More than 20 million people nationwide have lost their Medicaid coverage, many of whom are still eligible for the program. An unprecedented redetermination process has resulted in a sharp rise in disenrollments from the government funded health insurance program for people with low incomes.
In California, some health advocates are calling for the Department of Health Care Services (DHCS) to pause disenrollments during the redetermination process because of the high rates of Latinos in the state that have lost their Medi-Cal coverage, California’s Medicaid program, for “procedural” reasons, meaning they didn’t submit the proper paperwork on time. Early surveys suggest that Latinos experience more challenges with Medi-Cal re-enrollment than other demographic groups.
Annual eligibility checks were paused by the federal government in 2020 because of the COVID-19 pandemic as part of an effort to keep as many people as possible insured during the health crisis. Those regulations began unwinding in 2023, giving states 12 months to return to pre-COVID operations. Over the course of the year, millions of people have lost Medicaid coverage, many for procedural reasons. Some states have decided to pause procedural disenrollments during the redetermination process in an attempt to address the high rate of people dropped because of paperwork.
At the federal level, the Biden Administration supports states’ decisions to put a pause on dropping people from Medicaid during the redetermination process.
U.S. Health and Human Services Secretary Xavier Becerra, whose office oversees the Centers for Medicaid and Medicare Services (CMS), tells El Tímpano that he supports states that have utilized a pause on disenrollments during the redetermination process. “We support it,” he said at an event in San Francisco on April 9. “We can’t require a pause at the federal level, only the states can because they run the state program, but we have always supported every state that has called for a pause. And many have. So we’re very supportive of it.”
In California, however, DHCS is reluctant to implement a pause on disenrollments. While Latinos consistently make up roughly half of state-wide disenrollments each month since redeterminations began, the overall number of people who are being dropped from the program has decreased month after month. In total, disenrollments dropped by 26% between December and January, for example.
“As such, DHCS does not believe a pause of disenrollments is necessary,” DHCS spokesperson Tony Cava said in an emailed statement on Feb. 27. “It is important to note that disenrollments do occur as part of the normal Medi-Cal redeterminations process, and the disenrollment rates observed through the unwinding are similar to pre-COVID-19 historical trends.” (When reached on April 16, Cava did not offer additional comments and said the department’s original comment on the subject is accurate.)
For us, one single Latino who gets disenrolled because of procedural issues is one too many.
Seciah Aquino, executive director of the Latino Coalition for a Healthy California
Federal rules allow DHCS to automatically re-enroll people if the department can verify their eligibility without additional information. People are disenrolled only when additional information is needed and they don’t respond to DHCS requests for that information. Disenrollments have been decreasing, Cava says, in part because the state has increased utilizing this type of automatic re-enrollment.
Still, Latinos have been disproportionately affected by Medi-Cal disenrollments—more than 707,000 have lost coverage at some point during the past year of redeterminations, according to DHCS data, more than any other racial or ethnic group.
Advocates say the state should instead continue the redetermination process without using procedural disenrollments. While people can regain their coverage after being removed from the program for procedural reasons, it isn’t necessary to drop people from Medi-Cal in the first place while that eligibility is in question, advocates argue.
“For us, one single Latino who gets disenrolled because of procedural issues is one too many,” said Seciah Aquino, executive director of the Latino Coalition for a Healthy California, a health advocacy organization. “Our community looks very different post-pandemic.”
Latinos bore the brunt of the pandemic and many have not physically or socioeconomically recovered, she says. “Given that this is a new reality for Latinos, we need to catch up with that and be able to be responsive to support the population where they’re at now.”
In addition, the pool of Latino Medi-Cal recipients has changed since the pandemic started. Though Medi-Cal renewals themselves are not new, the state expanded incrementally to include pools of undocumented immigrants who meet income requirements for the program during the pandemic. For some, like undocumented young adults and those over 50, this was their first experience with the renewal process.
Why have states implemented pauses in disenrollments?
It’s possible that people simply do not know that the annual renewal process has resumed —states have not been able to reach parts of their populations, and people who do not speak English or who are new to the Medicaid system could likely be having a more challenging time holding on to their coverage, says Katherine Hempstead, Senior Policy Adviser at the Robert Wood Johnson Foundation, a national health equity and research organization.
While states had months to plan for restarting the annual renewal process, many states did not expect such high rates of procedural disenrollments, she adds, leading to some implementing temporary pauses.
“The logistics of this have been harder than I think a lot of people envisioned,” she said. “The communications process wasn’t working as well as [officials] sort of anticipated that it would. And that, I think, made a lot of states kind of look to pause and just give everybody more time.”
According to CMS, 15 states have requested temporary pauses in disenrollments to give officials more time to for targeted outreach. The longest of such pauses have been for two months in Colorado, New Hampshire, and South Carolina.
Does a pause work?
Whether a pause has a direct effect on disenrollment rates is unclear, say both Hempstead and Akeiisa Coleman, Senior Program Officer for Medicaid at The Commonwealth Foundation, also a national health advocacy and research organization.
Coleman, however, notes that in September 2023, the federal government required 30 states to temporarily pause disenrollments because of glitches in their redetermination processes. Those pauses, Coleman says, helped systems better process automatic renewals by slowing the overall redetermination process down. “I think those pauses have helped states make adjustments to their systems,” she says, “improve some of their messaging, and so that’s contributed to some of that improvement in those rates.”
A pause alone, Hempstead adds, won’t be effective if the state doesn’t implement additional changes to reach the people who are being procedurally disenrolled. “If you say, ‘Well, we don’t really know what’s going wrong, we’re just gonna kind of wait a little bit and then keep doing the same thing,’” she says, “it could be possible then that [a pause] wouldn’t really help that much.”
