As the CEO of a large public health plan serving 1.6 million people in Southern California, I always welcome feedback from my members. When Maria, a friend and community partner, invited me to join her and listen to some of our most vulnerable residents describe their challenges with the public health system, I rose to the occasion.
It was a warm spring day last April when I entered the backyard of a modest San Bernardino home. There were twenty-five people there, but they didn’t know who I was, other than someone who knew Maria and might be able to help her through what she was going through.
So residents spoke openly about their experiences and frustrations.
A mum told how a simple communication error stopped her premature baby from signing up Medi-Cal, California’s Medicaid Program, I also met a young couple who became homeless while waiting 12 months for Medi-Cal to cover their HIV drugs. Others described long wait times on the phone, dropped calls and difficulties finding a live voice to help them.
His stories shook me to the core. employees of my organization, Inland Empire Health Plan, and our provider partners work hard to advocate for and care for each member. But clearly, we needed to do more.
The faces and stories of that afternoon a year ago will stay with me forever. And when I think about the very real possibility of a new public health crisis emerging from COVID-19, they top public health emergency protection Medicaid programs across the country have been eliminated. What is happening in California may be happening in other states across the country.
Beginning in March 2020, PHE allowed Medicaid beneficiaries to skip the annual eligibility determination process. During the pandemic, our Medi-Cal members did not need to take any action to keep their benefits.
But on April 1, that changed. Once again, the state began contacting members by mail for information to help determine eligibility for the ongoing Medi-Cal program.
Now, you might be thinking, “So, what’s the big deal?” Public health plans in California and the rest of the country are concerned that an overlooked piece of mail could have disastrous consequences. Everything depends on the member receiving the packet, completing the requested information and submitting it by a certain deadline. Those who do not respond in time will be removed from the program and will lose all of their public health benefits. Members can begin losing coverage as early as July 1.
Consider how an interruption in coverage could affect members receiving treatment for a serious illness or chronic condition. And even for healthy people, medical costs incurred for just one illness or injury can quickly wipe out the savings.
In My Health Plan’s coverage area alone, which includes Riverside and San Bernardino counties, nearly 300,000 could lose their Medi-Cal benefits because of a simple oversight. this is unacceptable.
With so much at stake, health plans can do more to ensure that their members don’t fall through the cracks during this critical time. We must personally reach out to the members and provide hands-on assistance.
To prepare, our health plan has hired more than 50 new employees and trained hundreds more specifically for the Medi-Cal rescheduling process. Our members live in two large Southern California counties covering over 27,000 square miles. Much of it is rural, so strategic partnerships with community-based organizations are allowing us to better reach our members, whether they are at church or on the street.
We’ve also partnered with state and local county Medi-Cal agencies to Help raise awareness, share data and deliver strategic messagingAs California and other states sound the alarm about the large number of projected coverage losses.
And that may prove to be the most important piece. Without this leadership and the support of our county Medi-Cal agencies, our member outreach efforts will be limited. Inland Empire was an early pioneer of this type of partnership, and California now highly encourages other county agencies to do the same with health plans in their area.
We are receiving a monthly list of our members for renewal, with updated and verified contact information. Our team will immediately call or message the member that an important packet is coming in the mail. Once the packet is received, we will assist the member in completing and submitting the required information.
Timing is critical, so it is important to follow up frequently until the member submits the information by mail, phone, online or at the local county Medi-Cal office.
Essentially, some people may lose their Medi-Cal benefits because their household income now exceeds the eligibility requirements. But they will not fall through the cracks and still remain a part of the healthcare system. These members will automatically be enrolled in Covered California, the state health insurance marketplace established by the Affordable Care Act. There, they may be eligible for a federally subsidized health plan.
If it seems like we’re going to extraordinary lengths to help our members complete simple paperwork, consider the alternative: Up to 3 million Californians could be fined if they don’t complete the process on time. You may lose your Medi-Cal benefits. Nationally, the Centers for Medicare and Medicaid Services estimates that up to 15 million people could lose their current coverage.
These are the kind of people I met in that San Bernardino backyard: hard-working individuals of modest means doing their best to tackle some of life’s toughest challenges. In an era of stagnant wages, rising inflation and high housing costs, they are more dependent than ever on this vital safety net. How can we do less?