As the CEO of a large public health program serving 1.6 million people in Southern California, I always welcome feedback from our 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 care system. , I took the opportunity.
It was a hot spring day last April when I walked into the backyard of a modest home in San Bernardino. There were 25 people there, but they didn’t know who I was, except for one guy who knew Maria and was able to help them through what they were going through.
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So the residents talked freely about their experiences and frustrations.
One mother described how a simple communication error prevented her premature baby from enrolling in Medi-Cal, California’s Medicaid program. I also met a young couple who became homeless while waiting 12 months for Medi-Cal to pay for their HIV drugs. Others described long wait times on the phone, interrupted calls and difficulty finding a live voice to help them.
Their story shook me to the core. The staff at my organization, Inland Empire Health Plan, and our provider partners work hard to advocate for and care for each member. But obviously, we need to do more.
The faces and stories of the afternoon a year ago will forever stay with me. And they are at the forefront of my mind when I think about the real possibility of a new public health crisis as COVID-19 emergency public health protections have ended for our programs. Medicaid programs nationwide. What is happening in California is happening in other states across the country.
As of March 2020, PHE has allowed Medicaid beneficiaries to skip the annual eligibility process. During a pandemic, our Medi-Cal members are not required to take any action to maintain their benefits.
But on April 1, that changed. Again, the state has continued to contact members by mail for information to help determine continued Medi-Cal eligibility.
Now, you might be thinking, “So, what’s the big deal?” What is of interest to public health programs across California and the rest of the country is that one piece of mail ignored can have dire consequences. Everything depends on the member receiving the package, completing the requested information and sending it before a certain deadline. Those who do not respond in a timely manner will be removed from the program and lose all public healthcare benefits. Members can start losing coverage as early as July 1.
Consider how an interruption of coverage could affect members who are being treated for a serious illness or chronic condition. And even for healthy people, out-of-pocket medical expenses for just one illness or injury can quickly deplete savings.
In my health plan’s coverage area alone, which includes Riverside and San Bernardino counties, nearly 300,000 people could lose their Medi-Cal benefits because of negligence. That’s not acceptable.
With so much at stake, health plans can and must do a lot more to ensure their members don’t fall into disrepair at this critical time. We must approach each member and provide hands-on support.
To prepare, our health plan hired more than 50 new employees and trained hundreds of staff specifically for the Medi-Cal redefining process. Our members live in two large counties in Southern California that cover more than 27,000 square miles. It’s largely rural, so strategic partnerships with community-based organizations are allowing us to better reach our members wherever they are, whether it’s at church or on the street. street.
We’ve also partnered with state and local county Medi-Cal agencies to help raise awareness, share data, and coordinate strategic messaging, as California and other states ring the bell. warning about large amount of insurance loss expected.
And that may be the most important part. Without this leadership and support from county Medi-Cal agencies, our member outreach efforts would be limited. Inland Empire was the first pioneer of this kind of partnership, and California now strongly 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, along with updated and verified contact information. Our team will immediately call or text members to let them know that an important packet is about to arrive in the mail. After receiving the package, we will assist the member to complete and submit the necessary information.
Timing is critical, so it’s important to keep applying until the member submits the information by mail, phone, online, or at the local county Medi-Cal office.
Certainly, some people may lose their Medi-Cal benefits because their household income currently exceeds the eligibility requirements. But they won’t fall through the cracks and will still be part of the healthcare system. These members will be automatically enrolled in Covered California, the state’s health insurance marketplace established under the Affordable Care Act. There, they may be eligible for a federally subsidized health insurance program.
If it looks like we’ll do our best to help our members fill out simple paperwork, consider an alternative: Up to 3 million Californians could lose their Medi- Cal if they do not complete the process in a timely manner. Nationally, the Centers for Medicare and Medicaid Services estimates up to 15 million people could lose their current coverage.
These are people like the people I met in that San Bernardino backyard: people who work hard with a degree of humility who do their best to deal with some of life’s toughest challenges. In an age of stagnant wages, rising inflation and high housing costs, they depend more on this vital safety net than ever before. How can we do less?
