All adults, ages 26 to 49 years of age, will be eligible for Medi-Cal as of January 1, 2024, regardless of whether they have satisfactory immigration documentation, if they are otherwise meet the eligibility conditions. However, many adults may have Medi-Cal as of 2022, but could lose it as the Covid Pandemic Public Health Emergency ends and Medi-Cal returns to normal operations.
A Medi-Cal Bridge for Young Adults over to 2024
When the Covid Pandemic Public Health Emergency was declared, no one had their Medi-Cal enrollment terminated unless they proactively demonstrated they were no longer eligible, such as gaining employer sponsored health insurance. Previously, Medi-Cal had been expanded to include young adults up to the age 26.
Some young adults, who lacked proper immigration documents, were granted Medi-Cal prior to or during the Public Health Emergency. Those individuals have now aged out of that program and risk losing Medi-Cal coverage when the system resumes normal operations. This means they will have a gap in coverage until January 1, 2024, when they would once again be eligible for Medi-Cal.
Fortunately, for those individuals who may have aged out of the system, Medi-Cal is building a temporary bridge for them over the 2023 year. The following is from the All County Welfare Directors letter, I 22-34, August 22, 2022, addressing the bridge for this gap.
Medi-Cal Policy Guidance and Implementation
SUBJECT: COVID-19 Public Health Emergency (PHE) Unwinding for Individuals who Aged out of the Young Adult Expansion during the PHE
The purpose of this Medi-Cal Eligibility Division Information Letter (MEDIL) is to provide counties with policy and case processing instructions for individuals who age out of the Young Adult Expansion during the COVID-19 PHE or the 12-month COVID-19 PHE unwinding period.
During the federal COVID-19 PHE, the Department of Health Care Services (DHCS) used various program flexibilities to respond to the pandemic and provide continuous access to care for millions of Californians. As part of the federal continuous coverage requirements, DHCS maintained ongoing Medi-Cal coverage for young adults who were conferred state-only full scope Medi-Cal under the Young Adult Expansion, and who would have otherwise lost their Medi-Cal eligibility due to aging out at 26 years of age during the PHE.
As enacted by Senate Bill 184 (Chapter 47, Statutes of 2022), beginning on January 1, 2024, California will implement state-funded full scope Medi-Cal benefits to individuals age 26 through 49, regardless of immigration status if otherwise eligible. Under federal requirements outlined by the Centers for Medicare and Medicaid Services (CMS), DHCS must redetermine the eligibility status for all individuals in Medi-Cal once the COVID-19 PHE ends. As such, those individuals who have aged out of the Young Adult Expansion most likely be determined ineligible for state-funded full scope Medi-Cal due to their age once post-PHE renewals begin.
In an effort to maintain continuity of coverage for these individuals until the 26 through 49 expansion takes effect on January 1, 2024, households that contain an individual who has or will age out of the Young Adult Expansion during the COVID-19 PHE or 12-month COVID-19 PHE unwinding period must have their annual renewal deprioritized to the end of the COVID-19 PHE unwinding period.
Additionally, the county shall follow the guidance as outlined in All County Welfare Directors Letter (ACWDL) 22-18 and not process any changes in circumstances during the COVID-19 PHE unwinding period unless the change in circumstance results in a positive change. In instances when a positive change would result in the Young Adult Expansion individual moving from state-funded full scope to restricted scope, the county must maintain the same level of coverage until the post-PHE annual renewal process is completed. Furthermore, the individual shall not have coverage reduced to restricted scope as a result of an automated age batch in the Statewide Automated Welfare System (SAWS).
DHCS is working closely with the SAWS on the implementation of this policy and additional instructions regarding this population will be provided prior to the end of the COVID-19 PHE.
This policy change should reduce the anxiety of some people who worry they may lose Medi-Cal for a period of time before they become eligible again in 2024.