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San Diego assemblymember proposes solutions to Medi-Cal eligibility burden

Over 325,000 children in San Diego County rely on Medi-Cal, California's health insurance program for low-income individuals. Each year, families have to prove eligibility or risk losing coverage. KPBS health reporter Heidi de Marco says a San Diego assembly member wants to take that burden away from families.

Over 325,000 children in San Diego County rely on Medi-Cal, California's health insurance program for low-income individuals. In San Diego County, there were nearly 9,000 fewer child Medi-Cal recipients in March of this year than last year.

Just weeks after 9-year-old Israel Fernandez had heart surgery last year, his mother, Beatrice Fernandez, learned he’d lost his Medi-Cal coverage.

“It was a six-hour surgery. He stood overnight, everything went fine. I got home that weekend and I had a letter from Molina (Health care) saying that he was going to be discontinued because they'd never received the paperwork. I started freaking out because in October he had a follow-up appointment with his cardiologist. And we looked up in the system and he was discontinued,” Fernandez said.


After numerous phone calls to California's Department of Health Care Services and help from a case manager at La Maestra Community Health Centers, Israel’s Medi-Cal was reinstated the day before his check-up.

“It’s scary. For me, it's life and death,” Fernandez said.

During the pandemic, the federal government waived annual eligibility requirements for Medicaid — called Medi-Cal in California. But reinstated them in March 2023. As of February 2024 more than 1.2 million people have been disenrolled in California for procedural reasons according to an analysis of state data by KFF Health News.

Mayra Alvarez, president of the advocacy organization The Children’s Partnership, said children are unnecessarily losing their health coverage when they need it the most.

“We want to make sure — particularly our youngest children ages zero to five, when we know that 90% of brain development occurs — that they don't have to worry about losing that coverage. That their families can focus on taking them to the doctor to get those preventive services, those screenings, those vaccinations that put our children on the right path to healthy childhood development,” she said.


Most eligible recipients were removed from the program over paperwork, clerical errors and other procedural issues. There is also a backlog of Medi-Cal renewal applications causing gaps in coverage Alvarez said.

“It is an all-hands-on-deck approach to educate families about the need to renew their eligibility for Medi-Cal,” Alvarez said. “We created a set of videos featuring promoters speaking in languages like Spanish, Mandarin and Punjabi to try and reach families in their language so that they can be educated about this process and be reminded of what are the steps necessary to reapply for Medi-Cal to re-determine that eligibility.”

The Children’s Partnership is also working with San Diego Assemblymember Tasha Boerner to urge Gov. Gavin Newsom to fund continuous Medi-Cal coverage for children in his May budget revisions. Boener authored AB 2956, which seeks to stop Medi-Cal disenrollment for adults in California.

Boerner said many families discover their Medi-Cal coverage has lapsed while at the doctor or in the emergency room.

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