Initial Reaction to the Governor’s #CABudget

Earlier today, Governor Jerry Brown released his proposed budget for the 2015-16 state budget, which continues California’s commitments on health care and health reform, but also continues the cuts made during the recession, and doesn’t make the investments needed to reduce barriers to coverage, increase access for Medi-Cal patients, or cover the remaining uninsured.

HEALTH BUDGET OVERALL: While the Governor’s budget continues California’s efforts on health reform, we are disappointed the budget proposal also continues the recession-era cuts to health and human services. California’s comeback depends on not just paying down the wall of debt but breaking down the wall of poverty. California has made dramatic progress under the Affordable Care Act to expand coverage with mostly federal funds, and we need this new budget to continue that momentum, by removing barriers to coverage, ensuring those covered in Medi-Cal get access to care, and extending coverage to the remaining uninsured.

IMMIGRANT HEALTH CARE: California should be proud of our long history in Medi-Cal of covering immigrant populations otherwise excluded from federal programs, and this budget neglected to affirm that policy for those under the President’s order, not to mention the rest of the remaining uninsured. For the benefit of the health system we all rely on, we will push this year to ensure access to coverage for all Californians, regardless of immigration status. Immigrants are a vital part of our community and economy and should be fully included in our health system.

THE CONTINUED CUTS; The California comeback hasn’t included many families still struggling, and should extend to the health and human programs that were cut in the recent recession. This budget leaves in place cuts to key public health programs, Medi-Cal benefits, and provider rates–rates that are the lowest in the nation and that make access to doctors, specialists and other providers harder for some of the 12 million Californians with Medi-Cal coverage. Restoring and investing in Medi-Cal, as the Legislature proposed last year, would improve access to care, and bring in enhanced federal matching funds into our health system and economy. We should remember that the surplus was created in part out of $15 billion in cuts to health and human services–cuts that continue today and into the future. Ultimately, the level of services for California should not be set at the level of resources available during the worse recession since the Great Depression.

KEY HEALTH POLICY DECISIONS: The budget does include some specific budget-related adjustments based on policy decisions made last year to reflect the county administration workload in enrolling new Medi-Cal recipients ($48 million), and in including behavioral health treatment for autism ($89 million). The budget also proposes policy changes like:

* Requiring those in limited benefit programs to seek enrollment in full coverage programs–a goal consumer advocates support, but want to be sure that those programs continue for folks not eligible for comprehensive coverage or for when such comprehensive coverage doesn’t provide those services.

* Imposing an open enrollment in Medi-Cal, which would restrict access and limit choice for those eligible for Medi-Cal

* Revamping/broadening the managed care organization tax that currently funds Medi-Cal to meet federal guidelines and support a restoration for in-home supportive services.

* Seeking ways to improve participation in the Coordinated Care Initiative for those seniors and people with disabilities in both Medi-Cal and Medicare.

* Pursuing a renewed five-year Medicaid waiver to “support ACA implementation, drive significant delivery system transformation, and provide long-term fiscal stability of the Medi-Cal program.”

There are key health budget policy issues not addressed by this budget:

* It’s disappointing the budget does not remove the estate recovery provision that complicates enrollment and discourages patients for signing up for Medi-Cal coverage. Last year, the Governor vetoed a bill to limit Medi-Cal estate recovery, arguing the policy change should be done in the budget instead. We will vigorously pursue this change, so some Californians don’t fear that their loved ones lose the family home as a result of signing up for coverage.

* Our biggest priority is taking the momentum of the Affordable Care Act, and the President’s recent executive actions, to ensure coverage for all Californians, regardless of immigration status–which would yield positive benefits for the health system we all rely on. California has been a leader in including immigrants in our society and investing in our future–the next and most vital step is in health care.

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