The informational hearing delved into some of the Medi-Cal policy issues where the legislature and Brown Administration disagree.
The Administration has proposed limiting the benefits provided to some specific populations in what they call a “moderated approach” to protect themselves from unspecified fiscal “unknowns”. Specifically, the Administration has proposed that women who are eligible for pregnancy Medi-Cal are only covered for pregnancy care, and not other health care needs. (The Administration did acknowledge that federal regulations do not allow this restriction.) Additionally, the Administration proposes not covering Long Term Care. These restrictions are not included in the bill language and Senator Hernandez, the bill’s author expressed opposition to the Administration’s proposed amendments. There was also discussion of whether the state would provide additional benefits to the newly eligible population (optional benefits like dental care that were cut from the existing Medi-Cal program) because of the enhanced federal funding.
Enrollment and Re-determination
The Administration stated that they were committed to implementing all the simplifications that were required by the federal government, but also proposed some policies that contradict the goal of an efficient, streamlined, and consumer friendly enrollment and re-determination system. While the Administration agrees with the provisions of SBX1 1 that would use the federal hub to determine various eligibility criteria, they are proposing unprecedentedly rigorous paper verification of residency. The Affordable Care Act requires that states first use electronic verification and only require paper documentation as a backup measure.
Additionally, advocates agreed with legislators on the importance of expanding access to Medi-Cal to former foster youth up to age 26, so that they should be afforded the same opportunity to remain covered as young adults who have parents to depend on.
Shifting Medi-Cal Populations to the Exchange
The Administration is proposing shifting some formerly Medi-Cal eligible populations, such as legal immigrants who have been in the country less than 5 years, to the Exchange. Advocates testified against moving these very low-income Californians from no-cost Medi-Cal to cost-prohibitive private insurance from the Exchange.
Tie Back Language, Efforts to Halt Expansion
The Administration proposes amendments granting itself (the Director of DHCS) unreasonably broad authority to make fundamental changes to the Medi-Cal program in the case of any changes in federal policy. Senator Hernandez and advocates called this proposal “grossly overstepping” their authority. Senator Anderson articulated that the Republican caucus is very interested in tie-back language.
In his closing remarks, Senator Hernandez urged committee members to support the bill because this is an historic opportunity to expand coverage to the most vulnerable Californians. There is clearly a great deal of policy negotiation that must happen to move this legislation forward in the most robust way possible. Senator Anderson was the only Republican member of the Committee present today and while he voted no he suggested he may vote for it in the future. The bill passed 6-1, with Democratic members all voting to move it forward to Appropriations.