65 years and older and those qualifying for Medi-Cal because of a disability) have been disproportionately disenrolled compared to their representation among redeterminations due. The updated data show this gap being erased, with non-MAGI representing 10% of the renewals due and only 9% of the disenrollments, compared to earlier data showing non-MAGI as 13% of the renewals due and 19% of the disenrollments. This is due both to a decrease in the disenrollment rate for non-MAGI and an increase in the disenrollment rate for MAGI.

The 90-day updated data do not include demographics, so we cannot report on whether the new data show disparities or differences by race, ethnicity, age, gender, or language.

Since writing, DHCS has posted an additional month of updated data. Stay tuned for further analysis and updates here.

Update: November Redetermination Data

Posted February 8, 2024

Key numbers (rounded) from the November data include:

Of the over one million redeterminations due in November:

• 47% continued in Medi-Cal coverage (about 493,000)
• 19% were disenrolled (about 205,000)
• 34% had a redetermination still in process (about 359,000)

Other takeaways:

• 92% of disenrollments were due to procedural reasons, rather than determinations that the enrollee was no longer eligible, up slightly from the previous month. (Examples of procedural reasons include paperwork not being received by the county Medi-Cal office on time or paperwork missing required information or proof.)
• The statewide ex parte rate (36%) stayed roughly the same compared to the previous month (37%). (Ex parte is a process whereby Medi-Cal uses other sources of information to confirm eligibility without requiring additional information from the enrollee.)
• The ex parte rate for non-MAGI enrollees (those who qualify because they are over 65 or have a disability or both) went down dramatically from 8% to 4% from the previous month.This is troubling, since non-MAGI enrollees are being disenrolled at a somewhat disproportionately high rate compared to their representation among renewals due. (In November, non-MAGI enrollees comprised 13% of redeterminations due and 15% of those disenrolled.) The good news is the gap has been shrinking. It will be important to see what future data show.

Explore more data, available under Document Downloads, to see breakdowns by age, race, and language.

As noted in our original post, people have 90 days from the date of their disenrollment to get their Medi-Cal coverage reinstated. DHCS has released updated data reflecting this “settling” of the numbers for June, July, and August. Check back here for our analysis of these figures.

Update: October Redetermination Data

Posted January 3, 2024

Key takeaways from the October data include:

• 90% of disenrollments were due to procedural reasons, rather than ineligibility determinations. (Examples of procedural reasons include paperwork not being received by the county Medi-Cal office on time or paperwork missing required information or proof.)
• Californians who qualify for Medi-Cal based on a disability or being over age 65 or both (called “non-MAGI”) continue to be disenrolled at a disproportionately high rate compared to their representation among renewals due.
• The statewide ex parte rate went up slightly from the previous month (from 35% to 37%). (Ex parte is a process where Medi-Cal uses other sources of information to confirm eligibility without requiring additional information from the enrollee.)
• After increasing last month, the ex parte rate for non-MAGI remained steady this month.

Update: September Redetermination Data

Posted December 6, 2023

Key takeaways from the September data include:

• 91% of disenrollments were due to procedural reasons, rather than ineligibility determinations. This is up slightly from the previous month (89%). (Examples of procedural reasons include paperwork not being received by the county Medi-Cal office on time or paperwork missing required information or proof.)
• Californians who qualify for Medi-Cal based on a disability or being over age 65 or both (called “non-MAGI”) continue to be disenrolled at a disproportionately high rate compared to their representation among renewals due.
• However, the percentage of non-MAGI enrollees having their Medi-Cal coverage renewed via ex parte increased dramatically, rising from less than 0.5% in August to 8% in September. (Ex parte is a process where Medi-Cal uses other sources of information to confirm eligibility without requiring additional information from the enrollee.) This should translate into more seniors and people with disabilities maintaining Medi-Cal coverage in future months and is likely the direct result of the implementation of recent policy improvements.

Explore the full data, available under Document Downloads.

Key Takeaways from Medi-Cal Redetermination Data for June–August 2023

Posted November 4, 2023. This was the first update provided by CHCF.

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.