As state lawmakers propose a major expansion of Medi-Cal to help California implement President Obama's healthcare overhaul, county officials are raising concerns that the proposal could siphon critical dollars from their safety-net programs.
On Monday, legislative leaders in both houses sponsored bills that would dramatically expand the state's public insurance program. Under the proposals, individuals earning up to 138% of the federal poverty level -- or $15,415 a year -- would be covered, potentially adding more than 1 million Californians to the Medi-Cal rolls.
The federal government would subsidize costs for the first three years, phasing down to 90% afterward.
Currently, counties receive state funding to care for the uninsured. But Gov. Jerry Brown has said that if the state were to administer the Medi-Cal expansion it may reduce the roughly $2 billion it gives to counties each year to cover the new costs. In his proposed budget, the governor said the state might also shift some state responsibilities, such as child care, to counties to offset costs.
Kelly Brooks-Lindsey, a lobbyist for the California State Assn. of Counties, said counties will still be responsible to cover residents who remain uninsured even after the federal Affordable Care Act takes effect next year. For instance, if Californians miss the deadline for open enrollment in a new state-run insurance exchange, they will have to wait a year for another chance to sign up, she said.
There are also people who cannot afford insurance on the open market but make too much money to qualify for Medi-Cal.
"We need to make sure we have enough revenues to pay for whatever remaining responsibilities we have and the populations we will continue to serve," Brooks-Lindsey said.
On Monday, Assembly Speaker John A. Perez (D-Los Angeles), author of the Medi-Cal legislation in the lower house, said he was working with county officials to hammer out a compromise.
"We think that there's a way to get to an accommodation where counties will be very happy with the outcome," he said. "But this is a very complex area and we expect there to be a lot of debate in both houses of the Legislature as well as with all the stakeholders."
-- Michael J. Mishak in Sacramento