Read on Twitter
(1/) My Zócalo @ThePublicSquare column today is about the rapid growth of Medi-Cal (what we call Medicaid here) into the most important program in California, the closest thing we have to a safety net for all. https://www.zocalopublicsquare.org/2020/06/30/medi-cal-health-care-connecting-california-joe-mathews/ideas/connecting-california/
(2/) Medi-Cal deserves more attention now because its no-or-low-cost health services provide a vital backstop in this time of pandemic and free-falling employment, and because it holds possibilities that have yet to be realized...
(3/) Even as new state budget makes cuts, Medi-Cal expansion, supported by federal funds under the ACA, keeps growing, to more than $110 billion. This covers surging enrollment—gov’s office estimated 2 million people will join Medi-Cal this year after losing jobs or insurance.
(4/) 14.5 million Californians—more than 1/3 of us—will be on Medi-Cal by summer’s end, double the number in 2010. Roughly 1/2 of California children are on Medi-Cal. So are 2/3 of our nursing home residents. https://www.zocalopublicsquare.org/2020/06/30/medi-cal-health-care-connecting-california-joe-mathews/ideas/connecting-california/
(5/) Before Obamacare, Medicaid covered only certain categories of poor adults. But ACA funds states to open Medicaid eligibility to virtually all low-income adults under 138 percent of the poverty line No state embraced this Medicaid expansion more fiercely than California...
(6/) But Medi-Cal struggled to keep up with the needs of all the new enrollees. While millions now may be protected from financial ruin if they get sick because Medi-Cal is paying the bills, Medi-Cal does not guarantee high-quality healthcare...
(7/) The obstacles lie in the way care is disbursed. In California, 80 percent-plus of people on Medi-Cal are enrolled in managed care organizations, which aren't performing so well. @CHCFNews report found quality of their care declined or stayed flat on most measures 2009-2018
(8/) Medi-Cal mirrors state's complexity. Though Medi-Cal is federal and state program overseen, managed care plans are at the county level. Some counties have 1 publicly managed plan; others “2-plan” model w/ public & commercial option; SD and Sac have multiple commercial plans
(9/) So if you’re on Medi-Cal, your experience varies depending on your plan and where you live. You’re more likely to get the care you need in Yolo County, with one plan, than next door in Sacramento County, with confusing array of commercial plans.
(10/) Before pandemic, 2020 looked like year of Medi-Cal reform. Health advocates were pushing to require Medi-Cal managed care plans to show continuous improvement in health outcomes. Children’s advocates were working to make Medi-Cal better for kids, and...
(11/) governor was pursuing amitious proposals called CalAIM. They involved using Medi-Cal to help the most vulnerable Californians—particularly homeless—with their most difficult challenges, from mental health to housing. https://www.dhcs.ca.gov/provgovpart/Pages/CalAIM.aspx
(12/) Now, with COVID consuming everything, CalAIM is on hold. So is expanding Medi-Cal to cover undocumented seniors. In this pullback you see political reality: Medi-Cal, as part of a federal program, remains vulnerable to the national partisan struggle over healthcare.
(13/) Congressional Republicans still seek cuts in Medicaid; Trump remains committed to overturning Obamacare thru legal challenges, regulatory changes. And if Congress doesn’t produce more aid for California, it could force future cuts in payments to Medi-Cal providers.
(14/) Nevertheless, the program seems poised to grow because the need is so great. Payments to managed care plans should be tied access, quality of care, and patient outcomes. And California must train more and better healthcare workers if quality is going to improve...
(15/15) Medi-Cal is such a big part of CA healthcare that improvements to the program could benefit the whole system. And with way the world is going, you’ll need Medi-Cal before you know it. https://www.zocalopublicsquare.org/2020/06/30/medi-cal-health-care-connecting-california-joe-mathews/ideas/connecting-california/
