Transferring Knowledge: Improving Medicaid Access for People Experiencing Homelessness

May 2025

Sometimes when you’re addressing one challenge, you uncover another. When we set out to help homeless service providers navigate Medi-Cal renewals (California’s Medicaid program) in the summer of 2023, we didn’t expect to uncover another systemic challenge faced by people experiencing homelessness: keeping Medi-Cal when moving across county lines.

When annual Medi-Cal renewals resumed after a three-year pause due to COVID-19, over 15 million Californians were required to renew their coverage. Our team recognized a critical need to support the state’s homeless service providers and their clients. Medi-Cal provides critical health care coverage and services to many people experiencing homelessness. Providers hadn’t supported Medi-Cal renewals in over three years, and members experiencing homelessness faced risks of losing coverage during the process.

With support from the California Health Care Foundation, our team released a toolkit with guidance for providers and conducted trainings and monthly office hours state-wide. As providers gained confidence with renewals and state policies improved through auto-renewal practices, office hour discussions extended to other pressing Medi-Cal topics. It turned out, renewals weren’t the only challenge to address.

One topic that came up repeatedly was Medi-Cal inter-county transfer. Because Medi-Cal is administered separately by 58 individual counties, members must initiate an inter-county transfer whenever they move to a new county. As people experiencing homelessness move between counties more frequently than others, delays or missteps in the transfer process can cause disruptions to vital health care access and housing supports. Office hours attendees shared stories about the administrative roadblocks their clients faced, and we saw a widespread lack of clarity around the who, what, where, and how of keeping Medi-Cal after a cross-county move.

Our team felt compelled to address this gap and our partners at the California Health Care Foundation were willing to flex with us to meet this new challenge. We partnered with the Western Center on Law & Poverty, who provided helpful legal insight on Medi-Cal rules and rights for members, to create Moving With Medi-Cal: A Guide to Inter-County Transfers. The Guide provides step-by-step instructions and a roadmap for initiating a transfer, selecting a new health plan, and accessing key contacts at critical points in the transfer process. Our team hosted two webinars on inter-county transfers, attended by nearly 360 participants across California. The broad participation from legal services staff, health care providers, and homeless service providers was testament to the need for accessible and accurate information on Medi-Cal processes.

Medi-Cal provides unprecedented support to people experiencing homelessness. For providers and their clients to truly leverage its benefits, it is crucial that information on complex Medi-Cal rules and processes is readily available and accessible. Our team remains committed to bridging these information gaps, one inter-county transfer at a time.

By Riley Meve and Julie Silas

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Riley Meve is a Policy Analyst at Homebase.

Julie Silas is a Senior Directing Attorney at Homebase.