Better Understanding the Governor’s Medi-Cal Projected Budget for FY 2015-16 and 2016-17

January 15, 2016

The Medi-Cal budget for FY 2015-16 was estimated at $92 billion and the budget projected for 2016-17 is $85 billion or $7 billion less. The General Fund portion is estimated at $17.6 billion for 2015-16 and at $19 billion for FY 2016-17 or $1.4 billion more. The total reported budget does not include either local CPEs or the General Fund expenditures of other linked departments, such as Developmental Services and Social Services.

What are some of the big ticket items that we need to keep an eye on?

  1. Global Payment Program: $2.6 billion in FY 2015-16
  2. PRIME: $800 million annually
  3. Dental care augmentation in the waiver: $75 million annually
  4. Whole Person Care Pilots: $900 million in FY 2016-17
  5. Residential treatment under the waiver: $76 million in 2016-17
  6. Waiver savings from the federal match for designated state health programs: $37.5 million in General Fund annually
  7. Medicare Part B Premium Increases $205 million
  8. Capitated rate adjustment in 2016-17: $327 million
  9. Orkambi drug benefit for patients with cystic fibrosis: $39 million in FY 2016-17
  10. Managed care rates for the new ACA eligibles: $15 billion in 2015-16, declining by $2.6 billion in 2016-17
  11. Full scope coverage for undocumented children: $148 million in 2016-17
  12. Behavioral health treatments for children in regional centers: $102 million
  13. MCO tax: decline of $1.7 billion if not renewed
  14. Retroactive managed care rate adjustment: decline of $2.4 billion in 2016-17
  15. Funding for county administration of the ACA expansions: $170 million

Source: 2016-17 Department of Health Care Services: Governor’s Budget Highlights