On Sunday the State Legislature passed a budget for the 2014-15 fiscal year. We’ll have the details of the final enacted budget once Governor Brown signs it (some line items could be vetoed), but in the meantime we want to focus on a somewhat shocking budget item that was added last minute. The State is rejecting philanthropic matching funds to help sign up people for Medi-Cal.
The California Endowment offered a $6 million grant to the Department of Health Care Services to fund enrollment and annual renewal assistance for Medi-Cal, specifically $58 per new enrollment and $25 per renewal payments to Certified Enrollment Counselors, aligned with Covered California payments. The funds were accepted for efforts in FY 2013-14 and served as the state match, doubling the money through federal matching funds to the state. Reportedly, the Brown Administration asked the Legislature to reject the grant funds this year, despite a lack of costs to the State. The $12 million turned down could be used to newly enroll more than 200,000 people in coverage.
Why would the Governor and the Legislature turn down funds that are at no cost to the State? The decision implies that California doesn’t want to maximize Medi-Cal enrollment.
In 2014, more people signed up for Medi-Cal than initially projected. While the federal government is paying for most enrollees, the State must pay for half of the cost of care to individuals who sign up now despite being previously eligible under the pre-ACA rules. More previously eligible but unenrolled individuals signed up for Medi-Cal than expected, prompting the Governor to allocate more funding for them in the revised budget. Could the decision to reject matching funds be a result of “sticker shock?” Or is this some legislative compromise that needs negotiating?
Cutting enrollment efforts, particularly efforts with no cost to the state, is not the way to achieve savings. Medi-Cal enrollment is available year-round and can be at the point of service, including expensive emergency services for health issues that could have been prevented. But because less education and enrollment help will be available, fewer individuals will enroll in Medi-Cal until they have a pressing health care need, meaning less prevention, higher costs, and worse health outcomes.
This decision is not aligned with the intentions of the ACA. We have a duty to educate Californians on their health care options and are fortunate to have the philanthropic funds to do so. California has been a leader in ACA implementation, exceeding expectations and setting a model for the rest of the country. We can’t afford to step back from that.