2021-22 CA Budget Takes Major Steps to a More Universal & Equitable Health Care System

The State Legislature passed the final 2021-2022 health budget bill (AB 133) that includes historic investments in expanding and improving health coverage for millions of Californians. It now goes to Governor Newsom for his final signature in the coming days. Many of the proposals included in this budget bill were key priorities of the Care4All California coalition of over 70 consumer, community, labor, progressive, and health care organizations working to advance the goal of quality affordable health care for all Californians as soon as possible.

The coalition supported these investments which, working together, represent important steps to a more universal, equitable, and affordable health care system in California. These organizations pushed for key proposals to improve Medi-Cal and reduce health care disparities for low-income Californians and communities of color that made it into the final 2021-22 budget, including:

  • Expanding Medi-Cal, in a first-in-the-nation action, to cover 235,000 income-eligible undocumented immigrant adults age 50 and over.
  • Ending the assets limit for seniors and people with disabilities to access Medi-Cal, making CA the first state to fully end this antiquated rule that prevented 18,000 from enrolling in our state Medicaid program.
  • Improving Medi-Cal coverage for pregnancy and post-partum to reduce inequitable maternal mortality rates for black and indigenous women.
  • Creating culturally and linguistically appropriate Medi-Cal documents.
  • Continuing Cal-AIM reforms to improve and streamline the Medi-Cal program.

Together these investments will provide over 250,000 more Californians with health coverage through Medi-Cal and improve the program for the more than a third of Californians – and half of California’s children – who are enrolled in Medi-Cal.

In addition to these major Medi-Cal reforms, the coalition also worked to improve affordability for many Covered California enrollees that were included in the final budget:

  • Subsidizing state-only coverage by one dollar, allowing hundreds of thousands of low-income Californians to get true zero-premium plans.
  • Building a new Covered California affordability reserve, and directing Covered California to develop options for further reducing cost-sharing, such as for high deductibles and copays.

One major piece supported by the campaign that is still under negotiation is the creation of an Office of Health Care Affordability – an effort to tackle the rising cost of care with a more coordinated, holistic approach. First proposed by the Governor in his January budget, the Legislature agreed to create this new Office in order to collect and analyze information and identify trends in health care prices. This data would be used to set enforceable cost targets and includes accountability measures for those not meeting the goals. Negotiations with different stakeholders in the health industry are continuing.

More details in this factsheet from Health Access

Since 2017, the Care4All California campaign has worked on what can be done at the state level to build and improve upon the federal Affordable Care Act, without the need of federal interventions or an act of Congress. ​​​These wins this year join previous gains the coalition has helped make in California such as instituting first-in-the-nation state subsidies to help more low- and middle-income Californians afford coverage in Covered California, expanding Medi-Cal to young adults regardless of immigration status, implementing more tools to fight the skyrocketing cost of prescription drugs, and making our health system more accountable to ensuring equity and higher quality care.

Here is reaction on the budget bill’s passage from key leaders of the #Care4AllCA campaign including Health Access California, Western Center on Law & Poverty, California Immigrant Policy Center, California Pan-Ethnic Health Network, The Children’s Partnership, SEIU California, NextGen California, and the California Physicians Alliance:

This budget takes big steps toward a more universal and equitable health system, building on the progress California has made implementing and improving on the Affordable Care Act over the last decade. The removal of unfair exclusions in Medi-Cal, and making Covered California more affordable, will make it easier for hundreds of thousands of Californians to get on and stay on coverage. The pandemic reminded all of us of the urgency of health care and coverage for not just ourselves, but our fellow community members; this budget makes big strides toward a better health care system that we all rely on.