Californians could lose health insurance if federal policies end

In summary

The expiration of two COVID-19 emergency programs means Californians could lose their Medi-Cal insurance or find covered California unaffordable.

Millions of Californians could lose or switch to new health coverage as two federal programs that have helped many people keep or pay for insurance are due to expire this year.

Two to three million Californians could lose their Medi-Cal coverage, some as soon as this summer, after the federal government’s COVID-19 public health emergency ends, now slated for next month. In addition, 150,000 Californians may not be able to afford their covered health plans in California unless federal US bailout grants, which are due to expire at the end of this year, are renewed, according to a report. released Wednesday.

The COVID-19 pandemic has triggered investments and protections that have increased the number of people with health insurance. In California, nearly 14.5 million people are enrolled in Medi-Cal — the highest number ever — and a record 1.8 million people purchased a health plan through Covered California in the last registration period.

But these federal protections are temporary. And state health officials are now preparing for their expiration, considering how to protect the most Californians.

Medi-Cal and the Public Health Emergency

Before the pandemic, people on Medi-Cal had to renew their coverage every year, but the process has been frozen for two years.

During the federal government’s public health emergency, states cannot remove people from Medicaid — known as Medi-Cal in California, the health insurance program for low-income people.

But the emergency is set to expire after April 15 unless extended for another 90 days by the Biden administration.

An estimated two to three million Californians could lose Medi-Cal coverage because they are now earning too much to qualify or failing to provide the information needed to stay on the program, health advocates said.

While many people could switch from Medi-Cal to other types of insurance, advocates worry that many will get lost in the administrative complexities and lose their coverage.

Jacey Cooper, the state’s Medi-Cal director, said the state should begin the process of redetermining who is eligible in May if the emergency order ends in April. Since registrants need 60 days notice, people who need to update their eligibility information in July would need renewal packages by May.

Federal guidelines give states 12 months to complete a person’s eligibility review.

For most adult enrollees, the limit to qualify for Medi-Cal is 138% of the federal poverty level, about $17,609 for singles and $36,156 for a family of four. Eligibility is based on income and household size. (Some groups like pregnant women are entitled to slightly higher incomes.)

While many people could switch from Medi-Cal to other types of insurance, advocates worry that many will get lost in the complexities and lose their coverage.

Anthony Wright, executive director of Health Access, said people dropping out of Medi-Cal isn’t necessarily a bad thing — people’s incomes may have gone up and now they’re eligible for subsidized coverage on Covered California, or some may have recovered the benefits of the employer.

“Our hope is that this number (2-3 million) does not reflect the number of people who will become uninsured, but rather the number of people leaving Medi-Cal, which could be for good reasons,” he said. -he declares.

Still, people can get lost in paperwork or just never learn they’re supposed to submit a renewal request, said Monika Lee, associate director of communications for the California Pan-Ethnic Health Network.

“We expect losses,” she said. “If the state sends something to your home and you don’t live there anymore, how will you know you’re losing your coverage? »

Cooper has a similar concern, noting that his department estimates that 7-10% of enrollees have changed addresses in the past two years. “We need up-to-date contact information so that when the public health emergency ends, we can reach and contact individuals,” she said. People can update their contact information at their county’s Medi-Cal office.

Cooper said his department will help people who are no longer eligible for Medi-Cal transition to other types of coverage, whether it’s employer-based insurance or a health plan. at low cost through Covered California.

But Covered California also warns that a separate issue — an upcoming federal aid expiration — could affect whether those who were previously on Medi-Cal enroll or not.

Covered California and federal grants

Last year, the federal government’s U.S. bailout provided California with about $3 billion earmarked for additional financial aid through California Covered. As a result, more people signed up and 24% of consumers signed up for plans with monthly premiums of $10 or less, according to Covered California.

The enhanced federal grants are locked in for the rest of this year, but if Congress lets it expire, enrollees would see their bonuses go up next year. Covered California estimates that low-income Californians could see their monthly premiums double from an average of $65 to $131. Middle-income enrollees would no longer receive financial assistance.

Covered California estimates that low-income Californians could see their monthly premiums double from an average of $65 to $131.

About 150,000 people could be forced to drop their plan because they could no longer afford it, according to the Covered California report.

People across the country, “without the expansion of US bailout subsidies (will) face sticker shock that will mean coverage is out of reach. Many of them are likely to be from communities of color,” said Peter V. Lee, executive director of Covered California.

Covered California’s report shows significant enrollment gains among these communities, including a 33% increase in enrollment among African Americans this year compared to 2020.

California in 2020 became the first state in the nation to offer assistance to middle-income residents who previously earned too much to qualify for federal grants. But the increased aid provided by the federal government has been more significant and has replaced state aid.

“There is no deadline for when the federal government must act, but the sooner the better,” Lee said.

This is because the state typically announces the rates it negotiates with insurance companies for the following year around July, and in October people begin to receive renewal notices with an estimate of their new costs. Lee said insurers may decide to raise premiums if they expect fewer people to sign up.

“There is no deadline for when the federal government must act, but the sooner the better.”

Peter V. Lee, Executive Director of Covered California

“It’s not just fewer people, it’s going to be fewer, healthier people,” Lee said.

If the increased aid disappears, healthy people will be among the first to drop their coverage, Lee said. And the sicker the pool of registrants, the higher the premiums for everyone.

The good news, Wright said, is that Congress has an incentive to act and renew that aid. “It would not be in anyone’s interest for bonus peaks to be announced in September or October of an election year,” he said.

A group of California lawmakers have crafted vaccine laws that would be the most aggressive state approach to vaccines in the country.


Many undocumented immigrant workers will not be eligible for public health insurance even if they do not earn a living wage. This leaves them with few viable options for cover.


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