Covered California: Public Health Emergency Extension & How to Assist Medi-Cal Beneficiaries

In response to the impacts of the COVID-19 pandemic, a national Public Health Emergency (PHE) was declared by the Health and Human Services Agency in January 2020 and has been periodically extended to date – the latest extension for the PHE is effective April 16, 2022, through July 15, 2022.

As a reminder, the PHE triggered a temporary increase in federal funding to support states that administer Medicaid (Medi-Cal in California) and the Children’s Health Insurance Program (CHIP), with the condition that states cannot terminate a beneficiary’s enrollment during the PHE unless they move out of state, become deceased, or the beneficiary requests a voluntary termination of eligibility from their local county social services. This Medi-Cal continuous enrollment requirement has caused some confusion. Please reference our Medi-Cal Reminders and When to Contact County Social Services Guide, which outlines important information that certified enrollers can use when assisting Medi-Cal beneficiaries who may be eligible for and wish to enroll into a Covered California plan.

Qualifying Life Events & Special Enrollment Period

Consumers can enroll in a Covered California health plan or change their current plan only during Open Enrollment unless they experience a Qualifying Life Event (QLE)—this is called a Special Enrollment Period (SEP). Please review the information in our Special Enrollment Period Toolkit, which contains details of the newly added Qualifying Life Events, including the Public Health Emergency QLE outlined below, to help you assist in enrolling consumers who experience a Qualifying Life Event.

• Pandemic (COVID-19)/Public Health Emergency
  • This QLE is in effect if there is a declared national public health emergency, or if there is a declared state of emergency due to a pandemic at the national or state level.
    • A national public health emergency currently exists, as proclaimed by the Health and Human Services Agency.

Please Note: Special Enrollment does not apply to Medi-Cal applicants. These consumers can apply for coverage anytime during the year and do not need a Qualifying Life Event to gain coverage.

Medi-Cal Eligibility: Older Adult Expansion

Beginning May 1, 2022, a new law in California will expand Medi-Cal to adults 50 years of age or older regardless of immigration status. All other Medi-Cal eligibility rules, including income limits, will still apply.

The Department of Health Care Services has a dedicated webpage with additional information including toolkits, FAQs, and other resources – please visit the Medi-Cal Older Adult Expansion webpage here.

If you have questions, call us today at 866-568-9649!