​DHCS Stakeholder News - August 22, 2022

In an effort to maintain continuity of coverage for individuals who turn age 26 until the Medi-Cal expansion of people ages 26-49 takes effect on January 1, 2024, the Department of Health Care Services (DHCS) will continue existing state-funded full-scope Medi-Cal coverage for this group, even after the COVID-19 public health emergency (PHE) ends.

When the COVID-19 PHE ends, many individuals included in the young adult expansion will age, or would have already aged, out of coverage when they turn 26—which for some, may be months before their state-funded full-scope Medi-Cal coverage will begin again under the 26-49 expansion. DHCS will resolve that by continuing to provide them with state-funded full-scope Medi-Cal coverage before the expansion occurs. This will be done by instructing counties to deprioritize their annual redetermination after the end of the PHE and before the 26-49 expansion policy begins. This is critical in preventing a reduction of benefits for these individuals due to age and immigration status if their post-PHE renewal occurs before the 26-49 ex​pansion policy is implemented. DHCS updated the Medi-Cal COVID-19 PHE Operational Unwinding Plan to reflect changes to the policy for this population.

As enacted by Senate Bill 184 (Chapter 47, Statutes of 2022), California will implement state-funded full-scope Medi-Cal to individuals age 26 through 49, regardless of immigration status, if otherwise eligible, beginning on January 1, 2024. This Medi-Cal expansion is another important step to help close health equity gaps in California, and will improve access to care for some of the state’s most vulnerable populations.

As part of the federal continuous coverage requirements under the COVID-19 PHE, DHCS maintained ongoing Medi-Cal coverage for young adults who were provided 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. The current COVID-19 PHE ends on October 13, 2022. However, since states have not received the 60-day advance notice in mid-August, it is anticipated that the COVID-19 PHE would be extended until at least January 2023 by the federal government.

Once the COVID-19 PHE ends, federal requirements outlined by the Centers for Medicare & Medicaid Services require Medicaid agencies to redetermine eligibility for all individuals enrolled in the program. In accordance with Medi-Cal policy, this population would most likely be determined ineligible for continuing state-funded full-scope Medi-Cal due to their age and immigration status at their scheduled annual renewal if the renewal occurs prior to the 26 -49 expansion taking effect. Federal guidance for the COVID-19 PHE unwinding allows states to prioritize populations as part of their PHE unwinding annual redetermination strategy, so long as it is completed within 14 months.

Last modified date: 8/22/2022 12:18 PM