Tag: Medicaid Reform

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[MM Curator Summary]: CMS is allowing CA to spend Medicaid dollars on inmates 90 days before release.

 
 

Clipped from: https://www.nhregister.com/news/article/california-prison-inmates-to-get-some-medicaid-17744646.php

 
 

WASHINGTON (AP) — The federal government will allow Medicaid dollars to treat some people in prisons, jails or juvenile detention centers for the first time ever, the Centers for Medicare and Medicaid Services announced Thursday.

CMS will allow California inmates to access limited services, including substance use treatment and mental health diagnoses, 90 days before being released. Since Medicaid was established, federal law has prohibited Medicaid money from being used for people who are in custody, with inmates having access to their health care coverage suspended.

The move will provide more stability for inmates and juvenile detainees as they exit institutions and reenter the outside world, CMS administrator Chiquita Brooks-LaSure said Thursday.

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She said the change will allow the state to “make unprecedented advancements for incarcerated individuals who have long been underserved.”

At least 10 other states have asked CMS for exemptions to use Medicaid dollars to treat inmates before they are being released. California could be a model for those states, especially since the program is new territory for Medicaid and is expected to be a massive undertaking, said Vikki Wachino, who oversees the Health and Reentry Project.

California state officials said Thursday that they hope some inmates will begin accessing services through Medicaid starting in 2024. Incarcerated people will be screened and assessed for eligibility to access the state’s Medicaid program. If eligible, case workers will help them develop a care plan for reentry.

It will take at least two years to roll out the program in all the state’s prisons, said Jacey Cooper, the state’s Medicaid director.

Millions of people are expected to be affected, with California releasing nearly half a million inmates from state prisons or county jails every year and roughly 80% of those people qualifying for Medicaid.

People who are leaving prison, jail or juvenile detention often don’t know where to start with getting medical care, Wachino said.

“Right now, there is an enormous barrier to care when people leave prison and jail,” Wachino said. “As you know, many times when they’re released, they’ve been left to fend for themselves, with very, very few supports.”

___

This story was first published on Jan. 26, 2023. It was updated on Jan. 27, 2023, to delete an incorrect reference to the Health and Reentry Project being at the Commonwealth Fund. The project is not at the Commonwealth Fund.

MM Curator summary

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[MM Curator Summary]: SD lawmakers are inspired by GA’s recent win.

 
 

Clipped from: https://www.dglobe.com/news/south-dakota/medicaid-work-requirement-proposal-passes-south-dakota-house-committee

A resolution looking to allow the legislature to consider work requirements on the newly expanded Medicaid program is one step closer to the 2024 ballot.

 
 

PIERRE, S.D. — An effort to allow South Dakota to consider work requirements on “able-bodied” members of the newly expanded Medicaid program in the state passed its first legislative hurdle by an 11-2 party-line vote at a House State Affairs hearing on Jan. 30.

While opponents relayed concerns about the implementation of work requirements and the supposed inefficacy of similar experiments in other states, Rep. Tony Venhuizen, a Republican from Sioux Falls, said he brought the amendment as a way to begin a work requirement conversation currently prohibited by the language of the Medicaid constitutional amendment passed by voters last year.

“The costs of administering it would likely be outweighed by the savings we would see by incentivizing work,” he told the committee. “But again, I don’t want to get too far into the detail of how this would be implemented because we are several steps away from that.”

As written, the proposed amendment would make an exception to the Medicaid constitutional language — which says the state “may not impose greater or additional burdens or restrictions” on those newly eligible for the Medicaid expansion program — allowing the legislature to consider imposing work requirements on “any person, under this section, who is able-bodied.”

The proposal to offer voters an opportunity to impose work requirements on able-bodied individuals carries the support of 30 lawmakers.

The legislature can refer ballot measures and amendments to voters with a majority vote in each chamber. Were Venhuizen’s proposal to succeed this session, it would go onto the ballot in the 2024 general election.

The Medicaid program, as it currently stands in the state, is a federal-state cost-share health care program available to children, low-income families and disabled adults.

However, upon the successful expansion of Medicaid last election, the eligible population grew, raising the eligible income levels for low-income families and allowing any adult under 138.5% of the federal poverty line to access the program.

Unlike the populations that Medicaid traditionally serves, Venhuizen argued, many in the expanded population are able to work.

Still, opponents to the proposal, many of them representing health care organizations in the state, expressed concern that the definition of “able-bodied” in the relatively general amendment offered by Venhuizen could have negative consequences.

“I think the lack of definition around the word able bodied [is a concern.] We saw this in North Dakota actually a lot when I was spending some time up there with the legislature, folks that deal with mental health issues,” said Tim Rave, the executive director of the South Dakota Association of Healthcare Organizations. “They’re probably physically able to work if that was the definition, but the challenges that they’re having with their mental health problems could be prohibiting them from being active in employment.“

Other opposing arguments cited research from Arkansas that work requirements created “substantial coverage loss” among expanded populations and the infeasibility of implementation due to federal opposition.

While the Biden administration has struck down work requirements in every case — as Medicaid is a program with federal oversight and states must seek approval to change certain rules — Venhuizen noted that 13 states imposed these requirements under the Trump administration, and nine more, including South Dakota, pending approval.

“I do think it’s fair to assume that, if there’s a change in administration, this could be back on the table,” he said.

Venhuizen and the members of the committee in favor of moving the proposal to the House floor argued that several of the points brought up by the opposition were well-founded; however, he argued that giving the legislature the option to discuss the proposal would be the better venue for discussing the specifics.

“I thought that line of argument raised an important concern,” Venhuizen said, specifically referencing a point raised about the seasonal nature of parts of the state economy. “I can see arguments on both sides, but that’s exactly the kind of thing we should be thinking about [as a legislature.] It’s a little concerning to me that the Medicaid amendment in its current form makes that decision for us.”

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[MM Curator Summary]: Indiana lawmakers are positioning to tighten up SNAP spending.

 
 

Clipped from: https://www.iowapublicradio.org/state-government-news/2023-01-26/iowa-house-panel-advances-snap-bill-medicaid

 
 

Republicans on a House panel advanced a bill Thursday that would change who can qualify for food and medical assistance in Iowa.

It would establish new limits on assets Iowans could hold while receiving food assistance, known as SNAP. Under the bill, the state would also ask the federal government for permission to enforce work requirements for some Medicaid recipients. And the bill would direct the state to do additional verification of Iowans’ eligibility for SNAP and Medicaid.

Republicans on the panel said the House Health and Human Services Committee would be working on changes to the bill in the coming weeks, which would include seeking federal permission to ban the use of SNAP benefits to buy candy and soda.

Supporters of the bill say it will ensure taxpayer dollars are only spent on people who truly need the help.

A wide range of groups that advocate for low-income Iowans, people with disabilities, children, and health care organizations oppose the bill. They say people who need help with food and medical care could lose their benefits if the bill becomes law.

Journey Berzett of Urbandale told lawmakers she has a disability and relies on SNAP to buy food. She asked them to consider people like her.

“To you, I’m a stranger. You think people like me are probably the one exception who is worthy of these entitlement programs,” Berzett said. “Or maybe you don’t. Maybe you think the right to life, liberty and the pursuit of happiness only applies to those who can afford it. What I do know is that community is about coming together and helping each other, and this bill does not do that.”

Tyler Raygor, a lobbyist for Americans for Prosperity, said he supports the bill because public assistance should be narrowly tailored.

“We think it’s important to remember we’re dealing with finite taxpayer dollars,” Raygor said. “When you have folks on these programs who don’t need them, that puts these programs in jeopardy for folks who truly do need them, like folks that we’ve heard from today.”

Only two other groups publicly support the bill. One is the Opportunity Solutions Project, a group associated with a conservative think tank based in Florida called the Foundation for Government Accountability. The organization has been pushing for public assistance asset tests and Medicaid work requirements in Iowa for years. The other is Iowans for Tax Relief.

Lina Tucker Reinders, the executive director of the Iowa Public Health Association, said she is very concerned about the proposed asset test. She said SNAP is a tool people can use to pull themselves out of poverty.

“When people are using the other tools available to them to do things like save for a down payment for a home to move to a neighborhood for their children, to save money in a 529 plan for their kids’ college—things that we know are effective in breaking generational poverty—it creates a cliff effect,” she said. “And so they’re punished for doing those things that they’re told are the right things to do to break the cycle of poverty.”

Other opponents of the bill say it could put SNAP benefits at risk for some Iowa families that have more than one car. They also raised concerns about how much it would cost the state to hire more people and get a new computer system to make more eligibility checks possible.
 

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[MM Curator Summary]: NY is looking to get a double waiver approach approved to transform how it uses IMDs to impact SUD and SMI outcomes.

 
 

Clipped from: https://bhbusiness.com/2023/01/20/why-one-state-is-pushing-back-against-medicaids-imd-exclusion/

New York state hopes to strengthen and remake state-managed behavioral health care by getting around the so-called IMD exclusion.

It’s doing so by securing federal Medicaid funds typically forbidden from covering facility-based behavioral health through its latest 1115 waiver amendment.

On Jan. 5, the Centers for Medicare & Medicaid Services (CMS) announced New York applied for a waiver to Medicaid’s now-antiquated institution for mental disease (IMD) exclusion. New York has asked for federal matching funds for Medicaid to be allowed to cover IMD services to address serious mental illness (SMI), substance use disorder (SUD) and serious emotional disturbance (SED) for adults and children.

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New York specifically is seeking matching funds to reimburse short-term inpatient, residential and other services for SMI and SUD by IMDs. The state is also applying for matching funds to help transition patients in state psychiatric facilities back to the community up to 30 days before their discharge.

“The objective of the demonstration is to transform the role of some state psychiatric inpatient facilities and [SUD] residential treatment facilities, improve care transitions and access to community-based treatment and support services, and improve health and behavioral health outcomes in individuals with chronic and/or [SMIs] by transforming selected (pilot site) state-run psychiatric hospitals, facilities, and campuses from long-term care institutions to community-based enhanced service delivery systems,” the 1115 waiver amendment proposal states.

Since the beginning of Medicaid in 1965, the Social Security Act forbade federal funds for Medicaid from covering treatment provided by facilities where 16 or more beds are dedicated to treating behavioral health issues of people aged 21 to 64.

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This move was intended to prevent states from offloading state psychiatric hospital costs on the federal government through the jointly funded and managed Medicaid program. It was also part of a political and regulatory retreat from treating behavioral health issues in large hospital-like settings, with champions of that movement including President John F. Kennedy.

The movement is sometimes referred to as deinstitutionalization.

However, some see the start of the deinstitutionalization movement as the start of the present psychiatric bed shortage, even within the federal government.

“There’s been an understanding in the past several years that this lack of federal funding contributes to high levels of unmet need,” Madeline Guth, senior policy analyst for Kaiser Family Foundation (KFF), told Behavioral Health Business. “The federal government has been providing some new mechanisms in the past few years for states to get an exception to this exclusion and get some federal financing for IMD services for non-elderly adults.”

The mechanisms, including the Medicaid 1115 waiver, allow states to secure some federal funding for certain IMD-related services.

Medicaid 1115 waivers, if approved by the federal government, allow states to experiment with different ways of implementing the Medicaid program.

There are three specific 1115 waiver benefit expansions that are related to behavioral health.

KFF, which tracks these waivers, found that 34 states have received approvals for an IMD exclusion payment exemption for SUDs. Additionally, 10 states have an exemption for mental health treatment, with 23 states having other exemptions for community-based health and behavioral health. 

Recent presidential administrations have enabled ways around the IMD exclusion through the 1115 waiver.

In July 2015, the Obama administration allowed for 1115 waivers to “develop a full continuum of care for individuals with SUD, including coverage for short-term residential treatment services not otherwise covered by Medicaid,” which included the IMD exclusion. 

The Trump administration announced in November 2019 that it approved the first-ever 1115 waiver related to IMD exclusion for SMIs and SEDs for adults and children.

Addressing the IMD exclusion did come up during the legislative work in 2022 that culminated in a sweeping behavioral health bill included in the omnibus funding bill passed just before Christmas. However, it was not included in the final bill that was signed into law on Dec. 29. 

While New York’s latest 1115 waiver application is not unprecedented, it does reflect a two-for-one application for two IMD exclusion exemptions — including both SMI and SUD funding.

Further, the New York waiver and the other waivers tracked by KFF show that states of all political leanings seek to address mental health via innovations to Medicaid.

Medicaid is the single largest payer of mental health services in the U.S. 

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[MM Curator Summary]: The state house is hearing all about designs to pilot a new program to use Medicaid funding to impact homelessness, a la HI, AZ and NY.

 
 

 
 

Clipped from: https://www.golocalprov.com/news/ri-legislators-want-to-use-medicaid-waiver-funds-to-provide-homeless-with-h

 
 

 
 

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The proposal comes after a recent multi-week protest about RI’s homelessness policies at the State House. PHOTO: Sionni

Rhode Island legislators on Tuesday introduced a proposal to create a pilot program testing the effectiveness of using Medicaid waiver funds to provide the chronically homeless with housing.

Rhode Island State Representative David Bennett and State Senator Josh Miller’s proposal (2023 H-5098), modeled after legislation in Hawaii, directs the Executive Office of Health and Human Services (EOHHS) to commission Medicaid waiver funds for a pilot program covering supportive housing services to people suffering from chronic homelessness. 

The program would provide individuals with behavioral health services, case management, personal care and assistance services, home and community-based services and housing support services. Arizona and New York have similar programs, housing thousands of chronically ill individuals and saving taxpayers in both states.

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“As an RN case manager, I’ve worked with a lot of these folks. When they don’t have a roof over their heads, it’s very hard to make sure they’re taking their medications regularly, make sure they’re going to the doctor,” said Bennett (D-Dist. 20, Warwick) who is a registered nurse who has seen the impact of housing first hand. But once they have housing, they can recover and stand on their own two feet again.”

 
 

Modeling Other States

According to the National Alliance to End Homelessness, roughly 20% of homeless individuals are defined as chronically homeless, meaning they have been homeless for at least a year and suffer from chronic and complex health conditions including mental illnesses, substance use disorders, and medical conditions. Without stable housing, they cycle in and out of emergency departments, inpatient hospital stays, psychiatric centers, detoxification programs, and jails, costing taxpayers roughly $35,000 per year as of 2017.

“The acute correlation between homelessness and adverse health conditions is a heinous reality. Unfortunately, issues tend to be aggravated since the tragedy of homelessness brings more attention to shelter than to treatment options,” said Miller (D-Dist. 28, Cranston, Providence). “Getting people into housing removes the burden of finding shelter and allows for the freedom to get connected with programs and employment opportunities, while directly engaging in the most effective preventative care mechanism we have, a roof.”

One of the biggest health costs related to homelessness is emergency room visits, said Miller, who co-chaired a 2013 Senate commission that studied ways to reduce ER visits. Homeless individuals show up to emergency rooms for many reasons. 

According to the legislators’ release, homeless individuals “often struggle to get preventive care, so regular problems may not get treatment until they become critical. Emergency rooms cannot, by law, turn anyone away for inability to pay, so homeless individuals can use them to address more mundane health issues. Sometimes, shelters are full and families just need somewhere warm to sleep.”

 
 

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[MM Curator Summary]: A new maternal care program will distribute funds to OB practices focused on bending troubling maternal mortality trends.

 
 

 
 

Clipped from: https://www.journal-news.com/community/governor-ohio-medicaid-launch-maternal-care-program/ZMPG3CKRDBHEVDEZWZTLV47HRI/

 
 

A new Comprehensive Maternal Care program has launched in Ohio and is expected to improve health outcomes for mothers, infants and their families by addressing food instability, housing options and more.

“Giving all Ohioans the best possible start at life truly begins before a child is even born and that means ensuring the child’s family has access to the resources they need,” said Ohio Gov. Mike DeWine, who collaborated on the program with Ohio Department of Medicaid Director Maureen Corcoran. “Personalized access to those supports from trusted community partners and high-quality, responsive care that focuses on patients lead to better, healthier outcomes for mothers, babies, and their families,” he said.

‘This is a baseline year’

Ohio Medicaid estimates investing $5 million in the program by the end of its first year, reaching more than 14,000 pregnant and postpartum patients and enrolling 77 medical practices currently caring for pregnant and postpartum patients.

“This is a baseline year,” said Marisa Weisel, Ohio Medicaid’s deputy director of strategic initiatives. The program provides quarterly payments to practices based on the number of Medicaid patients those practices typically serve, according to Weisel.

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The Comprehensive Maternal Care program creates a framework for providers and community partners to develop individualized plans to support women and families who’ve historically lacked ready access to high-quality, responsive care before and after pregnancy, according to the governor’s office.

“Ohio Medicaid and our vision for the ‘Next Generation’ of care commits to delivering a personal care experience to every Ohioan served,” Corcoran said, referencing Ohio Medicaid’s Next Generation managed care program. The next stage of implementation will launch on Feb. 1, which will include managed care plans.

“The (Comprehensive Maternal Care program) model builds on that commitment by encouraging providers and communities to partner on building a trustworthy and comprehensive system of care for members,” Corcoran said.

What that care looks like

The practices involved in the program may use the funds to help their patients achieve better health outcomes, as Ohio Medicaid will be monitoring them through measurements to allow those practices to track how they are doing.

“We could have a practice that decides they want to hire a community health worker with their extra resources,” Weisel said. The health worker could help patients sign up for benefits such as WIC, help them work on finding stable housing or help get women connected with the behavioral health system to deal with post-partum depression.

Weisel said post-partum depression can play a big role in the parent’s ability to care for their child. It also points to how mental health impacts maternal mortality rates. In an analysis on pregnancy-related deaths between 2017 and 2019, the Centers for Disease Control found four out of five pregnancy-related deaths could have been avoided, with 23% of those deaths being associated with mental health conditions, including deaths to suicide and overdose/poisoning related to substance use disorder.

The health practices involved in the program also must consider and link patients to resources that address broader factors of health, such as housing, food instability and transportation.

“We know that health care is not the only thing that matters,” Weisel said. “There are often other barriers to them accessing care.”

Additional support

Gina McFarlane-El, CEO of Five Rivers Health Centers, said the Comprehensive Maternal Care program will help them continue to care for their pregnant patients. Five Rivers Health Centers is the 10th largest federally-qualified health center in Ohio, seeing more than 27,000 patients a year. Of their pregnant patients, approximately 22% of them are uninsured.

In addition to health visits, McFarlane-El said Five Rivers Health Centers also supports their pregnant patients through programs like their diaper and bra banks, as well as with group visits for pregnant individuals.

“Diapers are one of those things that are not supported through any of the various funds that our women receive, so we created Montgomery County’s first diaper bank within this area through our Healthy Start program,” McFarlane-El said. “We use those resources to help women not worry about diapers.”

Cost figures vary for diapers, but the National Diaper Bank Network estimates the average monthly supply of diapers costs approximately $80 in Ohio, costing parents approximately $960 a year.

Five Rivers Health Centers also offers group prenatal care visits through the program Centering Pregnancy. Toni Tipton, a certified nurse midwife at Five Rivers Health Centers, said pregnant women can take part in group prenatal visits to allow for them to learn more and connect with other individuals whose delivery dates are similar to theirs.

“We really highly recommend it for first time moms, and it also provides social support,” Tipton said. The program is also aimed at decreasing infant mortality, while also increasing breastfeeding and immunization rates.

McFarlane-El said they will use some of the funds they receive through Ohio Medicaid’s Comprehensive Maternal Care program to support those programs and expand other efforts.

Requirements for providers

Participation in the Comprehensive Maternal Care program requires obstetrical practices to receive feedback from patients and families, such as through advisory councils or other means, which can then be used to improve patient experiences and reduce disparities.

“One thing we’ve heard, sometimes (patients) don’t feel like they’re able to communicate effectively with their provider,” said Weisel. This program then encourages those practices to get regular feedback from patients.

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Additionally, Weisel said practices must use the pregnancy risk assessment to identify women in need of a first prenatal appointment and ensure timely access to appointments and services. This assessment also helps Ohio Medicaid track pregnant individuals’ needs and maintain their Medicaid coverage while they’re pregnant and also after their pregnancy. In April of last year, Ohio Medicaid extended its coverage of benefits for new mothers from 60 days to 12 months after the birth of their child.

Additional criteria for participation includes engaging community supports, evaluating the mother’s and family’s experiences throughout the treatment, ensuring patient involvement and care continuity with their providers and assessing the practices’ operations to make sure they are achieving healthier outcomes.

MM Curator summary

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[MM Curator Summary]: Talk to the hand, expansioners (says GA rep).

 
 

Clipped from: https://www.beckerspayer.com/payer/georgia-wont-take-up-full-medicaid-expansion-anytime-soon-lawmakers-say.html

Georgia will not consider a full expansion of Medicaid in the near future, The Atlanta Journal-Constitution reported Jan. 19. 

Georgia House Speaker Jon Burns said the state instead needs to focus on Georgia Governor Brian Kemp’s proposal to expand the program, which would require adults to work at least 80 hours a month to qualify for Medicaid coverage. 

The more limited expansion is slated to begin this summer. State officials estimate it will insure around 50,000 adults. If the state fully expanded Medicaid, it would insure around 400,000 adults, The Atlanta Journal-Constitution reported. 

MM Curator summary

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[MM Curator Summary]: One of the territories now has 87% of its Medicaid costs paid for by federal taxpayers. 4-Eva.

 
 

Clipped from: https://www.saipantribune.com/index.php/nmis-83-pct-federal-match-rate-for-medicaid-is-now-permanent/

 
 

Esther Muña

Thanks to the CNMI’s health partners as well as the efforts of Delegate Gregorio Kilili C. Sablan (D-MP), the federal match rate for the CNMI’s Medicaid program will now permanently remain at the current 83%.

Commonwealth Healthcare Corp. CEO Esther Muña shared the good news during a news briefing yesterday that Sablan recently informed CHCC that the Biden administration has decided to permanently keep the federal match rate for the CNMI’s Medicaid at 83%, meaning the CNMI would only shoulder 17% of Medicaid-related costs.

“I did get a call from Congressman Sablan…that we’re getting the 83% and it’s permanent. That’s obviously great news. It’s been something that we’ve been fighting for—equitable funding financing for the territories,” she said.

Essentially, Muña said, the CNMI government would now only have to shoulder 17% of medical costs accrued by the Medicaid program. Previously, the CNMI was shouldering 50% before it was lowered to 45% and the CNMI still could not afford it.

CHCC hopes that the 17% match will prove more affordable for the CNMI as it would come from the Commonwealth’s general fund.

“The 83% is going to come from the federal [government] and the 17% is going to come from the local funds appropriated for CHCC. The reason why we opted to do this is because, in the past, we’ve always struggled to find the funds to cover our match. It used to be 50%, then our match was lowered to 45% and that obviously was still very difficult. We are hoping that now, the CNMI can afford 17%,” she said.

Muña said this is a great opportunity for CHCC to look at how it can better address health care access with the extra funding it would save with the federal government shouldering 83% of Medicaid costs.

“This is a great opportunity for us to plan better and also to really address the health issues of the CNMI and even for public health,” she said.

According to Saipan Tribune archives, the Marianas’ current 83% federal match rate, technically called the Federal Medical Assistance Percentage, or FMAP, is higher than it is for any state.

The FMAP was set in U.S. Public Law 116-94 in 2019, extended in U.S. Public Law 117-103, in a previous continuing resolution in early 2022, and again in another fiscal 2023 continuing resolution which was passed on Dec. 20, 2022.

The continuing resolution provided appropriators more time to draft an omnibus spending bill to cover the entire fiscal year which has since been passed, permanently keeping the FMAP for the CNMI at 83%.

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[MM Curator Summary]: In which the op-ed writer suggests the un-thinkable.

 
 

Clipped from: https://www.ocregister.com/2023/01/11/california-should-accept-the-federal-governments-invitation-to-trim-medi-cal-rolls/

 
 

California should accept the federal government’s invitation to trim Medi-Cal rolls

Despite tougher fiscal conditions, Governor Newsom’s January budget proposal for California misses an opportunity to take advantage of a large cost-saving opportunity other states will be leveraging in the coming months.

Since 2020, the federal government has prevented states from removing no-longer-eligible Medicaid beneficiaries from the program’s rolls. Now that this pandemic emergency measure was eliminated by the omnibus budget bill Congress passed last month. California should join other states in enforcing eligibility requirements for those receiving healthcare benefits.

Of the $297 billion in state revenues Newsom expects to spend in 2023-2024, the largest share – $102 billion – is devoted to Health and Human Services. Most of the spending in this category will take the form of provider reimbursements by the state’s Medicaid program, known as Medi-Cal.

Normally, the federal government covers 50% of Medi-Cal reimbursements for most beneficiaries. But during the COVID-19 pandemic, Congress increased the federal percentage to 56.2%, as long as the state maintained continuous coverage for everyone using the program as of early 2020 or added to the program thereafter. Now, the federal share will gradually fall back to 50% in early 2024, and the continuous coverage mandate will be removed.

According to federal data, California’s population of Medicaid beneficiaries grew from 10.3 million at the beginning of the pandemic to 12.6 million in September 2022 (the last month that data was available). An additional, 1.3 million young people are enrolled in the Children’s Health Insurance Plan, meaning that over one third of the state’s population is now covered by federal/state health programs that do not require participant contributions.

Many states plan to respond to the federal policy change by systematically reviewing all Medicaid beneficiaries to see whether they still qualify for benefits. For example, Texas has identified a cohort of 1.4 million beneficiaries that are most likely to be deemed ineligible because they have reached the age of 65 (and should instead use Medicare) or no longer have an eligible dependent child in their household. Once the state is allowed to begin disenrollments in April 2023, it plans to run electronic data matching algorithms on this cohort to determine who should be removed from the program.

California appears to have no such plan. The governor’s budget summary projects a large increase in General Fund Medi-Cal spending due to the “loss of increased federal funding consistent with the end of the federal Public Health Emergency while costs for caseload persist through the year.”

This is unfortunate because the state expects to have a $22.5 billion budget shortfall in the next fiscal year and further deficits thereafter. Rather than make meaningful cuts to balance the budget, many of Newsom’s budget balancing measures involve taking on more long term debt and shifting resources between funds.

In California, where political leaders have emphasized the need for universal health coverage, the idea of disenrolling Medi-Cal beneficiaries may seem anathema. But it is necessary to minimize wasteful and fraudulent spending. Right now, Medi-Cal is covering highly skilled workers who, after being temporarily unemployed, got high paying jobs as the economy bounced back. These individuals can afford to pay for their company’s insurance coverage. Other beneficiaries may have moved out of state or stopped participating in the program for other reasons. Unless their names are removed from the rolls, unscrupulous providers could file claims under their names.

Medi-Cal beneficiaries who are now self-employed or who hold jobs at employers that do not provide healthcare benefits are eligible to buy policies on Covered California, often with large federal insurance subsidies. So, rather than contribute nothing to the cost of their care, they might expect to pay a relatively small amount for healthcare coverage.

While enforcing eligibility rules may seem cruel, it is necessary to ensure that state resources are available for the truly needy without bankrupting taxpayers or driving them out of the state. The previous Democratic-controlled Congress has invited all states to trim their Medicaid rolls; this is an invitation that California should accept.

Marc Joffe is a federalism and state policy analyst at the Cato Institute.