Medi-Cal Implications of Graham Cassidy For Low-Income Californians

News sources are reporting that the last grasp Graham Cassidy bill will be voted on early next week.  Ahead of the September 30th deadline (the last day the bill could pass with less than 60 Senate votes).

Certain provisions within this legislation would have a direct  and potentially negative impact on Medi-Cal (California Medicaid).

Under the ACA (ObamaCare), California expanded Medi-Cal as allowed under the law.  This expansion is, in large part, funded by the federal government and not the state government. Adults with incomes below 138% Federal Poverty Level and children under 19 with family incomes below 266% are eligible to enroll in MAGI Medi-Cal.  The expansion did away with asset testing and eligibility is determined by income.  

Simply put, under the proposed Graham Cassidy bill, the expansion of Medicaid (Medi-Cal in California) would be reversed and future federal funds that might be used by states would be provided in block grants.  This reversal would essentially remove the income-based eligibility expansion in California.  This may also revert the system back to and income and asset based eligibility program.

For low-income families, this could be financially difficult.  As the Graham Cassidy bill also eliminates subsidies on exchanges (Covered CA in our state), families with incomes between 100-138% FPL might well find themselves priced out of healthcare coverage entirely.  

If the bill were to pass and be signed into law, California could certainly decide on how to allocate the block grant monies whether it be to continue Medi-Cal expansion, income-based subsidies, or Covered CA as a marketplace (exchanges would also be eliminated under the legislation).

Depending on the source, California has between 26-30% of its population covered by Medi-Cal, second only to employer group coverage.  

I will be paying close attention to this legislation and will be posting here, on Facebook and Twitter as things progress.



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