Santa Clara County looks for missing Medi-Cal members

Low-income residents in Santa Clara County are losing their state-sponsored health care at a time when the public hospital system is experiencing unprecedented demand for services.

Medi-Cal members dropped from 458,000 to 425,000 in the county between June 2023 to January, according to a report released last month. Yet the Social Security Administration said these numbers are comparable to pre-pandemic levels, while health advocates said insuring people will be crucial to avoiding already overcrowded emergency rooms at local hospitals.

“The numbers are actually normal and mirror what they were before the pandemic, which is shocking to us too because we thought we had all this loss of contact,” Manuel Garcia, a Social Services Agency eligibility worker, told San José Spotlight. “We thought there would be higher discontinuance rates. We have been able to stay at an average level.”

Officials at the agency said total membership has continued to trend downward after January, but noted that may be due to residents applying for a Covered California plan.

While total membership consistently declined, the number of discontinued individuals also sharply declined from 7,224 in November to 2,851 in January.

Bob Brownstein, a strategic advisor with Working Partnerships USA, is coordinating Medi-Cal outreach for the county. He said the main cause for the decrease was the official end of the pandemic, during which residents stayed on Medi-Cal on a rolling basis without needing to re-enroll.

Once the state of emergency ended, roughly 400,000 residents had to re-enroll and the county needed to determine if they qualified for Medi-Cal, he said.

“The reason you’re seeing people falling off every month is because people’s month of enrollment came up and that’s the time you’re supposed to be re-enrolling and if there’s a problem, that’s when it manifests,” Brownstein told San José Spotlight.

Most county Medi-Cal recipients have stayed on top of their enrollment status, Brownstein said, but about 20% of them are hard to reach.

He led a countywide effort two months ago to visit a list of residents who hadn’t responded to re-enrolling. Brownstein and community canvassers knocked on more than 100 doors and only found seven Medi-Cal members who might be eligible to re-enroll — a testament to how difficult it’s been to reach people.

Santa Clara Valley Healthcare CEO Paul Lorenz said the county health system depends on timely reimbursement for care provided to patients, and that the county health system screens incoming patients for Medi-Cal eligibility.

“Medical coverage, like any coverage for an individual, is important so people have the ability to access health care on a regular basis, including primary and preventative health care,” Lorenz told San José Spotlight. “In situations where they have an urgent need, they can seek care in the appropriate setting — for example, urgent care instead of an emergency room.”

The drop in Medi-Cal recipients comes amid plans to end trauma, stroke and heart attack services at Regional Medical Center in East San Jose. While owner HCA Healthcare cites financial strain as the reason for the Aug. 12 end in services, county doctors warn it could cause a 70% surge in trauma patients — about 2,600 cases per year — being admitted to Santa Clara Valley Medical Center (VMC) eight miles away. VMC has a history of being ill-equipped and under-resourced, and physicians fear ambulance service will be spread thin and break the county health system.

Keeping the county’s poorest residents enrolled in Medi-Cal can ensure they get preventative care so that they don’t develop health emergencies and add further strain to the county’s emergency rooms, Brownstein said.

“The last thing you need right now is to have somebody showing up with an urgent medical condition at Valley Medical Center that could have been prevented,” Brownstein said.

One of the challenges with residents under Medi-Cal is that California’s reimbursement rate to the health care providers is among the lowest in the country, he added. This can drag out wait times and prevent poor patients from crucial primary care, mental health and birth and gynecological appointments.

Brownstein said providing health care to low-income residents is always going to be costly. Yet those reimbursements still bring revenue to the system and bring people into preventative care.

“We’re continuing to do everything we can in terms of working with community-based organizations, community colleges, schools, churches, clinics, to get that word out,” he said. “There’s no question that reaching that last 20% is tough.”

Contact Brandon Pho at [email protected] or @brandonphooo on X, formerly known as Twitter.