As healthcare policy changes affect coverage requirements across the country, Blue Shield of California and its Medi-Cal subsidiary, Blue Shield of California Promise Health Plan, are helping members understand their options and stay connected to the care and resources they need.
Recent federal and state changes are expected to affect eligibility, enrollment, affordability, and access to care for millions of Americans. While the impacts will vary, Blue Shield’s focus remains the same: helping members meet new eligibility requirements, maintain coverage whenever possible, and avoid interruptions in care.
"Periods of policy change can create uncertainty for members, providers, employers, and communities," said Ellen Sexton, executive vice president and chief growth officer at Blue Shield of California. "Our responsibility goes beyond responding to policy changes. We must help people successfully navigate the changes by making information easier to understand and providing the support they need."
Health plans across the country are preparing for increased administrative complexity and more frequent eligibility reviews. For Blue Shield and Blue Shield Promise, that work is already underway.
Meeting members where they are
Blue Shield Promise serves more than 500,000 Medi-Cal members in Los Angeles and San Diego counties and is actively helping members navigate upcoming eligibility and enrollment changes.
Approximately 185,000 members will need to complete twice-annual coverage redeterminations, while about 70,000 members will transition from Blue Shield Promise to state-administered Medi-Cal fee-for-service coverage because of eligibility changes. To help members prepare, Blue Shield Promise has launched extensive outreach and retention efforts to keep people informed and connected to care.
"Absolutely every member matters," said Kristen Cerf, president and CEO of Blue Shield Promise Health Plan. "When coverage requirements change, our focus is on using every avenue available – including personalized outreach, community partnerships, and one-on-one support – to help people understand their options and keep their coverage whenever possible, while maintaining access to the care they need."
These efforts include outreach through L.A. Care and Blue Shield Promise’s 14 Community Resource Centers throughout Los Angeles County, along with provider training sessions and community town halls. Blue Shield Promise is also using retention call centers and collaborating with local organizations serving Medi-Cal members throughout Los Angeles and San Diego counties. Coverage-related messaging has also been incorporated into member interactions, with resources developed to help eligible members navigate new requirements.
The work is already making a difference. In the first half of the year, Blue Shield Promise teams conducted outreach to every household affected by Medi-Cal coverage losses, helping more than 11,700 members regain coverage.
Building stronger community connections
Supporting members through change takes a coordinated effort across healthcare and the broader community. Blue Shield and Blue Shield Promise work with providers, health plans, and community organizations, as well as advocacy groups and local partners, to help members understand new requirements and retain coverage whenever possible. Together, they are working to keep members connected to care.
That support includes community information sessions and member events, along with provider engagement and other assistance delivered where members live and work.
“Strong community partnerships are essential, especially during times of change,” said Gary Culp, senior vice president of Government Markets at Blue Shield of California. “Meeting this moment requires health plans, providers, community organizations, and local leaders to work together in new ways. By aligning resources and expertise across sectors, we can build stronger support networks that help communities stay healthy and connected while building greater resilience.”
These collaborations also strengthen the broader healthcare system by supporting the providers and organizations that are often the first point of contact for members navigating complex healthcare changes.
Looking ahead
As the healthcare landscape continues to evolve, Blue Shield remains focused on improving access to care and affordability, while helping members achieve better health.
Through personalized member outreach and provider engagement, strengthened by community partnerships and advocacy, Blue Shield is committed to helping Californians navigate change with confidence.
More broadly, Blue Shield’s parent company Ascendiun has launched Worthy, focused on policy changes to make the U.S. healthcare system more affordable and transparent, as well as more digital and personalized – with a goal of making healthcare worthy of us all.
"Healthcare works best when people understand their coverage, can access the care they need, and trust that support is available when challenges arise,” Sexton said. “That's the role we intend to play as the policy environment continues to evolve.”
Learn more
Along with experts from ZS, chief growth officer Ellen Sexton recently co-authored How Regional Health Plans Should Respond to the One Big Beautiful Bill Act.
To learn more about Medi-Cal changes for Blue Shield Promise members, click here, or call Blue Shield Promise support teams at 866-820-6009 (enrollment) or 855-636-5251 (retention), Monday through Friday, from 8 a.m. to 6 p.m.