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California Counties and state lawmakers reach provisional plan for Medi-Cal expansion

Thousands of uninsured patients attend a free temporary health clinic In Los Angeles.
Thousands of uninsured patients attend a free temporary health clinic In Los Angeles.
Kevork Djansezian/Getty Images

After months of wrangling over how to pay to expand Medi-Cal--California’s  health care program for low-income residents--counties and state lawmakers have sketched out a formula for splitting the costs.

California opted to expand Medi-Cal by more than a million people next year as part of federal health care reform.  

In exchange, the Brown Administration asked counties to relinquish hundreds of millions of dollars they get from the state each year to treat the poor at public hospitals and clinics.  The thinking was that counties costs would drop because many of those people would be eligible for Medi-Cal.

But local officials pushed back.

LA County lobbied for a cost-based formula for figuring out how much money, if any, counties should give back. 

“The most important thing for L.A. County was to have an agreement with the state where our costs are taken care of as it relates to the Medi-Cal expansion in addition to making sure that our safety net is sustained, ” county Assistant Chief Executive Officer Ryan Alsop said Wednesday.

More than a million people in L.A. County are likely to remain uninsured after Medi-Cal is expanded and the Affordable Care Act is fully implemented.  Alsop said it’s imperative for the county to retain enough money to take care of them. 

Farrah McDade-Ting, an analyst with California State Association of Counties, said that under an agreement that’s still being finalized, counties will collectively relinquish a $300-million dollars in state funds for indigent care next year as a kind of  “down payment.”

After that, McDade-Ting says, counties would get to choose between two formulas: one would be a 60-40, state-county split of any savings and the other would be more precise. It would calculate how much counties have spent on indigent care in the most recent 4 years and determine how much they save from more residents going onto Medi-Cal. 

Counties vaccinations and other general public health program costs would be excluded from the equation.

McDade-Ting said the deal won’t be final until county leaders agree to the actual language of a budget trailer bill being crafted for a vote as early as Friday.