During the COVID-19 pandemic, the federal government required states to maintain continuous uninterrupted insurance coverage for Medicaid enrollees. State Medicaid programs, including California’s Medi-Cal, were not allowed to terminate coverage for any individuals for the duration of the public health emergency. This policy ensured over 15 million Californians could keep their Medi-Cal coverage throughout the pandemic. After nearly three years, the federal government ended the continuous coverage provision on March 21, 2023. States were given 14 months to “unwind” the continuous eligibility provision and redetermine Medicaid eligibility for all enrollees. California’s “unwinding period” began on April 1, 2023, and the Department of Health Care Services (DHCS) began disenrolling individuals on July 1, 2023.
In December 2023, California implemented several federal enrollment flexibilities including waivers to increase ex parte rates, improve outreach strategies, and simplify income verification. To understand the impacts of these flexibilities on California’s communities of color, CPEHN analyzed monthly preliminary redetermination data published by DHCS from June 2023 to May 2024, disaggregated by race/ethnicity and written language. By comparing the overall redetermination rates of the first half of the unwinding (June 2023 – November 2023) to the overall redetermination rates of the second half of the unwinding (December 2023 – May 2024), we found that the implementation of the federal flexibilities significantly reduced racial, ethnic, and linguistic disparities in ex parte renewal, continuation, and discontinuation rates, particularly for individuals with limited English proficiency.
The following tables display the percentage change in the overall ex parte renewal, continuation, and discontinuation rates from the first 6 months to the second 6 months of the unwinding, disaggregated by race, ethnicity, and written language. Additional rates and totals are summarized in the second set of tables.
A few highlights from the analysis:
- Statewide, the overall ex parte rate nearly doubled, increasing from 33% to 63% – an 88% increase and the overall continuation rate increased by 48%, from a rate of 47% to 70%. The overall statewide discontinuation rate dropped by 48%.
- Latines experienced a nearly 100% increase in the overall ex parte rate and a 52% increase in the overall continuation rate, jumping from 46% to 69% of Latines continuing in coverage.
- The ex parte rate for individuals whose primary written language is Spanish increased by a whopping 186% – the largest increase among all groups. It is evident that the flexibilities to increase ex parte rates significantly benefited these enrollees and contributed to a 75% increase in the overall continuation rate for this group.
- Individuals whose primary written language is Cantonese experienced a 123% increase in the overall ex parte rate and a 57% decrease in the overall discontinuation rate, from a rate of 10% to 4%.
For questions and inquiries about this data and analysis, please contact info@cpehn.org
Medi-Cal Unwinding Terms:
Medi-Cal Unwinding: The 12-month period between June 2023 and May 2024 during which California’s Department of Health Care Services began redetermining all Medi-Cal beneficiaries and disenrolling individuals from Medi-Cal.
Continuous Coverage: A COVID-19 public health emergency federal policy that prohibited states from disenrolling individuals from Medicaid. Under this policy, California’s Medi-Cal beneficiaries remained covered without having to renew coverage.
Federal Flexibilities: Temporary authorities, waivers, and state plan amendments granted to states by the Centers for Medicare & Medicaid Services (CMS) that allowed states to adopt strategies to protect the continuity of coverage in Medicaid and the Children’s Health Insurance Program.
Continued: Refers to Medi-Cal enrollees who were determined eligible and continued in coverage. These enrollees either continued via ex parte or via a renewal form.
Continued via ex parte: The process by which Medi-Cal automatically confirms eligibility based on other available sources of information without requiring any action from the enrollee.
Continued via renewal form: The process by which Medi-Cal manually confirms eligibility based on information submitted by the enrollee in a renewal form.
Discontinued: Refers to Medi-Cal enrollees who had their coverage terminated after being determined ineligible or for procedural reasons. Some reasons individuals may be determined ineligible for Medi-Cal include excess income or no longer living in California.