Medicaid Health Plans Step Up Outreach Efforts Ahead of GOP Changes

ORANGE, Calif. — Carmen Basu, dressed in a red jacket and wool scarf, stood outside the headquarters of her local health program one morning after running free groceries. She brought her husband, her teenage son and her 79-year-old mother-in-law to help.

They seized canned food, fruits and vegetables and a grocery store gift card. And then Basu spotted a row of tables in the parking lot occupied by county social service workers who were helping people apply for food assistance and health coverage. Her mother-in-law, also a Medicaid recipient, might be eligible for food assistance, she was told.

“That would be less money that I would have to put aside,” said Basu, who has been the sole breadwinner for the Anaheim family since her husband suffered a stroke. “Maybe I can use this extra money to cover other expenses.”

Basu was among more than 3,000 people who attended a CalOptima event in November in one of California’s wealthiest counties. It marked the start of a $20 million campaign by health insurer Medicaid to help low-income residents obtain and maintain health coverage and food benefits as federal restrictions under President Donald Trump’s One Big Beautiful Bill Act take effect.

The law cuts more than $900 billion in federal funding for Medicaid, known in California as Medi-Cal. It also cuts about $187 billion from the Supplemental Nutrition Assistance Program, or SNAP, known as CalFresh in California. This represents approximately 20% of the program budget for the next 10 years. As a result, up to 3.4 million Medi-Cal beneficiaries and nearly 400,000 CalFresh beneficiaries could lose their benefits. (Most CalFresh recipients also receive Medi-Cal.)

Republican officials say the changes, some of which have already taken effect, will prevent waste, fraud and abuse through expanded eligibility checks and work requirements. Still, Medicaid health plans across the country are stepping up their outreach to low-income households in an effort not to lose enrollees, many of whom are already struggling with high grocery and medical costs.

In Los Angeles County, LA Care Health Plan launched community information sessions this month to inform the public about upcoming changes to Medi-Cal. Hawaii’s AlohaCare is mobilizing a Covid-era coalition to help mitigate the impact of Medicaid coverage losses. And Community Behavioral Health, a Medicaid managed care plan for behavioral health in Philadelphia, plans to hold a series of summits starting next year to publicize the changes.

“We know these changes will affect many of our members,” said Michael Hunn, CEO of CalOptima, one of about two dozen Medi-Cal managed care plans that pay monthly based on their number of enrollees. “We have a big responsibility to ensure they understand and can adapt to these changes as they are implemented. »

CalOptima, a public entity whose board of directors is appointed by county supervisors, has allocated up to $2 million through the end of 2028 to pay eligible county workers during events such as food distribution to provide on-site assistance. It’s funding that An Tran, director of the Orange County Human Services Agency, said can help fund critical outreach that the county otherwise couldn’t afford.

Orange County has approximately 1,500 eligibility officers to manage re-enrollments and verification checks for approximately 850,000 Medi-Cal members and more than 300,000 CalFresh beneficiaries.

“We’re talking about families who desperately need help, especially at a time when food prices and inflation are high and they’re struggling to survive,” Tran said.

In addition to funding county workers, CalOptima intends to provide grants to community organizations to conduct medical outreach and conduct a public awareness campaign in multiple languages ​​to educate enrollees about the new requirements, Hunn said.

U.S. Rep. Young Kim, a Republican who represents part of Orange County, did not respond to a request for comment but said the Trump-signed budget bill, which she voted for, “takes important steps to ensure federal dollars are used as efficiently as possible and to strengthen Medicaid and SNAP for our most vulnerable citizens who really need it.” She and other Republicans said it would provide tax relief to American workers.

After nearly an hour with an eligibility officer, Basu learned she earned too much for her mother-in-law, who lives with the family, to qualify for CalFresh. Now, Basu said she worries about medical eligibility changes for immigrants, which she said could affect her mother-in-law, who was granted legal permanent residency about a year and a half ago.

“Before we had this, we paid cash for cardiology, for labs, everything. It was very expensive,” Basu said. “I think I will have to pay out of pocket again in a few months. It’s a lot for me. It’s a burden.”

In most of the country, people who have had a green card for less than five years are generally not eligible for federally funded Medicaid. However, California provided state-funded health coverage for them and for low-income immigrants without legal status.

But even these benefits are being reduced due to state budget pressures. In July, the state will eliminate dental benefits in full for some enrollees who have had a green card for less than five years, as well as some other immigrant enrollees. A year later, this group will begin to be charged monthly premiums.

And starting in January, California will freeze registrations for people 19 or older without legal status, as well as for certain legally present immigrants. This will also reinstate an asset limit for all older enrollees.

Meanwhile, the state is drafting guidelines for counties on how to implement federal changes to Medicaid eligibility, said Tony Cava, a spokesman for the California Department of Health Services. Federal work rules and biannual eligibility checks are expected to take effect by early 2027 and apply to people enrolled under the Affordable Care Act’s coverage expansion.

The California Department of Human Services, which runs CalFresh, has already changed the way home utility costs are calculated and imposed a cap on benefits for very large households. It is still developing guidelines regarding federal work requirements and changes that disqualify some noncitizens, the agency’s deputy director, David Swanson Hollinger, said at a recent hearing.

The Department of Health Care Services has developed a “What Medical Members Need to Know” webpage on state and federal changes to Medicaid. It also leverages a network of medical “coverage ambassadors” to provide information and updates to communities across the state in multiple languages. And it collaborates with counties and Medi-Cal managed care plans to support community enrollment assistance, including at local events, Cava said.

Aquilino and Fidelia Salazar, a husband and wife who are receiving help with a CalFresh application, said they don’t expect to be affected by the work requirements and Medi-Cal eligibility changes. That’s because they are both permanent residents of the United States who have chronic health conditions and cannot work, they explained. Individuals considered physically or mentally incapable of working may be exempt from work requirements. But the couple fears other immigrants in their community could lose care.

“It’s not fair because a lot of people really need it,” Fidelia Salazar said in Spanish. “People earn so little and then medicines and going to the doctor are extremely expensive. »