On April 1, 2023, California began the process of redetermining eligibility for about 15 million Medi-Cal enrollees following the official end of the COVID-19 public health emergency. As a result of the redetermination process, two to three million beneficiaries may no longer be eligible for Medi-Cal.

The redeterminations are based on the beneficiaries’ next annual renewal date (done on a rolling basis and not all at once). The counties resumed their normal redetermination process on April 1 for beneficiaries with a June 2023 renewal date. The first disenrollments for those deemed no longer eligible for Medi-Cal/Medi-Cal managed care coverage will begin in July.

Given the number of beneficiaries impacted, it will be extremely important for physicians to  verify/re-verify their patients’ eligibility to avoid denials. Additionally, physician practices that are on capitated contracts may see decreases in monthly capitation payments due to eligibility changes. Physicians are encouraged to review their monthly capitated payments and the affiliated enrollee reports carefully to monitor for any decreases in payment due to disenrollment.

DHCS is in the process of creating a provider outreach toolkit to help providers assist and inform Medi-Cal patients about the redetermination effort and the easiest ways to ensure their contact information is up to date and they are responding to renewal letters.

In the meantime, practices can encourage beneficiaries to update their contact information by visiting KeepMedicalCoverage or MantengaSuMediCal, signing up for updates via email and text message, and being on the lookout for renewal packets that may come through regular mail for cases that could not be renewed using information the local county office has available. DHCS has also published an FAQ and a Keep your Community Covered messaging toolkit, available in 19 threshold language.

For more information click here.

Contact: CMA’s Center for Economic Services, economicservices@cmadocs.org or (800) 786-4262.