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Millions of Children on Medicaid at Risk of Losing Coverage

More than 6.7 million children are at risk of losing insurance coverage once pandemic-era restrictions on Medicaid income eligibility checks are lifted on April 1, according to a report by the Georgetown Center for Children and Families.

Legislation enacted early in the pandemic in 2020 temporarily increased federal funding for state Medicaid programs under the condition that states continuously cover beneficiaries until the end of the public health emergency. The ranks of Medicaid beneficiaries grew by nearly 20 million people as the program acted as a health insurance safety net. However, the Consolidated Appropriations Act of 2023 slowly unwinds the federal continuous coverage requirement through May 2024, allowing states to start eligibility redeterminations next month for all 83.5 million Medicaid beneficiaries—including more than 34.2 million children.

To protect children in low-income families, the Consolidated Appropriations Act requires states to provide 12 months of continuous Medicaid and Children’s Health Insurance Program eligibility to children under 19 beginning Jan. 1, 2024, if they don’t already do so. Most states have some form of continuous eligibility for children to protect them from losing coverage during redeterminations of their parents’ eligibility, but 17 states and the District of Columbia do not have such a provision, the Georgetown center found.

Redeterminations require beneficiaries to reapply for health insurance, verifying their income and ensuring that they meet all the other eligibility criteria to continue to receive benefits. However, the process can be complicated and take up to 14 months, and families who fail to complete it on time may lose coverage.

The impact of redeterminations on children’s health-care access concerns many Medicaid stakeholders across the country. Eligibility checks have traditionally caused coverage losses due to bureaucratic roadblocks, said Jennifer Wagner, director of Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities, a nonpartisan research and policy institute.

“Historically, we lose a lot of people during the renewal. Recipients are often sent a form by mail to the last known address, which may have changed. Some people might not get the notice they got a renewal in the mail. Others might not act timely because they have very complex situations and may not respond in time. Some might not even understand the notices that they are getting. They’re historically very confusing,” she said.

Public policy advocates also fear that chronic staffing shortages will cause state Medicaid agencies to face backlogs in processing redetermination applications, leading to more unintended policy cancellations.

survey by the National Association of Medicaid Directors found that over a fifth of all state Medicaid agencies have job vacancy rates of over 20%, with some states seeing up to 40%.

The problem is nationwide, even in well-funded states like California, which invested $146 million into its unwinding strategy, stakeholders say. California has done little to rectify the chronic shortages in front-line Medicaid workers in its 58 counties, David Kane, senior attorney at the Western Center of Law & Poverty, said.



L.A. County-run hospitals could expand free and discounted care

Hospitals run by Los Angeles County could make free care available to more of their financially strapped patients under a new proposal aimed at expanding relief from medical bills.

County health officials said the proposed changes, which also include deeper discounts for other eligible patients, could ultimately benefit thousands of people in the county, yet are unlikely to have a significant effect on hospital finances.

The move comes amid ongoing concern across California about residents putting off or forgoing medical care due to the expense, despite state efforts to expand access to charity care and make sure patients know about financial assistance.

Under the proposed rules, free care would be available to eligible L.A. County residents with incomes under 200% of the federal poverty level, or $60,000 for a family of four under current guidelines. The existing cutoff is 138% of the poverty level, which amounts to $41,400 for a family of four.



Western Center Roundup – August 2022

Making History, Meeting the Advocates, Mike’s Milestones & The Search for His Successor

Opening the Search for Western Center’s Next Policy Advocacy Director

After 19 years of leading Western Center’s trailblazing policy work, Mike Herald is preparing for his retirement at the close of this year. We are in awe of what Mike has accomplished during his tenure – from tackling unjust fees and fines that place a high price on being poor – to securing historic budget and policy wins to expand public benefits for families – Mike has advanced some of the most pivotal policies to end poverty in CA.

“We are so grateful for Mike’s impact and legacy after nearly 20 years of faithful service to Western Center and those we serve. As we prepare for Mike’s well-deserved retirement, we look forward to celebrating him and our policy team’s accomplishments under his leadership.” – Crystal Crawford, Executive Director, Western Center on Law and Poverty

We invite you to learn more about Mike’s Milestones and the many accomplishments made by the Policy Team during his tenure. Stay tuned for more information on Mike’s retirement celebrations to be held in October in Los Angeles and December in Sacramento.

We’ve opened the search for Mike’s successor. View the Director of Policy job description and please share widely with your networks. More Western Center employment opportunities can be viewed HERE.

Meet The Advocates: CA Street Vendors and Access to Healthy Food 

Did you miss Monday’s Meet the Advocates webinar? Don’t worry, you can watch the recording HERE!  The webinar featured a conversation with Rudy Espinoza, Executive Director of Inclusive Action for the City and Western Center Policy Advocate Christopher Sanchez, facilitated by Abraham Zavala, Western Center Outreach & Advocacy Associate. Panelists shared about the decade long history of organizing to expand rights for street vendors and how SB 972 can eliminate barriers to licensing by updating CA’s retail food code. The bill provides a clear pathway for food entrepreneurs to grow their businesses, which is key to expanding access to healthy food and produce to communities across the state. Learn more about how you can support CA Street Vendors and see SB972 to the finish line.

The evening before standing with street vendors to testify at the Capitol, Christopher Sanchez was recognized with the California Latinx Capitol Association Foundation’s Advocate Champion Award. You can watch his inspiring acceptance speech HERE.

Monkeypox: Your Rights to Testing, Vaccines, and Treatment

The federal government declared a public health emergency for Monkeypox on August 4, 2022. California declared a state of emergency for Monkeypox on August 1, 2022. These declarations allow the federal and state governments to work quickly to provide testing, vaccines, and treatment. Senior Attorney David Kane provides critical information in Western Center’s August Health Care Tip: Monkeypox: Your Rights to Testing, Vaccines, and Treatment

The Inflation Reduction Act Passes, Expanding Healthcare Access and Affordability

We applaud the passage of The Inflation Reduction Act, which includes the most historic health reforms since the passage of the Affordable Care Act, providing California families with much needed relief from skyrocketing prescription drug prices, capping costs in Medicare, and preventing major health premium spikes in Covered California. Western Center Senior Policy Advocate Linga Nguy weighs in on how the Act’s passage will translate into expanded health access and affordability for individuals, seniors, and families with low incomes.⁠

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Local government is key to establishing equity in California

As the State of California considers reparations to correct fundamental economic harms caused by slavery, it is local governments that have the authority to either aid or thwart such equity initiatives. A dispute in Fresno, where proposed industrial expansion threatens a community-led plan to address generational equity concerns, is one example. In the coming months, the Fresno City Council and mayor will decide the fate of the southwest Fresno community, providing a potential case study for the ways racial, economic and environmental injustice can play out in California.

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Democratic lawmakers prepare to push Newsom on safety net spending

Democratic lawmakers will push Gov. Gavin Newsom to do more to help the poor as they enter budget negotiations based on plans the Assembly and Senate budget subcommittees passed in recent days.

Taking advantage of a rosy budget outlook and hefty reserves, Senate lawmakers have advanced budget proposals that include expanding Medi-Cal to undocumented young adults and seniors and restoration of most Medi-Cal benefits that were cut during the recession, including audiology, speech therapy, podiatry and incontinent supplies.

Newsom is proposing to require Californians to have health coverage indefinitely, but has offered only three years of financial assistance to cover premium costs — and his subsidies mostly target middle-income people. That has drawn criticism from groups representing low-income residents.

“The penalty can be seen as reverse Robin Hood,” said Linda Nguy, a lobbyist with the Western Center on Law & Poverty. “It taxes lower-income people to subsidize people with higher incomes.”

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PRESS RELEASE: Western Center bill package could strengthen Medi-Cal for seniors



Assemblymembers Wood, Carrillo and advocates promote package of bills to strengthen Medi-Cal for seniors


AB 715, AB 1088, AB 1042 (Wood), and AB 683 (Carrillo) will work together to make Medi-Cal more equitable while creating greater stability for seniors and adults with disabilities


Sacramento, Calif., (April 2, 2019) – Today, Assemblymembers Wood and Carrillo joined advocates from Western Center on Law & Poverty, Justice in Aging, and Disability Rights California to highlight a package of new bills that, if passed, will work together to make Medi-Cal more equitable and accessible, while creating greater stability for seniors and adults with disabilities. The bill package is in committee this afternoon. Footage from the press conference is available here


“Seniors are California’s fastest-growing population,” said Assemblymember Jim Wood (D-Santa Rosa). “Between now and 2026, the number of Californians 65 and older is expected to climb by 2.1 million, according to projections by the state Department of Finance — the only age bracket to grow in scale. Within this ever-growing population, we have some of our most vulnerable seniors who often have to make difficult choices – to pay for their rent and utilities, see a doctor, or purchase groceries or the medications they need. My goal this year, with three bills and two significant budget requests, is to make a positive difference in their lives.”


Currently, four separate Medi-Cal rules limit Medi-Cal’s effectiveness. The four new bills in the “Senior Package” would address those pitfalls, ensuring California seniors and adults with disabilities have access to the care they need.


“The Affordable Care Act made health care more accessible for a lot of people, but we left seniors out,” said Jen Flory, Policy Advocate at Western Center. “Seniors on Medi-Cal face stricter program rules and risk losing their health care at a time when senior poverty is on the rise. No one should lose their health care because they turn 65.”


The four bills in the package include:


AB 715 (Wood) – Eliminates the Senior Penalty

Raises the Medi-Cal income eligibility limit for seniors and adults with disabilities to 138% of the federal poverty level. Resolves unfair situations in which seniors and adults with disabilities are subject to a lower income eligibility limit than others in the Medi-Cal population. Will create parity between other Medi-Cal programs that serve adults and the Medi-Cal Aged & Disabled program. It will also reduce the number of low-income seniors who have a share-of-cost, which is typically an unaffordable monthly amount that seniors must pay before Medi-Cal will cover costs.


AB 1088 (Wood) – Improves Continuity of Medi-Cal Coverage

Stops seniors and adults with disabilities from flipping between free and share-of-cost Medi-Cal. Currently, this happens because the Medi-Cal income counting rules deduct an individual’s out-of-pocket payment of the Medicare Part B premium from their income, but stops deducting that payment when it comes from the state as a benefit of free Medi-Cal, creating a nonsensical loop—a senior can yo-yo on and off of the free Medi-Cal program simply because of the difference created by one income deduction, despite no change in their actual income. AB 1088 stops this yo-yoing by creating an income deduction when the state payment of the Part B premium would disqualify someone from free Medi-Cal, thus ensuring the individual’s stable enrollment in Medi-Cal.


AB 1042 (Wood) – Helps Seniors Keep their Home

Updates and expands the home upkeep allowance, which helps ensure seniors and adults with disabilities who have a short-term stay in a nursing facility do not lose their home or belongings. Currently, an individual who resides in a nursing home should have access to the home upkeep allowance, which allows an individual to keep money for up to 6 months to pay for rent or mortgage so they don’t lose their housing while in a nursing home. In practice, however, the allowance is rarely used, limited in scope, and is such a small amount—$209—that it is insufficient. AB 1042 corrects this by increasing the amount of the home upkeep allowance and allowing the individual to use it to preserve their home, or set up a home (e.g., pay a rental deposit or costs of a storage space).


AB 683 (Carrillo) – Increases Financial Stability for Low-Income Seniors

Increases and simplifies the asset eligibility limit for Medi-Cal and eliminates those limits for the Medicare Savings Programs, which makes Medicare more affordable. This bill is needed because the current asset rules are so low that they affect seniors’ financial stability and perpetuate racial inequity within the Medi-Cal program. Currently, the asset limit is $2,000 for an individual and $3,000 for a couple. That limit has remained unchanged since 1989. Although asset exclusions exist, including property used as a primary residence, people of color are much less likely to own real property. This means that a senior with $4,000 in the bank is ineligible for Medi-Cal, but a senior who owns a home worth hundreds of thousands of dollars is eligible. AB 683 helps address this disparity by allowing individuals to have up to $10,000 of assets and a couple to have $15,000; ensures more people qualify for the Medicare Savings Program; and simplifies asset rules so low-income seniors and adults with disabilities have an easier time understanding and complying with the rules.



For more information, contact:

Jen Flory, Western Center on Law & Poverty, [email protected]

Claire M. Ramsey, Justice in Aging, [email protected]

Valley residents make their voices heard in Sacramento


The weather didn’t stop thousands of Valley residents – from Bakersfield to Stockton – from traveling to Sacramento on March 6 to raise their voices at the State Capitol demanding change for a healthier San Joaquin Valley and all its residents.

Approximately 2,000 Valley residents, advocates, and local elected leaders gathered at the Capitol Mall for this year’s ‘Equity on the Mall’ to rally for a ‘Golden State for All.’

The annual event is conducted by the San Joaquin Valley Health Fund, a funding collaborative of 18 funders and 90 community organizations established by The Center at Sierra Health Foundation.

Residents represented nine counties in the San Joaquin Valley with the commun goal to bring much-needed attention to the health inequities faced by children and families living in the region.

…“A child can’t put their childhood on hold until an affordable housing unit is built or the market adjusts, and solutions that allow low‐income families to access existing housing are a critical component of ensuring children succeed,” said Alexander Harnden, Housing Policy Advocate with the Western Center on Law & Poverty.

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We Stand United Against Trump’s Divisive Public Charge Rule

Western Center’s Mona Tawatao shared her wisdom on the Trump Administration’s proposed Public Charge rules in the California Health Report. An excerpt is below, the full piece is available here.

In this country, we believe that our value and ability to contribute to society should not be based on how we look or how much money in our wallets. These principles of fairness and equal opportunity are what unite us as a nation.

The Trump administration’s proposed public charge rule flouts these core values. It is yet another one of the President Trump’s schemes to divide us. This is the president who has also torn apart families seeking asylum protection at our southern border and declared a “national emergency,” bypassing Congress and our Constitution, in an attempt to build a wall between the United States and Mexico.   

Medical credit cards purport to ease medical cost burdens, but end up creating stress. A new Western Center-sponsored bill could change that

By Jen Flory, Western Center Health Policy Advocate

For many medical consumers, medical credit cards are offered as a way to pay for unexpected medical costs not covered by insurance. Those costs can include trips to the dentist, chiropractors, and veterinarians. Most people know how quickly medical bills can upend a person’s finances, so medical credit cards can seem like a good deal – especially when they are presented with a zero percent introductory rate.

The tricky part about medical credit cards, and what many consumers of the cards misunderstand, is that while they enjoy that zero percent rate for a period of time, when the introductory period is up, they will not only pay a higher rate (which is to be expected), but they will also face deferred interest. Deferred interest provisions allow card issuers to charge interest on the entire original balance, regardless of how much is paid off during the introductory period. That extra interest adds an unexpected burden for the medical consumer who thought they were doing something to help with their medical bills.

For example, if a consumer puts $1,000 on their card and pays off $900 by the end of the introductory period, the new 26.99% interest rate will be charged not on the remaining $100 balance, but on the original $1,000. The consumer will end up paying $269.90 in interest on a $100 balance.

To add insult to injury, many people are encouraged to sign up for medical credit cards while they are awaiting services in treatment rooms. Without the time and means to research alternatives, and in such stressful circumstances, consumers don’t have the opportunity to fully understand what they are signing up for.

Consumers have also reported being signed up for credit cards while sitting in a dental chair about to get treatment, or for dental services that could have been covered by Medi-Cal. Many Medi-Cal recipients are still being charged for dental services in spite of the restoration of dental services for adults with Medi-Cal. In some cases, the needed services are not covered by Medi-Cal; in other cases, Medi-Cal services are available to treat the condition, but patients are upsold more expensive services, which often end up on medical credit cards.

In 2009, AB 171 (Jones) was passed to require dentists to give notices prior to signing a patient up for a credit card to pay for services. In 2014, SB 1256 (Mitchell) expanded those rules to any licensed health care provider. While the law does provide for basic patient notification, few consumers understand how deferred interest provisions work, so they are shocked by high interest charges later added to their account.

To protect medical consumers, Senator Holly Mitchell has introduced SB 639, which would prohibit medical providers from offering products with deferred interest provisions, and would prohibit them from signing patients up for medical credit cards in treatment areas. The bill would also require providers that accept Medi-Cal to explain to patients what Medi-Cal does and does not cover, and it would require language in the notices about medical credit cards to be written at a 6th grade reading level.

Third-party financing may have a place when patients need services they cannot immediately pay for, but more must be done to protect consumers. Products with ‘gotcha’ clauses like deferred interest have no place in a medical practice. Consumers should never feel pressured into applying for medical credit cards, and they should always understand what they are signing up for — especially since their health and wellbeing is on the line.

Nonprofit Dental Insurer Under Scrutiny For ‘Flagrant’ Spending

Dental insurance giant Delta Dental of California is facing mounting criticism for paying its CEO exorbitantly, flying board members and their companions to Barbados for a meeting, and spending a small fraction of its revenue on charitable work — all while receiving significant state and federal tax breaks because of its nonprofit status.

Now, the company — which has 36.5 million enrollees in 15 states and the District of Columbia — is hoping to pay $155 million to acquire a 49.5 percent stake in for-profit medical and dental insurer Moda Health

…In December, Consumer Reports, California Pan-Ethnic Health Network, Health Access and the Western Center on Law & Poverty penned a letter to California regulators asking them to assess whether it’s appropriate for Delta Dental to be investing in a for-profit insurer.

Read more here