July 11, 2012
This report examines how the state finances county administration of these programs and explores the potential impacts of several changes underway and on the horizon, such as budget cuts, a new methodology for determining Medi-Cal administrative payments to counties, and the transition of children from Healthy Families to Medi-Cal. Several implications of the Affordable Care Act (ACA) are also discussed, including:
- Medicaid expansion and eligibility simplification. Medi-Cal enrollment could grow by 1.8 million or more people beginning in 2014. At the same time, the ACA requires simplification of the enrollment and redetermination processes.
- Role of California’s Health Benefit Exchange. Federal regulations will let California decide whether eligibility for most Medi-Cal applicants will be determined by the Exchange or Medi-Cal.
- Eligibility determination systems. Federal funding is available through 2015 to upgrade Medi-Cal eligibility determination systems to streamline eligibility across Medi-Cal and the Exchange.
- Adoption of a Basic Health Program. County workload may increase if the state elects to create a Basic Health Program for individuals with incomes up to 200% of the federal poverty level who do not qualify for Medi-Cal.
- Realignment of health care programs. The governor’s proposed budget discussed changing responsibilities for the funding and delivery of certain health care services in response to low-income, uninsured Californians moving out of county programs and into Medi-Cal or the Health Benefit Exchange.
Taken together, these programmatic changes will alter the landscape of funding for county administration of eligibility for public assistance benefits and provide an opportunity to rethink the role of counties.