Lessons Learned from California’s Medi-Cal Unwinding

Delivery System ReformPolicy Analysis and Development

Jun 26

Written By

In response to the COVID-19 pandemic public health emergency (PHE), Congress provided funding for states to maintain continuous Medicaid coverage for members, which resulted in increased Medicaid enrollment nationwide. After the continuous coverage requirement ended in March 2023, states began the “unwinding” process to return to normal Medicaid operations by resuming redeterminations and disenrolling no longer eligible individuals. To support states during unwinding, the federal Centers for Medicare & Medicaid Services provided a range of flexibilities that states could adopt.

States took varied approaches to unwinding, including the number and type of federal flexibilities they adopted. Facing the largest redetermination caseload in the country, California adopted numerous federal flexibilities, invested in a robust statewide outreach campaign, and developed strong partnerships. These efforts allowed the state to maintain Medi-Cal coverage for a majority of members.

The California Health Care Foundation (CHCF) partnered with Aurrera Health to identify lessons learned and remaining opportunities to improve Medi-Cal enrollment and renewal processes from California’s experience during unwinding. Aurrera Health conducted desk research, facilitated interviews with California and national experts, and convened an in-person roundtable to inform the development of Lessons from the Medi-Cal Unwinding: How California Protected Coverage and Policy Options to Improve Renewals. The report outlines key successes and challenges from California’s unwinding experience and highlights opportunities to improve renewal processes and continuity of coverage in the future, including:

Extending or Permanently Adopting Key Federal Flexibilities to maintain high ex parte renewal rates and reduce administrative burdens.
Enhancing Training and Capacity for Eligibility Workers through improved funding, technology adoption, and interactive learning opportunities.
Streamlining Application and Renewal Processes with simpler forms, better data integration, and automation of eligibility verifications.
Improving Member Outreach and Accessibility by refining messaging strategies, ensuring language and disability accommodations, and aligning Medi-Cal communications with Covered California.
Strengthening Partnerships Between Counties, MCPs, and CBOs to improve data sharing, enhance trust, and facilitate smoother case resolutions.

The full report is available on CHCF’s website and includes additional detail about successes, challenges, and opportunities for California as well as insights from other states. Aurrera Health will continue to monitor how federal policy changes may impact future efforts to improve continuity of coverage and renewal processes and how we can learn from lessons during unwinding.

If you are interested in learning more about how Aurrera Health can help your organization navigate Medicaid eligibility and enrollment in the current federal policy landscape, please reach out to Lauren Block.