State, Counties At Odds Over Safety-Net Funding Amid Medi-Cal Expansion

At a Wednesday hearing of the Assembly Budget Subcommittee on Health and Human Services, state and county officials continued to disagree on Gov. Jerry Brown's (D) proposed plan to expand Medi-Cal under the Affordable Care Act, the Sacramento Bee's "Capitol Alert" reports.

Medi-Cal is California's Medicaid program (Walters, "Capitol Alert," Sacramento Bee, 3/6).

Background

Under the ACA, the Medi-Cal expansion would affect individuals with incomes up to 138% of the federal poverty level, or $15,415 annually.

Brown's fiscal year 2013-2014 budget proposal earmarked $350 million to cover the increased enrollment.

The federal government will fund the expansion for the first few years, according to the ACA.

Brown has said that the state might try to cover subsequent costs by reducing the roughly $2 billion it provides counties each year to cover health care services for uninsured individuals.

County officials have expressed concern that such proposals to reduce their funding could have a negative effect on their safety-net health care facilities (California Healthline, 3/6).

Hearing Details

At the hearing, Mitchell Katz -- director of the Los Angeles County Department of Health Services -- suggested that the state is using the threat of more county oversight to persuade local officials to accept cuts in state payments for indigent care.

Katz said state indigent care funding already does not cover county costs for providing such treatment. He added that counties still will have significant indigent care costs following the Medi-Cal expansion for individuals who still will not qualify for coverage.

Meanwhile, Mac Taylor -- budget analyst for the state Legislature -- said that returning some indigent care funding to the state would be "reasonable" because it would "offset the state's costs for the (Medi-Cal) expansion or other state priorities."

Toby Douglas -- state director of health care services -- said that counties should relinquish some of their indigent care funds because the Medi-Cal expansion "has to be sustainable in the long haul" ("Capitol Alert," Sacramento Bee, 3/6).

For more information about the hearing, check out today's Capitol Desk.