The COVID-19 pandemic triggered unprecedented growth in Medi-Cal enrollment, fueled by the federal continuous coverage requirement that prohibited disenrollments during the federal public health emergency. The end of the requirement in March 2023 marked the beginning of the “unwinding,” during which California resumed regular Medi-Cal redetermination processes.

During the unwinding, California processed 11 million redeterminations, the most of any state in the nation. Roughly two million people were disenrolled, and 66% of these disenrollments were due to procedural reasons (e.g., missing paperwork rather than a determination of ineligibility).

This report examines California’s approach to the unwinding, highlights key successes and challenges, and identifies opportunities to improve Medi-Cal renewals going forward. These lessons take on new urgency as Congress (at the time of publication) considers a reconciliation bill that could add even more administrative hurdles to Medicaid enrollment and renewals. Hundreds of thousands of eligible Medi-Cal enrollees (possibly more) would lose coverage because they have difficulty navigating an even more burdensome renewal process.

In the face of this federal threat, California must do what it can now to streamline and improve the process.

Successes:

• Adoption of federal flexibilities. California adopted over a dozen federal flexibilities to minimize inappropriate disenrollments, improve contact information accuracy, and streamline eligibility verifications.
• Increased ex parte renewals. California’s ex parte renewal rate more than doubled during the unwinding, rising from 31% to 63%, reducing administrative burdens and preventing unnecessary coverage losses.
• Robust outreach and communications. A statewide multimedia campaign, multilingual materials, and community-based partnerships helped inform members about renewal requirements.
• Data transparency. California provided detailed, disaggregated unwinding data through an interactive public dashboard, enabling stakeholders to track trends and target approaches.
• Stakeholder engagement. Regular collaboration between the state, counties, managed care plans, and community-based organizations improved coordination and messaging.

Notable challenges:

• Eligibility worker capacity and training. Counties faced workforce shortages and long call-center wait times, creating barriers for members attempting to renew coverage.
• Operational inefficiencies. Manual data entry and system issues, including the simultaneous implementation of a new statewide eligibility system, slowed processing and led to avoidable procedural disenrollments.
• Member confusion and outreach limitations. Some enrollees reported not receiving renewal notices, while others were overwhelmed by redundant or confusing outreach messages.
• Variability in county-level coordination. Collaboration between counties and community-based organizations was inconsistent, with some organizations struggling to obtain necessary case information to assist members with the renewal process.

Future opportunities:

• Extend or permanently adopt key federal flexibilities to maintain high ex parte renewal rates and reduce administrative burdens.
• Enhance training and capacity for eligibility workers through improved funding, technology adoption, and interactive learning opportunities.
• Streamline application and renewal processes with simpler forms, better data integration, and automation of eligibility verifications.
• Improve member outreach and accessibility by identifying enrollees’ preferred communication methods and collecting data on outreach effectiveness to better target messaging.

Explore a companion CHCF research paper, Lessons from the Medi-Cal Unwinding: Enrollee Experiences and How They Would Fix Renewals, for more recommendations on improving renewal processes, outreach and communication, and customer service.

The post Lessons from the Medi-Cal Unwinding: How California Protected Coverage and Policy Options to Improve Renewals appeared first on California Health Care Foundation.

During the COVID-19 public health emergency, a federal continuous coverage requirement prohibited states from disenrolling anyone from Medicaid. The end of the requirement in March 2023 marked the beginning of the “unwinding,” during which California resumed regular Medi-Cal redetermination processes.

During the unwinding, California processed nearly 11 million Medi-Cal renewals resulting in approximately two million people being disenrolled. Two-thirds of these disenrollments were for procedural issues (e.g. missing paperwork), not because the person was determined ineligible.

Between November 2023 and April 2024, the California Department of Health Care Services partnered with SSRS to conduct six monthly surveys to learn about the experiences of enrollees procedurally disenrolled. A number of survey respondents participated in a qualitative follow-up study to elicit further information about their perspectives, the impact of their disruption in coverage, and their suggestions for how the renewal process could be improved.

The principal findings:

• Although some Medi-Cal enrollees who were procedurally disenrolled expressed satisfaction with the renewal process, it was also very common for enrollees to be unaware of the need to renew their Medi-Cal coverage or how to do it, or to end up feeling confused, intimidated, or unsupported once they attempted to renew.
• Enrollees with chronic conditions and disabilities, those with limited English proficiency, and those who have highly fluctuating incomes shared uniquely difficult challenges during the renewal process, putting them at extra risk to lose coverage.
• Although many participants indicated that procedural disenrollment had little impact on them, as they were readily able to reenroll or obtain other coverage, some participants reported that procedural disenrollment had negative effects on access to care, their physical and emotional health, and in some cases, their financial well-being.

Participants’ suggestions for improving the renewal process to minimize procedural disenrollments in the future included the following:

• Improving communication about the process
• Simplifying the renewal packet
• Enhancing availability and quality of customer service
• Providing greater transparency about what happens after the renewal form is submitted

These lessons take on new urgency as Congress (at the time of publication) considers a reconciliation bill that could add even more administrative hurdles to Medicaid enrollment and renewals. Hundreds of thousands of eligible Medi-Cal enrollees (possibly more) would lose coverage because they have difficulty navigating an even more burdensome renewal process. In the face of this federal threat, California should heed the lessons of the unwinding and take action now to streamline the process and improve communication and customer service for enrollees.

This is a companion paper to Lessons from the Medi-Cal Unwinding: How California Protected Coverage and Policy Options to Improve Renewals, which explores other important lessons from the unwinding and recommendations.

The post Lessons from the Medi-Cal Unwinding:Enrollee Experiences and How They Would Fix Renewals appeared first on California Health Care Foundation.

Cynde Soto, a quadriplegic who requires around-the-clock care, has been on Medi-Cal for most of her life. Recently, she came into a modest inheritance, about $8,000, that has helped cover her daily expenses. But it also means that she would lose her state health insurance under a proposal from Gov. Gavin Newsom.

Newsom has proposed restoring a $2,000 limit on an individual’s assets — including savings accounts and property other than a home and a car — and $3,000 for couples to qualify for Medi-Cal. Anyone 65 and older or disabled who exceeds that limit would be ineligible. Newsom also is proposing a cap on how much home care Medi-Cal enrollees like Soto could receive.

In unveiling the proposal, Newsom said that California has a “spending problem” and needs to make “difficult choices” to address the state’s $12 billion deficit, which he attributed in part to growing Medi-Cal costs. His proposal would save the state $94 million this budget year and more than $500 million the next year, according to the governor’s budget document.

But health advocates say that it’s almost impossible for someone to live with just $2,000 in assets in California. Rent often exceeds that amount, and medical expenses not covered by insurance quickly add up.

Advocates say Newsom’s proposal unfairly targets people with disabilities and the elderly — those who are most likely to need full-time care and have fixed incomes.

“It’s draconian — $2,000 is no safety net for people,” said Kim Selfon, an attorney with Bet Tzedek, a legal services organization in Los Angeles.

For Soto, a Medi-Cal limit on assets would mean she would either lose the caretakers who help her bathe and eat or have to spend all of the money except for $2,000. With the inheritance, Soto said she can afford repairs to her Long Beach condo and buy medical supplies that Medi-Cal doesn’t cover, such as bandages or nutritional drinks to supplement her diet.

“It’s not cheap being disabled,” Soto said. “I’m really scared. I cannot live without my help.”

When Asset Limits Were Lifted, Medi-Cal Enrollment Surged

Some lawmakers and disability advocates have argued against the asset limit for years. They say it forces people into poverty and hasn’t kept up with rising inflation and cost of living. 

Newsom agreed to raise the limit to $130,000 per person in 2022. Then in 2024, the limit was erased completely. Now Newsom wants to bring back the original limit of $2,000, an amount that was set in 1989. 

This would reinstate complex rules about wealth and property that kept thousands of seniors and disabled people from qualifying for Medi-Cal. Under those rules, an individual’s first home and car are exempt, but other properties count toward the $2,000 limit. The balance of a 401k or retirement account are exempt, although payouts are considered income. Life insurance, cash on hand and savings accounts also count towards the limit. Even certain types of funeral plots count. 

The test would apply only to people 65 and older as well as those with disabilities, which creates a financial cliff for those about to turn 65. Medicare, which many seniors use for health insurance, does not cover long-term care and requires some co-pays, so many people use Medi-Cal to supplement their Medicare benefits.

In a recent Assembly hearing, Newsom administration officials said when the limit was eliminated, far more people enrolled in Medi-Cal than anticipated, contributing to the state’s growing costs. Between 112,000 to 115,000 people enrolled compared to early estimates of just 40,000, said health care services director Michelle Baass.

Seniors make up a small portion of all Medi-Cal enrollees, but they’re about twice as expensive as the average enrollee because they use more medical care. The elimination of the asset test last year contributed to most of the senior enrollment growth and cost the state about $500 million more than expected, according to a report by the nonpartisan Legislative Analyst’s Office. 

Still, lawmakers during the hearing questioned the prudence of kicking seniors and people with disabilities off of the program and whether it would actually save money in the long run. 

Assemblymember Pilar Schiavo, a Democrat from Santa Clarita, said these groups would need more expensive care like nursing home stays or homeless services if the asset test were reinstated.

“This is going to lead to more homelessness of seniors and the disabled. That’s what’s going to happen, and that will cost our state money too,” Schiavo said.

Making It ‘More Expensive to Age in California’

Al Sanderson, one of Selfon’s clients, says that’s exactly what would happen to him. The Redondo Beach resident broke his neck three years ago in a surfing accident that left him paralyzed.  

Sanderson said his monthly rent costs more than the asset limit. He has significant savings as a former high school physical education teacher and baseball coach that he uses to pay for utilities, transportation and things that his kids need now that he no longer works. 

If he got kicked off of Medi-Cal and lost his caretakers, Sanderson said he would lose his independence.

“How am I going to pay people to come help me? How am I supposed to survive and live? I’d have to go to a nursing home,” Sanderson said.

Without full-time home care, both Sanderson and Soto would most likely end up in nursing homes, a more expensive option that is covered by Medi-Cal. The state pays on average more than $114,000 per person each year for nursing home care, according to Justice in Aging, which pushed for the elimination of the asset test. In contrast, the average annual cost of in-home care is less than a quarter of that, $25,400 a year.

Kevin Prindiville, executive director of Justice in Aging, said Newsom’s proposal would “make it more expensive to age in California.”

California’s elimination of the asset test came under fire this month from congressional Republicans, who claimed that it allows the “wealthiest Californians” to get free health care. But lawyers with legal aid organizations that help people enroll in Medi-Cal say that’s not happening. 

Regardless of their assets, Medi-Cal enrollees still need to meet income limits, which are currently 138% of the federal poverty level, or about $1,800 per month, said Linda Nguy, a lobbyist with the Western Center on Law and Poverty. 

“Our clients are not millionaires,” Nguy said. “We’re talking about people with very low incomes who aren’t able to access the health care services that they need.”

Ronald Dallatorre, 58, enrolled in Medi-Cal just two months ago. He had been looking forward to getting caretakers to help him at his Compton home so that his wife could take a break. 

Dallatorre got sick with COVID-19 in April 2020. He spent four weeks on a ventilator and almost a year in a hospital. Now the former heavy duty mechanic has Guillan-Barré syndrome, an autoimmune disease that attacks the nervous system, causing muscle weakness and numbness.

Dallatorre uses a wheelchair and can’t move his hands. His wife quit her job with L.A. Unified School District to take care of him full-time. The Dallatorres also own a second home that a close family friend lives in, rent-free. Under the proposed budget, Dallatorre would be ineligible for Medi-Cal because of this property.

If he is kicked off Medi-Cal because of the asset test, Dallatorre said his medical costs would still be covered through his wife’s insurance, but they can’t afford caretakers. His wife would have to continue as his full-time support.

“I worked 40 years of my life never receiving help, always paying taxes. I was glad to do it because I thought maybe when I need it, somebody will be able to help me,” Dallatorre said. “I didn’t know how stupid the system is.”

This article was first published by CalMatters on May 29, 2025.

Authors & Contributors

Kristen Hwang, MJ, MPH

Reporter, CalMatters

Kristen Hwang reports on health care and policy for CalMatters. She is passionate about humanizing data-driven stories and examining the intersection of public health and social justice.

Prior to joining CalMatters, Kristen earned a master’s degree in journalism and a master’s degree in public health from UC Berkeley, where she researched water quality in the Central Valley. She previously worked as a beat reporter for The Desert Sun and a stringer for The New York Times California COVID-19 team.

https://calmatters.org/

The post ‘I’m Really Scared’: Elderly and Disabled Californians With More Than $2,000 Could Lose Medi-Cal appeared first on California Health Care Foundation.

When most people think of Medicaid, they think of health insurance — a public program for low-income families, older adults, children, and people with disabilities. But that’s only part of the story. Medicaid isn’t just about health coverage. Medicaid is one of the largest and most effective economic engines in the United States.

Each year, the federal government alongside states invest billions of dollars into Medicaid. That money doesn’t sit in government accounts — it moves through communities. It keeps hospitals open, supports hundreds of thousands of jobs, sustains rural health systems, and fuels a growing workforce of home care aides, behavioral health providers, and community-based service workers. For every dollar spent, Medicaid generates ripple effects far beyond health care. It helps the restaurant worker stay employed, enables older adults to remain in their communities, and gives entrepreneurs the security to open their small businesses.

Medicaid, the Economic Driver

Yet despite this, Medicaid is rarely discussed as an economic driver.

Too often, it’s treated as little more than a budget line — a cost to be managed or trimmed. But this view is dangerously short-sighted, especially now.

The country is at a crossroads. Pandemic-era coverage protections have ended, and more than 10 million people have already lost Medicaid as part of the so-called “unwinding” process. Meanwhile, states are grappling with strained safety-net systems, workforce shortages, and budget uncertainty. These challenges are real — but so are the opportunities.

Because Medicaid is about more than health insurance. It’s about jobs, stability, and economic growth.

Every time Medicaid pays for a doctor’s visit or funds a home health aide, that payment supports a job. That job supports a family. That family strengthens a local economy. And as Medicaid evolves — covering services like housing supports, nutrition, behavioral health, and social services — its economic impact only grows.

It also boosts workforce participation. When people have health coverage, they stay healthier, miss fewer days of work, and avoid financial ruin from medical bills. Medicaid gives working parents, caregivers, and people managing chronic conditions the stability they need to stay employed and contribute fully to their communities.

Reframing Our Understanding of Medicaid

The evidence is clear, especially in states that expanded Medicaid under the Affordable Care Act. Expansion has fueled job growth, strengthened hospitals, improved family financial stability, and helped prevent rural health systems from closing their doors.

I saw this firsthand in California, where I served as Undersecretary of the state Health and Human Services Agency. Medi-Cal, the state’s Medicaid program, covers more than 15 million people — roughly one in three Californians. Through initiatives like CalAIM, California has used Medicaid funding not just to treat illness but to tackle the root causes of poor health: housing instability, food insecurity, mental illness, and more. Along the way, the state has created new opportunities for employment and forged cross-sector partnerships that strengthen both community health and local economies.

This kind of innovation should be the norm — not the exception. But it requires reframing how we see Medicaid.

Proposed federal Medicaid cuts could lead to 217,000 lost jobs in California, $37 billion in reduced economic output in the state, and $1.7 billion in lost state and local tax revenue, according to the UC Berkeley Labor Center.

At the same time, two recent polls — one national by the Kaiser Family Foundation (KFF) and another focused on California by the California Health Care Foundation (CHCF) — show overwhelming bipartisan support for Medicaid. The KFF poll found that 82% of Americans want Medicaid funding to be either maintained or increased, while only 17% support cuts. In California, the numbers are even more striking: the CHCF poll found that 87% of Californians want Medi-Cal funding preserved or expanded, with just 13% favoring cuts. And for many, Medicaid is personal — more than half of Americans say they or a family member have benefited directly from the program. These numbers cut across political, geographic, and demographic lines, underscoring that Medicaid isn’t just popular — it’s essential.

Medicaid, the Strategic Asset

Policymakers in Washington, D.C., face hard fiscal choices. But weakening Medicaid would be counterproductive. It would hurt families, destabilize local economies, and undercut workforce participation at a time when employers are already struggling to hire and retain talent.

The question we should be asking isn’t whether we can afford Medicaid — it’s how we can make Medicaid work harder for our communities. How can we align it with other public and private investments to drive better health outcomes and greater economic resilience?

The answer starts by seeing Medicaid not as a budget burden, but as a strategic asset — a catalyst for growth, stability, and economic prosperity.

In a time of economic and social uncertainty, we have a choice: pull back or invest in smarter systems that deliver for people and strengthen the economy. Medicaid should be at the center of that strategy.

It’s time we start treating it that way.

This article first appeared in LinkedIn on April 13, 2025 and is reprinted here with permission. The author updated it with additional data before publication here.

Authors & Contributors

Marko Mijic

Former undersecretary, California Health & Human Services Agency

Marko Mijic is the former undersecretary of the California Health and Human Services Agency (CalHHS). He is currently a managing director at Sellers Dorsey and an Impact Fellow at the UC Berkeley School of Public Health.

At CalHHS, he managed 12 departments and five offices, overseeing more than 34,000 employees and an annual budget exceeding $260 billion. In this role, he focused on refining government operations, enhancing access to health and human services, and advancing an equitable recovery from the pandemic. He served under two governors and three CalHHS secretaries during his tenure.

Mijic’s leadership emphasized improved services for marginalized communities, including older adults and individuals with disabilities, grounded in a commitment to justice, equity, diversity, and inclusion. 

The post Medicaid Is One of America’s Strongest Economic Engines. Why Don’t We Treat It That Way? appeared first on California Health Care Foundation.

Stephanie Grier has reached an age when many people retire. Instead, the 65-year-old is trying to figure out how she might work two jobs if the health coverage she and her family rely on through Medi-Cal, California’s Medicaid program, were to be drastically cut. 

Grier lives in Colfax, a small, Gold Rush-era town about an hour northeast of Sacramento. She currently works one full-time job: caring for her 16-year-old grandson, Alexander Villano, who has severe intellectual disabilities.  

“He needs 24-hour supervision because he doesn’t understand what’s dangerous and what’s not dangerous, so he needs to be watched pretty much all the time,” Grier said. “He’s a sweetheart, but he’s 6 foot 1 and weighs [a lot]…He can on occasion get aggressive, and he’s not someone that’s easy to find care for.” 

A Medi-Cal benefit called In-Home Supportive Services (IHSS) allows Grier to stay home and care for Alexander. She also looks after his 18-year-old brother Michael, who has autism. All three are enrolled in Medi-Cal, which covers each of their individual medical care needs. In addition, Grier is one of the 1.7 million Californians who have both Medicare and Medi-Cal. Medi-Cal steps in to pay for Medicare premiums and out-of-pocket costs for seniors with low incomes like Grier. Without Medi-Cal, she would likely not be able to afford her Medicare coverage. Without all this support, Grier said she would face an impossible situation: needing to find another job to cover household bills and medical expenses while still having to care for Alexander. 

Fear of ‘Chaos’

“There would be chaos in the family,” she said.  

That critical support now is on shaky ground. Budget cutters in Congress seek to reduce federal Medicaid spending by up to $880 billion over the next decade, triggering fears about the future among nearly 15 million Californians enrolled in Medi-Cal. While it’s not clear yet exactly how the cuts would be allocated, Medi-Cal enrollees and health care providers are concerned the reductions will cause widespread hardships for Californians with low incomes or disabilities, seniors in long-term care, and the overstretched health care system. 

In Congressional District 3, a swath of eastern California that stretches 200 miles and spans 10 sparsely populated counties, about 1 in 4 people get health coverage through Medi-Cal. Medi-Cal spent a total of $2.25 billion on covered services and programs in the district in 2024. That spending supports over 10,000 people helped by the IHSS program, regional centers serving 7,000 people with developmental disabilities, and services for more than 1,500 foster youth. 

Medi-Cal providers and recipients fear major cuts will damage working families, seniors, people with disabilities, and children in the program; financially destabilize the 14 hospitals and other providers who serve those receiving Medi-Cal; and disrupt the broader economy and community that benefits from the infusion of state and federal money that ripples across local businesses, households, and city and county treasuries.    

“To cut back on Medicaid is self-destructive,” said Janice LeRoux, executive director of First 5 Placer, a community-based organization that works to improve systems serving families and young children in Placer County. “This is not a program that’s full of waste, fraud, and abuse. It’s one that’s really helping our neighbors, people who we see in the grocery store, people who take care of us.” 

To Grier, having Medi-Cal means that, when Alexander broke his leg in elementary school, he was able to get a full-body cast, wheelchair, x-rays, and other care he needed. The program also paid for him to get therapy for his autism and specialized dental procedures, she said. And when Grier’s grandsons get sick or need preventive care, Medi-Cal covers their doctor’s visits.

‘People Will Remain Sicker for Longer’

Medi-Cal is also vital for Michelle Padilla, 49, of nearby Rocklin, who has a genetic disorder called 22q11.2 deletion syndrome, also known as DiGeorge syndrome or velocardiofacial syndrome. Padilla is immunocompromised and has a heart condition. Even though she carries commercial insurance through a job, she relies on Medi-Cal to help cover out-of-pocket costs related to her frequent doctor’s visits and surgeries.  

Providers fear cuts to Medicaid would make it harder for people to get this kind of care. This could happen directly, if people are forced off Medi-Cal and left uninsured, or indirectly, if payments to Medi-Cal providers are reduced, which would make it harder for them to continue serving patients.  

Jonathan Porteus, PhD, is CEO of WellSpace Health, a nonprofit community health system and the largest Medicaid provider in Placer County. He said his clinics would continue to see patients if funding for Medi-Cal were to be cut or people were to lose coverage, but they wouldn’t be able to hire as many medical staff. That would leave people waiting longer for care and force more patients into emergency rooms, he said.  

“Essentially people will remain sicker for longer, and obviously we know that there’s a consequence,” he said. “You get sicker, you have chronic conditions develop, medications won’t be refilled or available…it’s a cascade.”   

It’s not the scenario Porteus envisioned only a few months ago. WellSpace Health has been expanding services and locations and is about to open a new health center in Roseville, in Placer County. It’s supposed to include a new ob/gyn residency program to help meet a desperate need for prenatal and delivery services in the region, and the first dental clinic in the area that accepts children with Medi-Cal, so families won’t have to drive to Sacramento. With possible funding cuts looming, that now hangs in the balance, he said.    

Meanwhile, Adam P. Dougherty, MD, MPH, chief of emergency medicine at Sutter Medical Center in Sacramento, is gearing up to see more patients in his emergency room who are driving in from rural areas east of the city because of untreated conditions or lack of Medi-Cal coverage. Already, it’s hard for many Medi-Cal patients in Congressional District 3 to get timely appointments with cardiologists, neurologists, and other specialists because the rural provider network is narrow and health care infrastructure expansion hasn’t kept pace with population growth, he said. If there are significant cuts to Medicaid, that will only get worse, he predicted. 

“Cuts could potentially bring us back to a time where we’re seeing uninsured populations in the 15% to 20% range, which is just totally unacceptable from not only a health care delivery point of view but from a taxpayer point of view,” Dougherty said. “Paying for somebody on Medi-Cal is pennies on the dollar” compared to paying to treat uninsured people for unmanaged conditions in the hospital. 

Any decrease in Medicaid funding is particularly threatening to the stability of hospitals in rural areas, whose patients tend to be people with low incomes. Hospitals are required by federal law to provide emergency care to everyone, regardless of a person’s ability to pay, so they would see higher costs if the number of uninsured people rises. 

At Eastern Plumas Health Care, a critical access hospital system serving Eastern Plumas and Sierra Counties, about one-third of patients are on Medi-Cal, and 30% are over 65 years old. Without that hospital, area patients would need to drive 50 miles to Reno, Nevada, or 150 miles to Sacramento to get care — which is especially difficult during winter months in the mountains.  

Technically, the Eastern Plumas hospital only breaks even on Medi-Cal patients because it receives supplemental Medicaid payments for rural hospitals, said CEO Doug McCoy. He’s worried those supplements could be drastically curtailed or ended altogether. That would require the hospital to cut services and halt medical technology upgrades, affecting all Eastern Plumas patients, not just those on Medi-Cal, he said. 

“Reductions to the Medi-Cal reimbursement would be significant, and we have forecasted that that would clearly put us operating in a negative, based on some of the proposed potential reductions,” he said. “We’d be in an operational deficit every month.”  

Medicaid cuts are expected to negatively impact the local economy as well. Medi-Cal currently accounts for $2.25 billion in spending in the vast Congressional District 3, according to the UC Berkeley Labor Center. Hospitals there rely on Medicaid for about one-quarter of their funding and in turn power the economy to the tune of 16,000 jobs supported by hospital spending, according to the California Hospital Association.  

Partnership HealthPlan, a Medi-Cal managed care organization that covers about 1 in 5 people in the district, contracts with 1,227 specialists (over-represented in Sacramento’s northeastern suburbs in western Placer County), 305 primary care providers, 325 ancillary providers, and 27 hospitals and long-term care facilities, according to data provided by Partnership.  

Hospitals at Risk

Sonja Bjork, CEO of Partnership HealthPlan, said the organization has invested significant resources into attracting providers to the region and retaining them through incentive programs. They’ve also built up a network of doulas to serve Medi-Cal patients expecting babies. She’s concerned that cuts would end these efforts and threaten the financial stability of hospitals and nursing facilities. She’s also worried it could lead to Medi-Cal enrollees not being able to find care because too few providers are available to serve them. 

“Medi-Cal is so important in these rural communities for so many reasons, for their economic well-being, for people getting the basic health care they need, for specialty care, and even emergency care,” she said. 

Back in Colfax, Grier has been weighing her options. So far, none of them is good. If she were to lose benefits for providing care to her grandson and had to find work outside the home, she could leave Alexander with his 18-year-old brother who has an attention deficit disorder, with an aunt who has schizophrenia, or in an institution. The last one would not only be devastating for Alexander and his family, it probably would be more expensive for taxpayers, she said. 

“I don’t think they’ll actually be saving money,” Grier said about implications of the proposed cuts. “It would just be like taking money out of one pocket and putting it into another.” 

Authors & Contributors

Claudia Boyd-Barrett

Independent journalist

Claudia Boyd-Barrett is a longtime journalist based in Southern California. She writes regularly about health and social inequities. Her stories have appeared in the Los Angeles Times, San Francisco Chronicle, San Diego Union-Tribune, and California Health Report, among others.

Boyd-Barrett is a two-time USC Annenberg Center for Health Journalism fellow and a former Inter American Press Association fellow.

See more

Andri Tambunan

Documentary photographer and videographer

Andri Tambunan is a Sacramento-based documentary photographer and videographer. He specializes in photojournalism and long-term narrative. His documentary work focuses on social justice, health, environmental conservation, and identity, and he has a passion for using visual narrative to inform, engage, and effect social change.

As a multimedia journalist and storyteller, Tambunan has experience as a producer, visual creator, editor/curator, and project manager. He is proficient with image-editing software, studio lighting, video and audio capture, and many genres of photography.

See more

The post From the Sierra Nevada to Death Valley, Rural Californians Fear Medi-Cal Cuts appeared first on California Health Care Foundation.

During the COVID-19 pandemic, states received increased Medicaid funding on the condition that they would postpone disenrollments as long as the federal COVID-19 public health emergency (PHE) remained in effect. This “continuous coverage” requirement allowed millions of Californians to stay on Medi-Cal during an unprecedented health crisis.

The federal Consolidated Appropriations Act of 2023 specified that the Medicaid continuous coverage requirement would no longer be linked to the PHE. The requirement ended on March 31, 2023.

Medi-Cal resumed its normal renewal processes on April 1, 2023. From that start date, it has 14 months to redetermine eligibility for around 15 million current enrollees. It’s estimated that during this “unwinding period,” two to three million Californians may leave the program. The vast majority will be eligible for other types of coverage but may need help transitioning. Many Californians who remain eligible for Medi-Cal are at risk of getting disenrolled from the program simply due to administrative or procedural barriers, such as Medi-Cal eligibility offices lacking enrollees’ current addresses after the last two tumultuous years.

This collection highlights recommendations and tools to help the state and key partners navigate the unwinding period while minimizing disruptions to Californians’ access to care and coverage.

In addition to the resources below, see Covered California’s Auto Enrollment Toolkit (available under “Medi-Cal Transition”). Soon after the federal continuous coverage requirement ends, Covered California will begin automatically notifying and completing plan selection for Californians who lose Medi-Cal coverage if they are eligible for a subsidized plan on Covered California. The toolkit provides more information for consumers and enrollment partners.

Featured Resources

Expert Perspective

State Works to Increase Access to Medi-Cal As Millions Seek Enrollment Renewal

From the front lines of eligibility redetermination, a California Department of Health Care Services official shares insights and recommendations.

January 4, 2024

Medi-Cal

Key Takeaways from Medi-Cal Redetermination Data

August 14, 2024

Medi-Cal

Efforts to Improve Medi-Cal Enrollment Process Are Paying Off

February 29, 2024

Health Insurance Coverage

How to Improve Medi-Cal Enrollment Renewals for Millions

December 6, 2023

Health Equity

DHCS: ​​​Keep Your Medi-Cal​

May 31, 2022

Expert Perspective

Medi-Cal Enrollees: Here’s How to Verify Your Eligibility

California’s safety-net health program has resumed annual eligibility checks after three years. That means enrollees will need to provide updated personal information to maintain coverage. Here’s what to watch for.

May 8, 2023

Medi-Cal

Health Consumer Alliance Keep Your Coverage Resource Page

April 5, 2025

Renew Your Medi-Cal Online with BenefitsCal

November 30, 2023

Thousands of Californians are losing Medi-Cal every month. What to do if you lose coverage.

September 25, 2023

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Tool

Medi-Cal Renewal for People Experiencing Homelessness: Toolkit

This toolkit equips service providers, people experiencing homelessness, health enrollment navigators, and communities with the resources to keep current Medi-Cal members covered. It is available in English and Spanish.

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​​​​​​​​​​​Medi-Cal ​​Continuous Coverage Unwinding Dashboard

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Expert Perspective

Medicaid’s Continuous Coverage Requirement Is Over. What’s Next for California?

Using best policies and practices, California has the opportunity to ensure that the Medi-Cal eligibility and enrollment system always prioritizes keeping people covered.

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Medi-Cal

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CMS: Unwinding and Returning to Regular Operations After COVID-19

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The post Medi-Cal and the End of the Federal Continuous Coverage Requirement appeared first on California Health Care Foundation.

A congressional proposal to cut $880 billion of federal funding to Medicaid, including California’s Medi-Cal program, is raising alarm bells among health care and social services providers in every corner of the state. Medi-Cal is a critical lifeline for nearly 15 million Californians, including those with severe disabilities and chronic conditions who rely on its coverage for essential medical and support services.  

In Orange County, families expressed fear and anger about the repercussions of large-scale Medi-Cal cuts, and health care leaders share their concerns. Medi-Cal covers more than one million Orange County residents, including 44% of the county’s children and teens. 

Seth R. Teigen, MHA, the CEO of Providence Mission Hospital in Mission Viejo, said public insurance programs finance essential care to the community. Cuts to reimbursement for Medi-Cal and other funding sources could “drastically impact the overall sustainability of the health care system” by reducing hospital revenue and increasing costs related to uncompensated care. “This would result in us having to evaluate which programs and services we can continue to make available in the community,” said Teigen. “Medi-Cal is an essential part of our financial health.”  

Eric H. Ball, MD, a pediatrician with Children’s Hospital of Orange County-Mission, predicts that if the cuts are adopted, the local economy will tank, medical bankruptcies will skyrocket, diseases once easily treated when caught early will likely become public health catastrophes, and the number of medical specialists able to maintain a practice will dwindle. “Taking away Medi-Cal, or even reducing benefits, would be devasting,” he said. “If there are no hospitals and no specialists to take care of our kids, our health care system just doesn’t work.” 

Ball said more than half of the patients in the Children’s Hospital of Orange County Primary Care Network are covered by Medi-Cal. “There was a time when my practice didn’t take Medi-Cal, and then in 2008 we saw lots of parents lose their jobs,” he said. Breadwinners who never thought they’d need a government safety net became Medi-Cal enrollees, including in areas of relative affluence, he said. “In our practice, we realized Medi-Cal can be an important bridge for families.”  

Ball said that in addition to harming children and people with disabilities, Medicaid cuts would decimate hospitals. In his area, Children’s Hospital of Orange County-Mission, Chapman Global Medical Center, Foothill Regional, and HealthBridge Children’s Hospital generate between nearly 30% and 90% of their net patient revenue by providing care to Medi-Cal enrollees, according to a CHCF analysis of the latest data submitted by hospitals to the California Department of Health Care Access and Information. What’s more, economic data indicate that Medicaid spending has a powerful effect on local economies. In addition to employing hospital and health care providers and staff, it fosters job growth in a variety of sectors and raises average annual household earnings. Income paid to health care workers and vendors stimulates spending, a portion of which is recycled through state revenues that then offset the state’s share of program costs, according to a 2021 Commonwealth Fund study. 

Worried Sick

Kim and Joseph Hüber of Lake Forest, California, say they are worried sick about what could happen to them and their 19-year-old daughter Leah, who was born with Down syndrome and later diagnosed with Lennox-Gastaut Syndrome, a rare and severe form of epilepsy characterized by cognitive and behavioral impairments in addition to seizures. Leah, who requires assistance to walk, talk, use the bathroom, and eat, is a Medi-Cal enrollee.   

“Taking care of Leah is like taking care of a newborn, only she weighs almost the same as I do,” said Kim. During the pandemic, Leah’s school went online and was no longer caring for her in person during the daytime. At the same time, the high school that Kim taught at moved to online instruction, and it was impossible for her to do that job and care for Leah at the same time. Kim retired early from her job as a high school math teacher and became Leah’s full-time caregiver.  

The Hübers are grateful that they have one another, that Joseph is employed as a high school science teacher, and that they have the support of colleagues and families. But without the services and supplies paid for by Medi-Cal, they can’t imagine how they would get through their days. Medi-Cal covers 100% of Leah’s routine doctor and specialist visits, surgeries, and hospital stays, as well as medical equipment, supplies, and medications. Kim estimates that without Medi-Cal her family would need to come up with at least $10,000 a month to meet Leah’s basic needs. In January, Leah was hospitalized with double pneumonia for five weeks, including three weeks in intensive care. That inpatient stay alone could have bankrupted the family.  

Kim is so unnerved that she has been waking in the middle of the night to read about the latest news and policy developments on her tablet. “Everybody is talking about possible Medicaid cuts,” she said. “We’re horrified. The fact that anyone could support cuts that would hurt a family in our position and someone like my daughter is unconscionable.” 

But she and her husband will stop at nothing to get their daughter the care she needs. “I think there are a lot of people out there who feel the same way,” said Kim. “They see that these cuts will negatively impact their loved ones. In fact, they’ll negatively affect everyone — except maybe the billionaires who are planning to move to Mars.”

Without Medi-Cal, ‘I Would Be Dead’

Anaheim resident Ruth Manzo, who works full-time for Community Action Partnership of Orange County, a community-based organization that helps connect people with housing and social services, agrees. Manzo supports her family of three — including her spouse with disabilities and her high school son.

For the past 17 years, the family has received health care only because of Medi-Cal. “Without Cal-Optima [the Medi-Cal plan for Orange County], I would be dead,” said Manzo, who has diabetes and bipolar disorder. Manzo maintains that regular doctor visits and access to medications and supplies like blood-sugar testing strips keep her healthy enough to work, provide for her family, and contribute to the community.   

Strong Public Support for Medi-Cal, Medicaid

As lawmakers consider changes to the Medicaid program, a recent national KFF Health Tracking Poll found that only 17% of Americans want a reduction in Medicaid spending. The vast majority of people either want Medicaid spending to stay about the same (40%) or increase (42%). Similarly, a recent CHCF survey found well over 80% of California adults believe Medi-Cal is important to the state, with two-thirds of Californians across party lines opposing Medi-Cal cuts. 

It is imperative for society to provide health care to our most vulnerable citizens, Providence Mission CEO Teigen said. “Medi-Cal is not a welfare program. It is an essential health program for moms, babies, veterans, seniors, and more. Many of our neighbors, our community members rely on Medicaid,” he said.  

Some experts say the public has grouped Medicaid with Social Security and Medicare as programs that should be protected from cuts by federal and state lawmakers. At a recent town hall in Tustin, a community near the Hübers’ home, a standing-room-only crowd of about 200 people voiced concern over potential Medicaid cuts.  

Disability Community Plans to Fight

Orange County resident Kim Doyle, whose 20-year-old daughter Trinity has a dual diagnosis of Down syndrome and autism, said her community is prepared to go to the mat. “People with disabilities and disability families are the invisible people,” she said. “But now we must be heard.”  It’s time to reprise the litmus test of former Vice President Hubert Humphrey, who in the 1970s observed that the ultimate moral test of any government is how it treats its children, elderly, and people with disabilities, Doyle said.  

Trinity is covered by her father’s health insurance and uses Medi-Cal only as secondary insurance. Nonetheless, the coverage it provides is crucial. The young woman has undergone 18 surgeries and countless other procedures, said Doyle. Without Medi-Cal, just one operation would have bankrupted the family.  

“Medi-Cal is a life-or-death issue for us,” she said.   

Authors & Contributors

Victoria Clayton

Victoria Clayton is a journalist and creative writer in Southern California. Her work has appeared in The Guardian US, The Atlantic, the Washington Post, Open Mind, and many other publications. She writes on a range of topics, including health, well-being, and family.

Clayton is a member of the American Society of Journalists and Authors.

Kyusung Gong

Kyusung Gong is an independent photojournalist based in Los Angeles and the Orange County area. He is a former staff photographer at the Orange County Register. He is working on an MFA degree in photography at the Academy of Art University and is a journalism lecturer at Cal State Long Beach.

The post Worried Orange County Families, Health Leaders Speak Out About Protecting Medi-Cal appeared first on California Health Care Foundation.

Evanne Levin of Rancho Mirage has been struggling with a difficult question lately: What will she do if her 101-year-old mother loses her Medi-Cal coverage? 

Medi-Cal, California’s Medicaid program, allows Levin’s mother Rose to receive daily in-home caregiving through the In-Home Supportive Services (IHSS) program. That makes it possible for her to live at home despite mobility and memory challenges. Without that support, Levin, 75, who has her own health and financial difficulties, isn’t sure how she would cope. 

“I wish I had a good answer, an easy answer,” said Levin, who lives near her mother and helps care for her outside of the four hours a day covered by IHSS. “I cannot be there for her all the time. We would have to look at a facility that accepts Medi-Cal as payment, and if Medi-Cal was going to be cut back, it’s going to impact the facilities as well.” 

Across California, Medi-Cal enrollees and their loved ones have been wrestling with similar questions since the US House of Representatives adopted a federal budget resolution that sets the stage for significant cuts to Medicaid.  

Levin lives in the congressional district that stretches across Riverside County and includes the cities of Corona, Lake Elsinore, Menifee, Palm Springs, Palm Desert, Indian Wells, and portions of Eastvale and Riverside. Over 256,000 people — about 34% of the district’s population — are covered by Medi-Cal. 

The prospect of Medi-Cal cuts has alarmed patients, health care providers, advocates, and caregivers across the region. They fear the budget cuts will harm the working families, seniors, people with disabilities, and children who rely on the program; the providers and institutions that provide services to them; and the broader economy and community. An estimated $11.57 billion in Medi-Cal funding flowed into Riverside County in 2024, according to the UC Berkeley Labor Center. Almost $3 billion of it was to cover the cost of caring for enrollees in the district. That money does more than support providers, clinics, and hospitals; it makes its way to local businesses, households, and city and county tax revenues too.  

Struggling Rural Facilities

Jarrod McNaughton is CEO of the Inland Empire Health Plan, a Medi-Cal managed care plan that covers 1.5 million of the approximately 2 million Inland Empire residents enrolled in Medi-Cal. The plan employs 4,000 people, including case managers and community health workers, and contracts with around 9,000 health care providers, hundreds of clinics, and every hospital in San Bernardino and Riverside Counties.   

Big reductions in Medi-Cal spending would devastate patients, providers, and the local economy, McNaughton said. He’s especially worried about reduced Medi-Cal support for struggling rural facilities, which could be forced to make massive service cuts, or even close, he said. On average, Medi-Cal accounts for almost 20% of net patient revenue going to hospitals in the congressional district. At certain hospitals, it accounts for more than half.  

Other knock-on effects of Medicaid cuts could be that more people with chronic conditions flood hospital emergency departments because they can’t access preventive care, and fewer providers cover Medi-Cal patients because of lower reimbursement rates, McNaughton said. 

“You will see catastrophic patient outcomes from these kinds of cuts,” McNaughton said. “You’re going to see a strain on the system for everybody, regardless of whether you’re commercially covered, whether you’re covered by a government program like Medicare or any other program, because now you’re going to have an influx of patients into hospitals that are already going to be stretched so thin.” 

Community Clinics Brace for Significant Disruptions

Community clinics would be hurt too, said Andy Piskoulian, CEO of Centro Medico Community Clinic, a nonprofit community health center with five clinics in the Inland Empire, including ones in Corona and Riverside. The organization provides health care to approximately 15,000 patients in the congressional district, almost all of whom have Medi-Cal.  

If cuts happen, ancillary services such as dental, vision, and podiatry care could be the first to go, Piskoulian said. Patients could end up waiting months for medical appointments as staffing is reduced, he added. The clinic may also have to slash such programs as free transportation for seniors and acupuncture services that have helped reduce some patients’ needs for addictive pain medications. 

Piskoulian said he’s especially frustrated at the prospect of Medi-Cal cuts rolling back progress the center has made in reaching and helping more patients. In the past three years, Centro Medico opened a clinic at a homeless shelter in Corona that expedites the medical tests people need to get off the streets, opened a clinic in a remote desert community where people previously had to drive 30 miles to see a doctor, and began coordinating medical and social services for 800 high-needs patients under CalAIM. The organization also plans to open a resource center in Corona that will provide health classes, social services connections, after-school tutoring, job search help, and other services for area residents. 

“We’re like, oh my god, where are we going?” Piskoulian said. “Hopefully this beautiful model that I think would do an amazing service to the community doesn’t fall because of what’s about to happen.”  

Polling Finds Widespread Anxiety

Fear over potential Medicaid funding reductions is widespread: a recent poll by NORC at the University of Chicago found two-thirds of Californians are worried that enrollees will not be able to access the same level of benefits in the future. That same poll found broad support for Medi-Cal among Californians across party lines, with 8 out of 10 Democrats and nearly two-thirds of Republicans wanting the program to stay the same as it is today or receive additional funding.  

One of those expressing anxiety is Amie Cullop of Meniffee, a retired US Army sergeant who completed two tours of duty in Iraq and now fears that Medi-Cal cuts could make it harder to care for her son Miles. The six-year-old was born with a neuromuscular disease that affects his breathing, mobility, and endurance.  

Although Cullop has health insurance through the military, it doesn’t cover all of Miles’ therapies and out-of-pocket medical costs. Medi-Cal paid for the early intervention therapy that taught Miles to sit, eat, walk, and hold a pencil. It now covers occupational, physical, and speech therapies as well as adaptive equipment that allows him to do schoolwork, play the piano, and dream of becoming a pediatric pulmonologist.  

“I credit the services he has received to where he is,” Cullop said. “I don’t want to see other families struggling, other kids struggling, especially when I know the good these programs and the funding Medicaid provides can do.”  

Barriers to Mental Health Care

Linda Hart, founder and executive director of the African American Health Coalition, worries Medicaid cuts could make it even harder for people with mental health conditions to get treatment. Her organization works in Black communities across San Bernardino and Riverside Counties to provide mental health education and referrals.  

Hart’s adult son relies on Medi-Cal to pay for medications to control his schizophrenia and for services that enable him to access to stable housing. Without that support, Hart worries he and others with severe mental illness could become a risk to themselves or others and could put pressure on first responders.   

“It’s not just cutting someone off of Medi-Cal, it’s what are the ramifications of when that happens?” Hart said. “You may be thinking about saving money, but you’re going to lose lives.” 

At the Inland Caregiver Resource Center in Colton, staff are fielding constant questions from anxious seniors and their caregivers about what potential cuts to Medi-Cal could mean for them, Executive Director Carmen Estrada said. The center, which supports older adults and their family caregivers with counseling, respite, and housekeeping services, works with many people who receive In-Home Supportive Services.  

“A lot of the people we see, they’re just making it. Any cut could keep them from staying in the home where they want to be and [lead to them] being homeless or even institutionalized,” Estrada said. “It is definitely a scary time.” 

‘Personal and Emotional’

Scared is how Kristine, 68, of Desert Hot Springs feels. Since her husband died in 2018, she has relied on IHSS-paid home health aides to help her with daily tasks such as using the bathroom, preparing food, and going to doctors’ appointments. Kristine, who asked that her last name be withheld because she feels vulnerable, has a type of inflammatory arthritis that left her partially paralyzed and functionally blind.  

“I would literally be institutionalized [without IHSS] because I can’t care for myself and my care providers cannot work for free, and I have no family,” she said. “I don’t have someone that can step in that’s not paid to help me. It’s so personal and so emotional that I have a hard time languaging it.” 

Back in Rancho Mirage, Evanne Levin said she’s been closely monitoring the news about Medicaid funding coming out of Washington in between the hours she spends every day overseeing her mother’s care.  

“I think about all the people who don’t have a me to help them,” she said. “Our elders and those with disabilities should be treated with greater respect … I’m speaking for my mom and me, but I’m also speaking on behalf of all of those that don’t have their own voices.”  

Authors & Contributors

Claudia Boyd-Barrett

Claudia Boyd-Barrett is a longtime journalist based in Southern California. She writes regularly about health and social inequities. Her stories have appeared in the Los Angeles Times, San Francisco Chronicle, San Diego Union-Tribune, and California Health Report, among others.

Boyd-Barrett is a two-time USC Annenberg Center for Health Journalism fellow and a former Inter American Press Association fellow.

John Valenzuela

John Valenzuela, a seasoned freelance photographer and former staff photographer for Southern California News Group, captures stories through his lens.

The post In Riverside County, Potential Medi-Cal Cuts Distress Constituents, Health Leaders appeared first on California Health Care Foundation.

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Midwives are specialized maternity care clinicians who support birthing people’s reproductive health through pregnancy, childbirth, and postpartum care. Midwives, ob/gyns, and family physicians are trained to deliver babies in California. An element of successful midwifery care is appropriate consultation with ob/gyns and transfer to physician care if the need arises. Although midwives are the primary maternity care providers in many industrialized nations — which have significantly better maternal health outcomes than the US — they are an often-overlooked workforce in this country.

Access to Midwives Is Critical to High-Quality Maternity Care

In California and nationwide, a worsening ob/gyn shortage paired with hospital labor and delivery unit closures have generated interest among advocates and some policymakers, who are pushing to expand the number and scope of practice of midwives.

• California credentials two types of midwives: nurse-midwives and licensed midwives.
• In 2021, there were 420,000 births in California, with 86% of those delivered by physicians and 13% delivered by midwives. With California’s demand for ob/gyns projected to exceed supply by 1,160 full-time equivalents by 2030, midwives could help address the workforce shortage and other maternity care access issues that loom large.
• Midwifery care is recognized by many health policy experts as an important model for improving maternity care outcomes and addressing racism-based disparities in maternal health care, especially when provided by culturally and racially concordant providers.
• Robust research demonstrates that midwifery care results in positive health outcomes. These include lower rates of cesarean sections and fewer interventions during birth, as well as higher rates of spontaneous vaginal birth and higher patient experience scores.
• In a survey of California mothers, a majority said they would want or consider a midwife for a future pregnancy.

Aspiring Midwives in California Face Shrinking Training Options

• Certified nurse-midwives: The state has 1,200 certified nurse-midwives — nurses with graduate training from approved nurse-midwifery programs who provide care mostly in hospitals. California has only two education programs for nurse-midwifery, and one is not currently admitting students.
• Licensed midwives: California’s 500 licensed midwives are providers trained in approved three-year programs who mainly practice in birth centers and homes. The state currently has no accredited midwifery training programs for licensed midwives, though two are in the works with funding from the California Department of Health Care Access and Information.

Policy Considerations: What Can State Leaders Do to Increase Access to Midwives?

• Expand professional autonomy. The state statutes for licensed midwives and nurse-midwives impose a narrower scope of practice than their training allows and require physician oversight in certain situations, undermining their professional autonomy. Nearly 9 in 10 licensed midwives identify government scope of practice restrictions as a “major” (39%) or “minor” (49%) problem in their practices. Among nurse-midwives, 10% consider this a “major” and 27% a “minor” problem in their practices.
• Integrate midwives into the health care system. In addition to ensuring access to midwives who have professional autonomy, truly integrating midwives into maternity care in California requires the respectful inclusion of midwives as members of the health care team as well as broad insurance coverage of midwifery services in both hospital and community settings.
• Increase funding to grow the midwifery workforce. Expanding access to midwifery care in California requires financial support for midwifery students to reduce barriers to education, for clinical sites to take in midwifery students, and for midwives of color to diversify the workforce.
• Streamline licensing requirements for birth centers. Research shows freestanding birth centers provide high-quality, midwife-led care that can produce excellent outcomes for birthing people and babies. But due in large part to California’s onerous licensing requirements that many experts say do not improve safety, at least 19 birth centers have closed since 2020, leaving the state with only five licensed birth centers.

To learn more:

• Cochrane Library: Midwife Continuity of Care Models Versus Other Models of Care for Childbearing Women
• CHCF: Understanding California’s Midwife Workforce
• CHCF: Midwives Speak: Integration Challenges in California’s Health System
• CHCF: Advancing Midwifery and Birth Equity in California
• CHCF: Listening to Mothers in California survey (2018)

The post What Is a Midwife? — Policy at a Glance appeared first on California Health Care Foundation.

Artificial intelligence (AI) is swiftly reshaping the health care landscape, but the impressive array of helpful new tools is not equally accessible to everyone. While private hospital systems and commercial insurance plans can afford technologies that could alleviate burdens on their workforce and improve patient care, California’s health care safety net is at risk of being left behind. It’s a problem that worries the people who run the medical and social service organizations that serve millions of Californians with low incomes.  

If safety-net institutions miss out on the potential of AI, it could widen persistent racial and ethnic health disparities in that population, said Stella Tran, senior program investment officer at the CHCF Innovation Fund. “It would be a tale of two health systems,” she said.  

The potential applications of AI are significant: Ambient note-taking technologies that could reduce burnout and give providers more face time with patients. Chatbots that could offer speedier access to care. Tools that could assist with diagnostics and help predict patient health outcomes. Many others are being developed as well. 

CHCF wanted to learn more about spreading AI equitably, so it partnered with the California Health and Human Services Agency to listen to 45 safety-net leaders from across the state. In three focus group sessions conducted between August and October 2024, leaders of managed care plans, hospitals, community clinics, and community-based organizations offered their perspectives on AI. There was a strong desire to share their experiences and perceptions. “We had one clinic leader drive over three hours each way to be at the table,” said Katie Heidorn, CHCF’s director of state health policy. 

Safety Net Access to AI

The lively strategic discussions, which offered confidentiality to encourage candor about sensitive issues, confirmed that safety-net organizations face restrictive barriers to the safe and effective adoption of AI. Those obstacles include prohibitive costs, workforce limitations, and concerns about liability.  

Participants shared the capabilities of AI that excite them, offered use cases, and commiserated over challenges — especially the need for increased resources to help safety-net institutions rapidly adopt AI tools that could improve their services. Many said their organizations cannot afford to integrate new digital tools into their workflows. “The pricing models don’t work for the safety net,” said Kara Carter, CHCF’s senior vice president for strategy and programs. AI products that charge per usage or per provider visit are currently too expensive for safety-net organizations, she said, adding, “That’s going to have to change.” 

Participants also explored group purchasing and other strategies to access AI products. One solution could be for vendors to offer discounts to safety-net organizations, perhaps by partnering with other AI companies to create bulk deals, said Heidorn. 

But that method wouldn’t ease the infrastructure and personnel requirements, she said. Few safety-net organizations can afford to hire expert staff to oversee AI implementation.

Well-resourced hospital systems have large data management capacity, with large IT departments and data science staff at their disposal. “A community clinic may not have the data scientists on staff needed to implement AI,” said Tran.

Because safety-net organizations are already burdened by projects aimed at improving infrastructure and care delivery, the surge in AI technology is causing a sort of paralysis, participants said. Organizations may need to put AI adoption on the back burner because they are prioritizing the enhancement of other technical capabilities, such as data exchange.  

Nimble Organizations Take More Risks

“Across the board, there are underlying problems in infrastructure,” Carter said. “But if we wait to move on AI until we fix all of those, we miss the boat.”  

The sessions revealed that nimble organizations with simpler structures and decisionmaking pathways feel freer to take risks with AI, such as a small community health worker organization that created its own generative AI tools because commercial options didn’t suit their specific needs. 

Providers say they often hesitate to purchase AI tools because the financial benefits are unclear. “We need to find examples of return on investment and share them widely to make the case for AI really clear,” Tran said. 

Ambient scribing improves physicians’ quality of life by reducing the time needed to write patient notes after hours. Hospitals and health systems, however, assign less value to savings generated by physicians who were volunteering their time anyway. Yet when the tool is framed as a way to bolster employee retention, other cost savings become clearer. “What is the cost of losing the doctor? Or of hiring a new provider?” Tran said. Taken further, employee retention yields savings by ensuring that patients can be seen in a timely fashion, and therefore possibly avoid developing more complex conditions that are expensive to treat.   

Examining returns on investment this way reflects lessons learned from mistakes of the past, CHCF leaders said, pointing to missed opportunities when electronic health record (EHR) systems were introduced two decades ago. That process resulted in discrepancies in the implementation of EHRs in well-resourced versus safety-net systems. “It was fragmented, and it wasn’t made for effective data exchange,” said Carter. “Those mistakes have been really expensive to fix.”  

The listening tour showed that safety-net organizations already see the AI revolution as an opportunity to do things differently, Carter said. “I was thrilled to hear that sentiment from participants,” she said.  

Top Worries About AI in the Safety Net

But as eager as they are to seize AI opportunities, several concerns about access and equity remain top of mind. 

First and foremost, safety-net providers are worried about who bears the financial risk for AI errors. They said the state should establish accountability guidelines showing which parties are responsible for the safety of the technology. “They’re concerned about risk if it messes up,” said Heidorn.  

The path of least resistance may be to put the onus on health organizations rather than on AI developers because health care providers are already accustomed to being heavily regulated, Heidorn said. But that might create a chilling effect in which safety-net organizations avoid AI out of liability fears, she said.  

On the other hand, laying too much financial risk on developers might deter innovators from tackling safety-net problems. Some form of safe harbor for providers and developers alike may be the sensible path forward, Carter said. “Organizations want to be able to try and fail, and that is hard to do without clear accountability,” she added.  

Safety-net organizations need to be included in data exchange networks, and their patient data should be used to train AI models to counter racial and ethnic biases, Carter said. Small clinics need to have access to the same large data resources that well-resourced systems have, and AI innovators need to ensure that their technologies prioritize primary care. “We can’t be leaving out the part of the infrastructure that safety-net patients interact with the most,” Carter said.  

Likewise, attention needs to be directed to ensuring that certain regions and populations aren’t left out of these digital advances. The Central Valley and rural Northern California, for instance, suffer from poor broadband connectivity, affecting organizations’ abilities to implement new AI technologies. Participants from Southern California emphasized the challenges of sharing data between Los Angeles County’s many systems, while those from the Central Valley spoke of the need for data exchange programs that can follow the movements of farmworkers. And regions with sizable immigrant populations are concerned about the technologies reaching those who speak languages other than English. Designing AI tools that can address these barriers will help to shrink health care’s existing digital divide. 

Extensive Dialogue Needed

Crafting new policies will require extensive dialogue among lawmakers, safety-net providers, and AI developers. “There are information gaps on all sides,” Heidorn said. “We need to ensure that lawmakers are educated in AI, and that the AI learnings specific to health care are passed on to the state.” 

So far only health care leaders and providers have had input on AI, so CHCF plans to host listening sessions with safety-net patients to understand their perspectives, said Heidorn. That will help policymakers, developers, and safety-net leaders ensure that the deployment of AI is tethered to the future of health equity. Already, Medicaid enrollees have worse health outcomes than those with commercial coverage — and if Medicaid patients are unable to reap the same benefits of AI tools as commercial health systems, those disparities will worsen. What’s more, in the face of workforce shortages, primary care deserts, and other critical health care problems facing the state, AI could help the Californians with lower incomes edge closer to having equitable access to care.  

The safety net needs to be given a seat at the table, CHCF leaders said. “AI can address long-standing issues in our delivery system,” said Tran, “and we want to make sure our corner of the world has access to that.”  

Authors & Contributors

Robin Buller

Robin Buller is an Oakland-based writer, researcher, and editor. She has reported on harm reduction, maternal health, migration, housing, and policing for The Guardian, The Oaklandside, and other publications.

Originally from Canada, she holds a doctorate in history from UNC Chapel Hill and has lived in California since 2018.

Jessica Brandi Lifland

Jessica Brandi Lifland is a freelance photographer, instructor of journalism at City College of San Francisco, and mother. Her work with publications and nonprofits such as Operation Smile, Tostan, and the California Health Care Foundation has taken her all over the world, including West Africa, the Middle East, Kosovo, Burma, Haiti, and South America.

For two decades she has been photographing the National Cowboy Poetry Gathering and has been working on a long-term project documenting the lives of the cowboy poets of the American West in affiliation with the Western Folklife Center. She plans to make her project into a book.

The post AI Tools Promise Better Care but Challenge Safety-Net Providers appeared first on California Health Care Foundation.

How does Medi-Cal support seniors?

Medi-Cal, California’s Medicaid program, provides health insurance to people with low incomes of all ages. More than 1.7 million Californians are enrolled in both Medicare and Medi-Cal, including adults age 65 and older and people with disabilities. For these groups, Medi-Cal covers essential services that are not covered by Medicare, such as nursing facility care; services that help people with cooking, bathing, and other daily tasks so they can live independently; and several other critical programs. 

What are examples of programs Medi-Cal covers that Medicare does not?

Medi-Cal covers the costs of several programs known as “long-term services and supports,” which more than 1.1 million of California’s seniors and people with disabilities rely on every year. These programs include home and community-based services (HCBS) and long-term nursing home care that are not covered by Medicare. Medi-Cal makes it possible for seniors with low incomes to afford Medicare coverage by paying for monthly premiums and out-of-pocket costs. Medi-Cal also covers dental, vision, and hearing services for these seniors, while Medicare does not. More information on key Medi-Cal services on which seniors and people with disabilities depend can be found below.

Most seniors can’t pay for nursing homes without Medi-Cal.

Medi-Cal is the primary source of funding for more than 6 in 10 Californians in nursing facilities.

• Home and Community-Based Services: Medi-Cal pays for a wide range of essential services not covered by Medicare, such as the In-Home Supportive Services (IHSS) program, that help older adults live independently in their homes and avoid higher-cost nursing homes. In addition to covering the costs of personal care aides who help with day-to-day tasks like bathing, dressing, and housekeeping, HCBS programs include services that deliver nutritious food to seniors, home modifications that help prevent falls and injuries, transportation assistance getting to doctors’ appointments, and care management. Nearly one million Medi-Cal enrollees rely on these services every year. Without Medi-Cal, these services would be unattainable for seniors with low incomes, with private in-home care in California costing an average of $38 per hour.
• Long-Term Nursing Home Care: Medi-Cal is the primary payer of nursing home care for seniors. Over 100,000 California seniors receive short- or long-term care in nursing homes each year, and Medi-Cal is the primary payer for 61% of the state’s nursing facility residents (see chart). Medicare pays for up to just 100 days in a nursing facility and only after a qualifying hospitalization. For people without other insurance or the ability to pay out of pocket, Medi-Cal is the only option to pay for long-term stays, which cost an average of $137,000 per year.
• Medicare Cost Sharing: For people enrolled in both Medi-Cal and Medicare, Medi-Cal also covers the cost of Medicare premiums, which are often several hundred dollars every month, as well as out-of-pocket costs like copays and deductibles. Nationally, one in six Medicare enrollees (roughly 10 million people) rely on Medicaid to pay for the health care Medicare provides. In California, over 1.7 million seniors and people with disabilities have their Medicare premiums and out-of-pocket costs covered by Medi-Cal. Without coverage of these expenses, most seniors with low incomes would not be able to afford Medicare coverage. That’s why any cuts to Medi-Cal would reduce access to Medicare for California’s older adults with low incomes.

To learn more:

• Defending Medi-Cal in 2025
• CHCF Poll: Californians Across Party Lines Overwhelmingly Support the State’s Medicaid Program
• Medi-Cal and the Role of the Federal Government — Policy at a Glance
• Long-Term Care in California
• Medi-Cal Long-Term Services and Supports Dashboard (California Department of Health Care Services)
• A Cut to Medicaid is a Cut to Medicare (Justice in Aging)
• Federal Cuts to Medicaid Will Harm Older Californians on Medi-Cal (Justice in Aging)

The post Medi-Cal and Seniors — Policy at a Glance appeared first on California Health Care Foundation.

Perhaps no state has more to lose than California in the federal budget proposal House Republicans passed this week. That spending plan sets up significant cuts to Medicaid, the health insurance program for low-income people. California has taken just about every route and opportunity to expand the Medicaid program, known as Medi-Cal. Today, 14.9 million Californians are enrolled in it, and federal funding cuts would almost certainly roll back services and coverage for some of them.

Looking for a way to offset the cost of extending President Donald Trump’s 2017 tax cuts, the House advanced a bill on February 25 that directs the Energy and Commerce Committee to find $880 billion in spending cuts over the next 10 years. Those cuts, budget and health policy experts say, would largely have to come from Medicaid, also known as Medi-Cal in California.

The Senate voted for its own, narrower budget bill last week. Next, both chambers have to work out their differences and agree on one budget.

At this point, it’s not clear which Medicaid services would be cut or how many people exactly would lose coverage because lawmakers can hit the spending reductions in a number of ways.

Still, enrollees, health advocates and providers in California and across the country are now grappling with what the cuts would mean for them and the people they care for. In press conferences and online meetings, they’ve called the proposed cuts a “five-alarm fire” and  Republicans’ vote “the ultimate betrayal” of their constituents.

Their outcries echo the first Trump administration, when in 2017 House Republicans voted to repeal the Affordable Care Act. The law ultimately survived, but that health care vote helped stir up the “blue wave” that flipped Republican House seats in the 2018 election.

Cuts Would Help Pay for ‘Tax Breaks to the Ultra-Wealthy’

“These cuts would rip care away from children, seniors, disabled Californians, and more while raising costs for everyone, all to give tax breaks to the ultra-wealthy,” Amanda McAllister-Wallner, interim executive director of Health Access California, a health consumer advocacy group, said in a statement following the House vote. “This is just the beginning — we will be pushing our California Congress members at every turn to put the health of their constituents first.”

Medicaid is the backbone of California’s social safety net. It covers half of all children and 40% of all births. It also covers long-term care services for seniors and disabled people.

Since 2014, the state has expanded the program big time — first to more adults allowed in the Medicaid expansion under the Affordable Care Act, and gradually to low-income immigrants, regardless of their legal status. Cuts to the scale that Republicans in Congress are proposing, advocates and providers say, would be harmful across the board.

Hospitals, doctors and county officials are also speaking out against the proposed cuts because Medicaid is a key payer, especially for those located in rural areas or communities with high poverty rates. If these facilities can’t keep their doors open, entire communities, not just people enrolled in Medicaid, could lose access.

House Speaker Mike Johnson, a Louisiana Republican, has said savings could be accomplished through eliminating Medicaid fraud and waste — although that would only get Republicans so far. Johnson has cited about $50 billion in alleged fraud, a small slice of the GOP’s goal total, the Washington Post reports.

Reductions Would Leave a Big Budget Hole for State

Medicaid accounts for a significant portion of states’ budgets. The program is jointly funded by the federal government and states, meaning federal cuts would leave major budget gaps that would force reductions in services and enrollment, and also could trigger cuts to other state programs. California’s budget includes $161 billion for Medi-Cal, of which more than half is paid for with federal funds.

Based on proposals that Republicans in Congress are considering, California could lose $10 billion to $20 billion a year, the California Budget Policy Center estimates.

A big question mark is how exactly Congress will meet its savings goal — Republican lawmakers have floated a number of proposals, but it’s unclear yet what could stick.

They’ve proposed imposing work requirements, for example. The idea behind that is enrollment would drop as people who don’t meet the requirements get kicked off the program. But the spending reductions from such a policy would not get Republicans all the way to their target, said Edwin Park, a research professor at the Georgetown University McCourt School of Public Policy.

A second proposal would require restructuring the program so that instead of the federal government paying states a fixed percentage of Medicaid costs, it could set a spending cap per enrollee.

Under the Affordable Care Act, California opened up its Medi-Cal roll to low-income adults who had previously not been covered. The federal government pays California 90% of the cost for this expansion group — that’s up from the state’s 50% regular match rate. Republicans may also choose to eliminate the increased match rate for adults covered under this expansion.

“One reason that these types of cuts are popular among federal policy makers is because…it really allows the blame to be placed on governors and state legislatures,” Park said. “The federal government is cutting federal funding, making it harder for states to finance their share of the cost of Medicaid, but it’s not actually saying ‘You have to cut eligibility in this way or cut provider rates in this way.’”

“It’s really, ‘States, you figure it out, you have to balance your budget,’’” Park added. “And you know, there’s only three choices: higher taxes, cutting the rest of the budget, which is primarily education in California, and then, most likely, really dramatically cutting Medi-Cal in the state.”

2.2 Million Seniors and People with Disabilities

President Trump and Republicans have promised to not touch seniors’ Medicare, but millions of seniors also rely on Medicaid. In California, about 2.2 million seniors and people with disabilities are enrolled in Medi-Cal, according to data from the state’s Department of Health Care Services.

Traditional Medicare does not cover services including dental, vision and hearing benefits. Seniors typically have to buy into a Medicare Advantage plan to get that covered. Low-income seniors in California can access those services with no or at a low-cost through Medi-Cal.

Nursing home stays and in-home care are also largely covered by Medicaid. Nationally, about 6 in 10 nursing home residents are covered by Medicaid, according to an analysis by KFF, a health polling and research organization.

“Medicare has huge gaps in coverage and Medicare is really expensive,” said Amber Christ, managing director of health advocacy at Justice in Aging, which advocates on behalf of older adults. “It is Medicaid, not Medicare, that is the primary payer of long-term care in this country.”

Because of their high needs, seniors and people with disabilities are the most costly population. In California, they make up about 15% of the people enrolled in Medi-Cal, but account for roughly half of all the program’s spending.

“So if the state wants to go where the money is, that’s seniors and people with disabilities. That’s long-term care, nursing home care, community-based services,” said Park. To protect the coverage of this population, he said, the state would have to consider potentially making larger cuts for other groups of people.

Roll Back Services for California Kids

More than 5 million kids in California are insured through Medi-Cal and the accompanying Children’s Health Insurance Program. It pays for their preventive care, such as immunizations and screenings, but it also covers support services, such as counseling and therapy. For about 160,000 children in the foster care system, it also pays for an array of social services.

Getting kids insured has long been a priority for California. When the state began expanding Medi-Cal to undocumented people in 2016, children were first in line.

Perhaps less known is that Medi-Cal is also a big player in services provided at schools. It helps fund services and equipment for students with disabilities, such as hearing aids and specialty transportation. It reimburses school districts for certain providers, including psychologists and social workers, for example. Across the state, some districts also provide physical and mental health care to children and their family through school-based health centers that also draw down on Medi-Cal funding.

“The rates of depression and anxiety among youth are rising at alarming rates, and for many, Medi-Cal services are their only option for care,” said Michele Cantwell-Copher, the Fresno County superintendent of schools, on a media call with advocates and parents on Thursday. “Ensuring that children have access to the mental health support they need is critical to their well-being and their success in schools.”

Medi-Cal is a keystone program for many kids but also for their birthing parent — it pays for about 40% of the state’s births. California offers coverage for pregnant people at slightly higher income levels than the regular cut-off, allowing more to qualify. It provides coverage during their pregnancy and 12 months postpartum, paying for standard obstetric visits, prescriptions, laboratory services, doula services and hospital care.

“If we want kids to have a healthy start, that means making sure that their birthing parent has access to health care,” said Mike Odeh, health policy director at Children Now. “Those early years really are important for both babies and parents. There are a lot of services in that time period that really are critical, and any reduction in those services could have very bad effects.”

This article, first published by CalMatters on February 28, 2025, was supported by the California Health Care Foundation.

Authors & Contributors

Ana Ibarra

Ana Ibarra is a Sacramento-based health reporter. She joined CalMatters in 2020 after four years at Kaiser Health News, where she covered California health care and policy. She started her reporting career at McClatchy’s Merced Sun-Star. Her work has also appeared in the Washington Post, Los Angeles Times, USA Today, and many other state and national news outlets.

Ibarra is a 2015 fellow of the Center for Health Journalism at USC Annenberg and a Cal Poly Pomona graduate.

Jessica Brandi Lifland

Jessica Brandi Lifland is a freelance photographer, instructor of journalism at City College of San Francisco, and mother. Her work with publications and nonprofits such as Operation Smile, Tostan, and the California Health Care Foundation has taken her all over the world, including West Africa, the Middle East, Kosovo, Burma, Haiti, and South America.

For two decades she has been photographing the National Cowboy Poetry Gathering and has been working on a long-term project documenting the lives of the cowboy poets of the American West in affiliation with the Western Folklife Center. She plans to make her project into a book.

The post California Has a Lot to Lose If Trump Slashes Medicaid appeared first on California Health Care Foundation.

Editor’s note: Since 2019, California has undertaken a series of major health care reforms that have reshaped the state’s health system. From Medi-Cal expansion and CalAIM to new workforce initiatives and data exchange, these changes represent some of the most transformational health policies in state history. 

Understanding how these initiatives work together — and their collective impact on Californians’ access to care — can be challenging. To provide perspective on these reforms, The CHCF Blog invited Marko Mijic, who held senior positions at the California Health and Human Services Agency (CalHHS) for nine years, include serving as undersecretary from 2021 to 2024, to share his insights. As someone who helped develop and implement many of these policies, Mijic offers a unique perspective on how they fit into California’s broader strategy. 

California has a transformative vision for how to build a Healthy California for All that goes beyond expanding access to health insurance coverage and health care. Under the leadership of Governor Gavin Newsom, the state aims to achieve better health outcomes for communities that have been left behind by building a more resilient safety net system and a more robust state economy. A healthier population leads to increased productivity and economic participation, especially for Medi-Cal enrollees, who typically hold lower-wage jobs.  

This vision aims to close the gaps that the COVID-19 pandemic exposed so starkly. A strong and well-designed safety net drives economic stability, strengthens communities, and supports population health. This promotes shared prosperity and enhances overall economic well-being. 

Over the past six years, California has made tremendous strides by increasing enrollment in Medi-Cal and Covered California health plans and integrating health and social services geared to the needs of the whole person and family. This work recognizes that access to health insurance and health care is necessary, but not sufficient, to guarantee better health outcomes. We cannot afford to stop there.  

Aligning Health Care Delivery with the Needs of People

At the core of this vision is CalAIM (California Advancing and Innovating Medi-Cal), the groundbreaking Medi-Cal initiative focused on whole-person care, preventive services, and coordinated care. It addresses non-medical drivers of health that do not originate within a clinic or a hospital. CalAIM moves us from a system that compartmentalizes services and reacts to health crises to one that emphasizes prevention and coordination. Through it, California is aligning health care delivery with the needs of people, ensuring that individuals do not only receive essential care in moments of crisis.  

CalAIM does not stand alone. It serves as the foundation that supports and connects multiple efforts aimed at reforming California’s safety net. Taken together, these reforms are so broad and complex that it will take many years for Californians to fully reap their benefits. These California programs were enabled in the same way they are in any state — through strong, cooperative partnerships with the federal government.  

Collectively, we need to make continuous improvements across multiple federal and state administrations, incorporating lessons learned at every step of the way. This requires patience, unwavering commitment, and the resolve to stay the course even during times of challenge or uncertainty. The work must remain grounded in the needs and experiences of everyday Californians and shielded from changing political winds.  

Following Blueprints for the Future 

California’s formal Master Plans for Aging, Developmental Services, and Early Learning and Care are guiding this transformation. They provide a roadmap to a safety net that can adapt to evolving demands. These blueprints emphasize long-term sustainability to withstand future challenges. As they evolve, these master plans will ensure that California’s health and social services systems remain responsive and grounded in equity.  

Additionally, the latest Medi-Cal managed care contracts are critical to this process, as they redefine expectations for health plans to prioritize integrating physical and mental health services while also addressing non-medical drivers of health, such as access to food, housing, and transportation. This approach creates a more robust, efficient, and equitable system providing quality services.  

Behavioral Health Care Provides Essential Support 

Increasing access to and integration of behavioral health services is central to Medi-Cal members and all the communities served by safety-net providers. California’s behavioral health initiatives, such as Proposition 1 and BH-CONNECT (California Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment), focus on integrating care and ensuring the availability of comprehensive mental health and substance use services.  

Behavioral health challenges are often intertwined with other non-medical drivers of health, such as poverty and housing instability. California’s historic $4 billion investment in the Children and Youth Behavioral Health Initiative prioritizes prevention and early intervention by addressing mental health needs before they escalate as well as building resources to support kids who need help now. Responding to these needs holistically is essential to improving health outcomes and fostering long-term community resilience.  

Expanding Community Capacity to Shield Californians from Escalating Crises 

Investments in the Behavioral Health Continuum Infrastructure Program, the Community Care Expansion Program, and other efforts ensure Californians have access to community-based care that shields them from crises, thereby prioritizing resilience and well-being. By supporting community-based organizations and expanding capacity, California is helping to ensure that its health care safety net is strong enough to catch individuals and families before they experience homelessness or incarceration. By expanding access to residential care, crisis stabilization units, and wraparound services, California is anticipating needs and offering protection and stability in the community not in institutions. 

Adopting Affordability Efforts to Keep Costs Manageable 

California’s affordability initiatives, such as CalRx and the Office of Health Care Affordability, curb the growth of prescription drug and health care services costs by publishing health care prices and developing policies aimed at reducing out-of-pocket expenses for consumers. California is intentional in making health care costs sustainable for people with low incomes while lowering the financial barriers that keep many from seeking needed care. Success would lead to improved population health, increased productivity, and enhanced economic growth.  

Ensuring Connectivity Through Data Exchange  

The Data Exchange Framework acts as the wiring of the integrated system, enabling seamless real-time communication and coordination that allows health and social services providers to deliver cohesive whole-person care. The framework enables broader coordination and shared learning by creating information bridges between California’s health care system and external partners, such as housing providers and community-based organizations. This is vital for addressing complex, interrelated social challenges that require cross-sector collaboration. Effective and real-time data exchange will enable different systems to “talk” to each other and create a human services ecosystem that is more responsive to community needs.  

Building a Skilled Workforce 

California is creating a resilient health care infrastructure by building a pipeline of skilled workers and fostering a workforce culture that values diversity and equity. The Workforce for a Healthy California initiative invests in a culturally diverse labor force that reflects the state’s demography. This ensures that high-quality care is provided with cultural competence and delivered equitably. To address workforce retention, this initiative offers training and career development opportunities to help staff stay in the system. Demand is growing for health care professionals in California, especially those who are willing to work in underserved communities. Investing in this workforce can help meet the needs of the most diverse state population in the US.  

Government, Providers, and Communities as Co-Builders 

Government, health care providers, community-based organizations, and managed care plans all play critical roles in this grand collaboration. Each stakeholder brings unique and essential expertise, resources, and perspectives to the work. Government offers the policy and funding framework, while providers deliver the care. Community-based organizations ensure that the system is equitable and that it meets the needs of diverse populations. Managed care plans help to streamline services and connect the dots. By working together, these stakeholders create a system that is more responsive, adaptable, and focused on the well-being of all Californians. 

An Equitable, Resilient System that Benefits Everyone

The volume and complexity of these state initiatives may be overwhelming. It’s up to all of us involved in health and social policy to turn the puzzle pieces of the last six years into a cohesive reality that sparks cultural change and prioritizes equity at every level of implementation. Now more than ever, we need to be unapologetic about our progress and roll up our sleeves to build a system of hope, opportunity, and justice.  

Building this transformed safety net is a labor-intensive, long-term endeavor. It requires time, discipline, and openness to change. Health care providers, community-based organizations, and managed care plans must embrace a cultural shift to a system where collaboration, trust, and equity are first principles. We must find ways to work together to realize the promise of California as the place where we see our diversity as a strength and embrace our responsibility to take care of one another.  

This work demands resilience, collaboration, and unshakeable commitment. As part of any major transformation, challenges are inevitable. Each of us must be an active, fully engaged participant. When obstacles arise, we cannot retreat. We must dig deeper, solve problems creatively, and adapt together. 

Authors & Contributors

Marko Mijic

Marko Mijic is the former undersecretary of the California Health and Human Services Agency (CalHHS). He is currently a managing director at Sellers Dorsey and an Impact Fellow at the UC Berkeley School of Public Health.

At CalHHS, he managed 12 departments and five offices, overseeing more than 34,000 employees and an annual budget exceeding $260 billion. In this role, he focused on refining government operations, enhancing access to health and human services, and advancing an equitable recovery from the pandemic. He served under two governors and three CalHHS secretaries during his tenure.

Mijic’s leadership emphasized improved services for marginalized communities, including older adults and individuals with disabilities, grounded in a commitment to justice, equity, diversity, and inclusion. 

Beyond his public service, he serves on the board of Opening Doors, a nonprofit advocating for immigrants, refugees, and survivors of trafficking. He contributes to the advisory board of the Center for Public Sector AI, which supports government leaders in utilizing artificial intelligence and emerging technologies to address critical service delivery challenges.

Mijic’s career includes roles at the American Heart Association and the US Department of Health and Human Services in Washington, DC. He holds a bachelor of science from the University of Utah and a master of public policy from American University.

The post California’s Safety Net at a Crossroads appeared first on California Health Care Foundation.

Executive Summary

• Californians across party lines overwhelmingly support Medi-Cal. Eighty percent (80%) of Democrats, 75% of Independents, and 62% of Republicans agree that the program should generally stay as it is today (Question 7).
• There is little support for cutting federal Medi-Cal funding among Republicans, Democrats, or Independents. Across party lines, there is little support for reducing federal funding for Medi-Cal: Only 13% of Californians favor cuts to federal funding for the program. Five percent (5%) of Democrats, 13% of Independents, and 27% of Republicans support cuts (Question 5). Only 12% of Californians believe federal spending on Medi-Cal is excessive (Question 6), and 73% support maintaining its current scale (Question 7).
• Californians continue to believe everyone should have access to health coverage. Three in four (75%) Californians think everyone in the state should have health insurance coverage, even if it means increasing federal spending. Strong majorities of Democrats (91%) and Independents (76%), as well as half of Republicans (50%) hold this view (Question 11).
• Medi-Cal is widely viewed as important to the state — and most Californians across party lines say the program is “personally” important to them. An overwhelming majority of Californians (91%) believe Medi-Cal is important to the state. This view is held by 98% of Democrats, 83% of Independents, and 85% of Republicans (Question 1). Over half of Californians (54%) — including 55% of Democrats, 61% of Independents, and 50% of Republicans — view Medi-Cal as personally important to them and their families (Question 2). Majorities of Californians across political affiliations have either received Medi-Cal benefits themselves or have family members who have (Question 3).
• Large majorities of Californians say Medi-Cal is working well, but anxiety about the program’s future is high. Nearly six in 10 (58%) Californians say Medi-Cal is working well for most. Two-thirds (66%) of Democrats, more than half (55%) of Independents, and nearly half (46%) of Republicans agree. Among those who have been in Medi-Cal or have a family member in the program, over 70% say it’s working well (Question 4). Anxiety about Medi-Cal is high, with two-thirds (67%) of Californians worried that enrollees will not be able to access the same level of benefits in the future that they do today (Question 12a).

Poll Questions

Methodology

The post Poll Explores Californians’ Attitudes on Medi-Cal, Covered California, and Federal Cuts to Both appeared first on California Health Care Foundation.

Last year, CHCF brought together consumer advocates and experts from across California’s health care system to focus on prior authorization, a common practice by health insurers to review and approve drugs, diagnostic tests, and medical treatments before agreeing to pay for them. These practices really are quite common — according to CHCF’s most recent health policy poll, 40% of Californians needed to wait for a prior authorization in the last year. And a significant proportion of that group waited for authorization of the same treatment, procedure, or medicine more than once.  

The results of our stakeholder work were published last summer and discussed at a CHCF webinar in December. Relevant then, they are particularly timely now given the renewed national attention to the practices of health plans like UnitedHealthcare, the nation’s largest health insurance company.  

The shocking killing of Brian Thompson, the company’s CEO, on December 4, 2024, provoked a gut-wrenching national conversation about how these insurance practices are implemented and the urgent need to reform them. Public anger over how some insurers delay and deny claims reinforces numerous academic studies, independent investigations, and significant anecdotal evidence that suggest prior authorization processes are fundamentally broken for patients, providers, and plans alike.

Providers often don’t know and can’t easily find the criteria that health plans use to decide if a certain type of care should be considered medically necessary. The process to appeal denials is often inefficient and time-consuming. Repeated prior authorizations during treatment can disrupt a patient’s care, exposing them to the risks of medical harm or high out-of-pocket costs. Finally, there’s little public information about how often prior authorization processes are used or how well they work.

Prior Authorization Must Be Fixed, Not Abandoned

So why not just do away with prior authorization for specific services or for certain providers? How about ending it entirely? Because there is equally clear evidence and broad consensus that, when done properly and judiciously, prior authorization plays crucial roles in ensuring Californians can access the right care at the right time, and in lowering the total cost of care for patients and the system as a whole.

For example, it can help ensure that patients seek care from credentialed providers in their network, which makes patients less likely to get saddled with unexpected bills after a procedure. It can protect patients from getting care known to be ineffective or inappropriate based on clinical studies or guidelines. And it can result in switching to equally effective but lower-cost care options, such as generic drugs instead of name brands.

So while stakeholders strive to improve prior authorization processes, they must not overcorrect, which would make health care more expensive for Californians. We can and should prioritize both goals — affordable care and better access to care.

Possible Solutions

What can policymakers, industry leaders, and consumer advocates do together to retain the benefits of prior authorization while improving the processes by which this important function is carried out? The patient advocates, behavioral health specialists, health care providers, health systems, and health plans convened by CHCF suggested these four concrete steps:

1. Lean into automation. Recent federal regulations emphasize automating many mundane administrative parts of the prior authorization process, such as confirming a patient’s health plan coverage, determining the need for prior authorization, and facilitating information exchange between providers and health plans. This can eliminate frustrating delays and inefficiency. California could go further by mandating or incentivizing automation of prior authorization processes for all payers and providers subject to state regulation.
2. Generate more public data. Federal regulations make Medicare, Medicaid, and ACA marketplace plans collect and publicly report items and services that require prior authorization, the percentage of authorization applications that were denied, the percentage reversed upon appeal, and other metrics. California could apply these requirements to all state-regulated plans and to provider organizations that perform prior authorizations. This transparency could lead to improvements and increased accountability.
3. Reduce repeat prior authorizations. Several states have addressed the frequency with which prior authorizations are required by extending the time frame during which an approval remains valid. California could develop an approach that avoids the need for repeat authorizations for chronic care or other care that is subject to well-defined clinical protocols. In addition, California could consider straightforward and broader protection for patients who change health plans during a course of treatment.
4. Develop transparent principles. All California health plans periodically evaluate whether to revise the list of services subject to prior authorization, but the public knows little about the rationale and motivation for these decisions. Disclosing this information could enable providers and patients to better understand the reasoning and could build public trust in the review process.

Reforms in the Offing

Fortunately, several federal and state reforms consistent with these priorities are underway and should bear fruit soon. Perhaps most important, the federal government is about to require Medicare and Medicaid managed care plans to move toward automation and release prior authorization metrics. Private insurers like Blue Shield of California and Humana are already voluntarily testing and piloting ways to automate their prior authorization systems.

While promising on their own, none of these efforts is sufficient to bring the scale and speed of change that is needed by Californians. As health care leaders build these reforms, CHCF’s report can inform efforts to effectively and responsibly repair prior authorization so that it makes our health care system more affordable while ensuring fewer patients and providers experience delays in care, administrative burdens, and significant frustration.

Authors & Contributors

Kristof Stremikis

Director, Market Analysis and Insight

Learn more about Kristof Stremikis

The post Reforming Prior Authorization in California appeared first on California Health Care Foundation.