A partir del 1 de enero, Medi-Cal implementará nuevos contratos estandarizados con sus 22 planes de salud gestionados, que cubren en total al 99% de los inscritos.

Los nuevos contratos refuerzan la aplicación de medidas de calidad, especialmente para mujeres y niños; y exigen que los planes de salud informen públicamente sobre el rendimiento de los proveedores médicos, ―y en algunos casos otras aseguradoras, en las que delegan atención―. También ordenan que los planes revelen la cantidad de inscritos que no tienen acceso a la atención primaria, y que inviertan más para cubrir esa brecha.

Además, comprometen a los planes a una mejor integración de la atención física y mental, y a una mayor capacidad de respuesta a las necesidades culturales y lingüísticas, la orientación sexual e identidad de género de los miembros.

Para cumplir con estas promesas, los reguladores estatales deberán ser más estrictos de lo que han sido hasta ahora. Pero eso podría ser difícil, ya que los cambios están ocurriendo al mismo tiempo que varias otras iniciativas que podrían competir por la atención del personal y confundir a algunos beneficiarios.

A partir del próximo año, más de 700,000 inmigrantes sin papeles serán elegibles para una cobertura completa de Medi-Cal. Además, se espera que aproximadamente 1.2 millones de beneficiarios en 21 condados deban cambiar de planes de salud después que el estado reorganizara el conjunto de aseguradoras el año pasado, y varios condados cambiaran la forma en que ofrecen Medi-Cal.

Algunos condados solo tendrán un plan. Donde haya más de uno, los inscritos que estén perdiendo su plan deberán elegir uno nuevo.

Kaiser Permanente, el gigante de la atención gestionada con sede en Oakland, comenzará un nuevo contrato directo con el estado en 32 condados, un gran cambio administrativo que no debería interrumpir la atención para la mayoría de los inscritos.

Y, por primera vez, se cambiará a miles de inscritos de Medi-Cal en cuidados residenciales a planes de atención gestionada, ya que el estado acelera su distanciamiento del Medi-Cal tradicional, de pago directo.

Todo esto ocurre en medio del llamado desmantelamiento de Medicaid (que comenzó cuando terminaron las protecciones de la pandemia), por el cual más de 900,000 personas han sido eliminadas de Medi-Cal hasta ahora, un proceso que, se espera,  continúe hasta el próximo verano.

“Mi cabeza está dando vueltas pensando en todo eso sucediendo al mismo tiempo”, dice John Baackes, CEO de L.A. Care Health Plan, el plan de Medi-Cal más grande del estado, con casi 2.6 millones de miembros. “Nuestro centro de llamadas está abarrotado”.

Tony Cava, vocero del Departamento de Servicios de Atención Médica (DHCS), que supervisa Medi-Cal, dijo que los nuevos contratos, firmados por todos los planes de atención gestionada de Medi-Cal, proporcionarán una “cobertura de calidad, equitativa y completa”, enfatizando en la prevención y “ofreciendo servicios que aborden las necesidades de atención a largo plazo a lo largo de la vida del miembro”.

Y en un acción innovadora, los nuevos contratos también requieren que los planes de salud reinviertan por primera vez una parte de sus ganancias, entre el 5% y el 7.5%, en las comunidades donde operan.

También ofrecen una serie de incentivos y penalizaciones, que incluyen retener un pequeño porcentaje de los pagos a los planes de salud con la posibilidad de que lo recuperen alcanzando objetivos de calidad y equidad en salud.

Y los planes de salud rentables que no cumplan con las expectativas deberán reinvertir un 7.5% adicional de sus ganancias en la comunidad. Todo esto se suma a las multas aumentadas que los reguladores pueden imponer a los planes de salud con bajo rendimiento.

Los nuevos contratos de Medi-Cal también consagran elementos clave de CalAIM, un experimento de $12 mil millones y cinco años, ya en marcha, en el que los planes de salud buscan proporcionar una variedad de servicios sociales para los miembros de Medi-Cal más necesitados, incluida asistencia para vivienda y comidas adaptadas médicamente, con el argumento de que la pobreza y las inequidades sociales relacionadas a menudo están en la raíz de los problemas de salud.

Hasta ahora, sin embargo, la implementación ha sido lenta.

Abbi Coursolle, abogada senior en la oficina de Los Ángeles del National Health Law Program, dijo que el requisito de que los planes informen públicamente sobre la atención proporcionada por sus proveedores médicos subcontratados debería aumentar la responsabilidad, ayudando a los inscritos a navegar mejor por Medi-Cal. “Esto es un avance en el que los defensores han estado prestando atención durante más de una década”, dice Coursolle. “Hay tanto ir y venir de la gente entre el plan de salud y el grupo de proveedores. Eso diluye tanto la responsabilidad”.

Otro gran cambio para Medi-Cal es la eliminación de la llamada prueba de límite de activos para un cierto grupo de inscritos, incluidas personas de edad avanzada, ciegas, con discapacidades, en atención a largo plazo o en Medicare.

Además de cumplir con los requisitos de ingresos, las personas han tenido que mantener el valor total de sus activos personales por debajo de ciertos umbrales para calificar para Medi-Cal. Los activos contados incluyen ahorros, ciertas inversiones, segundas viviendas e incluso segundos automóviles.

Hasta el año pasado, esos límites eran tan bajos, $2,000 para un individuo, que las personas prácticamente no tenían la capacidad de acumular ahorros si querían estar en Medi-Cal. A mediados de 2022, sin embargo, el límite se elevó a $130,000, lo que significó que para la mayoría de las personas sujetas a la prueba, los activos ya no eran una barrera para la elegibilidad.

En 2024, la prueba de activos se eliminará por completo.

Pero dado el cambio del año pasado, la eliminación total probablemente genere solo unos pocos miles de nuevos inscritos en Medi-Cal. Aún así, debería prevenir que las personas tengan la molestia burocrática de tener que demostrar que están por debajo de cierto umbral de activos.

Si quieres tener más información sobre la prueba de límite de activos, el DHCS tiene respuestas sobre el tema en su sitio web (dhcs.ca.gov).

Si te preguntas si estás entre los 1.2 millones de miembros de Medi-Cal que necesitan cambiar de plan de salud, y aún no has recibido una comunicación al respecto, el departamento tiene una herramienta en línea para informarte sobre los planes disponibles en tu condado a partir del 1 de enero.

Casi la mitad de las personas que necesitan cambiar de plan son miembros de Health Net en el condado de Los Ángeles que serán transferidos a Molina Healthcare como parte de un acuerdo de compromiso que el estado alcanzó el año pasado, para evitar enredarse en demandas de planes de salud enojados que perdieron en una competencia de licitación.

Si necesitas cambiar de plan y tienes suerte, tus médicos pueden estar en el nuevo plan. Asegúrate de verificar. Si no están, es posible que puedas mantenerlos por un año o el tiempo suficiente para completar un tratamiento que ya está en marcha.

El DHCS tiene una hoja informativa que describe tus derechos a tener esa continuidad. También puedes contactar a tu plan de salud actual para obtener información adicional o preguntar en la oficina de Medi-Cal de tu condado.

La Health Consumer Alliance (1-888 804 3536, o healthconsumer.org) es otra fuente de información y asistencia, al igual que el defensor del cuidado gestionado de Medi-Cal (1-888-452-8609, o MMCDOmbudsmanOffice@dhcs.ca.gov).

A pesar de las mejores intenciones del estado, la grave escasez de profesionales médicos podría ser un gran obstáculo.

“Mientras estas expansiones de la cobertura y estas innovaciones están ocurriendo, se está construyendo sobre una fuerza laboral de salud que ya está tensionada”, dijo Berenice Nuñez Constant, vicepresidenta senior de relaciones gubernamentales en AltaMed Health Services, uno de los grupos de clínicas comunitarias más grandes del estado.

Con escasez de personal o no, los planes de salud deben cumplir con sus obligaciones contractuales. Anthony Wright, director ejecutivo del grupo de defensa Health Access California, dijo: “A cierto nivel, se trata de hacer que los planes sean responsables de lo que prometen y de obtener decenas de miles de millones de dólares por ello”.

Este artículo fue producido por KFF Health News, que publica California Healthline, un servicio editorialmente independiente de la California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Starting Jan. 1, Medi-Cal, California’s Medicaid program, will implement new standardized contracts with its 22 managed care health plans, which collectively cover 99% of enrollees. The new contracts tighten enforcement of quality measures, especially for women and children; require the health plans to report publicly on the performance of medical providers ― and in some cases other insurers ― to whom they delegate care; and mandate that plans reveal the number of enrollees who don’t have access to primary care and invest more to plug the gap. They also commit plans to better integration of physical and mental health care and greater responsiveness to the cultural and linguistic needs, sexual orientation, and gender identity of members.

To realize these promises, state regulators will have to be tougher than they have been in the past.

But that might be difficult, because the changes are happening at the same time as a number of other initiatives that could compete for staff attention and confuse some enrollees.

Beginning next year, over 700,000 immigrants without permanent legal residency will become eligible for full Medi-Cal coverage. In addition, an estimated 1.2 million beneficiaries in 21 counties will need to change health plans after the state last year rejiggered the constellation of insurers and multiple counties switched the way they deliver Medi-Cal. Some counties will have only one plan left. Where there is more than one, enrollees who are losing their plan will have to choose a new one.

Kaiser Permanente, the Oakland-based managed care giant, will start a new direct contract with the state in 32 counties, largely an administrative shift that should not disrupt care for most enrollees. And thousands of Medi-Cal enrollees in residential care will be switched into managed care plans for the first time, as the state accelerates its move away from traditional, direct-pay Medi-Cal.

All of this is happening amid the so-called unwinding, in which over 900,000 people have been shed from Medi-Cal thus far, and disenrollments are expected to continue until next summer. The unwinding follows the termination of pandemic-era protections.

“My head is spinning thinking about all of that going on at the same time,” says John Baackes, CEO of L.A. Care Health Plan, the state’s largest Medi-Cal plan, with nearly 2.6 million members. “Our call center is stacked to the gills.”

Tony Cava, spokesperson for the Department of Health Care Services, which oversees Medi-Cal, says the new contracts, signed by all the Medi-Cal managed care plans, will provide for “quality, equitable, and comprehensive coverage,” emphasizing prevention and “offering services that address long-term care needs throughout a member’s life.”

And in a groundbreaking move, the new contracts also require health plans for the first time to reinvest a portion of their profits ― between 5% and 7.5% ― in the communities where they operate.

They also provide a number of carrots and sticks, which include withholding a small percentage of payments to health plans with a chance for them to earn it back by reaching quality and health equity benchmarks. And profitable health plans that don’t meet expectations will have to reinvest an additional 7.5% of their profits in the community. This is all on top of increased fines that regulators can levy on poorly performing health plans.

The new Medi-Cal contracts also enshrine key elements of CalAIM, a $12 billion, five-year experiment, already underway, in which health plans aim to provide a range of social services for the neediest Medi-Cal members, including housing assistance and medically tailored meals, on the grounds that poverty and related social inequities are often the root of health problems. So far, however, the rollout has been slow.

Abbi Coursolle, senior attorney in the Los Angeles office of the National Health Law Program, says the requirement for health plans to report publicly on the care provided by their subcontracted medical providers should increase accountability, helping enrollees better navigate Medi-Cal.

“This is a step forward that advocates have been paying attention to for over a decade,” Coursolle says. “There’s so much ping-ponging people back and forth between the health plan and the provider group. That dilutes accountability so much.”

Another big change for Medi-Cal is the elimination of the so-called asset limit test for a certain subset of enrollees, including people who are aged, blind, disabled, in long-term care, or on Medicare. In addition to meeting income requirements, people have had to keep the total value of their personal assets below certain thresholds to qualify for Medi-Cal. The assets that are counted include savings, certain investments, second homes, and even second cars.

Until last year, those limits were so low ― $2,000 for an individual ― that people had virtually no ability to accumulate savings if they wanted to be on Medi-Cal. In mid-2022, however, the limit was raised to $130,000, which meant that for the majority of people subject to the test, assets were no longer a barrier to eligibility. In 2024, the asset test will be eliminated altogether.

But given last year’s change, the total elimination will likely generate only a few thousand new Medi-Cal enrollees. Still, it should save people the bureaucratic headache of having to prove they’re below a certain asset threshold.

If you want to learn more about the asset limit test, the DHCS has an FAQ on the subject on its website (dhcs.ca.gov).

If you wonder whether you are among the 1.2 million Medi-Cal members who need to change health plans, and you haven’t already received communication on the subject, the department has an online tool to tell you the plans that will be available in your county as of Jan. 1.

Nearly half the people who need to switch plans are Health Net members in Los Angeles County who are being transferred to Molina Healthcare as part of a compromise agreement the state struck last year to avoid becoming mired in lawsuits by angry health plans that lost out in a bidding competition.

If you need to change plans and you’re lucky, your doctors may be in the new plan. Make sure to check. If they are not, you may be able keep them for up to a year or long enough to finish a course of treatment that is already underway. The DHCS provides a fact sheet outlining your rights to continuity. You can also contact your current health plan for additional information or ask your county Medi-Cal office. The Health Consumer Alliance (1-888‑804‑3536, or healthconsumer.org) is another source of information and assistance, as is Medi-Cal’s managed care ombudsman (1-888-452-8609, or MMCDOmbudsmanOffice@dhcs.ca.gov)

Despite the state’s best intentions, an acute shortage of medical professionals could be a big obstacle. “As these coverage expansions are happening, and as this innovation is happening, it is being built on a health workforce that is already strained,” says Berenice Nuñez Constant, senior vice president for government relations at AltaMed Health Services, one of the state’s largest community clinic groups.

Labor shortage or not, the health plans must deliver on their contractual obligations. Anthony Wright, executive director of the advocacy group Health Access California, says, “On some level, this is about holding the plans accountable for what they are promising and getting tens of billions of dollars for.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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La mujer de 48 años, que trabaja como gerente administrativa en una organización sin fines de lucro, puede recibir atención de emergencia por un paquete limitado de beneficios que el estado pone a disposición de los inmigrantes sin papeles.

También ha podido tener sus mamografías, radiografías y análisis de sangre en clínicas que cobran en base a los ingresos del paciente. Sin embargo, conseguir citas lleva mucho tiempo y a menudo están lejos de su casa. “Es muy frustrante, porque tienes que tener tiempo para ir, y no puedes simplemente perder un día de trabajo”, dijo Milagro, quien pidió que no se publicara su apellido por temor a las autoridades de inmigración.

Milagro y su esposo se encuentran entre los más de 700,000 inmigrantes de entre 26 y 49 años que se espera que califiquen para el seguro de salud completo a partir del 1 de enero.

Ese día, California dará el paso final para abrir Medi-Cal, el programa de atención médica del estado para residentes con bajos ingresos, a todos los que cumplan con los requisitos de elegibilidad, independientemente de su estatus migratorio.

Como he informado con frecuencia, obtener atención de calidad a través de Medi-Cal puede ser un desafío. Pero esta población —a menudo sostén económico del hogar que no puede permitirse enfermar— podría obtener un acceso mucho mejor a servicios como atención primaria y especializada, chequeos dentales de rutina, medicamentos recetados, atención hospitalaria, análisis, pruebas de imagen, y servicios de salud mental.

Los nuevos inscritos se sumarán a más de 655,000 niños, adultos jóvenes de hasta 25 años y adultos de 50 años y más que ya se han registrado en Medi-Cal a través de expansiones anteriores para residentes sin papeles, según los datos más recientes del Departamento de Servicios de Atención Médica del estado.  

Defensores de inmigrantes indican que las personas sin seguro médico generalmente están más enfermas y mueren más jóvenes. “Esto cambiará la vida de las personas que ahora podrán hacerse chequeos regulares, análisis, saber si pueden tener diabetes o hipertensión”, dijo Sarah Dar, directora de políticas en la oficina de Los Ángeles del California Immigrant Policy Center.

Milagro dice que está emocionada. “Nunca tuve chequeos regulares cuando era más joven”, dice. “Ahora, soy más consciente de que necesito cuidar de mi salud”.

Extender la cobertura completa de Medi-Cal a individuos elegibles de entre 26 y 49 años, independientemente de su estatus migratorio, se estima que costará al estado $1.4 mil millones en los primeros seis meses y $3.4 mil millones al año con la implementación completa.

La estimación del estado de poco más de 700,000 nuevos inscritos se basa en el número de personas en el grupo de edad que ya están registradas para un conjunto más pequeño de beneficios, conocidos como Medi-Cal de “alcance limitado”, una de ellas, Milagro. Este grupo se transferirá automáticamente al Medi-Cal completo el 1 de enero.

El estado ha comenzado a enviar avisos informándoles de los beneficios ampliados y dirigiéndolos a elegir un plan de salud de Medi-Cal, a menos que vivan en un condado que solo tenga un plan.

Será más difícil llegar a los inmigrantes restantes en el grupo de 26 a 49 años cubiertos por esta expansión, ya que el estado no sabe quiénes son, dónde están ni cuántos son. Defensores de pacientes, grupos comunitarios y oficinas de bienestar de los condados enfrentan varios obstáculos: barreras de idioma, desconfianza en las agencias gubernamentales y el temor de que inscribirse en beneficios públicos pueda poner en peligro las posibilidades de obtener la tarjeta de residencia (green card).

Un desafío es convencer a los inmigrantes de que estar en Medi-Cal es poco probable que afecte su futuro estatus migratorio bajo la llamada regla de carga pública.

Defensores señalan que California de todos modos no comparte la información de los inscritos con las autoridades federales de inmigración. Pero el fuerte sentimiento anti inmigrante que fue tan fuerte durante la administración Trump, y persiste mientras la nación se prepara para las elecciones de 2024, “envió un mensaje a estas comunidades de que deberían vivir en las sombras y de que no merecen beneficios”, explicó Dar.

Incluso será difícil encontrar a aquellos que ya están en la versión limitada de Medi-Cal si su información de contacto no está actualizada. Y podrían no ser incluso conscientes de que formaban parte de Medi-Cal. Si, por ejemplo, tuvieron una crisis de salud, los llevaron a la sala de emergencias y simplemente se les pidió que firmaran algunos documentos para cubrir su tratamiento, podrían no entender lo que significa recibir un correo de Medi-Cal.

Y algunos pueden temer cualquier contacto con el gobierno.

Lena Silver, directora de políticas y defensa administrativa en Neighborhood Legal Services of Los Angeles County, dijo que condujo una sesión de capacitación donde una mujer que trabaja con jornaleros dijo que muchos tenían miedo de abrir los sobres que habían recibido.

El Departamento de Servicios de Atención Médica está liderando una campaña de divulgación en 19 idiomas que incluye anuncios en radio, televisión y redes sociales.

Lo que potencialmente complica las cosas es el hecho de que la expansión de los beneficios de salud a este último (y más grande) grupo de inmigrantes coincide con la llamada cancelación de Medi-Cal, en la que más de 900,000 beneficiarios, hasta ahora, han sido eliminados del programa, principalmente debido a trámites incompletos, al expirar las exenciones por la pandemia.

Los inmigrantes con Medi-Cal limitado también deben demostrar que continúan siendo elegibles en base a sus ingresos, para evitar ser eliminados en el proceso de cancelación, lo que también puede resultar confuso cuando dicha solicitud se suma al aviso que les informa sobre sus nuevos beneficios recién ampliados.

Si tú mismo eres indocumentado, o un amigo o un ser querido, hay recursos disponibles para ayudar a navegar el proceso de inscripción en Medi-Cal. Una página en el sitio web del Departamento de Servicios de Atención Médica (dhcs.ca.gov) explica la expansión y tiene preguntas y respuestas frecuentes en varios idiomas detallando los nuevos beneficios.

Si necesitas ayuda para inscribirte en un plan de Medi-Cal o llenar formularios para demostrar tu elegibilidad, prueba con Health Consumer Alliance (healthconsumer.org o 1-888-804-3536).

Las clínicas comunitarias también son buenas fuentes, al igual que las oficinas de los condados que administran Medi-Cal.

Brenda, residente del condado de Los Ángeles de 33 años que también pidió que no se publicara su apellido porque no tiene papeles, dijo que será “una gran bendición” obtener beneficios completos de Medi-Cal.

Brenda llegó desde México cuando era niña y ha tenido que pagar la mayoría de sus necesidades de atención médica de su propio bolsillo. Rara vez va al médico, no ha visto a un dentista en tres años a pesar de los dolores de muelas, y ha usado los mismos anteojos por cinco años.

En enero, planea hacerse una prueba de detección de cáncer de mama y diabetes, que es frecuente en su familia. Y dijo: “definitivamente quiero arreglar mis dientes. Siempre he querido una sonrisa Colgate”.

Esta historia fue producida por KFF Health News, que publica California Healthline, un servicio editorialmente independiente de la California Health Care Foundation.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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The 48-year-old, who works as the office manager at a nonprofit, can get emergency care through a narrow set of benefits the state makes available to immigrants without legal residency. And she has been able to get mammograms, X-rays, and blood tests at clinics that charge according to income. But it can take a long time to get such appointments, and they are often far from home.

“It’s very frustrating, because you have to have the time to go, and you can’t just lose a day of work,” says Milagro, who asked that her last name be withheld due to fear of immigration authorities.

Milagro and her husband are among the more than 700,000 immigrants ages 26-49 expected to newly qualify for full health insurance come Jan. 1. That’s when California takes the final step in opening up Medi-Cal, the state’s health care program for low-income residents, to everyone who meets eligibility requirements, regardless of their immigration status.

As I have frequently reported, getting quality care through Medi-Cal can be a challenge. But this population — often household breadwinners who can’t afford to get sick — stand to gain far better access to services such as primary and specialty care, routine dental checkups, prescription medications, inpatient hospital care, lab tests, scans, and mental health services.

New enrollees will join more than 655,000 children, young adults through age 25, and adults 50 or over who have already signed up for Medi-Cal through previous expansions to residents lacking legal authorization, according to the most recent data from the state Department of Health Care Services.

Advocates for immigrants note that people without health insurance are generally sicker and die younger. “This is life-changing for people to now be able to go get regular checkups, get labs drawn, see if they might be diabetic or have high blood pressure,” says Sarah Dar, policy director in the Los Angeles office of the California Immigrant Policy Center.

Milagro says she is excited about what is coming. “I never had regular checkups when I was younger,” she says. “Now, I am more conscious of the fact that I need to take care of my health.”

Extending full Medi-Cal coverage to eligible individuals in the 26-49 age range regardless of immigration status is projected to cost the state $1.4 billion in the first six months and $3.4 billion a year upon full implementation.

The state’s estimate of just over 700,000 new enrollees is based on the number of people in the age group who are already signed up for a narrower set of benefits, known as “restricted scope” Medi-Cal, including Milagro. They will be automatically switched over to full Medi-Cal on Jan. 1. The state has begun mailing notices informing them of expanded benefits and directing them to choose a Medi-Cal health plan unless they live in a county with only one plan.

The remaining residents in the 26-49 age range covered by this expansion will be harder to reach because the state does not know who, where, or how numerous they are. Patient advocates, community groups, and county welfare offices face a number of obstacles: language barriers, wariness of governmental agencies, and fear that signing up for public benefits could jeopardize the chances for legal residency.

One challenge is to convince immigrants that being on Medi-Cal is unlikely to affect their future immigration status under the so-called public charge rule. Advocates point out that California doesn’t share enrollees’ information with federal immigration authorities anyway.

But the fierce anti-immigrant sentiment that was so prevalent during the Trump administration and lingers as the nation gears up for the 2024 elections “sent a message to these communities that they should live in the shadows and are not deserving of benefits,” says Dar.

Even those already in the restricted version of Medi-Cal will be a challenge to reach if their contact information is not up to date. And they could be unaware that they were part of Medi-Cal at all. If, for example, they had a health crisis, were taken to the emergency room, and were simply asked by hospital staff to sign some paperwork to cover their treatment, they might not understand what a mailing from Medi-Cal means.

And some may fear any contact by the government. Lena Silver, director of policy and administrative advocacy at Neighborhood Legal Services of Los Angeles County, says she conducted a training session where a woman who works with day laborers said many of them were afraid to open the envelopes they’d received.

The Department of Health Care Services is spearheading an outreach campaign in 19 languages that includes ads on radio, TV, and social media.

Potentially complicating matters is the fact that the expansion of health benefits to this last ― and largest — group of immigrants coincides with the so-called Medi-Cal unwinding, in which over 900,000 beneficiaries and counting have been disenrolled, mostly due to incomplete paperwork, as pandemic-era exemptions expire.

Immigrants with restricted Medi-Cal must also demonstrate their continued income eligibility in the unwinding, which can be confusing when such a request is piled on top of notices informing them of their newly expanded benefits.

If you, a friend, or a loved one is an immigrant without legal residency, resources are available to help navigate the Medi-Cal enrollment process. A page on the Department of Health Care Services website (dhcs.ca.gov) explains the expansion and contains an FAQ in multiple languages detailing the new benefits that come with it.

If you need help enrolling in a Medi-Cal plan or filling out forms to demonstrate your eligibility, try the Health Consumer Alliance (healthconsumer.org, or 1-888-804-3536). Community clinics are also good sources, as are county offices that administer Medi-Cal.

Brenda, a 33-year-old Los Angeles County resident who also asked to withhold her last name because she lacks legal immigration status, says it will be “a big old blessing” to get full Medi-Cal benefits. She arrived from Mexico as a child and has had to pay for most health care needs out of her own pocket. She rarely goes to the doctor, she hasn’t seen a dentist in three years despite toothaches, and her glasses are five years old.

Come January, she plans to be screened for breast cancer and diabetes, which runs in her family. And, she says, “I definitely want to fix my teeth. I always wanted a Colgate smile.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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She was taken to a hospital in Clovis, a city in Fresno County, near where the Reisz family lives. But the severity of Megan’s injuries — four broken ribs and a partially collapsed lung — prompted doctors to transport her 12 miles by ambulance to the Level I trauma center at Community Regional Medical Center in Fresno.

While Megan was still recovering at home from her injuries, she received a $2,400 bill from the ambulance company — after the family’s health plan had paid nearly $2,200.

“When we received the bill, I thought our insurance company was processing the claim incorrectly,” says Jennifer Reisz. An attorney, Reisz says she then spent hours on the phone with the health plan, the ambulance company, and a few consumer advocates. She learned that the ambulance company was not in the health plan’s network and was permitted to bill patients for any uncovered portion of its charges — a practice known as balance billing.

Starting Jan. 1, ground ambulance operators will be barred from doing that because of a new law signed by Democratic Gov. Gavin Newsom. California is the 14th state to provide some protection against balance billing for ground ambulance rides.

At the federal level, an advisory committee established under the No Surprises Act is working on a plan to address the problem nationally.

Both the federal law, which took effect in 2022, and a California law that predates it largely banned balance billing for hospital care and air ambulance services, but not ground ambulance services.

And that is hardly fair, since patients have zero control in a medical emergency over which ambulance company responds, whether it is in network, or how much it will charge.

In California, nearly three-quarters of emergency ground ambulance rides result in out-of-network bills. The average surprise bill for a ground ambulance ride in California is $1,209, the highest in the nation, according to a December study.

The new law, which applies to about 14 million Californians enrolled in state-regulated commercial health plans, limits how much a non-network ambulance operator can charge patients to the amount they would pay for an in-network ambulance.

The law also caps bills for uninsured people, stipulating they can’t be charged more than the Medi-Cal or Medicare rate, whichever is greater. (Medi-Cal is California’s Medicaid program, providing coverage to people with low incomes or disabilities.) And it prohibits ambulance operators and debt collectors from reporting patients to a credit rating agency or taking legal action against them for at least 12 months after the initial bill.

Under current law, people in distress sometimes decline to call an ambulance for fear of a huge bill, putting themselves or a loved one at risk, says Katie Van Deynze, policy and legislative advocate for Health Access California, which sponsored the legislation. With the new law, she says, “they will have peace of mind.”

Existing laws already protect Medicare and Medi-Cal beneficiaries from surprise ground ambulance bills. The new law does not cover the nearly 6 million Californians enrolled in the subset of employer-sponsored health plans that are federally regulated.

The advisory committee working on a federal fix agreed last week on nonbinding proposals that would, among other things, prohibit balance billing for the vast majority of ambulance rides and cap patients’ financial liability at $100. The committee plans to formally report its recommendations to Congress early next year for potential legislation.

Under California’s new law, patients can expect to save an average of nearly $1,100 per emergency ambulance ride and over $800 per nonemergency ride in the first year, according to a legislative analysis conducted this year.

Health plans will be required to pay ambulance operators the rates set by county authorities, which the study said would increase the average amount insurers pay per ride by around $2,000.

Since ambulance rides account for a tiny percentage of overall health plan spending, those increases should not raise premiums by much.

But local authorities might be tempted to hike ambulance rates over time to increase revenue for publicly run ambulance operators, such as fire departments, says Loren Adler, associate director of the Brookings Schaeffer Initiative on Health Policy. That could prompt health plans to raise ambulance copays, offsetting some of the consumer savings from the new law, Adler says.

Jenn Engstrom, director of CalPIRG, an advocacy group that helped shepherd the law through the legislature, notes there will be built-in accountability, since the legislation requires public reporting of ambulance rates. “If we notice that things start to skyrocket, there will be a need for legislative action or local action,” Engstrom says.

Reisz says the ambulance company that transported her daughter wrote off the bill after she made it clear she had no intention of paying it — and after her health plan ponied up a little more. But as she notes, not everyone is a lawyer adept at arguing their cause.

Even if you are no rhetorical wizard, you can take simple steps to protect yourself against errors or ambulance operators that disregard the new law.

Check your insurance policy to know your deductible and any copay or coinsurance should you ever need an ambulance. If you get an ambulance bill, don’t pay it right away. Check your insurer’s explanation of benefits to make sure what it says you owe matches what you think your cost-sharing amount should be. If the bill is higher, the ambulance company may be trying to pull a fast one. Call the ambulance company and tell them they need to knock the bill down. If they don’t, file a complaint with your health plan and include a copy of the bill.

If you disagree with your plan’s decision, or it takes more than 30 days for the plan to respond, take your complaint to the regulator.

The new law requires your insurer to tell you if your health plan is regulated by the state and thus subject to the statute. If it is, the regulator is likely to be the Department of Managed Health Care. You can contact that agency online (www.healthhelp.ca.gov) or by phone at 1-888-466-2219. If your health plan is regulated by the Department of Insurance, you can file a complaint online (www.insurance.ca.gov) or call 1-800-927-4357.

Another good resource is the Health Consumer Alliance, which offers free legal assistance in multiple languages. Call 1-888-804-3536.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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The office was already closed, but the whole eye care team was there waiting for me. One of them pricked my eyeballs with a sharp instrument, allowing the ocular fluid that had built up to drain. That relieved the pressure and restored my vision.

But it was the fourth vision-impairing pressure spike in nine days, and they feared it would happen again — heading into a weekend. So off I went to the emergency room, where I spent the night hooked up to an intravenous tube that delivered a powerful anti-swelling agent.

Later, when I told this story to friends and colleagues, some of them didn’t understand the importance of eye pressure, or even what it was. “I didn’t know they could measure blood pressure in your eyes,” one of them told me.

Most people consider their vision to be vitally important, yet many lack an understanding of some of the most serious eye diseases. A 2016 study published in JAMA Ophthalmology, based on an online national poll, showed that nearly half of respondents feared losing their eyesight more than their memory, speech, hearing, or limbs. Yet many “were unaware of important eye diseases,” it found.

A study released in July, conducted by Wakefield Research for the nonprofit Prevent Blindness and Regeneron Pharmaceuticals, showed that one-quarter of adults deemed at risk for diseases of the retina, such as macular degeneration and diabetic retinopathy, had delayed seeking care for vision problems.

“There is significantly less of an emphasis placed on eye health than there is on general health,” says Rohit Varma, founding director of the Southern California Eye Institute at Hollywood Presbyterian Medical Center.

Because eye diseases can be painless and progress slowly, Varma says, “people get used to it, and as they age, they begin to feel, ‘Oh, this is a normal part of aging and it’s OK.’” If people felt severe pain, he says, they would go get care.

For many people, though, it’s not easy to get an eye exam or eye treatment. Millions are uninsured, others can’t afford their share of the cost, and many live in communities where eye doctors are scarce.

“Just because people know they need the care doesn’t necessarily mean they can afford it or that they have the access to it,” says Jeff Todd, CEO and president of Prevent Blindness.

Another challenge, reflecting the divide between eye care and general health care, is that medical insurance, except for children, often covers only eye care aimed at diagnosing or treating diseases. More health plans are covering routine eye exams these days, but that generally does not include the type of test used to determine eyeglass and contact lens prescriptions — or the cost of the lenses. You may need separate vision insurance for that. Ask your health plan what’s covered.

Since being diagnosed with glaucoma 15 years ago, I’ve had more pressure checks, eye exams, eyedrops, and laser surgeries than I can remember. I should know not to take my eyesight for granted. And yet, when my peepers were filling with that vision-threatening fog last March, I felt oddly sanguine.

It turned out that those serial pressure spikes were triggered by an adverse reaction to steroid-based eyedrops prescribed to me following cataract surgery. My ophthalmologist told me later that I had come “within hours” of losing my eyesight.

I hope my brush with blindness can help inspire people to be more conscious of their eyes.

Eyeglasses or contact lenses can make a huge difference in one’s quality of life by correcting refractive errors, which affect 150 million Americans. But don’t ignore the risk of far more serious eye conditions that can sneak up on you. They are often manageable if caught early enough.

Glaucoma, which affects about 3 million people in the U.S., attacks peripheral vision first and can cause irreversible damage to the optic nerve. It runs in families and is five times as prevalent among African Americans as in the general population.

Nearly 10 million in this country have diabetic retinopathy, a complication of diabetes in which blood vessels in the retina are damaged. And some 20 million people age 40 and up have macular degeneration, a disease of the retina associated with aging that diminishes central vision over time.

The formation of cataracts, which cause cloudiness in the eye’s natural lens, is very common as people age: Half of people 75 and older have them. Cataracts can cause blindness, but they are eminently treatable with surgery.

If you are over 40 and haven’t had a comprehensive eye exam in a while, or ever, put that on your to-do list. And get an exam at a younger age if you have diabetes, a family history of glaucoma, or if you are African American or part of another racial or ethnic group at high risk for certain eye diseases.

And don’t forget children. Multiple eye conditions can affect kids. Refractive errors, treatable with corrective lenses, can cause impairment later in life if they are not addressed early enough.

Healthful lifestyle choices also benefit your eyes. “Anything that helps your general health helps your vision,” says Andrew Iwach, a clinical spokesperson for the American Academy of Ophthalmology and executive director of the Glaucoma Center of San Francisco.

Minimize stress, get regular exercise, and eat a healthy diet. Also, quit smoking. It increases the risk of major eye diseases.

And consider adopting habits that protect your eyes from injury: Wear sunglasses when you go outside, take regular breaks from your computer screen and cellphone, and wear goggles when working around the house or playing sports.

The Prevent Blindness website offers information on virtually everything related to eye health, including insurance. Other good sources include the American Academy of Ophthalmology’s “EyeSmart” site and the National Eye Institute.

So read up and share what you’ve learned.

“When you get together for the holidays,” says Iwach, “if you aren’t sure what to talk about, talk about your eyes.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

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The 60-bed safety-net residential treatment center in Santa Fe Springs, run by Los Angeles Centers for Alcohol and Drug Abuse, has a dedicated detox room, on-site physicians and nurses, substance abuse counselors, licensed therapists, and other practitioners. It offers group counseling as well as individual and family therapy, and it endorses the use of medications for addiction treatment, such as buprenorphine and naltrexone, which are increasingly considered the gold standard.

Willard Sexton, a staff member and former Allen House patient, says the most important part of his job is speaking with each resident daily. Most of them, like him, came to treatment straight from jail or prison, and he knows as well as anybody how stressful it is to stop using.

“It’s similar to grief and loss,” says Sexton, 35. “The drug was their best friend for a long time.” Interacting with them, he says, helps him in his own ongoing recovery.

At a time when drug use is among the nation’s gravest public health crises, a visit to the Allen House offers key lessons: Addiction is a chronic illness requiring constant vigilance, there’s no one-and-done solution, and relapses are part of the journey to recovery. Peer mentoring is an invaluable element of drug counseling, since people who have plodded the difficult path from dependence to sobriety understand the mindset of patients on a visceral level.

And most importantly for those who feel despair in the grip of addiction, there is hope. “Recovery happens,” says Michelle Doty Cabrera, executive director of the County Behavioral Health Directors Association of California. “Every single day people come into treatment and succeed in addressing their substance use disorders.”

Drug-related overdoses kill almost as many Californians as lung cancer, more than diabetes, and two to three times as many as car accidents, according to a report by California Health Policy Strategies, a Sacramento consulting group. The report showed there were about 11 times as many fentanyl-related deaths in 2021 as in 2017, accounting for more than half of overdose fatalities. And addiction can ruin lives even if it doesn’t end them.

But proper care for substance use disorders can still be hard to find. Experts in the field say residential treatment beds are in short supply. A pandemic-driven shortage of health care workers has hit the drug treatment world. Unscrupulous operators, with an eye on their bottom lines, may take advantage of people desperate for any answer. Commercial insurers often deny treatment requests or propose cheaper alternatives.

Some treatment programs shun anti-addiction medications that have proven effective. Physicians, nurse practitioners, and other providers with the requisite training can prescribe these drugs in California, but too few seem willing or able to do so — though that could change now that federal law no longer requires them to get a special waiver.

A page on the website of the Substance Abuse and Mental Health Services Administration (www.samhsa.gov) allows you to find practitioners in your area who treat patients with buprenorphine.

There’s no one-size-fits-all solution for addiction. Treatment can differ depending on the substance — opioids, alcohol, or methamphetamine, for example. And people with substance use problems come from all walks of life: Some are straight off the streets or out of jail or may have serious mental or medical conditions that require additional care. Others may be otherwise healthy with good jobs and insurance. If a clinic tries to sell you on a standardized treatment program, cross the place off your list.

And if someone tells you that after one stint in their program you or a loved one will be drug-free for life, run the other way. For many people, addiction is a chronic condition that ebbs and flows over many years. Too often, patients in the throes of an overdose are revived and then discharged with no follow-up.

“If we talked about treating other chronic illnesses like diabetes or asthma in the same way we often approach treating substance use, people would think we were crazy or would sue the doctor for malpractice,” says Bradley Stein, a psychiatrist and senior physician policy researcher at the Rand Corp.

Finding the treatment that is right for you or a loved one will take legwork.

Whether it should be a residential or outpatient program depends on multiple factors. People who need to be shielded from exposure to a dealer or a toxic domestic situation, require detox, or have mental health or medical conditions on top of their drug use generally are better off in a residential setting, says Randolph Holmes, medical director of the Los Angeles Centers for Alcohol and Drug Abuse. Outpatient settings are more suitable for people with stable lives and better health or those transitioning from residential treatment, he says.

The cost of treatment can vary widely depending on duration and the patient’s circumstances. In some cases, it can reach tens or hundreds of thousands of dollars.

Various websites allow you to search for nearby addiction treatment. The Substance Abuse and Mental Health Services Administration has a treatment locator at www.findtreatment.gov, or you can call its help line at 800-662-HELP (4347). Shatterproof (www.shatterproof.org) is another source for finding treatment. In California, the Department of Health Care Services publishes a list of substance use help lines by county.

If you’re on Medi-Cal, California’s version of the federal Medicaid program for low-income residents, your county is a good place to start. It can point you to several options, at least in more populous areas. Almost all patients with the Los Angeles Centers for Alcohol and Drug Abuse, for example, are Medi-Cal enrollees.

If you have commercial insurance, call your health plan first. Parity laws require insurers to cover substance use treatment, though they often find reasons not to provide the treatment your provider recommends. If your plan denies you treatment you think you need, you can file an appeal. The Department of Managed Health Care (www.dmhc.ca.gov), the state’s primary health plan regulator, has a help line (888-466-2219) that can assist in appealing your case. Or you can do it online. If the department does not regulate your plan, it can steer you in the right direction.

And remember that recovery is a long-term commitment.

When Sexton first started using in his early 20s, his drug of choice was meth. He later started smoking it with heroin and fentanyl mixed in, he says.

Several years ago, Sexton spent 45 days in residential rehab and got clean. Then he started seeing a woman who was addicted to heroin. He thought he’d help her get sober but ended up doing drugs with her instead. He landed in jail for two months, and a judge ordered him back into residential drug treatment.

Sexton says he continues to actively pursue his recovery even as he helps others do the same. “There are bumps in the road, but I feel like I’m in a Range Rover,” he says. “I’m not going to spill my coffee.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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You will likely hear and see public messages over the coming weeks urging you to update your contact information. Heed them.

Then, sometime between now and next spring, you’ll probably receive mail from the agency that administers Medi-Cal in your county telling you if you are still eligible for the safety-net health insurance program or asking for more information about your employment status, income, and household size. An information request would likely come in a bright-yellow envelope containing a roughly 20-page form about six weeks before the start of your renewal month.

Be on the alert: Medi-Cal is warning about scammers who have been contacting enrollees and requesting a fee to help people renew coverage. Don’t fall for it. No payment is required to renew your coverage.

But be sure to open your mail and respond to any official request for personal information. And be aware that updating your information could push you off Medi-Cal if your income has risen or if you have access to other insurance.

If you need help with any of this, especially that daunting renewal form, keep reading.

Medi-Cal, the state’s version of the Medicaid health insurance program for low-income residents, has embarked on a 14-month effort to reexamine the eligibility of its nearly 15.8 million members. It is part of the massive “unwinding” being undertaken by all state Medicaid programs after three pandemic years during which their rolls swelled. States had agreed, in exchange for extra funding from the feds, not to boot anyone except in cases such as fraud, death, or a move out of state.

On April 1, Medicaid restarted the annual eligibility checks that had been the norm before the pandemic. It will be the biggest shake-up in U.S. health coverage since the Affordable Care Act, though it cuts the opposite way: Between 8 million and 24 million people will likely be bounced from Medicaid nationally, including an estimated 2 million to 3 million in California.

To minimize the number of enrollees dropped unnecessarily, California’s Department of Health Care Services, which runs Medi-Cal, has launched a $25 million advertising and outreach campaign that will send messages in 19 languages. The department is enlisting the assistance of nearly everyone who has contact with Medi-Cal enrollees: county offices, health plans, medical providers, advocacy groups, and volunteers. And it got $146 million in supplemental funding to help counties cope with the unprecedented number of renewal decisions.

But some patient advocates, health plan executives, and community clinic administrators worry it will not be enough to help all enrollees who could lose coverage if they can’t be reached or don’t respond — especially transient and homeless people and those with language or cultural barriers.

Less than two months before the start of the unwinding, multiple counties, including Fresno and Sacramento, reported staffing shortages and the need to train eligibility workers.

Laura Sheckler, deputy director of policy at the California Primary Care Association, which represents about 1,300 community clinics statewide, says the nearly $60 million in state funds earmarked for “navigators” to assist Medi-Cal enrollees is not enough for her group’s members to provide all the help that will be needed. The association has asked lawmakers for another $60 million.

Some Medi-Cal members already know where they stand. Anthony Kelley, a 53-year-old single dad, is one of them. Kelley, who lives with his 14-year-old son, Nicholas, in Pacifica, California, temporarily lost his job as a driver for a concrete company in the early days of the pandemic and signed up for Medi-Cal. He got his job back about a month later, along with access to employer-sponsored health coverage, but he has stayed on Medi-Cal for the past three years. His son has been on Medi-Cal since he was born.

When San Mateo County sent Kelley a renewal form, he called and was told his $58,000 annual income likely meant he and his son would lose Medi-Cal coverage. Now, he’s waiting for that to happen.

“It sucks for my son,” Kelley says, adding that he fears Nicholas could lose his doctors. “But we’ll deal with it.”

If you are anxious or uncertain about what you need to do, don’t fret. Help is available.

You can call or visit your local Medi-Cal office to update your personal information or ask for assistance. The Department of Health Care Services (www.dhcs.ca.gov) lists on its website all county Medi-Cal agencies, with addresses, phone numbers, and links. You can also call Medi-Cal’s help line (800-541-5555).

If you want to avoid potentially long lines or telephone hold times, consider signing up for an account at www.benefitscal.com or www.mybenefitscalwin.org. Doing so will allow you to update your personal and financial information online and find your renewal date.

Another great resource is the Health Consumer Alliance (888‑804‑3536 or www.healthconsumer.org), which can help you navigate the complexities of renewal, or contest a termination decision you think is unwarranted. Community clinics, which provide care for nearly one-third of Medi-Cal enrollees, often have navigators on-site who can help fill out forms and answer questions. L.A. Care, the largest Medi-Cal health plan, has 11 centers across Los Angeles County that will offer help to anyone who needs it, not just its members. Fresno County has 14 such centers. Check with your health plan for similar resources.

Under a state law, SB 260, if you are bumped off Medi-Cal but still have income low enough to qualify for an insurance subsidy through Covered California, the state’s insurance marketplace, you will be auto-enrolled in a plan the exchange deems to be the best value at the lowest cost. Once notified of the plan selection, you will have 30 days to accept it, choose another plan, or decline coverage altogether.

“This doesn’t need to be all doom and gloom for people who have Medi-Cal,” says David Kane, a senior attorney at the Western Center on Law & Poverty.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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The federal government recently fixed a controversial Treasury Department rule tied to the Affordable Care Act that denied assistance to many families whose workplace coverage busted their budgets.

Because of the so-called family glitch, if a worker had access to employee-only coverage deemed affordable under federal guidelines, a spouse or dependents could not get help to buy a health plan through Covered California, the state’s ACA insurance marketplace, even if it was not affordable to put them on the employer plan.

This affected an estimated 5.1 million people nationally, more than half of them children, since employers often contribute only to an employee’s premium, leaving workers to pay full fare for other family members.

Under a new rule that took effect Dec. 12, if the cost of having you and your family on a workplace plan exceeds an affordability threshold — set at 9.12% of household income for 2023 — your spouse and dependents could qualify for financial aid to purchase insurance through Covered California. Affordability will be determined by how much you would have to pay to have them — and you — on your employer’s cheapest health plan.

ACA insurance subsidies come in the form of federal tax credits that can be taken upfront or settled with the IRS when you file your taxes the following year.

Estimates from the UCLA Center for Health Policy Research and the UC Berkeley Labor Center show that 391,000 Californians previously excluded from subsidies in Covered California would be eligible for them under the new rule. Of those, an estimated 149,000 would likely enroll in a Covered California plan. Those switching from an employer-sponsored plan would save an average of $1,478 per person this year, according to the two centers.

“Fixing the family glitch is a critical step in really delivering on the promise of the ACA,” says Jessica Altman, executive director of Covered California. “If you don’t have affordable coverage from another source, the marketplace is where you should be able to come for affordable coverage.”

So, if you are paying too much to cover your family members on your employer’s health plan, it is definitely worth finding out whether you can get a tax credit to help pay their premiums on a Covered California plan. But finding the answer is complicated and will take considerable legwork.

If you have steady employment, last year’s income will probably be a good proxy for 2023, adding any pay raise you expect in the coming year. You’ll also need to calculate how much you would pay for your employer’s lowest-cost health plan — both for employee-only coverage and for family coverage. If the cost for you alone is under the 9.12% threshold, you will not qualify for a subsidized Covered California plan, even if your spouse and dependents do. That means a family could be split between two policies, with separate deductibles and different provider networks.

You also need to determine whether the lowest-cost plan offered by your employer meets the minimum coverage standard under the ACA. That means it must cover at least 60% of your total allowed medical expenses during the year and provide sufficient coverage for hospital and physician services. If it does not meet those requirements, you and your family might be able to get a subsidized plan through Covered California, depending on your income.

If two spouses have access to employer coverage, you’ll need to perform this exercise for both options.

Is your head spinning yet? You’re not alone.

“This stuff is just really complicated,” says Kevin Knauss, an insurance agent in Granite Bay. “And how can we possibly expect families that are doing all kinds of different things — kids, Christmas — to really focus on this stuff?”

But don’t ignore the new rule, because you could be leaving money on the table. Covered California has a worksheet to help calculate your eligibility for subsidies. Your human resources department might be willing to help you fill it out. Or you could seek professional help, whether an insurance agent or other certified enroller. You wouldn’t need to pay a penny for either.

To find an insurance agent or certified enroller, log on to Covered California’s website (www.coveredca.com) and click on the “Support” tab. Or call 800-300-1506. Covered California has a very useful FAQ all about the fix to the family glitch.

The enrollment period for 2023 coverage started on Nov. 1 and runs through Jan. 31. If you buy coverage this month, it will start on Feb. 1.

The family glitch fix isn’t the only new thing with Covered California. Starting this year, you can put a dependent parent or stepparent on your health plan, as long as they are not eligible for or enrolled in Medicare.

And, in case you missed it, Congress extended through 2025 the supplemental tax credits that increase aid to people who were already getting some before and are available to many middle-class households that did not previously qualify for financial assistance.

The idea behind the expanded financial help is to limit the amount people spend on health care premiums to no more than 8.5% of household income, no matter how much money they make.

Knauss said he talked to a man in Marin County who was seeking a Covered California health plan for his family of four and qualified for a monthly subsidy of $1,400, even though he makes $200,000 a year. Being over 60 and living in Northern California, an expensive region, pushed his family’s premium to a level that opened the door for significant financial assistance, Knauss said.

If you are already enrolled in Covered California, don’t simply renew coverage for this year. Prices and provider networks can change from year to year, and there might be a new, cheaper option in your region. So shop around.

And whether you are new or returning to Covered California, know what your medical needs are likely to be. If you have a condition that requires intensive services, you might consider paying a higher premium in exchange for lower deductibles and coinsurance when you seek care.

Happy hunting.

Jessica Altman is the daughter of Drew Altman, who is president and CEO of KFF. KHN is an editorially independent program of KFF.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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If you feel the way I do, the answer is neither. I cringe at the thought of my body burning up at well over 1,000 degrees Fahrenheit or being pumped full of toxic chemicals and spending the rest of eternity in a cramped box 6 feet underground.

So here’s another question: How do you feel about having your body reduced to compost and used to plant a tree, grow flowers, or repair depleted soil in a forest?

Human composting doesn’t mean you’re tossed into a bin with potato peels, crushed eggshells, and coffee grounds. Rather, you’d be placed in a metal or wooden vessel, enveloped by organic materials such as wood chips, alfalfa, and straw, and then slowly reduced to a nutrient-packed soil. The process can take six weeks to six months depending on the methods used.

I don’t know about you, but I like the sound of that (at least compared with those other two options).

“I never felt like I had an option that works for me until now,” says Assembly member Cristina Garcia (D-Bell Gardens). She authored a bill, signed last month by Gov. Gavin Newsom, to legalize human composting in California.

California becomes the fifth state to allow this method of body disposal, commonly known by the more scientific-sounding name “natural organic reduction.” Colorado, Oregon, Vermont, and Washington have legalized the practice, and legislation is pending in several other states.

The California law takes effect in 2027, allowing time for regulators to establish the rules that will govern human composting in the state.

But it’s never too early to start planning for your death.

Heather Andersen, a 68-year-old consultant and former hospice nurse in Seattle, says she has already chosen to be composted when she dies because it is much easier on the environment than burial or cremation.

“We’re actually enhancing the Earth rather than taking away from it,” she says. And there’s a spiritual dimension to her decision, she says, since she’ll be “going back to being part of the whole cycle of life.”

Andersen, who is in good health, purchased a prepaid composting plan from Recompose, a Seattle-based green funeral home whose founder, Katrina Spade, is widely viewed as a pioneer of natural organic reduction for humans.

One naturally reduced human body can yield anywhere from 250 to 1,000 pounds of soil depending on the method used and the type and volume of organic materials mixed with the body. That’s enough to fill several wheelbarrows or the bed of a pickup. Once the process is complete, many families take a small box of the soil and donate the rest to conservation projects or flower farms.

Of course, being composted after death is not for everybody. For example, the California Catholic Conference objects to the new law. The methods involved, it said in a statement, “reduce the human body to a disposable commodity, and we should instead seek options that uphold respect for both our natural world and the dignity of the deceased person.”

Those who have chosen to have their bodies composted are generally motivated by ecological concerns.

With natural organic reduction, ”what we are in fact doing is taking everything that continues to be alive in a human body after the human being leaves it and turning it into something that can actually nurture the planet,” says Holly Blue Hawkins, of Santa Cruz County, whose Last Respects Consulting offers death planning services.

After death, the human body retains numerous elements and minerals that are nourishing to plants, including carbon, calcium, magnesium, nitrogen, and phosphorus.

Traditional burials pose many problems. The formaldehyde in embalming fluid puts funeral workers at risk for problems such as an irregular heartbeat, a dangerous buildup of fluid in the lungs, and, over time, cancer. Moreover, the toxic substances in embalming fluid can leach into the soil.

Not to mention that there just isn’t enough land in cemeteries for everyone to have their own plot indefinitely into the future.

Cremation, on the other hand, emits numerous pollutants that are harmful to humans, as well as millions of tons of carbon dioxide every year. And the percentage of people choosing cremation is growing fast, primarily because it is cheaper than a burial. Cremation is projected to account for 59% of body disposals this year and 79% by 2040, according to the National Funeral Directors Association. With about 3 million Americans dying each year, that’s a lot of bodies burning up.

Human composting has emerged only recently as an alternative to burial and cremation.

Since Recompose opened in December 2020, the company has composted fewer than 200 bodies. “Obviously, that’s a tiny fraction of the people who die in Washington state,” Spade says. But 1,200 customers have prepaid for natural organic reduction, which she believes is a sign of its growing appeal.

Many funeral entrepreneurs view human composting as a significant business opportunity in a $20 billion industry.

“Our owners have been holding discussions about expanding across the country as more states legalize it,” says David Heckel, advance planning consultant at The Natural Funeral in Lafayette, Colorado.

Return Home, a green funeral home in Auburn, Washington, encourages website visitors to “join the #idratherbecompost movement” and fill out a form letter urging their state legislators to legalize human composting.

Dying isn’t cheap, and composting is no exception. The cost of natural organic reduction ranges from $3,000 to just under $8,000, depending on which company you choose. The companies typically offer on-site ceremonies for an extra charge. That compares with an average funeral cost of just under $7,000 for a cremation and just over $9,400 for a traditional burial with a casket and vault.

Recompose, Return Home, The Natural Funeral, and Earth Funeral, of Auburn, Washington, all say they plan to set up shop in California after the new law takes effect. But Californians who want to return to the Earth as compost don’t have to wait until 2027.

All those companies offer prepaid plans and will arrange transport to their facilities out of state, for an extra fee, if you or your loved one dies before they are up and running in California — or if you live in a state where natural organic reduction is not legal. They will typically mail you or your family a small box of the resulting compost.

Another option is Herland Forest, a nonprofit cemetery in rural Washington, which charges $3,000. It has no plans for expanding to California but accepts bodies from other states with an extra fee for transport.

Call around and compare prices and methods. See what kind of vibe you get.

If the idea of human composting leaves you cold, whether for religious, personal, or family reasons, don’t worry. No one is forcing you to nourish a tree. “I’m not taking anything away,” Garcia says. “I’m just expanding the options that we have.”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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