The number of Californians who gained health insurance grew by 3 million people after the Affordable Care Act expanded Medi-Cal coverage in 2014 and 2015. But anticipated federal funding changes could over time force counties to shoulder more of the cost of paying for health care, or cut back enrollment and programs, according to a study by the UCLA Center for Health Policy Research.
Nearly one-third of the state’s 33 million people under the age of 65 are enrolled in the health insurance program for low-income and disabled residents known in California as Medi-Cal (or Medicaid in the rest of the United States). However, the percentage of Californians enrolled in the program varies greatly by county, as does the amount of money each county is spending on health care after that expansion, according to the study.
If the federal government acts to cap Medicaid funding to states, California counties such as San Bernardino, San Joaquin, Riverside, Placer, Mendocino, Monterey, Fresno and the Northern/Sierra region could see public health care take a bigger bite of their budgets.
Under the current version of Medi-Cal, anyone who qualifies is guaranteed benefits, and the program grows in response to increases in enrollment and health care costs. That would change under a block grant.
“The counties that had a big increase in enrollment will have a tougher time sustaining the same level of coverage because under a capped block grant, funding is at a set level,” said Shana Alex Charles, faculty associate at the center and the study’s lead author. “If you have an economic downturn and more people need Medi-Cal for health coverage, many counties will have to make a hard choice: the financial health of their county or the physical and mental health of their Medi-Cal beneficiaries.”
The study, which uses data from the California Health Interview Survey and the California State Controller's Office, contains maps as well as Medi-Cal enrollment and expenditure figures for 44 counties or county groups on:
- The percentage of residents under 65 who were enrolled during 2014-15: Fresno County had the highest proportion, 49 percent; Marin County the lowest, 10 percent.
- The percentage point change in enrollment from 2012 to 2014-2015: San Joaquin County had the highest increase, 22 percent; Madera and Yolo counties the largest declines, each down 5 percent.
- Per capita expenditures in 2015: Humboldt County had highest expense, $387 per capita; Yuba County the lowest, $79 per capita.
- The percent change in public health expenditures per capita from 2012 to 2015: Riverside County had largest increase at 39 percent; Yuba County the biggest decline, down 12 percent.