Californians hang on to health coverage, but low Medi-Cal enrollment remains a mystery

By Victoria Colliver 10/02/2020 03:01 AM EDT

A new report finds Californians largely held on to their job-based health insurance through the early stages of the pandemic, a finding that may partially explain why the state’s Medicaid enrollment figures have remained remarkably flat during the public health crisis.

While about 2.6 million Californians lost their jobs by the end of June, the number of people enrolled in employer-sponsored coverage dipped by just 1 percent — by about 190,000 — during the second quarter ending June 30, according to the analysis released Friday by the California Health Care Foundation.

The background: Based on the state’s experience with the recession a decade earlier, Gov. Gavin Newsom’ s administration in the May budget revision projected that about 2 million more Californians would be forced to enroll in Medi-Cal due to being out of work, bringing enrollment to an all-time high of 14.5 million people.

The findings: Much to the surprise of many health experts, that hasn’t happened.

Enrollment in Medi-Cal rose by just 242,000 people, or 1.9 percent, while signups for individual coverage increased by 50,000, or 2.2 percent, over the first quarter ending in March, enough to offset the modest job- based coverage declines. That’s just a fraction of what was expected.

“The lower-than-projected decline in job-based coverage helped explain why we haven’t seen 2 million more enrolled in Medicaid, as projected in the state budget,” said study co-author Laurel Lucia, director of the health care program at the University of California, Berkeley’s Labor Center. “There is still a question why California’s Medicaid enrollment growth is among the lowest in the country.”

The national picture: While some states, including Missouri and Oklahoma, have shown increases in Medicaid enrollment as high as 10 percent, the lack of a surge may be a national trend. But California’s experience on the lower end still stands out.

Possible explanations: Many pandemic-related job losses in California — and across the country — started out as furloughs, with employers continuing to provide health insurance coverage.

Some workers losing coverage may have had access to coverage through a spouse, or already had incomes low enough to qualify for Medicaid. In addition, basic needs, such as food and housing, may be considered more pressing than health insurance, leading some to go without coverage.

California’s large immigrant population may also have depressed enrollment. Workers may be worried about becoming ineligible for permanent residency under the Trump administration’s “public charge” policy, particularly if they have fellow household members who are undocumented. Eligibility redeterminations have been suspended during the pandemic, which also affects the enrollment numbers.

The outlook: The report’s authors note that while it’s a relief that losses were not as large as predicted, more may lie ahead. They say more research is needed to understand the full picture.

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