Dealing with Medi-Cal Expansion

A Totally New Paradigm in 2014

In 2014, Medi-Cal will be a very different from what it is today. Its eligibility and enrollment processes will be streamlined and designed to get people covered to stay covered. The Affordable Care Act (ACA) standardized eligibility rules for the entire nation, from zero to 400% of the federal poverty level (FPL) - the Medi-Cal program with eligibility up to 138% FPL and the Covered California extending eligibility from 138% to 400% of FPL. Medi-Cal is no longer a welfare program, but part of an overall system of near-universal coverage mandated by health care reform.

Medi-Cal Expansion Estimated at $5 Bil

The Affordable Care Act will add as many as 2 million more people to California's 7 million person Medi-Cal program. It's estimated that the cost of the expansion will be approximately $5 billion dollars over the next 10 years. California only pays a small share of the cost of those newly eligible for the program, but the cost of those people who were eligible before the law was passed must continue to be split evenly with the feds.

In California, there are already hundreds of thousands of people eligible for our state's Medi-Cal program, but not enrolled in it. There will be about 500,000 new enrollees in Medi-Cal who were eligible before the law was passed. This is a result, in part, of the law's streamlining eligibility criteria and processes. The law also provides funds for significant outreach, in particular through the actions of Covered California, that will be the portal to coverage.

Renegotiating the Medicare Waiver

An increase of $5 billion in state spending to expand access to the Medi-Cal does not necessarily mean having to raise taxes to balance the budget. An extremely important step was taken toward getting better value for the state's medical spending through the process of renegotiating the agreement, or "waiver," with the federal government that governs Medi-Cal payments to hospitals and for uninsured care.

California is already paying far too little for its Medi-Cal program. In particular, our provider reimbursement rates are among the lowest in the nation. This has helped contribute to a dynamic in which, according to the California Health Care Foundation, only 57% of physicians were accepting new Medi-Cal patients in 2008, and twenty percent of all practices were providing care to 80% of these patients.

Medi-Cal Provider Capacity a Question Mark

Guaranteeing that the Medi-Cal expansion results in meaningful access to quality health care therefore also means taking a close look at our provider capacity. Is the existing network of doctors, nurses and other health professionals who provide services to Medi-Cal enrollees adequate? Can we increase our capacity quickly enough to handle the significant Medi-Cal expansion without decreasing the quality of care to those current enrolled? How can we use our existing providers more efficiently to provide higher quality care? Are their innovative new models for care provision that will benefit not only Medi-Cal enrollees but all patients throughout the state?

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