CHA Supports Medi-Cal Expansion and Simplification of Eligibility Rules

The Honorable Ed Hernandez, Chair
Senate Health Committee
State Capitol, 2080
Sacramento, CA  95814
Fax:  (916) 445-0485

Subject: RE: SBx1 1 – Medi-Cal Expansion (Hernandez) – SUPPORT

California Health Advocates wishes to thank you for authoring SBx1 1. We write to express our support for this bill to expand Medi-Cal eligibility to low-income, childless adults and simplify Medi-Cal eligibility rules as required by the Affordable Care Act (ACA).  This momentous legislation will keep California moving toward full implementation of the ACA and will provide low-income Californians with the coverage they need. Of these newly eligible enrollees, 67% will be people of color and 35% of the adults will speak English less than well.

SBx1 1 would enact the adult expansion called for in the ACA – adopting a new eligibility category of adults with income up to 138% of the FPL ($15,856 per year for an individual).  SBx1 1 will make 1.4 million Californians newly eligible for Medi-Cal and will draw down an estimated $2.1-3.5 billion in federal funds in 2014 alone.

The expansion population will be funded 100% federally in 2014-2016 scaling down to a 90% federal match by 2020. In addition to bringing much needed dollars into California’s economy, the expansion will improve health outcomes for our lowest income residents, including communities of color.

California Health Advocates is a not-for-profit organization dedicated to providing quality Medicare and related healthcare coverage information, education and policy advocacy. We support this bill because it would provide more people, especially lower-income people, access to healthcare, thus reducing health disparities and improving the health of Californians.

SBx1 1 would give the new expansion adults the same scope of benefits provided to the existing Medi-Cal population in addition to the ten categories of Essential Health Benefits (EHB). This would result in one consistent benefit package in the Medi-Cal program. SBx1 1 would also expand the current “pregnancy-only” benefit package in Medi-Cal’s pregnancy program to full-scope benefits. This will help pregnant women stay healthy during their pregnancy and decrease the incidence of low-term births. Further, SBx1 1 would expand Medi-Cal to former foster youth up to age 26, a critical safety net for these vulnerable young adults.

Additionally, SBx1 1 would make several changes to the Medi-Cal’s eligibility rules, conforming to the ACA and decreasing administrative barriers by:

  • Requiring the use of the Modified Adjusted Gross Income (MAGI) for most populations.
  • Eliminating the asset test and deprivation test requirements.
  • Requiring Medi-Cal to accept a person’s self-attestation of their age, birthdate, family size, pregnancy status, residency, and household income. Self-attestation, along with electronic verification with federal and state sources of data, allows Medi-Cal to move away from outdated and cumbersome paper-based verification procedures.
  • Repealing mid-year status reports and streamlining the process for renewing coverage.
  • Allowing women in the AIM program to be enrolled until the end of the month after the 60th day following delivery.

While SBx 1 1 is a critical first step, the bill must be expanded to include all Legal Permanent Resident (LPR) adults with incomes less than 138% FPL ($15,856 a year or less). The ACA includes the option for states to expand their Medi-Cal programs to cover all of the newly eligible population, including LPRs here less than five years. California already provides access to these critical services to certain immigrant populations. Refusing to act will result in many low-income immigrants being denied access to affordable coverage in 2014. Under the current scenario, immigrants earning between $0 and $15,856 a year will be required to pay monthly premiums and up to $2,250 in out-of-pocket expenses for coverage in the Exchange. For someone earning roughly $1,300 a month or less, this represents at least 14% of that person’s income, or the difference between health care and a roof over one’s head. Expanding SBx 1 1 to include LPR adults is critical if we are to improve access to health care and eliminate health disparities in our state.

We appreciate the urgency in passing this critical legislation so that the state has enough time to implement the new rules by October 2013 for coverage to begin January 2014. California Health Advocates strongly urges your “aye” on SBx1 1.


Elaine Wong Eakin
Executive Director

cc:        Members of the Senate Health Committee
Governor Jerry Brown, (916) 558-3160
Diana Dooley, Secretary, Health & Human Services Agency, Fax: (916) 654-3343
Toby Douglas, Director, DHCS, Fax: (916) 440-5119
Ana Matosantos, Director, Department of Finance, Fax: (916) 323-0060

Karen Joy Fletcher

Our blogger Karen Joy Fletcher is CHA’s Communications Director. With a Masters in Public Health from UC Berkeley, she is the online “public face” of the organization, provides technical expertise, writing and research on Medicare and other health care issues. She is responsible for digital content creation, management of CHA’s editorial calendar, and managing all aspects of CHA’s social media presence. She loves being a “communicator” and enjoys networking and collaborating with the passionate people and agencies in the health advocacy field. See her current articles.