County Funding on the Line Under Medi-Cal Expansion Strategies
California counties stand to lose significant state funding under strategies for expanding Medi-Cal that are included Gov. Jerry Brown's (D) fiscal year 2013-2014 budget proposal, Kaiser Health News' "Capsules" reports (Varney, "Capsules," Kaiser Health News, 1/11).
Medi-Cal is California's Medicaid program.
Details of Brown's Budget Proposal
On Thursday, Brown released a budget proposal that includes a plan to expand Medi-Cal under the Affordable Care Act.
- Brown's budget plan also would:
- Earmark $350 million to boost the Medi-Cal expansion; and
- Permanently extend a tax on Medi-Cal managed care plans (California Healthline, 1/11).
According to Brown, the state's 58 counties could administer their own programs to expand Medi-Cal coverage or give up some of the $3 billion to $4 billion that they receive annually from vehicle registration fees and the state sales tax in exchange for the state managing the expansion.
Under a third option presented by Brown, states could forgo providing health care in favor of paying for child care for low-income families.
Negotiations in coming months will determine how much revenue counties would have to give up if they do not manage their own initiatives to expand Medi-Cal.
According to "Capsules," counties that operate public hospitals likely will have a high stake in the negotiations. The facilities -- which already are facing payment cuts under the ACA -- often are the only source of health care for uninsured individuals.
Many of the two to four million "residual uninsured" residents expected in the state in 2014 will be undocumented immigrants who are prohibited from purchasing insurance through Covered California, the state health insurance exchange. Such residents likely will continue to rely on county-run public health facilities for care.
Anthony Wright -- executive director of Health Access -- said that if the state takes funding away from counties, it "run[s] the risk of losing public hospitals and clinics at exactly the moment we need all the capacity we can get."
Spending Negotiations Not Unexpected
Farrah McDaid Ting -- senior legislative analyst at the California State Association of Counties -- said that Brown's move to begin negotiations on county health care spending was not unexpected. Ting said, "We knew there was going to be a conversation this year about how counties spend money on health care."
However, she said that many counties in the state have made progress over the last few years enrolling low-income residents into county-run programs that function similar to Medi-Cal plans with the expectation that they will switch to Medi-Cal coverage in January 2014 ("Capsules," Kaiser Health News, 1/11).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.