Navigators Are a Critical Component to Enrolling Individuals in Medi-Cal

February 4, 2022 |  By Heather Bates, MSW and Sarabeth Zemel, JD

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Over the years, California has generously expanded Medi-Cal to many populations so that it now serves as a lifeline for more than 13 million people or one-third the state’s population. Despite its size, there remains a percentage of eligible but unenrolled individuals, as well as those who cycle on and off Medi-Cal (also known as churn).

In 2019, the California Legislature passed a bill that created the Medi-Cal Health Enrollment Navigator Project and provided $59 million over three years to provide funding to counties and community-based organizations to enroll hard to reach potentially eligible Medi-Cal populations—those individuals and families living in unstable housing or rural areas and who lack transportation to travel to county eligibility offices; those who are reluctant to enroll due to immigrant status or have limited English proficiency; and those with behavioral health issues.Tablet user viewing an application form

The Center at the Sierra Health Foundation (The Center) worked with four community-based organizations (CBOs) in four rural Northern California counties to establish Navigator programs to help enroll those potentially eligible for Medi-Cal. Transform Health worked with The Center and the four CBOs to provide outreach and enrollment expertise and support as they stood up their navigator programs and began conducting outreach and enrolling individuals. The Center’s initiative ended in December 2021 and we assisted them in authoring a paper to share out lessons learned from the experience. The paper highlights several lessons for those interested in doing outreach and enrollment work, a critical checklist for developing navigation programming, as well as recommendations for improvement if the legislature or state continues the project beyond its current end date. These recommendations include:

  • Facilitate relationships and coordination between CBOs that employ trusted messengers and county eligibility offices.
  • Fund the project on a long-term basis and develop a stable workforce model.
  • Coordinate with Covered California.

You can read more about these recommendations and other lessons learned in the paper.

Contact Us

If you would like to learn more or work with Transform Health please contact Heather Bates at heather@transformhc.com.