As Sacramento County begins the process of dropping people from Medi-Cal, local organizations brace for impact

Updated April 13, 10:19 a.m.

At the Maple Neighborhood Center in South Sacramento, Gloria Torres handles all things Medi-Cal.

Torres is a community health worker at the center, which is run by the nonprofit La Familia Counseling Center. She helps dozens of individuals and families get enrolled in California’s free or low-cost health insurance program every month. Before the pandemic began, she was responsible for helping them stay enrolled in the program — reminding them to fill out their annual renewal packets when a copy was sent to the center. 

“We'll get like 40 annual renewals every month,” she said. “So there's an inside little joke, which is my fan mail comes in and I am responsible to open it up, call that client and ask them, ‘Did you fill it out?’”

But for the past three years, Torres hasn’t had to worry about making sure her clients keep their health insurance. 

That’s because at the start of the pandemic, the federal government gave states more money to keep people enrolled in their Medicaid programs, under a policy called “continuous coverage.” Usage soared, with more people added to the rosters than ever before. In Sacramento County, the number of people covered by Medi-Cal increased to about 633,000 – an over 40% increase according to the Department of Health and Human Services.  

This month, states like California are beginning the process of recertification again, and are expected to shed up to 3 million people from Medi-Cal; up to 14 million people are expected to be dropped from the Medicaid program nationwide. 

Most often, people are removed from  the program because they eclipse the income requirement or they are found to have health insurance through their employer. People can also be dropped, even if they’re still eligible, if there is a paperwork error or the county can’t find them to check their details. This is referred to as administrative “churn.”

The Public Policy Institute of California warns that this administrative “churn” can especially affect children, very old people, people who don’t speak English, and people experiencing homelessness. The so-called churn particularly impacts people who experience income volatility, more often people of color and those with lower levels of educational attainment. 

In Sacramento, the first set of renewal packets are slated to be distributed early in early May, and outreach campaigns are underway statewide to ensure people have updated their contact information, so they don’t get dropped from the program. About 10% of people who receive Medi-Cal in Sacramento are homeless. 

“Where we truly can't reach them is when we have a bad address and we have a bad phone number,” said Roselee Ramirez, with the county’s Department of Human Assistance. “So then we're relying on the customer to contact us once they realize that their benefits have been discontinued.”

During the pandemic, Torres said having Medi-Cal as a certainty was a boon to the families she serves. 

“With so many individuals, you know, being in the hospital, not being able to make ends meet, it was a great impact,” she said. “It impacted the individual that was going through the crisis, but it also impacted the family.”

Now, she says her team sees many families drop out of Medi-Cal because their incomes are slightly over the eligibility limit. She added that she worries that people will opt out of having health insurance entirely because it’s a cost their families can’t afford. 

“We see a lot of individuals that don't have health insurance. We have a lot of individuals that, you know, that are just [barely making] ends meet, right, because of the gas, the rent, everything goes up. They don't have an additional $375 or, you know, $500,” she said. 

According to Ramirez, in accordance with 2019’s SB 260, people who are dropped from Medi-Cal will automatically be enrolled in the lowest cost mid-level plan through Covered California. She said they will be given the option to select another plan and will be notified of the selection in writing.

Update your Medi-Cal information here.

This story has been updated to reflect that Sacramento County has not yet started dropping people from Medi-Cal health services.