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.

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.

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

Kaiser Family Foundation Medicaid Enrollment and Unwinding Tracker

November 30, 2023

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.

September 14, 2023

Homelessness

State Health and Value Strategies: Resources for States on Unwinding

November 30, 2023

Communicating to Medi-Cal Members About the Unwinding

June 21, 2023

Medi-Cal

Op-Ed: Preserving Health Coverage for Millions of Californians Requires All of Us

September 18, 2023

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

August 24, 2023

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.

April 5, 2023

Medi-Cal

DHCS: Medi-Cal COVID-19 PHE and Continous Coverage Operational Unwinding Plan

June 14, 2022

DHCS: ​​​​​​​​​​​​​​​​​​​Keeping Medi-Cal Beneficiaries Covered

May 27, 2022

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

May 31, 2022

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

View the Report

After a roughly three-year hiatus under federal policies designed to help people keep their health coverage during the pandemic, California has returned to requiring enrollees to annually renew their Medi-Cal coverage. California will need to redetermine Medi-Cal eligibility for over 15 million enrollees, an unprecedented undertaking.

To understand how this process (commonly referred to as “the unwinding”) is going, CHCF is monitoring detailed monthly data provided by the California Department of Health Care Services (DHCS), which administers Medi-Cal. Scroll down to our first update, posted on November 4, for an explanation of data measures and an analysis of the first quarter of data. Subsequent updates will be provided on a rolling basis as new data become available.

Update: Final Data for the Full Unwinding Period (June 2023–May 2024)

Posted November 18, 2024

The data for the full Medi-Cal unwinding period — covering the months of June 2023 through May 2024, including all 90-day updates for this period — are now available. With these data, we have a more complete picture of the impact of the unwinding. Here are some key takeaways from the statewide data:

• As anticipated, about two million people lost Medi-Cal as a result of the unwinding. In advance of the unwinding, DHCS had estimated that approximately two million people could lose coverage.¹ While preliminary data showed that 1.8 million people were disenrolled, the final 90-day update data reflects an additional 227,000 disenrollments, for a total impact of 1,998,710 people losing Medi-Cal. This loss represents a nearly 13% reduction in Medi-Cal enrollment from the pre-unwinding level of 15,973,004 enrolled in May 2023.²
• Most people who lost Medi-Cal were disenrolled due to procedural issues, not because they were determined ineligible. Nearly 90% of initial disenrollments were based on procedural issues, such as failure to return a renewal form on time. After the 90-day updates were taken into account, which adjusted for situations such as people initially disenrolled for procedural reasons but later reinstated (see below), the procedural disenrollment rate fell to 66%.
• More than one in seven people initially disenrolled were later determined to still be eligible. Of the 1,771,109 initially disenrolled, 268,533 (15%) later had their Medi-Cal coverage reinstated. These reinstatements were requested by the disenrollees and granted after findings that they remained eligible. An unknown number of other disenrollees may have qualified for reinstatement but never requested it.
• Older adults and people with disabilities were more likely to be procedurally disenrolled and more likely to have their coverage reinstated than other Medi-Cal enrollees. After taking the 90-day update into account, 83% of all disenrollments of older adults and people with disabilities (known as the “non-MAGI” population) were due to procedural reasons. The procedural disenrollment rate for others (known as the “MAGI” population) was 65%, nearly 20 percentage points lower. Meanwhile, the reinstatement rate (the share of people initially disenrolled who were later reinstated) was higher for the non-MAGI population (18.2%) than the MAGI population (14.7%). The net result was that the full unwinding period did not have disproportionate disenrollment impacts on older adults and people with disabilities, as had been indicated in earlier data.
• Nearly 2 million Medi-Cal enrollees are still waiting for their renewal to be processed. At the end of the unwinding period, plus 90 days, there are still 1,789,325 people with renewals in process. DHCS, in compliance with federal guidelines, has required all these renewals to be completed by January 31, 2025. We won’t know the full impact of the unwinding until these outstanding renewals are fully processed.*

While preliminary data showed that 1.8 million people were disenrolled, the final 90-day update data reflects an additional 227,000 disenrollments, for a total impact of 1,998,710 people losing Medi-Cal. This loss represents a nearly 13% reduction in Medi-Cal enrollment from the pre-unwinding level of 15,973,004 enrolled in May 2023.

As a new federal administration emerges, California will continue to learn lessons from the unwinding that could be used to improve Medi-Cal renewal processes and help to protect and expand the tremendous coverage gains Californians have experienced in recent years. Stay tuned for important new developments in Medi-Cal’s continuing evolution.

Explore more of the unwinding data, available under Document Downloads, below.

* As was the case with the previous 90-day data, updated data revise the number of renewals due each month for various reasons (see previous post). This impacts the number of renewals in process and the disenrollment and continuance rate. Note that in all redetermination data sets, the month of July appears to be an outlier, possibly due to a reporting or processing glitch.

Update: 90-Day Updated Redetermination Data (June 2023–February 2024)

Posted August 14, 2024

Back in April, we examined the first five months of 90-day updated Medi-Cal redetermination data (covering June 2023–October 2023). As we explained, the 90-day data can help provide a fuller picture of the impact of the unwinding than the data released monthly because people who have been disenrolled from Medi-Cal have 90 days (sometimes called the “cure” period) to get reinstated and because the updated data may capture progress on renewals still in process.

DHCS has now released 90-day updated data through February 2024, meaning there are now nine months of this more “settled” data. As we reported in the August 5 update below, the official unwinding period ended as of May 2024, and all of the monthly (or “pre-90-day”) data are now available, but we are still waiting for the final three months of 90-day updated data. Stay tuned for more once that update becomes available.

The nine months of “post-90-day” data now available continue to point to some important trends:

• Fewer renewals remain “in process.” Nearly half of the three million renewals initially identified as in process were completed. The 1.5 million renewals still in process as of February represent 16% of all renewals due.^*
• The procedural disenrollment rate is better, but still high.  The procedural disenrollment rate for February 2024 was 81% in the “pre-90-day” data and 50% in the “post-90-day” data.
• About half of those who are procedurally disenrolled and seek reinstatement are ultimately determined to be eligible.
  • About one-third of procedural disenrollees take advantage of the “cure” period to try to get reinstated, and about half of them succeed. For example, the February data show that about 32,000 fewer people were counted as procedurally disenrolled after the 90-day cure period, and about 16,000 people had their Medi-Cal reinstated.
  • In total, more than 219,000 people initially disenrolled had their Medi-Cal coverage reinstated between June 2023 and February 2024.
• The “post-90-day” data continue to show that the non-MAGI population (older enrollees and those in Medi-Cal because of a disability) are not being disenrolled at a disproportionately high rate. Although the “pre-90-day” data had shown a disproportionately high rate, the post-90-day data show that the non-MAGI population made up 9% of all disenrollments and 10% of all renewals due.

The 90-day updated data do not include demographics, so we cannot report on whether the new data show differences by race, ethnicity, age, gender, or language.

Stay tuned for more analysis as updated data become available.

Explore more of the 90-day updated data, available under Document Downloads, below.

* As was the case with the previous 90-day data, updated data revise the number of renewals due each month for various reasons (see previous post). This impacts the number of renewals in process and the disenrollment and continuance rate. Note that in all redetermination data sets, the month of July appears to be an outlier, possibly due to a reporting or processing glitch.

Update: Redetermination Data for the Full Unwinding Period (June 2023–May 2024) Now Available

Posted August 5, 2024

The unwinding period is officially over as of May 31, 2024. We now have preliminary data for all months of the unwinding and can take a quick look at how Medi-Cal enrollees fared — and what challenges remain.

Nearly two million people have been disenrolled from Medi-Cal, but that figure will change. Of the 13.3 million people who had Medi-Cal renewals due, 1.8 million were disenrolled during the unwinding period. This is a preliminary number likely to change for at least these two reasons:

• Nearly 3.7 million enrollees did not receive a final determination during the month that their renewal was due. Those “in process” renewals were subsequently processed or will be processed in the coming months. Some will result in enrollees continuing in Medi-Cal; others will result in disenrollments.
• People disenrolled have 90 days to reinstate their eligibility. (Scroll down to the update posted on February 16, 2024, for more information on this “cure period” and why it’s important.)

We won’t know the final accurate tally of disenrollments for several months. Stay tuned.

California made significant improvement in its rate of ex parte renewals (also known as auto-renewals). Ex parte is a process whereby Medi-Cal uses other sources of information to confirm eligibility without requiring additional information from the enrollee. This avoids burdensome administrative processes for both enrollees and county staff and prevents unnecessary gaps in coverage. (Scroll down to the first update posted on November 4, 2023, for more information on ex parte.)

California more than doubled its overall rate of ex parte renewals from an average of 31% in the first quarter (June–August 2023) to an average of 63% in the final quarter (March–May 2024). (This means that, of all enrollees who had a renewal due in that final quarter, 63% were deemed eligible to remain in Medi-Cal via the ex parte process.) For older Californians and those qualifying for Medi-Cal because of a disability (an enrollment category called “non-MAGI”), the ex parte rate dramatically improved from just 0.4% in June 2023 to 47% in May 2024.

Despite the improvement, this preliminary final data suggest that these enrollees who are older and/or have a disability had less access to the ex parte process and were disenrolled at a disproportionately high rate. For example, 16.6% of all disenrollments were non-MAGI enrollees, even though they made up only 13.3% of all enrollees with a renewal due. However, this may change when we get more (and better) data. As explained in the April 15 update (below), the last batch of “90-day updated” data showed that non-MAGI enrollees were NOT being disenrolled at a disproportionately high rate. Again, stay tuned.

Almost nine out of 10 disenrollments were for administrative — not eligibility — reasons. More than 85% of all disenrollments during the unwinding period were “procedural,” meaning the disenrolled person was not determined to be ineligible but simply failed to return their renewal form on time, respond adequately to requests for more information, or meet other procedural requirements. The rise in ex parte rates reduced the number of people who faced such procedural requirements, thus potentially avoiding some unnecessary disenrollments. Still, more than 1.5 million people lost Medi-Cal for “procedural reasons” and not because they were determined ineligible.

Future updates will be posted as more data are released. Explore more data, available under Document Downloads, to see breakdowns by age, race, and language.

Update: 90-Day Updated Redetermination Data June–October 2023

Posted April 15, 2024

Back in February, we examined the first release of 90-day updated Medi-Cal redetermination data (covering June–August). As we explained, the 90-day data can help provide a fuller picture of the impact of the unwinding than the data released monthly because people who have been disenrolled from Medi-Cal have 90 days to get reinstated and because the updated data may capture progress on renewals still in process when monthly data are reported.

DHCS has now released more of this 90-day updated data, adding data for September and October 2023, meaning there are now five months of this more “settled” data. The five months of 90-day data show a substantially more positive picture than the monthly (or “pre-90 day”) data on key measures:*

In addition, the 90-day data show that non-MAGI enrollees are not being disproportionately disenrolled compared to their representation among redeterminations due. This is important as, before full implementation of policy improvements, this group was being disenrolled at a disproportionately high rate. (For more on this topic, see previous posts.)

Looking across the five months of updated 90-day data, we see these trends:

• The disenrollment rate has been trending downward, from 24% to 20%. (We define disenrollment rate as the percentage of renewals due resulting in disenrollment.)
• The procedural disenrollment rate has dropped from 80% in June to 70% in October, a new low.
  • Although this substantial progress should be celebrated, note that this still means the majority of Californians losing their Medi-Cal coverage are being disenrolled for procedural reasons rather than being determined ineligible. We don’t know how many people procedurally disenrolled remain eligible for Medi-Cal.
  • The procedural disenrollment rate for non-MAGI enrollees has been declining but remains quite high, at 85% in October.
• Roughly 150,000 people have had their Medi-Cal coverage reinstated over the five months, or 16% of the original disenrollments. The percentage being reinstated was about 17% in June and has dropped to about 14% for September and October.
• Dramatic progress continues on the number of renewals in process (see above), although the pace may be slowing somewhat, landing at about 20% still in process in September and October.

The 90-day updated data do not include demographics, so we cannot report on whether the new data show differences by race, ethnicity, age, gender, or language.

Stay tuned for more analysis as updated data become available.

Explore more of the 90-day updated data, available under Document Downloads, below.

* As was the case with the previous 90-day data, updated data revise the number of renewals due each month for various reasons (see previous post). This impacts the number of renewals in process and the disenrollment and continuance rate. Note that in all redetermination data sets, the month of July appears to be an outlier, possibly due to a reporting or processing glitch.

Update: January Redetermination Data

Posted April 2, 2024

You may remember that December data showed dramatic improvements compared to previous months (see December post below). Most indicators show these gains holding. For older Californians and those qualifying for Medi-Cal because of a disability (an enrollment category called non-MAGI), the picture continues to substantially improve.

• After skyrocketing from 4% to 58% in December, the ex parte rate among the non-MAGI population continued to improve, climbing to 62%. (Ex parte is a process whereby Medi-Cal uses other sources of information to confirm eligibility without requiring additional information from the enrollee.)

Holding largely steady:

• The overall disenrollment rate was 8%, similar to December’s 9%.
• The share of disenrollments due to procedural reasons (e.g., paperwork issues, missing information) held steady at 81%.
• The statewide ex parte rate dropped from 66% in December to 60% in January, a decline but still notably improved from 36% in November.

What Conclusions Can We Draw at This Point?

This second month of data supports the case that these improvements are due to the key policies California implemented in the fall, perhaps most notably the expanded use of ex parte for non-MAGI enrollees, people experiencing homelessness, and folks with income at or below 100% of the federal poverty level. As we noted in our December post, ex parte not only removes burdensome paperwork for consumers but should also free up eligibility workers to focus on more complex cases. In the months ahead, we hope to see the ex parte rate increase and to see this translate into:

• Non-MAGI enrollees no longer being disenrolled at a disproportionate rate, compared to their representation among those with renewals due
• A shrinking portion of disenrollments due to procedural reasons
• A decline in the percentage of renewals still in process

Procedural Disenrollments

While January data show the portion of disenrollments due to procedural reasons down from its high of 92% in November, it remains extremely high at 81%. Most people being disenrolled are not being disenrolled due to a determination that they are no longer eligible but for reasons such as late or missing paperwork or information.

Stay tuned for future analyses as more data are released.

Explore more data, available under Document Downloads, to see breakdowns by age, race, and language.

Update: December Redetermination Data

Posted February 27, 2024

December data showed dramatic improvements compared to previous months. Most notably:

• The disenrollment rate plummeted from 19% to 9%.
• The share of disenrollments due to procedural reasons also dropped substantially, from 92% to 81%.
• The statewide ex parte rate increased from 36% to 66%. (Ex parte is a process whereby Medi-Cal uses other sources of information to confirm eligibility without requiring additional information from the enrollee.)

Also:

• The share of people who continued in Medi-Cal coverage increased from 47% to 72%.
• The portion of redeterminations still in process fell from 34% to 20%.
• Among the non-MAGI population, the ex parte rate skyrocketed from 4% to 58%. (Non-MAGI enrollees include adults age 65 and older and those qualifying for Medi-Cal because of a disability.)

These dramatic improvements may in large part be due to California’s implementation of federal flexibilities that allow more people to have their eligibility determined via ex parte, as explained below, as well as other beneficial policies and practices since the unwinding began. Some changes were implemented earlier this fall and so may not have been reflected in earlier data. However, it is important to remember that the December numbers here represent a single month of data. More months of data are needed to confirm this is a positive trend. We are hopeful it is!

More About Ex Parte

Ex parte not only removes burdensome paperwork from consumers but also should allow county eligibility workers to complete more redeterminations and focus attention on more complex cases.

In addition to other policy improvements, California expanded the use of ex parte for Medi-Cal eligible enrollees experiencing homelessness (and therefore unlikely to receive a renewal packet), people with income at or below 100% of the federal poverty level, and people with certain types of stable income such as social security payments and disability payments, which would include many non-MAGI enrollees.

The skyrocketing ex parte rate for non-MAGI enrollees is important, since this group has been disproportionately disenrolled, compared to their representation among renewals due, throughout the unwinding. If this much higher ex parte rate holds in the months ahead, we should see this disparity eliminated.

Stay tuned for future analyses as more data are released.

Explore more data, available under Document Downloads, to see breakdowns by age, race, and language.

As noted in our original post, people have 90 days from the date of their disenrollment to get their Medi-Cal coverage reinstated. Since my last post, DHCS has added another month of updated data reflecting this “settling” of the numbers for September.

Update: 90-Day Updated Redetermination Data for June–August 2023

Posted February 16, 2024

DHCS has begun releasing updated 90-day data about the Medi-Cal renewal process, in addition to the detailed monthly data it posts. The 90-day updated data can help provide a fuller picture of the impact of the unwinding for a couple reasons:

• After receiving a notice of disenrollment, people have 90 days (sometimes called the “cure” period) to get their Medi-Cal reinstated by supplying updated or missing information. The updated data should reflect these reinstatements, giving us a more “settled” idea of how many people are keeping their coverage.
• California has also seen the number of renewals remaining “in process” stack up. The updated data could show whether substantial progress is being made on these renewals in process.

The 90-day updated data for June–August 2023 is posted below under Document Downloads. We compared it to the original data for those three months to answer some key questions. (Note that in both data sets, July appears very different from June and August, possibly due to a reporting or processing glitch.)

Are people regaining their Medi-Cal coverage through the 90-day cure period? If so, how many?

Updated data show almost 93,000 people had their Medi-Cal coverage reinstated over the three months. This includes about 39,000 in June and almost 27,000 each for July and August. For the three months, that translates to 18% of the original disenrollments being reinstated.

Do the updated data show progress on the number of renewals in process?

The data show dramatic improvement, with 759,000 fewer renewals still in process for the three-month period. While the previous data for this same period showed about 37% of renewals due still in process, the updated data show only about 14% in process.

One important caveat here is the updated data revise the number of renewals due each month — showing 124,143 fewer renewals due over the three months. DHCS reports that this revised count reflects cases where people report a change of circumstance, which resets their renewal date to another month, as well as data clean up to address some earlier data issues related to recent changes in the county electronic eligibility system.

In addition to affecting the number of renewals in process, this reduction in renewals due impacts the disenrollment and continuance rates we describe below, since we measure those as a percentage of renewals due.

Do the updated data show more people getting disenrolled or more continuing? What do the data show about the disenrollment rate?

The new data show 443,020 additional people kept their Medi-Cal coverage. The updated data also show 192,000 additional disenrollments. With a smaller number of renewals due and a larger portion processed, the new data show both a higher continuance rate (63% compared to the earlier 47%) and a higher disenrollment rate than the earlier data (23% compared to 16%).

Do the updated data show any improvement on our high procedural disenrollment rate?

The “uncured” data for the June–August period showed 87% of all disenrollments were due to procedural reasons. The updated data show procedural disenrollments compose a smaller portion of disenrollments — 78% for the three months. This is positive news. August data show the most dramatic drop, from 89% to 74%.

What do the updated data show about disparities between groups? Are non-MAGI, who have been disenrolled at a disproportionate rate compared to redeterminations due?

Throughout the unwinding, non-MAGI enrollees (adults 65 years and older and those qualifying for Medi-Cal because of a disability) have been disproportionately disenrolled compared to their representation among redeterminations due. The updated data show this gap being erased, with non-MAGI representing 10% of the renewals due and only 9% of the disenrollments, compared to earlier data showing non-MAGI as 13% of the renewals due and 19% of the disenrollments. This is due both to a decrease in the disenrollment rate for non-MAGI and an increase in the disenrollment rate for MAGI.

The 90-day updated data do not include demographics, so we cannot report on whether the new data show disparities or differences by race, ethnicity, age, gender, or language.

Since writing, DHCS has posted an additional month of updated data. Stay tuned for further analysis and updates here.

Update: November Redetermination Data

Posted February 8, 2024

Key numbers (rounded) from the November data include:

Of the over one million redeterminations due in November:

• 47% continued in Medi-Cal coverage (about 493,000)
• 19% were disenrolled (about 205,000)
• 34% had a redetermination still in process (about 359,000)

Other takeaways:

• 92% of disenrollments were due to procedural reasons, rather than determinations that the enrollee was no longer eligible, up slightly from the previous month. (Examples of procedural reasons include paperwork not being received by the county Medi-Cal office on time or paperwork missing required information or proof.)
• The statewide ex parte rate (36%) stayed roughly the same compared to the previous month (37%). (Ex parte is a process whereby Medi-Cal uses other sources of information to confirm eligibility without requiring additional information from the enrollee.)
• The ex parte rate for non-MAGI enrollees (those who qualify because they are over 65 or have a disability or both) went down dramatically from 8% to 4% from the previous month.This is troubling, since non-MAGI enrollees are being disenrolled at a somewhat disproportionately high rate compared to their representation among renewals due. (In November, non-MAGI enrollees comprised 13% of redeterminations due and 15% of those disenrolled.) The good news is the gap has been shrinking. It will be important to see what future data show.

Explore more data, available under Document Downloads, to see breakdowns by age, race, and language.

As noted in our original post, people have 90 days from the date of their disenrollment to get their Medi-Cal coverage reinstated. DHCS has released updated data reflecting this “settling” of the numbers for June, July, and August. Check back here for our analysis of these figures.

Update: October Redetermination Data

Posted January 3, 2024

Key takeaways from the October data include:

• 90% of disenrollments were due to procedural reasons, rather than ineligibility determinations. (Examples of procedural reasons include paperwork not being received by the county Medi-Cal office on time or paperwork missing required information or proof.)
• Californians who qualify for Medi-Cal based on a disability or being over age 65 or both (called “non-MAGI”) continue to be disenrolled at a disproportionately high rate compared to their representation among renewals due.
• The statewide ex parte rate went up slightly from the previous month (from 35% to 37%). (Ex parte is a process where Medi-Cal uses other sources of information to confirm eligibility without requiring additional information from the enrollee.)
• After increasing last month, the ex parte rate for non-MAGI remained steady this month.

Update: September Redetermination Data

Posted December 6, 2023

Key takeaways from the September data include:

• 91% of disenrollments were due to procedural reasons, rather than ineligibility determinations. This is up slightly from the previous month (89%). (Examples of procedural reasons include paperwork not being received by the county Medi-Cal office on time or paperwork missing required information or proof.)
• Californians who qualify for Medi-Cal based on a disability or being over age 65 or both (called “non-MAGI”) continue to be disenrolled at a disproportionately high rate compared to their representation among renewals due.
• However, the percentage of non-MAGI enrollees having their Medi-Cal coverage renewed via ex parte increased dramatically, rising from less than 0.5% in August to 8% in September. (Ex parte is a process where Medi-Cal uses other sources of information to confirm eligibility without requiring additional information from the enrollee.) This should translate into more seniors and people with disabilities maintaining Medi-Cal coverage in future months and is likely the direct result of the implementation of recent policy improvements.

Explore the full data, available under Document Downloads.

Key Takeaways from Medi-Cal Redetermination Data for June–August 2023

Posted November 4, 2023. This was the first update provided by CHCF.

Starting April 1, 2023, California returned to requiring enrollees to annually renew their Medi-Cal coverage. This came after a roughly three-year hiatus under federal policies designed to help people keep their health coverage during the pandemic. Over the course of a little over a year, California will need to redetermine Medi-Cal eligibility for over 15 million enrollees, an unprecedented undertaking.

July 1 marked the first day Californians could lose their Medi-Cal coverage through the restarted redetermination process. The California Department of Health Care Services (DHCS), which administers Medi-Cal, shares detailed monthly data on how this process is going, as well as reporting on metrics required by the federal Centers for Medicare & Medicaid Services.

We now have three months of Medi-Cal renewal data reflecting redeterminations completed or in process during June, July, and August. The analysis below examines what the data can tell us and explains some of the basic data points.

Data and Timing

Each monthly dashboard produced by DHCS reflects the universe of cases due for renewal in that month, with any disenrollments among those cases effective the first day of the following month. For example, the June data show renewals due, in process, or continued during June, and disenrollments that were effective July 1. Data are typically posted roughly six weeks after the end of each renewal month.

This article focuses on state-level data. California’s Medi-Cal eligibility system is county-based, so it is important to look at county-level data while also recognizing that population size and composition will affect the numbers. A county-level look may reveal important dynamics invisible at the state level; for example, substantially higher- or lower-than-average disenrollment rates or disproportionate disenrollments for certain groups. Detailed data by county are available on the DHCS interactive dashboard.

How many people have been disenrolled from Medi-Cal, and how many people have had their Medi-Cal coverage continued?

Almost 3.2 million Medi-Cal members have come up for an eligibility redetermination since the process restarted earlier this year. So far:

• 511,166 Californians, or 16%, have been disenrolled.
• 1,483,421 Californians, or 47%, have had their Medi-Cal renewed.
• About 1.2 million Californians, or 37%, are still going through the process.

When tracking these numbers, it is important to understand that, among the over half-million Californians disenrolled, some already have other health coverage or will transition to other coverage, such as Covered California, which automatically facilitates enrollment for those who are losing Medi-Cal coverage and are eligible for financial help through Covered California. (Data is available on Medi-Cal Transitioner Profiles.)

Also, some who are disenrolled will regain Medi-Cal coverage. People have 90 days from the date of their disenrollment to get their Medi-Cal coverage reinstated by providing requested information. In the months ahead, updated data will be posted to reflect this “settling” of the numbers.

Looking beyond the numbers, any break in coverage can be devastating to people who need care. Many of the barriers that prevented people from renewing in the first place may also prevent them from “curing” their coverage during the 90-day period.

What is the main reason Californians are being disenrolled from Medi-Cal?

A small portion of Medi-Cal disenrollments have been because enrollees were determined to no longer be eligible, for reasons such as higher household income. The vast majority (87%) of Medi-Cal disenrollments have been due to procedural reasons.

What are “procedural reasons”?

Procedural reasons refer to being disenrolled for reasons other than being determined ineligible. Examples of procedural reasons include paperwork not being received by the county Medi-Cal office on time or paperwork missing required information or proof.

Some people may not return their renewal paperwork because they already know they are ineligible or they don’t want Medi-Cal coverage; others may not have received the renewal packet, may not understand what is being requested, or may not be able to get the answers or support needed to complete the information by the deadline.

Californians who have been disenrolled for procedural reasons — some 440,000 to date — may still be Medi-Cal eligible.

Who is being disenrolled? Are any groups being disenrolled at disproportionate rates?

Some data are missing, but the available self-reported data on the age, race and ethnicity, and language of the Californians disenrolled to date are shown below. (The data are also available for download below.) A separate important question is whether any groups are being disenrolled at disproportionately high rates, compared to their representation among the renewals due each month. To date, the available statewide data suggest that:

• Nonsenior adults are being disenrolled at a somewhat disproportionately high rate.
• Californians 65 and older and those who qualify for Medi-Cal based on a disability or being over age 65 or both (called “non-MAGI”) are being disenrolled at a disproportionately high rate. The ex parte rate, explained below, sheds further light on this.

What is the ex parte rate, and why is it important?

To renew enrollees’ Medicaid coverage, states are required to first attempt to confirm ongoing eligibility using information they have available without requiring additional information from the enrollee (e.g., looking at wage data from state sources). This is called ex parte renewal and is designed to reduce the burden on the consumer and streamline the renewal process. The percentage of California’s redeterminations completed using ex parte over the last three months has increased from 27% to 35%, meaning a greater share of renewals due are being done via ex parte — a positive trend.

Data to date show that adults 65 years and older and those qualifying for Medi-Cal based on having a disability (non-MAGI) are less likely to be renewed via ex parte, meaning they are more likely to have the additional burden of submitting information to renew, potentially leading to procedural disenrollment. California has recently adopted new policies to further streamline redeterminations for this population and automate ex parte. The impact of these improvements is not yet reflected in the data but should show up in the months ahead.

Data also show ex parte renewals being disproportionately low among Spanish-speaking and Latino/x enrollees. This merits further investigation; one barrier may be that the process relies heavily on data sources that advantage those with established credit histories, thereby excluding many immigrants.

Going Forward

In the months ahead, it will be important to watch the key metrics identified here, as well as to monitor county-level data. The data to date point to the need for continued and more aggressive action to help Californians maintain coverage, including more targeted strategic outreach and support for groups being disproportionately disenrolled. Check back here for updates.

The author acknowledges the State Health Access Data Assistance Center for its analysis of the DHCS data.

Notes

1. Medi-Cal COVID-19 Public Health Emergency and Continuous Coverage Operational Unwinding Plan (PDF), DHCS, September 18, 2023. ︎
2. Department of Health Care Services (DHCS) Continuous Coverage Unwinding Dashboard (PDF), DHCS, May 2023. ︎

Authors & Contributors

Amy Adams

Senior Program Officer, Improving Access

Learn more about Amy Adams

The post Key Takeaways from Medi-Cal Redetermination Data 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.

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.

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.

View the Fact Sheets

As of April 2025, Congress is considering large-scale federal cuts to programs that include Medicaid (called Medi-Cal in California). As this debate continues, it’s important to consider the vital role Medi-Cal plays in financially supporting the state’s hospitals.

In 2023 (the most recent data available), Medi-Cal patients made up 37% of all visits to general acute care hospitals in California. Medi-Cal paid these hospitals a total of $39 billion, which constituted about 30% of hospitals’ net patient revenue. These metrics are one way to help gauge how financially reliant hospitals are on the program.

The three fact sheets available on this page apply the same metrics to hospitals in three parts of the state: Congressional District (CD) 40, located in Orange County; CD 41, part of the Inland Empire region; and CD 22 in the Central Valley.

• CD-40 key facts:
  • Medi-Cal enrollees: 157,262 (21% of all residents)
  • Medi-Cal hospital visits: 142,383 (23% of all visits)
  • Hospital net patient revenue from Medi-Cal (all hospitals combined): $213 million (14% of all net patient revenue)
  • Hospital most reliant on Medi-Cal: Healthbridge Children’s Hospital (89% of net patient revenue from Medi-Cal)
• CD-41 key facts:
  • Medi-Cal enrollees: 256,180 (34% of all residents)
  • Medi-Cal hospital visits: 190,137 (33% of all visits)
  • Hospital net patient revenue from Medi-Cal (all hospitals combined): $460 million (19% of all net patient revenue)
  • Hospital most reliant on Medi-Cal: Menifee Global Medical Center (54% of net patient revenue from Medi-Cal)
• CD-22 key facts:
  • Medi-Cal enrollees: 521,192 (67% of all residents)
  • Medi-Cal hospital visits: 207,639 (46% of all visits)
  • Hospital net patient revenue from Medi-Cal (all hospitals combined): $820 million (50% of all net patient revenue)
  • Hospital most reliant on Medi-Cal: Kern Medical Hospital (72% of net patient revenue from Medi-Cal)

Explore the fact sheets for more data and information from the three congressional districts.

The post How Vital Are Medi-Cal Payments to Hospitals in CA Congressional Districts 22, 40 & 41? appeared first on California Health Care Foundation.

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.

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.

In March 2025, NORC at the University of Chicago fielded a 12-question poll among a representative sample of Californians in three congressional districts (22, 40, and 41) to assess attitudes about Medi-Cal, Covered California, and possible reductions to federal funding for both programs.

Key findings from CD-22 include the following:

• Strong bipartisan agreement on the importance of Medi-Cal.
  • Over 90% of Independents and Republicans, and 100% of Democrats, say that Medi-Cal is important to the state.
  • About 90% of Democrats, Independents, and Republicans consider Medi-Cal “personally important” to them or their families.
  • Eighty-two (82%) of all residents, including over 80% across all political affiliations, report that they or a family member have received Medi-Cal services.
• Strong bipartisan opposition to federal cuts.
  • Close to 8 in 10 (79%) Democrats, 68% of Independents, and 69% of Republicans oppose reductions in federal Medi-Cal funding.
• Widespread anxiety about Medi-Cal’s future.
  • Close to three-quarters (73%) of residents are concerned that future Medi-Cal enrollees may not receive the same benefits available today.

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.

As a physician, I have witnessed patients struggle with health issues caused or complicated by housing instability. It is terribly distressing to see a patient who could potentially live a healthy life encounter persistent structural obstacles to regaining a safe and reliable place to live.  

On March 12, I had the privilege of moderating a CHCF briefing that brought together leaders from California state government and providers of health care and social services to discuss how Medi-Cal’s three housing Community Supports are addressing homelessness. The “housing trio” — housing transition navigation services, housing deposits, and housing tenancy and sustaining services — were developed through Medi-Cal’s CalAIM initiative; they are designed to bring a more integrated and people-centered approach to caring for people with the most complex health and social needs, including those experiencing homelessness.  

More than 100 people attended in person at the Department of Health Care Services (DHCS) auditorium in Sacramento, and 650 more watched the live webcast. This strong attendance underscored the urgency and importance of the homelessness problem to our state. You can watch the complete video replay on our website.  

The Intersection of Health and Housing

Margot Kushel, MD, director of the Benioff Homelessness and Housing Initiative at UCSF, opened the briefing with insights from the California Statewide Study of People Experiencing Homelessness. She highlighted the ways that homelessness combines with physical and behavioral health problems to create a vicious cycle: Health issues increase the risk of homelessness, and living unhoused worsens health through exposure to trauma, sleep deprivation, environmental hazards, and impeded access to care. 

Kushel emphasized that the right interventions at the right time can prevent, mitigate, or end homelessness. While many will eventually resolve their housing situation independently, strategic support can dramatically reduce the duration of homelessness from years to months or even weeks. 

Cross-Sector Collaboration Breaks Down Barriers

The heart of the briefing was a panel discussion that started with the elephant in the room: how DHCS is thinking about the future of CalAIM in the face of federal uncertainties. 

Susan Philip, MPP, the DHCS deputy director of health care delivery systems, was crystal clear in her response. “As a state, as a department, we are fully committed to Community Supports and the scaling of them. We’re not going to speculate what the federal government might do, but … just to reiterate … we are fully committed. As [DHCS] Director Michelle Baass likes to say, ‘We are pedal to the metal on this.’”  

The panel discussion revealed both the challenges and the promising solutions that have emerged through the CalAIM initiative and the housing Community Supports. 

Cheryl Winter, MPH, associate director of California state policy at the Corporation for Supportive Housing, highlighted a fundamental challenge: Housing and health care organizations operate in different worlds with different languages, systems, and, crucially, funding mechanisms.  

“Homeless and housing service providers are having to enter into a new and very complex system of care, moving from a grant-funded system where you’re receiving funding up front, and you serve as many people as you possibly can, to one where you submit the data and reports and receive payment 30 to 90 days after services are provided,” Winter said. This misalignment creates significant cash flow challenges for community-based organizations (CBOs) trying to provide housing supports. 

Philip pointed to the emergence of “flex pools” as a promising strategy.  

“These local administrative entities braid together different funding streams to address cash flow problems,” Philip said. “They’re helping housing providers cover immediate costs like deposits and transitional rent that would otherwise be impossible under traditional Medi-Cal reimbursement timelines.” 

She added that administrative “hubs” are becoming critical intermediaries between CBOs and Medi-Cal managed care plans. These hubs handle the complex claims and invoicing processes so that each community-based organization doesn’t have to become a Medi-Cal billing expert overnight, she said. “That way, the CBO can focus on the bread and butter of actually serving the Medi-Cal members, and the administrative hub can work with the managed care plans on billing,” Philip said. 

The Housing Supply Challenge

Even with these innovations, there simply aren’t enough affordable units available for people with low incomes. 

“There are tens of thousands of people now receiving housing transition navigation services through Medi-Cal, which is incredible,” Winter said. “But providers have nowhere to navigate them to. This impacts everyone — the member, the providers, and the plans.” 

This reality resonated deeply with me. During my years practicing alongside Kushel at San Francisco General Hospital, we often wished we could write a “prescription for housing.” Today, through CalAIM, we’re closer to that reality. But unless the underlying housing shortage is addressed, our efforts will fall short. 

Expanding the Housing Support Toolkit

Philip detailed how DHCS has strengthened its commitment to whole-person care through CalAIM. “We know that housing stability is crucial for health and well-being, directly impacting physical, mental, and behavioral health,” she said. 

Beyond the initial trio of housing Community Supports, DHCS now offers these housing supports: recuperative care and short-term post-hospitalization housing. In December, the department began covering six months’ rent for unhoused people with complex health needs or transitioning out of a treatment, detention, or shelter facility. 

Setting Ambitious Goals Through Interagency Collaboration

Dhakshike Wickrema, MCP, the deputy secretary of homelessness at the California Business, Consumer Services and Housing Agency (BCSH), shared how the California Interagency Council on Homelessness is coordinating efforts across state departments and agencies. 

Its Action Plan for Preventing and Ending Homelessness in California has a goal of increasing the percentage of people experiencing homelessness who move into permanent housing from 18% a year to at least 60% annually over three years. 

“That’s an ambitious goal, but it’s the way we want to make sure every state agency and every state department is thinking about how to help people exit unhoused situations to permanent housing situations,” said Wickrema. “Those are places where there’s a sense of stability, a sense of dignity, where people can really take care of their health and be reunited with family and friends if that’s something they want to do, but really use CalAIM and other resources to turn that chapter in their lives.” 

This cross-sector approach is showing promising results. According to the statewide Homeless Data Integration System, about 63,000 people moved from homelessness into permanent housing in 2024. Philip noted that a forthcoming RAND/UCLA study will provide more comprehensive data on outcomes for individuals receiving housing Community Supports, including emergency department use and total cost of care. 

Audience Questions

From there, we invited audience questions, but unsurprisingly we could not get to all of them in the time remaining. Here are my responses to some additional questions from the Zoom audience that weren’t addressed at the briefing.  

Q: In Santa Barbara County, we have many providers of services. What is challenging is that to coordinate care holistically, it’s hard to link efforts. Any suggestions about how to make this work more seamlessly? 

A: This is a great question. Effective cross-sector partnerships are the cornerstone of work to improve outcomes for people experiencing homelessness. Coordination and collaboration take planning and care. A two-year, CHCF-funded project focused explicitly on bringing together partners from the health care and homelessness sectors, and it recently concluded. This brief captures lessons from that initiative. Here are a few takeaways:  

• Don’t just talk, do something! Come up with a project that would benefit from cross-sector engagement, and don’t let development of a perfect plan keep you from getting started. Our teams found that it’s better to get going, learn from doing, and adapt as needed rather than risk “analysis paralysis.” 
• “Boundary crossers,” the people who work in one sector and then move to work in another, play a crucial role in facilitating relationship development and progress between collaborating sectors.  
• Engaging people experiencing homelessness and/or those with lived experience of homelessness offers valuable insights that can inform the development of programs that will impact them and their community. 

Beyond these insights, communities in California can use resources that are available to support cross-sector collaboration. For example, the Providing Access and Transforming Health (PATH) Technical Assistance Marketplace offers free resources and technical support to help organizations implement Enhanced Care Management and Community Supports.  

Q: Each county in California has a different managed care plan assigned, and the individual counties often manage their own version of Medi-Cal. There is no data sharing within the county and plans. Often unhoused folks move from county to county, which poses a problem. How would you advise the plans to support these efforts? 

A: Although Medi-Cal is a statewide program, each of California’s 58 counties separately administers the program for most residents who live within that county. When someone moves to a new county and wants their Medi-Cal to continue, they need to ask for an “inter-county transfer.” The transfer process can be especially complicated for people experiencing homelessness. 

In that vein, we supported Homebase and the Western Center on Law and Poverty to create a practical guide, Moving with Medi-Cal: Inter-County Transfers.  

The Pathway Forward: Integration and Collaboration

A clear consensus emerged from our discussion at this briefing: No single sector can solve homelessness. The health care system brings valuable skills in assessment and individualized care planning. Housing experts understand the complex landscape of affordable housing resources. Government agencies provide crucial funding and policy frameworks.  

Only by working together can we create lasting solutions. 

The integration of Medi-Cal housing supports was a significant step forward in California’s approach to homelessness, which recognizes that health and housing are inextricably linked. While challenges remain, particularly around housing supply and cross-sector coordination, the innovations give us reason to be hopeful. 

As I reflect on the rich discussion at our briefing, I’m reminded that behind every statistic is a person deserving of dignity, health, and a place to call home. By breaking down walls between health care, housing, and social services, we’re building a more compassionate and effective system for Californians experiencing homelessness. The journey ahead is long, but partnerships forming today are laying the groundwork for effective and meaningful change. 

Authors & Contributors

Michelle Schneidermann

Director, People-Centered Care

Learn more about Michelle Schneidermann

José Luis Villegas

Independent photojournalist

José Luis Villegas is a freelance photojournalist based in Sacramento, California, where he does editorial and commercial work. He has coauthored three books on Latino/x baseball. His work appears in the Ken Burns documentary The 10th Inning and in the ¡Pleibol! exhibition that debuted at the Smithsonian Institution’s National Museum of American History and has been appearing at museums around the country.

Villegas’s work has been exhibited at the Museum of Fine Arts-Houston; the Baseball Hall of Fame in Cooperstown, New York; and at the Oakland Museum of California. Villegas also works as a medical photographer at Shriners Hospital in Sacramento.

The post How Medi-Cal Is Tackling Homelessness Through Innovative Housing Solutions appeared first on California Health Care Foundation.

Faced with $880 billion in possible federal budget cuts to the nation’s Medicaid program, communities in the Central Valley are bracing for a health care crisis that could destabilize access to medical care for many residents. In some areas, nearly two-thirds of the population is enrolled in Medi-Cal, and local health providers and families are warning policymakers about the implications of reduced access to essential medical services. For safety-net hospitals struggling to stay afloat and families living in fear for the well-being of their loved ones, the stakes are sky-high.  

More than 2.2 million Medi-Cal enrollees live in the agriculture-dominated Central Valley from San Joaquin County south to Kern County. Spending cuts would perhaps be felt most deeply in Kern and Tulare Counties, where up to two-thirds of residents are enrolled in Medi-Cal. Medi-Cal participation in Kern and Tulare far exceeds the statewide Medi-Cal enrollment rate of one in three Californians, according to the UC Berkeley Labor Center. 

“It is gut-wrenching, infuriating, and deeply alarming to consider what this area will look like if these cuts go through,” said Matthew Beare, MD, a physician with the Bakersfield health center of Clinica Sierra Vista, a Federally Qualified Health Center system. “The consequences of losing access to health care would be devastating, affecting friends, coworkers, families, and neighbors. Beyond the human cost, the economic impact will be enormous, as hospitals and clinic systems that are specifically structured to care for Medicaid recipients will be thrown into financial instability.” 

Patient Angst, Safety-Net Hospitals at Risk

Donna Hefner, RN, MSHS, the president and CEO of Sierra View Medical Center in Porterville, is also concerned about how the cuts would affect the 167-bed, full-service acute care facility. “We consider ourselves a safety-net hospital, which means we operate on very slim margins,” Hefner said. More than 41% of Sierra View’s patients are covered by Medi-Cal, according to a CHCF analysis of data from the California Department of Health Care Access and Information. Hefner, a native of the area who has worked in health care for three decades, says in the last 11 years she has witnessed a substantial increase in Medi-Cal enrollment among Central Valley residents and a sharp reduction in uninsured people paying for their own services and running up medical debt.  

“The reduction in self-pay that’s happened over the last several years has been positive both for the hospital and for the health of the patients,” said Hefner. “If the number of people covered by Medi-Cal decreases, it would have a negative impact on the hospital and on people’s health.”  

In 2008, Elaine Berg, a mother of three adult children, returned to her hometown of Bakersfield, California, to help provide end-of-life care for her elderly mother. That effort lasted 11 years and wiped out Berg’s savings. Now Berg is 65 years old, enrolled in both Medicare and Medi-Cal, and caring for her 45-year-old son, Alpha Omega “Poppy” Stewart. He was born with Down syndrome and is covered by Medi-Cal. 

Berg, who once owned two Ventura County facilities for the developmentally disabled, said national discussion of Medicaid spending cuts over the next decade has filled her with angst. “I’ve never in my lifetime worried that the most vulnerable people in the US would not be taken care of until now,” she said.  

Reductions in Primary Care Workforce

Clinica Sierra Vista, one of the nation’s largest community health centers, provides hundreds of thousands of medical visits a year and employs more than 1,500 people. The organization hires staff from the community, said CEO Olga Meave, MD. “With cuts, there’s no doubt that the health care workforce here will have to be reduced,” she said. The community faces the risk of extensive job loss, but it’s the patients who are of greatest concern to Meave. “If cuts mean we are only able to serve half of the patients we currently see, what happens to the other half?” she said. “Do they just show up at the emergency room? Our hospitals can’t take up the slack, and they shouldn’t be expected to.”  

Area hospitals Adventist Health, Dignity Health, Kern Valley Healthcare, Good Samaritan Hospital-Bakersfield, and Mercy Hospital attribute 25% to 69% of net patient revenue to Medi-Cal reimbursement, according to the CHCF analysis of state data. And 75% of the patients of Valley Children’s Healthcare, a network of eight pediatric specialty and primary care clinic facilities serving more than 1.3 million children in the Central Valley, are covered by Medi-Cal, according to spokesperson Rob Segura. Medi-Cal is “a critical program for Valley Children’s, our patients, and their families,” said Segura.  

The Central Valley is a major force in California agriculture and a critical link in American food production. Almonds, pistachios, grapes, citrus, carrots, lettuce, and tomatoes are among the area’s top commodities. Central Valley companies that farm and process these and many other crops for national and international distribution are highly dependent on the labor of healthy and able-bodied Medi-Cal enrollees to get the work done.  

‘We Deserve to Be Able to Live’

Berg is deeply worried about whether reductions in Medi-Cal spending could threaten the availability of covered services to her family. Stewart is awaiting foot surgery, and Berg fears Medi-Cal might discontinue coverage for his podiatric care and other needed treatments. She also has her own chronic medical conditions whose management requires unfettered access to checkups and prescription medications.  

Serious consideration of dramatic Medi-Cal cuts implies that she and Stewart are not worthy of being supported by society, she said.  

Berg said her son is active at Bakersfield’s St. Paul’s Episcopal Church and is known in the community for collecting donations for “Poppy’s bags” — brightly colored knapsacks filled with food, socks, and hygiene products for unhoused people. The two also are involved in pet rescue and adoption efforts in the Central Valley.  

“I get the sense that some politicians believe that if you’re on Medi-Cal, you aren’t valuable and that you don’t deserve medical care,” she said. “But we are valuable, and we deserve to be able to live.” 

Authors & Contributors

Victoria Clayton

Independent Journalist

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.

See more

Adam Perez, MS

Independent director and photographer

Adam Perez is an independent director and photographer born and raised in California’s rural Central Valley. His work spans genres and mediums — all rooted in intimate storytelling. The Emerson Collective, The Center for Cultural Power, The California Arts Council, and the Academy of Arts and Sciences have supported his work about farmworker communities.

His work has been featured in The New York Times, the Los Angeles Times, The New Yorker, TIME magazine, CNN, and NBC and has spanned the US and Latin America. He has also produced national campaigns for the ACLU, Apple, Airbnb, and AT&T.

See more

The post Kern, Tulare Counties Brace for Crisis Caused by Possible Medi-Cal Cuts appeared first on California Health Care Foundation.

It happens to lots of people during their working lives: Your body just can’t do it anymore. You need rest, recuperation, maybe physical therapy, or even surgery before you can resume your place on the assembly line, at the hospital bedside, in the driver’s seat, or bending over a hot stove.  

That’s what happened to Melissa Hamilton. Last November, she was working as a server at a restaurant near Redding in California’s Shasta County. Her hands gave out from carrying heavy plates to and from the kitchen. “The pain went up through the roof,” she remembers. She went to a local emergency room.  

At the time, she didn’t have health insurance or a primary care provider. After some back and forth, she was enrolled for Medi-Cal benefits through Partnership HealthPlan. The Federally Qualified Health Center (FQHC) where she is now being seen and treated, Shasta Community Health Center, serves some of the highest-risk populations in the state. At this FQHC, 82% of all patient visits are paid for by Medi-Cal, California’s Medicaid program, accounting for 60% of the center’s revenue. 

‘It Would Cut Both Our Bread and Our Butter’

People like Hamilton and clinics like Shasta Health are at particularly high risk if Congress follows through on its plans to make $880 billion in cuts to the Medicaid program over the next decade. The cuts being discussed “would impact our ability to provide quality care for this patient population,” said Darrick Nelson, MD, Shasta Health’s chief medical officer. “Generally, all FQHCs are on shoestring budgets as it is. It would cut both our bread and our butter.”  

He worries about many groups of patients, such as people with low incomes between 18 and 65 years old whose Medicaid eligibility was created by the Affordable Care Act. That’s the category Melissa Hamilton falls into. At 49, she’s worked her entire adult life but had never qualified for Medicaid until recently. “If you make $2,000 a month, that is too much,” she said. Now that she’s working 25 hours a week as a vendor at Costco and is living in a shelter, she meets the eligibility requirements.  

At Shasta Health, Hamilton has a regular doctor she likes. She gets physical therapy, an orthopedic consult, and lab work. “They are overall looking at my health, trying to get me back to a manageable pain level. If I did not have the continuum of care, I do not know what I would do,” she said.  

27,000 Square Miles of Mostly Wilderness

California’s First Congressional District encompasses 27,000 square miles of remote territory stretching from north of the Sacramento airport all the way up to the Oregon border and from Mount Shasta in the west to Nevada in the east. It includes the upper part of the Central Valley and mountainous national forest regions. While Chico and Redding are the district’s largest cities, the population density in those places is very low, and the lifestyle is rural.  

“Where I live is like the West Virginia of California,” said Jo Campbell, LCSW, the CEO of Hill Country Community Clinic in Round Mountain, California, population 160. The FQHC is 35 miles up a winding road northeast of Redding. “The majority of my patients are at or below poverty level.”  

Of the 760,000 people who live in District One, 327,000, or 43%, are covered by Medi-Cal. The area has one of the highest rates of Medicaid participation of any congressional district in the nation. In California only a handful of districts in the Central Valley and the Inland Empire are more reliant on Medi-Cal. 

‘The Sickest Area in All of California’

Hill Country Community Clinic serves 8,000 patients and records 40,000 visits a year. It employs 180 people at seven locations and has an annual budget of $22 million, including grant funding. It offers full medical and dental services and a “quite robust” behavioral health program that is fully integrated with primary care. People have 24-hour access to mobile urgent mental health care. Medicare and Medi-Cal together account for 75% of the FQHC’s revenue.  

People in this congressional district, Campbell said, “have limited resources. They have all the disproportionate outcomes related to lack of access to opportunity. There is a lot of trauma and poverty. We are the sickest area in all of California. We have the worst health outcomes and a low vaccination rate.” 

A key indicator of the headwind that hinders the progress of local residents is the region’s Adverse Childhood Experiences (ACE) scores, she said. ACE numbers are a measure of childhood trauma that predict the future local prevalence of adult chronic conditions. A score of four or higher suggests greater likelihood of heart disease, cancer, metabolic disease, substance abuse, and mental health problems, Campbell said. The average score in California is two; in Shasta County it is five.  

What would happen at her clinic if the Medi-Cal funding got cut? “If I am going to lose 30% of my revenue, I will have to make a 30% reduction” in the staffing and services that are available for patient care, Campbell said.  

Fragile Rural Health System

“We are very worried about the long-term impact of these cuts,” said Sonja Bjork, JD, the CEO of Partnership HealthPlan. “What it will do to provider networks; what it means to access to care, especially primary care; what it will do to the chronically ill and infirm; what it means for hospitals and their employees.”

Partnership is the Medi-Cal health plan for 279,000 people in the congressional district, of whom 54,000 are seniors with low incomes or people with disabilities. It also employs 1,400 people there. “We are very familiar with how fragile the health delivery system is in the rural areas,” said Bjork. “The hospitals, providers, and doctors rely on Medi-Cal. That is a big portion of their payer mix, their income. If there are major cuts, that is going to really destabilize some providers.” 

Bjork thinks deep funding cuts may turn out to be hospital killers. Rural, critical access hospitals are already on the ropes in many parts of the country. This could finish them off.  

One Emergency Bed

One such institution is Surprise Valley Community Hospital in Cedarville (population 437), operated by the Surprise Valley Health Care District. It serves a string of isolated hamlets squeezed between the South Warner Wilderness and the Nevada border. This hospital has one emergency bed, four acute beds, and 22 long-term care beds. It has 75 employees and operates on an annual budget of $10 million. It is the smallest hospital in California. 

“If they cut Medicaid, it would be devastating to our facilities,” said Frances Hannah, the CEO and administrator. “I have already cut out physicians. Myself, the administrator, I can draw blood. I drive the ambulance. My ambulance coordinator is also infection control. We are down to the bare minimum of services we can offer.” 

If the hospital closes — a real possibility, Hannah said, if the budget cuts go through — the next closest hospital would be Modoc Medical Center, which is just 23 miles away but is only accessible via a mountain road that traverses an elevation of 7,000 feet and is often impassable because of winter snow. Accessing a higher level of care entails driving five hours or using a medical airlift, she said. An average 52-mile domestic ambulance flight can cost uninsured or privately insured patients well over $12,000 depending on the circumstances, according to the National Association of Insurance Commissioners.  

While health care leaders are worried about the effects of these Medi-Cal budget cuts, the general public has yet to grasp the severity of what is at stake. Part of the issue is confusion around the nomenclature of health care itself.  

“Up here, what we see, people come, they say, ‘I have my insurance, it’s Partnership,’” said Brandon Thornock, MHA, CEO of Shasta Health. “A lot of people don’t connect the dots: Partnership is Medi-Cal, Medi-Cal is Medicaid. Medicaid is what they’re talking about cutting at the federal level. If they cut Medicaid, it’s going to affect your health care.” 

Authors & Contributors

J. Duncan Moore Jr.

Freelance author

J. Duncan Moore Jr. is a freelance writer based in Kansas City, Missouri, who has been writing about health care for more than 25 years. He is a founder of the Association of Health Care Journalists.

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