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Medi-Cal Expansion: Excitement and Concern from California’s Policymakers and Stakeholders

LIHPs in counties across the state are beginning to enroll newly eligible patients into Medi-Cal, which opens to all California citizens and 5 year legal permanent residents with incomes under 133% FPL on January 1, 2014. With more than 3 million Californians expected to become eligible for the program, Medi-Cal expansion poses great challenges for the state. California’s Medicaid program is already the largest in the country and the state’s budget stresses are unlikely to disappear anytime soon.

What does Medi-Cal expansion mean for California? To find out, Autumn Kieber-Emmons, Tom Bodenheimer, and Kevin Grumbach interviewed key health policymakers and stakeholders across the political spectrum. Their findings, summarized here, showed important areas of consensus:

  • Excitement about expanding coverage for low-income childless adults, from both Democrats and Republicans.
  • Concern that, even with the federal government paying 100% of costs for newly eligible beneficiaries, the state could spend $3 to 4 billion in new annual costs by 2020.
  • Hope that greater enrollment in managed care will help to control costs.
  • Apprehension about worsening provider shortages and more difficult access to care.
  • Belief that the 1115 waiver can and will be used to provide a “bridge to reform.”

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