CenCal Health prepares for Medi-Cal expansion

Expanding full-scope Medi-Cal coverage to all eligible Californians is crucial to building a healthier and inclusive state supported by an equitable healthcare system. New legislation scheduled to take effect in January 2024 established California as the first state in the nation to offer full-scope Medi-Cal benefits to all eligible residents, regardless of their immigration status. California had previously expanded Medi-Cal, regardless of immigration status, to residents aged 19 to 26 and seniors aged 50 and above. The latest age group to become eligible for full-scope benefits under the new legislation were adults ages 26-49.

The estimated numbers were unclear, but CenCal Health had to be ready to serve anywhere from several hundred to several thousand. Preparation for that requires multiple departments collaborating and careful planning months in advance to prepare.

As Member Services prepared to serve our new Adult Expansion population, a larger inter-department workgroup was formed to ensure readiness to welcome these members to CenCal Health without any break in service from that of our standard new member onboarding process.  Member Services worked with Provider Services to obtain lists from any willing network primary care providers that have treated self-pay or uninsured patients over the recent time that would potentially begin to receive Medi-Cal coverage effective January 1, 2024 under this expansion. The goal was to ensure passive enrollment to remain with these providers as the primary care provider if deemed Medi-Cal eligible in the expansion.  Working with IT to match members with previously seen PCPs, over 2,600 passive enrollment assignments were achieved, and all 15,768 members received an official PCP assignment whether by passive enrollment, member selection or auto-assignment.  Member Services prepared our call center team for the potential growth in membership and to be prepared for many questions about benefits and coverage.  We ensured all hands on deck, staggering lunches over longer periods of time with fewer staff out at given times, and utilized back-up staff with call center experience and from other departments to assist with the call volume. This onboarding process continued through February 2024 and the Member Services Department handled call volume increases of 47% daily as they assisted our new members in gaining an understanding of their coverage and welcoming them to CenCal Health.

The advanced planning paid off when over 15,000 new members joined the plan on January 1, 2024. It was the most significant single day of growth for CenCal Health since Healthy Families went live in 1998.