Medi-Cal Redetermination Challenges and Strategies – C4BH 8/10 Meeting

To ensure continuous coverage for Medicaid members during the COVID-19 Public Health Emergency (PHE), Congress waived requirements for Medicaid programs to annually “redetermine” or re-verify members’ eligibility starting in March 2020. With subsequent federal law ending the continuous coverage provision, state Medicaid programs are currently in the unwinding process to redetermine eligibility and renew coverage for nearly 95 million individuals across the country within a 14-month period. 

Contacting members, obtaining the proper paperwork, and reviewing documentation for redetermination is a huge undertaking for county Medicaid offices that are commonly facing staffing issues and a backlog of cases to process. There is widespread concern that many still eligible for Medicaid could lose their coverage due to procedural issues, and there is evidence of this occurring in at least 12 states where the Centers for Medicare and Medicaid Services (CMS) paused redeterminations due to high procedural disenrollments. 

As discussed in a recent Health Tech 4 Medicaid webinar with Lisa Bari of Civitas Networks for Health, health information exchange (HIE) is a resource that counties can use to support redetermination outreach efforts with the availability of up-to-date member contact information and connections to a member’s care team. For example, Maryland’s state-designated HIE, CRISP, is working to notify providers on their upcoming patients that will face redetermination within the next 90 days to assist with outreach planning. Similarly, Manifest MedEx, a California HIE, leveraged their data network during the COVID-19 pandemic to proactively identify and assist high-risk patients, and similar practices could be utilized to support local Medicaid renewal efforts across the state.

Marissa Montano, Ph.D, director of policy at the Insure the Uninsured Project (ITUP) joined the Connecting for Better Health (C4BH) coalition meeting on August 10 to share local insights into redetermination and strategies to support the Medi-Cal renewal process from ITUP’s 2023 Regional Workgroups. This summer, ITUP has been engaging local public health departments, clinic partners, community-based organizations, provider networks, hospitals, and other stakeholders in regional meetings across the state to share information and best practices around Medi-Cal redetermination and identifying community-driven health policy priorities for the coming year. 

In California, the Department of Health Care Services (DHCS) is committed to ensuring that everyone eligible for Medicaid maintains their coverage during redetermination. To support local efforts, DHCS is funding Medi-Cal Health Enrollment Navigators and promoting outreach strategies to keep eligible members enrolled in Medi-Cal. 

Montano reported that the discontinuance rates reported in DHCS data dashboards are reflective of what counties are experiencing, and additionally are similar rates prior to the COVID-19 pandemic. County Medicaid offices also shared that the largest volume of redeterminations are not expected until December and January, so counties and partners still have time to prepare for when most Californians will need their help.  

ITUP’s conversations identified some key challenges with redetermination, such as:

  • Data on which Medi-Cal members are up next for redetermination is not readily available in counties. Successful outreach practices require accurate data in order to target the right people at the right time.
  • There is confusion from enrollees with how to complete the Medi-Cal renewal process through the online portal. 

Montano also noted several policies and practices that counties are leveraging for successful redetermination efforts, including:  

  • California has taken advantage of all federal waiver flexibilities intended to ease the Medi-Cal renewal process, including opportunities for automatic renewals via eligibility for other public programs like CalFresh. The migration of case management systems for public benefit programs to CalSAWS will help support automatic Medi-Cal renewals. 
  • Clinics have seen success from training their entire staff on redetermination, including how to use the online portal. This is maximizing accessibility of services and keeping wait times to a minimum.
  • Local collaboratives that previously worked together during COVID-19 pandemic are coming together to identify the most updated data on Medi-Cal members and coordinate outreach efforts. 

Montano shared that ITUP plans to continue involvement in this area as the redeterminations process into 2024, especially as California expands Medi-Cal access to Californians regardless of immigration status.

To learn more about the Medi-Cal redetermination process, visit the DHCS website.


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