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Important Enrollment Rights to Know as Medi-Cal Redeterminations Are Underway

As mentioned in our recent article, due to the Consolidated Appropriations Act (CAA), states are now in the process of reviewing Medicaid eligibility for all enrollees and can disenroll people who no longer qualify for Medicaid (Medi-Cal in California). States have 14 months to complete the redeterminations starting April 1st. The CAA, passed in December 2022, ended the Medicaid continuous enrollment provision from the Public Health Emergency (PHE) as of March 31, 2023; that provision had been a lifeline for millions and a safeguard for continuous coverage during the three years of the pandemic.

Now California’s Department of Health Care Services (DHCS) is in the process of completing redeterminations for over 15 million people on Medi-Cal, and are sending redetermination packets out in yellow envelopes. Some of these people may have become eligible for Medicare during the last three years but did not enroll since they were covered with Medi-Cal. During this redetermination process, DHCS must determine people’s eligibility for ALL Medi-Cal programs and transfer people to another Medi-Cal program, including Medicare Savings Programs, if they are eligible. Below are some important Special Enrollment Periods (SEPs) and enrollment rights for people needing to enroll in Medicare, Medigap, or other health coverage.

SEP to Enroll in Medicare

  • People who became eligible for Medicare during the PHE but didn’t enroll have a 6-month SEP to enroll in Medicare starting the day their Medi-Cal coverage ends, with no late enrollment penalties. Coverage can begin the month after enrollment, or retroactive to the date Medi-Cal ended. Those who are no longer eligible for full Medi-Cal but are eligible for a Medicare Savings Program should be automatically screened and enrolled through the Department of Health Care Services (DHCS) county Medi-Cal offices.

Rights to Enroll in a Medigap

  • Those with the 6-month SEP to enroll in Medicare, also have a 6-month open enrollment period to enroll in a Medigap policy without a health screening. This right is under our state and federal law.
  • Those already on Medicare who lose their Medi-Cal, also have a 6-month open enrollment period to buy a Medigap should they need or want one. Also, if through the redetermination process they are eligible for Medi-Cal under a different eligibility standard and have a share of cost, they have a 6-month open enrollment period as well. Both situations are rights under California state law.

SEP to Enroll in the Marketplace

  • Those losing Medi-Cal who are not eligible for Medicare have a Marketplace SEP from April 1, 2023 to July 31, 2024.

With so much shifting in this “unwinding” period as Medi-Cal redeterminations resume, there are numerous scenarios that may cause potential lapses in coverage, people being eligible for programs they’re unaware of and confusion, and with that it creates a situation ripe for fraud. For example, people enrolled in Medicare D-SNP plans who then lose their Medi-Cal coverage, will then be disenrolled from their D-SNP plan. They will likely encounter intense marketing for other Medicare plans, that may or may not be a good fit for their needs.

Please continue to report any suspected enrollment fraud or misleading marketing to our California SMP at 1-855-613-7080. Contact your local Health Insurance Counseling and Advocacy Program (HICAP) for free, individual and unbiased assistance with navigating your coverage and enrollment options.