CV Family Struggles with Medi-Cal Changes

As California healthcare continues to recover from the COVID-19 era, the state's Medi-Cal program has begun to make some changes in the coming year, most notably the move towards a "Managed Health Care Plan." 

Now one Castro Valley family is hoping their story can shed light on the downsides of this Managed Health Care Plan and help bring positive change to state-assisted healthcare.

In Alameda, this new Managed Care Plan will run publicly in association with the Alameda Alliance for Health and will allow other care plans under Kaiser Permanente. Anthem Blue Cross will no longer be serving Alameda County under the new Medi-Cal plan.

These upcoming changes will most definitely affect a significant population of Californians. Medi-Cal serves more than 13 million citizens, with 17 percent of them being people with disabilities, according to the Medi-Cal Facts and Figures from 2021.

The changes to Medi-Cal are causing problems for people with specialized care needs. One of these people is Castro Valley resident Lori McNally, whose daughter Sara suffers from an extremely rare neurological condition called Moyamoya. 

Moyamoya disease is a disease in which certain arteries in the brain become constricted, with blood flow blocked by constriction and blood clots, drastically increasing the likelihood of strokes, paralysis, and seizures. It is most predominant in Asia but also disproportionately affects people with Down’s Syndrome, like Sara. 

Sara has been being seen by the same doctors at Stanford Medicine since her diagnosis in 2020. Stanford Medicine is the leading medical facility in their care with Moyamoya and is also one of the only facilities in Alameda County equipped to handle the rare disease.

The mandatory shift to a Managed Care Plan at Alameda Alliance for Health or Kaiser Permanente could be detrimental to someone like Sara.

Lori McNally works with the Special Olympics and thus has many connections to families with disabled loved ones. She said that she has seen “at least five other families that transferred, and their loved ones are getting sicker and sicker.” 

She applied for an exemption from the new managed care plan so Sara could continue getting the care she needs at Stanford Medical Center but was denied twice in the past two years.  

Another big change involves eliminating the asset limit for Medi-Cal enrollees as of January 1, 2024. This means that enrollees that used to have an asset limit of $2,000 per month for individuals and $3,000 per month for couples will no longer apply. 

This change will allow at least 18,000 more people to qualify for Medi-Cal and increase the economic security of the 1.4 million people enrolled in these programs statewide. 

McNally says it is frustrating to see these new changes to the state's healthcare assistance program—one created to help those in most need—will come at the cost of losing some important specialized care for certain citizens.

“I have done everything possible. No one is listening. I am not just fighting for my family. I am fighting for many others,” says McNally.