SACRAMENTO – Health care advocates warn that time is running out on drawing down federal dollars to expand Medi-Cal, a move that would prevent nearly 1.4 million low-income Californians from remaining uninsured when health care reform is fully implemented Jan. 1, 2014.
“California must take aggressive action now to implement the Medi-Cal expansion program fully and urgently for our health system and our economy,” asserted Anthony Wright, executive director of Health Access California, the statewide health care consumer advocacy coalition, while speaking at a press conference organized by the coalition here at the State Capitol on Thursday.
“If we don’t put together an infrastructure, we will be leaving behind federal dollars in D.C., instead of bringing them into our economy,” he added.
Health care advocates and lawmakers noted that up until now, California has been at the forefront of implementing a number of provisions of the Affordable Care Act, also known as Obamacare. It was the first state, for example, to pass legislation to set up the online exchange where people can purchase affordable and federally subsidized health insurance coverage, starting in January.
But recent disagreements between Gov. Jerry Brown’s administration and Democratic lawmakers over the Medi-Cal expansion program have left California trailing behind other states in ACA implementation.
Last month, Democratic Senate Health Committee chair Dr. Ed Hernandez introduced a bill (SBX1-1) that would expand Medi-Cal -- the state’s name for the low-income health insurance program known as Medicaid in the rest of the nation -- eligibility to more than one million Californians and simplify the enrollment process.
A companion bill (ABX1-1) was introduced in the Assembly by Speaker John A. Perez.
Together, the bills would expand Medi-Cal coverage to include even childless adults, who under existing Medi-Cal rules are not eligible for enrollment. They would also remove the asset test for eligibility – under current rules, individuals with cash and savings above $2,000 ($3,000 for a couple) don’t qualify.
Both bills have sailed through their respective chambers, but have stalled because Gov. Brown and lawmakers are at odds over some of the benefits that should be included in the expansion.
For instance, Brown’s plan for the expansion would move certain groups now covered by Medi-Cal, including recent documented immigrants, to the health insurance exchange. Democrats want the groups to remain eligible for Medi-Cal coverage.
Brown has proposed funding the Medi-Cal expansion by reducing the roughly $2 billion that the state annually provides counties, to pay for treatment of uninsured individuals. Democrats point out that taking money away from counties is unnecessary since the federal government will fund the expansion for the first three years.
“The federal government will fully fund Medi-Cal coverage for newly eligible Californians for the first three years, and not below 90 percent into the future,” noted Hernandez at the press conference.
The Brown administration and lawmakers have also locked horns over which entity will administer Medi-Cal expansion. Brown wants it to be administered by the counties, but health care advocates say that dividing the federal dollars among 58 counties will not be easy, given how much they vary in size and wealth.
“After the first three years, the counties will have to pick up some of the costs and not every county will be able to afford it,” asserted Alameda County Supervisor Wilma Chan. She said that in her county, there are an estimated 200,000 uninsured, of which 42,000 will be eligible for Medi-Cal when it expands.
Wright pointed out that it has taken three years to get California counties to launch the Low-Income Health Program (LIHP), a “bridge” program run by counties and funded by the federal government that allows people to have some form of health coverage until Jan. 1, 2014. And even now, he said, five of the 58 counties have still not come on board.
How, he asked, could counties be expected to meet all their federal requirements for Medi-Cal expansion, in the next six months?
“Federal reimbursements for Medi-Cal expansion begins on January 1, 2014,” Assembly Health Committee Chair Dr. Richard Pan pointed out, adding: “There are a whole chain of events that have to happen by a certain date (before that). Every month that goes by, there are people who are going to be on the uninsured list.”
“As a physician caring for Medi-Cal and uninsured patients,” he went on, “I understand the difference Medi-Cal coverage makes (in) people’s health.”
This article by Viji Sundaram was originally posted in New America Media on April 19, 2013.
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