Highlights

The California Department of Health Care Services (DHCS) partnered with the California Health Care Foundation (CHCF) and SSRS to conduct a rolling monthly survey of people who were disenrolled from Medi-Cal for procedural reasons during the continuous coverage unwinding period.

The purpose of the survey was to hear from people being disenrolled to identify renewal barriers and reasons for disenrollment to inform real-time changes aimed at helping people keep coverage. Additionally, the survey aimed to be used as a nudge to encourage Medi-Cal eligible members who were procedurally disenrolled to take action on their renewal.

Following the survey, SSRS researchers conducted six focus groups and four online bulletin boards with 61 Californians from counties across the state to learn more about their experiences with the renewal process, procedural disenrollment, the impact of coverage disruption, and any suggestions for how the renewal process could be improved.

Challenge

DHCS, who managed outreach, needed a way to reach out to procedurally disenrolled Medi-Cal beneficiaries. As such, contact information for the survey was drawn from the automated eligibility system Medi-Cal uses (CalSAWS). However, some contact information was missing, it was incomplete or outdated, which prevented the delivery of the survey invitation. Another challenge of the survey was ensuring Medi-Cal participants were able to complete the survey in their language of preference. In order to accomplish this, SSRS offered the survey in 19 languages, with 17 languages available online, and another 2 languages (Laotian and Mien) available via a call-in phone number.

Approach

DHCS used CalSAWS to initiate the survey outreach efforts and invite respondents to take the SSRS-programmed survey. To increase the response rate, at month five, a reminder survey invitation was sent via email and/or text, which subsequently increased the number of completed surveys in months five and six. To complement the surveys, a subset of survey respondents who indicated a willingness to be contacted for additional research were invited by SSRS to participate in a qualitative follow-up study to learn more about their experiences with the renewal process, procedural disenrollment, the impact of coverage disruption, and any suggestions for how the renewal process could be improved. SSRS researchers conducted six focus groups and four online bulletin boards with 61 Californians from counties across the state who were procedurally disenrolled from Medi-Cal during the 2023-2024 unwinding process.

Results

The survey conducted by SSRS indicated that many respondents lacked key information about the renewal process for Medi-Cal or never received a renewal packet. The efforts by SSRS allowed us to uncover some of the major obstacles that help explain why people were disenrolled during this period. Additionally, the qualitative component of the study uncovered how this disenrollment affected people’s lives. People reported that disenrollment negatively impacted their access to care, their physical and emotional health, and their financial well-being. Together, the findings from the surveys and the qualitative portion of this study offered insight into what would make the renewal process for Medi-Cal more transparent and supportive for its enrollees. The findings also provided ways to improve enrollees understanding of the process and minimize disruptions in coverage caused by procedural disenrollment.