Judy Perez’s son just learned to add double-digit numbers. He’s 32.
Stephen Perez suffers from myotonic dystrophy, which inhibits his mental and physical development. Medi-Cal, California’s version of the federal Medicaid health insurance program for the poor, allows Judy Perez to stay at home in La Habra and care for her son. A Medi-Cal program pays for in-home care.
Without Medi-Cal, “It would really put us in a mess,” said Judy Perez, whose husband is a custodian at a junior high school. “I don’t know where I would get a job, being (out of the workforce) for more than 10 years.”
She and other Californians who rely on Medi-Cal are anxious, if not panicked, about health care legislation on Capitol Hill that would drastically change Medicaid and a health insurance industry still finding its footing after the 2010 passage of the Affordable Care Act, also called Obamacare.
The Better Care Reconciliation Act offered by Senate Republicans would cut $772 billion from Medicaid, reduce the federal budget deficit by $321 billion and leave 22 million people – 15 million on Medicaid – uninsured by 2026, according to a nonpartisan Congressional Budget Office analysis released Monday, June 26.
The GOP House and Senate bills allow states to seek waivers from Obamacare coverage requirements governing private insurers. Both bills also would phase out funding for Obamacare’s Medicaid expansion; the Senate bill does so under a longer timeframe.
Right now, there’s no cap on what the federal government pays for a Medicaid enrollee’s bills. Both bills would change Medicaid by offering states a block grant of Medicaid money or placing a per-capita cap on what the program would pay for each enrollee.
By doing so, states would be forced to cut Medicaid benefits or restrict eligibility to make up for the loss of federal funding, said Jen Flory, a policy advocate specializing in health law and policy for the Los Angeles-based Western Center on Law & Poverty.
Under the House bill, California, which spends more than $100 billion a year on Medi-Cal, would have to replace about $24 billion in federal Medicaid dollars by 2027, according to the state Department of Health Care Services.
Caps would vary depending on the type of enrollee and growth in those caps would be indexed to the rate of inflation. But the Senate bill eventually uses a general inflation measure, rather than one tied to medical expenses. That would lead to even deeper Medicaid cuts than the House bill, opponents argue.
While children with disabilities are technically exempt from per-capita caps, “As soon as they turn 19, they would be affected by cut services,” Flory said.
“There are also a number of children who are not categorically disabled but are receiving a high level of services due to trauma, et cetera,” she said.
“I imagine there will be some dispute in which children to exclude from the cap … I just see more pressure and administrative bureaucracy on the horizon to administer this, not funding going to services.”
Medi-Cal by County
About 14 million people statewide – one in three residents – is enrolled in Medi-Cal, California’s version of the federal Medicaid health insurance program for the poor.
Here’s a look at enrollment numbers by county as of January, the most recent month for which such statistics are available.
Los Angeles County — 3.98 million.
Orange County — 913,941.
Riverside County — 848,535.
San Bernardino County — 887,482.
Source: California Department of Health Care Services.