By: Kristen Golden Testa, Policy Director at The Children’s Partnership

In California, more than half of children get health coverage through Medi-Cal, the state’s Medicaid program. Medi-Cal is a critical support system for California families with low incomes, providing children access to the care they need for a healthy start in life. As nearly 75% of children with Medi-Cal are children of color, the program is also a vital health equity tool.

While Medicaid programs across the country ensure children can grow up healthy and thrive, staying enrolled in coverage is not always easy. Families are required to renew their eligibility regularly, and too often, eligible children and families lose coverage due to administrative barriers and technical glitches. This problem was amplified last April when states began the “unwinding” process — redetermining Medicaid eligibility for all enrollees following an end to pandemic-era protections.

A recent report from the Georgetown University Center for Children and Families found that through December 2023, more than 4 million fewer children nationwide were enrolled in Medicaid/CHIP. During the unwinding period, the California Department of Health Care Services reports that through March 2024 over 330,000 children lost their Medi-Cal coverage, despite most of them remaining eligible. Of the California families that lost coverage during the unwinding, 80% did so due to “procedural” reasons, such as families not receiving renewal packets in the mail (nearly half of procedural disenrollments), long call wait times, or language barriers with renewal assistance.

It’s clear that Medi-Cal enrollment and renewal could be serving our children better. Administrative issues are leading to harmful gaps in coverage for California’s children. Fortunately, there are opportunities for improvement. At The Children’s Partnership (TCP), we firmly believe that the best way to strengthen the process is by centering the voices and experiences of the families Medi-Cal is intended to serve. In 2023, TCP undertook a two-phase research project with families of color, who make up the majority of Medi-Cal enrollees, and enrollment assisters to better understand families’ experience with the Medi-Cal renewal process during the unwinding and the impacts of gaps in coverage. Through this project, we began to uncover common issues in the renewal process and the opportunities to build on what has worked for families.

What has worked well:

• Automatic renewal (through ex parte): “[Medi-Cal] automatically renewed, so I didn’t have to do anything or go down there…I appreciated it,” said a Native American/Indigenous parent/guardian.
• Less frequent renewals (during pandemic continuous coverage): “I feel that they shouldn’t do [renewals] every year, maybe every two years,” said a Spanish-speaking Latine parent/guardian.
• Online renewal: “I go to the BenefitsCal account [California’s online Medi-Cal portal] and upload documents there… It’s much easier than going in person,” said an English-speaking Latina parent/guardian.

What needs to be improved:

• Poor Translation and renewal materials: “I barely understand any of it …Even if we can speak well in Spanish, every legal document is very complicated,” said a Mixteco female parent/guardian.
• Long wait times for help: “I was on the phone from 7:31 a.m. to 9:40 a.m. before I got through,” said a Black parent/guardian.
• Failures in the process: “One time, I took my documents to their office and handed them to the person at the window, and they still didn’t submit them,” said a Spanish-speaking Latina parent/guardian.

While the unwinding is coming to a close, Medicaid renewals will continue. We learned a lot from the people directly affected by the unwinding process. To make programs work better for families, states should listen to the families experiencing the enrollment and renewal processes and take their recommendations for improvement, including:

• Making Medicaid renewals less frequent by adopting multi-year continuous coverage for young children
• Streamlining Medicaid renewals to make the process easier for families, starting with making permanent federal flexibilities adopted during the unwinding period
• Boosting outreach and enrollment/retention assistance in the community
• Sufficiently staffing Medicaid offices to avoid long wait times when people seek help with enrolling and renewing coverage
• Simplifying family-facing renewal materials with glossaries of terms and clear indications of what items need actions, prioritizing quality translations

In June, California will finalize its annual state budget. Unfortunately, Gov. Newsom’s latest budget proposal failed to fund California’s multi-year continuous Medi-Cal coverage policy for our youngest children. This is short-sighted, as stable coverage during these early years of life – when 90% of brain development occurs – is paramount to healthy childhood development. The Newsom administration is also deciding whether to extend the renewal streamlining flexibilities offered by the Centers for Medicare & Medicaid Services, which have and would continue to reduce unnecessary disenrollments for children and adults greatly. Let’s hope the California legislature and governor agree to prioritize preserving children’s health care coverage, even in these tough budget times. We can do more to strengthen Medicaid and guarantee stable coverage for our kids so that all children and families have the opportunity to lead healthy, thriving lives.

Learn more about our research in our summary slide deck and fact sheet.

The Children’s Partnership (TCP) is a California-based children’s policy and advocacy organization committed to advancing child health equity through public policy, research and community engagement. TCP envisions a California where all children—regardless of their race, ethnicity or place of birth—have the resources and opportunities they need to grow up healthy and thrive. Learn more at childrenspartnership.org.