When the Governor released his budget last month, he did not propose cuts to the health care safety net, and he committed to prudently moving forward with the expansion of the Medi-Cal program. To that end, he proposed 2 options: a state-based option and a county-based option.
The Senate’s committee analysis lays out the following reasons that the county-based option is not viable:
1. Inefficient. California has 58 counties that would have to recreate a Medi-Cal system, including provider networks, administrative operations, and financial claiming mechanisms, all of which already exist at the state level.
2. Varied Implementation. As evidenced by the Low Income Health Program implemented on a county-by-bounty basis, county-based expansion will mean inconsistent implementation and unequal access to coverage.
3. Families Could Be Split Across Programs. This could create a situation where children are covered by the existing state Medi-Cal program while parents move (or churn) in and out of eligibility for the county-based program as circumstances change, creating disruptions in coverage.
4. Not All Counties Operate LIHPs. The Administration bases its proposal on the premise that counties could build off of what they are already doing with LIHP, but not all counties have started their LIHP, including counties with large uninsured populations like Fresno. This would create a potentially lengthy delay in access as those counties develop plans to serve the newly eligible.
5. Unclear if County-Based Option Would Get Federal Approval. The Administration itself acknowledges that the Federal Government may not approve this option.
In addition to this very clear position on the Medi-Cal expansion, the Senate analysis also expresses concerns about the exclusion of Long Term Care.