Who is covered and what could be cut? – Orange County Register

By Don Thompson | Kff Health News

Medi-Cal, California’s Complex, 174.6 billion dollars Medicaid Program, provides health insurance to nearly 15 million residents of low incomes and disabilities. The state is twice as many people as New York and more than three times more than Texas – the two states with the largest number of participants in Medicaid after California.

Registration is high because California goes beyond federal eligibility conditions, opening Medi-Cal to low-income residents. The state also offers a wide range of advantages, such as vision, dental care and maternity – some of which are largely paid by federal dollars but which also affects state expenditure.

But lately, Medi-Cal found herself in political reticlations.

Democrats say that the biggest threat to Medi-Cal is that $ 880 billion in GOP budget cuts are reduced to Washington, DC, which, according to health experts, would require eligibility restrictions, such as work requirements or program discounts to produce enough savings for a decade. The Republicans argue that Medicaid costs have increased due to fraud and abuse and that they criticize the State Democrats for having made the service available to immigrants, regardless of legal status.

In March, Governor’s administration Gavin Newsom borrowed $ 3.4 billion to cover an unexpected surpassing from Medi-Cal, and legislators affected additional $ 2.8 billion for the rest of the year. Although the Democratic Governor recognized a need for adjustments, he defended state efforts to covered more people. In 2022, California’s uninsured rate for residents under the age of 65 reached a record minimum of 6.2%, according to California Health Care Foundation.

While legislators debate the financing of the security program, here is what is at stake for the largest California health program.

Who is covered?

More than a third of Californians depend on Medi-Cal or the health insurance program for children closely linked to seeing a doctor, therapist or a dentist. They are counting on the program to obtain medication and access the treatment. This can also be a rescue buoy for families by allowing people with disabilities and the elderly to stay at home and provide coverage to their caregivers. He also finances nursing care for the elderly.

The overwhelming majority of registrants qualify because they earn 138% or less of the level of federal poverty: $ 21,597 per year for an individual person or $ 44,367 for a family of four. Although this is low for a state where the median income of households exceeds $ 96,000, it is much more generous than the family eligibility limit of Alabama, which represents 18% of the level of federal poverty, or Florida, at 26%.

Unlike Alabama or Florida, California extends the coverage to low -income adults without load. The state also covers more people who work, prisoners and other residents who would not qualify for the performance program if California legislators had not expanded the program beyond what the federal government needs.

According to state estimates, Medi-Cal covers approximately 7.3 million low-income families and 5 million additional adults, most of whom have no dependents. One million additional disabled people are counting on the program.

Medi-Cal also takes the tab for 1.4 million residents aged 65 and over for benefits not covered by Medicare, such as long-term care and dental, hearing and viewed care.

The majority of the beneficiaries of Medi-Cal Adults under 65 operate, according to a KFF examination of the data of the March 2024 census. In California, around 42% of unabled adults on the full-time work and 20% additional work part-time. Those who are not employed most often dealt with a family, school or patients.

According to state data, just over half of Medi-Cal’s recipients, around 16% white, 9% Asian or Pacific, and 7% black. This differs from the nation as a whole, where about 40% of people under the age of 65 who use Medicaid are white, 30% Hispanic, 19% black and 1% of natives.

Where does money come from?

The federal government pays around 60% of the Medi-Cal program. On the budget of almost $ 175 billion this exercise, Washington, DC, is expected to contribute $ 107.5 billion.

Additional $ 37.6 billion comes from the general state fund. The 29.5 billion end dollars come from other sources, including hospital costs, a tax on the organization of managed care, tobacco tax revenue and drug discounts.

California receives 50% of federal dollars corresponding for basic services, such as coverage for low -income pregnant children and women. But he obtained a correspondence of 90% for the 5 million Californians which he added to the rollers under the expansion of Medicaid authorized by the affordable care law.

Where is it going?

On average, Medi-Cal costs $ 8,000 per beneficiary, but costs vary considerably, according to a March analysis of the California legislative analyst’s office.

For example, people with disabilities represent 7% of registrants, but 19% of Medi-Cal spending, with an average annual cost of $ 21,626.

Meanwhile, the cost to cover the elderly reaches an average of $ 15,000. And higher registrations, to 1.4 million, have soared, increasing 40% since 2020, legislators have relaxed the rules for the number of assets that people 65 and over could have and are still eligible for the program.

California also spends a large part of the bill to cover around 1.6 million immigrants without legal status – around $ 8.4 billion out of $ 9.5 billion, said Guadalupe Manriquez, head of the budget for the Ministry of Finance program, at a recent audience of the assembly committee of the assembly.

What could be cut?

President Donald Trump in March said that he would not “touch Social Security, health insurance, Medicaid” but would focus on the release of “fraud of there”. However, health experts say Medicaid services would be emptied if the congress followed by massive discounts of expenses to pay to extend Trump’s tax cuts.

Congress Republicans have discussed the implementation of work requirements for unchanged adults, which could affect at least 1 million MEDICAID registrations in California, the greatest number of all states, according to an analysis of the urban institute.

Legislators could also reduce the expansion of Medicaid under the affordable care law, also known as Obamacare, which adopted in 2010 and allowed more people to qualify for Medicaid according to income. California, 39 other states, and Washington, DC, have chosen to adopt “the expansion of Medicaid”, in which the federal government pays 90% of the coverage of registrants.

Such a decision would cost billions of California every year if it had chosen to continue the coverage for around 5 million additional registrants which have acquired expansion coverage.