Managing Medi-Cal With Enrollment Up, Spending Down

A report from the National Center for Policy Analysis shows California at or near the extremes in two Medicaid categories:

• California has the second-highest percentage of Medicaid beneficiaries compared with the state’s population;
• California’s average Medicaid spending per enrollee is the lowest among the states.

The report — “The State of Health Care Spending,” released last month with detailed accounts of Medicare and Medicaid spending for all 50 states — arrives at a time of change and controversy for Medi-Cal, California’s Medicaid program.

Millions of newly insured Californians will join the Medi-Cal ranks next year as part of the Affordable Care Act.

The state Legislature authorized a 10% reduction in Medi-Cal reimbursements two years ago. The cuts are in limbo awaiting a ruling from federal court in response to a lawsuit challenging the reduction. A couple new bills — AB 900, by Assembly member Luis Alejo (D-Salinas), and SB 640, by Sen. Ricardo Lara (D-Long Beach), — aim to reduce the effect of Medi-Cal cuts.

Although the federal government initially will cover costs for many new Medi-Cal beneficiaries, the size and cost of the program are growing. Even if federal courts deny the state’s proposal to reduce reimbursement by 10%, pressure will be applied to reduce program spending.

With enrollment going up and already-low reimbursements going down, we asked legislators, state officials and consumer advocates how policymakers should steer California’s Medi-Cal course.

We got responses from: