The Transition From Medi-Cal to Covered California

Posted: November 15, 2023

Since the COVID-19 Public Health Emergency is no longer in effect, many programs that federal and state governments used to help individuals and families during the pandemic have also ended. Some of these programs, such as California’s Medi-Cal continuous coverage plan, helped ensure residents kept their Medi-Cal benefits during the crisis. Now that the pandemic is over and programs like the continuous coverage plan are “unwinding,” many Californians are being redetermined as ineligible for Medi-Cal and needing to switch to a new health insurance plan under Covered California.

If you’re one of the many transitioning from Medi-Cal to a Covered California health plan, keep reading. We’ll explore the unwinding of the continuous coverage plan and what you need to do to stay covered.

How Did the COVID-19 Public Health Emergency Impact Coverage in California?

In short, the federally declared COVID-19 Public Health Emergency (PHE) led California to create a plan to help residents maintain health insurance benefits during the crisis.

It began in January 2020 when the Department of Health and Human Services (HHS) declared a public health emergency in response to COVID-19. Any time there’s a disease outbreak that could cause widespread illness, the HHS can declare a public health emergency. During public health emergencies, the government might provide funding to help health care facilities offer free services to the general public, such as COVID-19 testing. This can help keep an outbreak under control. A PHE may also include helping to keep the public insured so individuals can afford health care.

Two months after the HHS declared a public health emergency, Congress passed the Families First Coronavirus Response Act (FFCRA), which required states to keep Medicaid beneficiaries enrolled without interruption until the health crisis ended. Under the FFCRA, states had the authority to be more flexible with their state-run Medicaid programs, such as California’s Medi-Cal program, to help their residents keep their coverage.

One way California’s Department of Health Care Services (DHCS) responded to the public health emergency was by creating a “continuous coverage” plan. This plan ensured that individuals enrolled in Medi-Cal would not have their information reviewed and reconsidered for eligibility during the emergency. In other words, if someone reported a change in income or household size during the PHE, it would not have impacted their Medi-Cal eligibility. That way, Medi-Cal beneficiaries kept their insurance during the emergency and felt less financial strain if they needed medical care.

Understanding the Continuous Coverage Operational Unwinding Plan

When public health emergencies end, so do some of its programs. However, this doesn’t mean that residents are left without support. An “unwinding plan” describes government efforts to make the transition back to normal as smooth as possible.

The unwinding of California’s continuous coverage plan started as a result of the Consolidated Appropriations Act of 2023. Under this act, continuous Medicaid coverage is no longer tied to the public health emergency, and states are required to return to their pre-pandemic process of determining coverage eligibility. Medi-Cal started its transition in April 2023 and began to redetermine the eligibility of program beneficiaries with a June renewal date.

Now that business has returned to normal and Medi-Cal is reviewing and redetermining its beneficiaries’ eligibility, millions of Californians are at risk of losing their Medi-Cal coverage. Still, those who are not eligible for Medi-Cal will not necessarily be left uninsured. DHCS implemented the Medi-Cal COVID-19 PHE and Continuous Coverage Operational Unwinding Plan to help individuals stay covered during this transition. Under this plan, beneficiaries no longer eligible for Medi-Cal will be automatically enrolled in a Covered California plan.

Understanding Auto Plan Selection for Medi-Cal Transitioners to Covered California

If you received a notice stating you no longer meet Medi-Cal eligibility requirements, know you still have a health care plan. Covered California automatically enrolled you in a plan to continue your coverage.

Expect coverage to begin at the start of the following month — if you were enrolled in a Covered California plan in June, benefits will begin on July 1. That said, there are a few steps to take to get things rolling.

What Actions Do I Need to Take?

You can activate your plan in a few steps after you’ve been automatically enrolled:

• Pay your plan’s first month’s premium
• Agree to the plan’s terms and conditions

You have a month to pay your premium from the auto-enrolled plan’s start date. You’ll pay this amount directly to the health care plan and can do so online through Covered California.

Say your auto-selected plan starts June 1 — you have until June 30 to pay the month’s premium. You can start using your benefits in July, assuming you pay the first month by the 30th of the month.

What If I Don’t Have a Premium to Pay?

You could have a $0 premium, depending on your income and household size. Initiate coverage by agreeing to the terms and conditions online or by phone, even if you don’t owe anything.

What If I Miss the Deadline?

Don’t forget to opt in or pay your first payment, or you’ll lose the plan that’s been auto-selected for you. You can choose your own plan if this happens. You’ll still be in the special enrollment period that started when you lost Medi-Cal and were auto-enrolled in Covered California.

You have 60 days to select your health plan from the date of auto-enrollment. For example, you’ll have until August 29 to select a new plan if your Covered California plan started July 1. You’ll have to wait until the next open enrollment period for coverage if you don’t take action within the 60-day window.

Switching From Medi-Cal to Covered CA

If you’re still enrolled in Medi-Cal but have experienced life changes, update your information promptly. Medi-Cal beneficiaries have 10 days to report changes that could affect eligibility.

For instance, if you have a new job, your income might be too high for Medi-Cal. You must report your income change to Medi-Cal to avoid owing money when filing your tax return.

You can update your information online or by phone. You may also submit changes to your local office via fax or mail.

You need to update your information whenever you experience a household size or income change. In general, you must report the following:

• Household size changes
• New address
• Income changes
• Marriage or divorce

If it’s determined that you no longer qualify for Medi-Cal, you can switch to a Covered California plan. Losing your Medi-Cal benefits is a qualifying event and places you in a special enrollment period. Other qualifying events include having a baby, getting married or moving somewhere else within the state. Unless you have a qualifying event, you would have to wait for the regular enrollment period to purchase health coverage through Covered California.

You can apply for a Covered California plan with us at Health for California. Our application process only takes about 10 to 20 minutes.

Find the Best Insurance Plan With Health for California

If you’re one of the many Californians transitioning to a Covered California plan, we can help. Browse and find a Covered California health insurance plan with Health for California.

Our application is fast and simple, and our representatives are happy to answer your questions. Request a free quote online or contact us today to find your best health care plan.