One of the key provisions of the Affordable Care Act (ACA) that will help more people get insured (2 million in California alone) is the expansion of Medi-Cal to cover individuals up to 133% of the Federal Poverty Level. This includes adults with no dependent children, which are currently left out of Medi-Cal, regardless of their poverty status.
The ACA implementation timeline doesn’t have this major coverage expansion go into effect until 2014. However, under California’s “Medicaid waiver,” the state won approval from the Federal Government to start expanding Medi-Cal early in order to phase in federal reforms taking effect in 2014. In particular, it allows counties to use the funds that they currently spend on indigent care, and get federal matching funds to provide Medicaid-type coverage.
Ten California counties (Alameda,Contra Costa, Kern, Los Angeles, Orange, San Diego, San Francisco, San Mateo, Santa Clara, andVentura) already sponsor these “coverage initiatives” as part of the previous “waiver.” The new waiver agreed to late in 2010 allows them to expand these pilot programs much more aggressive as we get closer to 2014.
The new waiver also allows more counties to take advantage of these federal funds under the ACA. Most of the existing counties, and 13 new counties, have received planning grants from Blue Shield Foundation to help map out these coverage expansions. Fresno, Merced, Monterey, Placer, Riverside, Sacramento, San Bernadino, San Joaquin, San Luis Obispo, Santa Barbara, Santa Cruz, Stanislaus, and Yolo at least took this step to see if they will proceed with an expansion of coverage to their residents.
Eligible entities (a county, a city and county, or a consortium of counties serving a region consisting of more than one county) must submit letters of intent to the Department of Health Care Services by today, and full proposals by February 14th. However, DHCS will be allowing applications on a rolling basis after these deadlines.
The state is calling this expansion program the Low Income Health Program or LIHP. These LIHPs expands a version of Medicaid to individuals between 19 and 64 years of age who have family incomes at or below 133 percent of the FPL (or less based on participating county standards), are not already enrolled in or eligible for Medicaid or CHIP, and who have otherwise been determined to be eligible for enrollment in the county program. Counties can also take advantage of additional funds to expand coverage up to 200% of the poverty level.
In these tight budget times, there will be no State General Fund dollars for the program. The LIHPs will use funds provided by counties or other county-based entities (again, money they currently spend on indigent care), matched by federal dollars.
We will provide additional updates once we know which counties will be participating in the expansion. Please contact Health Access if you would like support in advocating for expansion of Medi-Cal in the county that you live or work.