Medi-Cal and the Affordable Care Act

Welcome to CaliforniaPart of the Affordable Care Act includes the ability for states to choose to expand their Medicaid program. In California, the program is called Medi-Cal. There have been problems with this program in the past. Here is a brief summary of what California is planning to do in regards to the expansion.

In December of 2012, a U.S. Court of Appeals made a decision about a situation that had been going on since sometime in 2009. The state of California cut the reimbursement rate for doctors, hospitals, and other health care providers who treated patients who were covered by Medi-Cal.

The short version of this story is that the court ruled that the state was allowed to do that. Many felt that this would make it more difficult for people who are covered by Medi-Cal to find doctors who would agree to see them.

The Affordable Care Act includes a portion that allows states to choose to expand their Medicaid programs to cover more low-income people. If a state chooses to do so, the federal government will provide 100% of the funding for the first three years. After that, it will provide 90% of the funding.

The California Senate is considering legislation that would allow for expansion of Medi-Cal. The legislation is called SBX11, and it would expand Medi-Cal coverage for people who earn up to 138% of the poverty level, (or $15,415 a year). This would add over 1 million Californians to the Medi-Cal rolls.

SBX11 would also streamline the Medi-Cal enrollment process to help sign up people who are currently eligible but are not enrolled. This could add 240,000 to 510,000 people to Medi-Cal by 2019. Governor Jerry Brown has called a special session of the Legislature for the purpose of allowing the health care bills that he signs to take effect within 90 days rather than next year.

One thing to keep in mind, though, is that California has had some severe problems with its budget. This is the reason why Governor Jerry Brown is interested in caution when it comes to Medi-Cal. He feels that the long term costs of the expansion of Medi-Cal are unknown, and has concerns about the potential for it to cause big problems with California’s budget.

At the time I am writing this blog, it remains to be seen what will happen. Some questions still need to be answered. Will California end up expanding Medi-Cal? How will this affect the budget for the next few years? What happens if the state increases the number of people who are eligible for Medi-Cal coverage and doesn’t raise the reimbursement rate for the health care providers who treat the people?

Image by Ken Lund on Flickr