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Ensuring Health Care Access through the Medi-Cal Renewal Relief Act: A Conversation with Mayra E. Alvarez

Huge numbers of children in California count on Medi-Cal for health coverage, including about half of those from ages 0-5. When kids are sick, they miss more school, and they miss out on learning. Even short drops in health coverage can mean missing critical screenings and assessments to ensure their healthy development.

However, right now, lots of eligible families are losing coverage for minor issues and bureaucratic challenges, something that AB 2201 is trying to address.

To learn more, we spoke with Mayra E. Alvarez, President of The Children’s Partnership, which is a co-sponsor for the bill authored by Assemblymember Tasha Boerner:

What problem is the Medi-Cal Renewal Relief Act trying to solve, and why has the renewal process become such a critical issue for families across California?

What our data has consistently shown us—and why we believe every policymaker in this state should be concerned—is that families are not losing Medi-Cal because they are ineligible. They are losing it because our systems were not built with them in mind.

California’s own Department of Health Care Services found that about half of the cases in which children lose Medi-Cal coverage are attributed to a catchall category called “failure to respond” and that failure is likely due to housing insecurity and administrative hurdles, such as not receiving renewal forms at a current address, long call wait times, and difficulty responding to additional documentation requirements. These are not failures of families. These are failures of the system.

The Medi-Cal Renewal Relief Act, or AB 2201, addresses the loss of coverage among eligible Californians due to paperwork and administrative barriers, not ineligibility. During the 2023 Medi-Cal Unwinding, CA implemented federal streamlining strategies (“unwinding flexibilities”) that significantly reduced procedural terminations and doubled the rate of automatic renewals. These strategies helped ensure more eligible Californians kept their Medi-Cal coverage without needing to submit additional paperwork.

The impact on children’s coverage was immediate and dramatic. Medi-Cal data shows that churning rates for children dropped from 7.5% in 2019 to just under 1% during the federal continuous coverage protection. This protected 340,000 California children and youth from coverage gaps. The rate of children with any gap in coverage fell from 11% to just 3%, amounting to over 400,000 fewer California children having any gap in coverage.

Prior to these strategies being in place, 92% of Medi-Cal disenrollments were due to procedural or “paperwork” reasons. This translated to many enrollees losing coverage through no fault of their own, even though they were likely still eligible. Children and youth accounted for roughly one-third of disenrollments. When these strategies were terminated in June 2025, the rate of successful automatic renewals was cut in half.

When H.R. 1 goes into effect in June 2027, it will increase Medi-Cal paperwork by adding work requirements and requiring renewals every six months, putting millions at risk of losing coverage and straining county systems. AB 2201 restores automatic verification tools to reduce paperwork, prevent unnecessary coverage losses, and ease county workload.

Reports show that many Californians lost Medi-Cal coverage not because they were ineligible, but because of paperwork and administrative barriers. What does this reveal about how public systems can unintentionally create obstacles for families?

The overwhelming majority of children losing coverage still qualify. We are removing kids from health care not because they don’t deserve it but because of a misspelled name, an address on file that’s out of date, or a phone call that no one ever answered.

Our research found that parents of color reported that they often have to work hard to keep their child enrolled in Medi-Cal, and sometimes even small clerical errors, such as the misspelling of a name, could require multiple calls to the program to protect a child’s coverage, many times with no solution provided. One parent shared that her son’s name included an apostrophe that the Medi-Cal data system could not process. It took nearly two years for that parent to get her child’s documents corrected, and all of that labor fell on her.

That is not an anomaly. That is a pattern. And our call wait time study confirmed it: the overall average hold time for Medi-Cal calls is 55 minutes, with 44% of calls yielding a hold time of one hour or longer, and one in five calls being disconnected entirely because call volume was too high. How is a working parent—imagine a mother or father who cannot leave their job for an hour navigating a bureaucratic phone system in a language that may not even be their own—supposed to maintain coverage for their children under those conditions?

One application assister, from our research, shared: “Sometimes it takes up to two, three hours to get through a phone call with the county…I’ll request a call back to the patient, but sometimes it’s hard for them to communicate with the county. Let’s say they only speak Spanish, and they don’t have a translator, and the county calls back, but they don’t speak the language. It’s hard for them to communicate.”

What this reveals is that our public systems can unintentionally become gatekeepers. When we design programs without centering the lived realities of the families we serve, we create obstacles that effectively function as barriers to care, even when no one intended them to.

During the pandemic, California implemented automatic and simplified renewal processes that helped more families maintain health coverage. What lessons did the state learn from that period, and how would this legislation build on those lessons?

The pandemic gave us an unintended natural experiment, and the results were unambiguous: when we removed administrative obstacles, more children stayed covered.

In response to COVID-19, Congress enacted the Families First Coronavirus Response Act, which required state Medicaid programs to keep all enrollees continuously enrolled for the duration of the public health emergency. This shielded over 15 million Californians, including 5.7 million children, from losing their health coverage.

What the pandemic taught us is something advocates have known for a long time: the problem was never the families. The problem was the process. When we streamlined renewal, when we stopped requiring families to repeatedly prove they still deserve care, coverage held, and children stayed enrolled. That stability is not just a coverage statistic. It translates directly into children getting the preventive care, screenings, and immunizations they need at the exact moments in development when those things matter most.

In 2022, California adopted a permanent policy of multi-year continuous coverage for young children from birth to age five, recognizing how important stable coverage is during this critical period of early childhood development. That is the right direction. Legislation that builds on this approach—extending continuous coverage protections, automating renewals, reducing documentation burdens—would lock in what the pandemic proved was possible and make it a permanent feature of how our system operates. Unfortunately, California has yet to take the next steps to make this child and family-centered shift a reality.

We cannot allow the progress of the last several years to be unwound because we returned to a status quo that was never working for families in the first place. This is why we are co-sponsoring AB 2201 and why we are working with advocates like Western Center on Law & Poverty, Health Access CA, Justice in Aging, Latino Coalition for a Healthier California, and the National Health Law Program to move forward a broader legislative package focused on strengthening Medi-Cal enrollment and renewal processes to keep families continuously covered.

This includes:

This legislative package protects Medi-Cal access, reduces red tape, and helps eligible Californians maintain the care they rely on. It upholds California’s leadership in expanding coverage and advancing a more equitable health system for California’s children and families.

How does continuous access to health care—especially for children—affect broader outcomes such as school attendance, early learning, family stability, and long-term well-being?

When we talk about children’s health coverage, we are really talking about the foundation for everything else. Education, family stability, long-term economic security—all of it is connected to whether a child can see a doctor when they need to, get a developmental screening on time, and receive care without their family having to fight the system to keep them enrolled.

Early childhood development is a critical time, with 90% of brain development occurring between birth and age five. National pediatric standards call for 15 well-child visits, multiple screenings and assessments, and a full schedule of immunizations in those first five years of life. A child who loses coverage—even for a short period—can miss those visits. And those gaps have consequences that extend far beyond that moment.

The health outcomes we see in our schools, in our early learning programs, in our juvenile justice and child welfare systems—they are downstream of this.

  • School attendance: When children have consistent health coverage, they are more likely to receive timely care for illness and chronic conditions, leading to fewer preventable absences and better school participation.
  • Early learning: Continuous access to preventive care, developmental screenings, and behavioral health services supports early identification of needs that directly affect readiness to learn.
  • Family stability: Reliable coverage reduces financial strain and stress on families, helping parents and caretakers avoid medical debt.
  • Long-term well-being: Ongoing access to care ensures continuity in treatment, vaccinations, and care management, improving long-term health and economic outcomes.

Stable coverage is a health equity strategy. It is an education strategy. It is a family stability strategy.

We know Medi-Cal is the major source of coverage for more than half of all children in California. This is precisely why The Children’s Partnership is proud to be part of the Medi-Cal 2030 Coalition—which is united by the idea that Medi-Cal is foundational to the future of California, and that getting it right requires a laser focus on the people whose lives are most impacted by its success. The principles the coalition has developed are a direct response to what our research has shown: that the program, despite its enormous scale, has not fully lived up to its promise.

The principles we’re advancing through Medi-Cal 2030 speak directly to what continuous coverage for children makes possible. For example, Principle 4 calls for comprehensive care from birth to death, including the full scope of Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services for children, recognizing that Medi-Cal must provide medically appropriate and comprehensive health care that meets people’s needs across their lifespan. And Principle 2 is clear that eligibility determinations and processes must be designed to make coverage easier to get and keep.

That is not abstract policy language. That is a commitment to the child whose name had an apostrophe the system couldn’t read; to the family that sat on hold for an hour only to be disconnected; to ensuring that Medi-Cal is governed by principles that put people first—not paperwork first—is how we make that stability permanent.

What would a truly family-centered public benefits system look like in California, and how close are we to achieving that vision?

A truly family-centered public benefits system would be built around family experience, not institutional convenience. It would have automatic renewals as the default, phone lines that actually answer, and community-based organizations embedded in the enrollment process as trusted messengers who know these families, speak their languages, and understand the real barriers they face. Most importantly, families themselves would have real decision-making power over how the system is designed and delivered.

How close are we? We’ve made genuine progress. California is moving in the right direction through expanded coverage, community health worker investments, doula and dyadic care, Enhanced Care Management, and more. But that progress is under real threat from changes to federal Medicaid, a hostile federal administration, and ongoing economic uncertainty. We cannot take any of it for granted.

That’s exactly why this moment calls for bold, coordinated action and why we’re so energized by the coalition work happening right now. Through the Medi-Cal Early Futures Project, The Children’s Partnership and the Bringing Up California network is working with Health Management Associates and the Center for Birth Justice to lead a statewide effort to gather input from families, providers, and system partners—through interviews, focus groups, and listening sessions—to generate equity-centered recommendations that improve access, coordination, and outcomes for children ages 0-3. Community voice isn’t an add-on to this work. It is the foundation.

Through Bringing Up California, alongside FIS and so many others, we have a vehicle to turn that community voice into political power, connecting families across the state around a shared vision for what California owes its youngest children. When families can see themselves in the policies being debated, when they are the ones demanding change, that’s when systems actually shift.

We are building toward the vision. And with the right investments, the right coalitions, and the continued will of leaders in this room, we are going to get there.