Low-income seniors and disabled people who rely on Medi-Cal have been mostly ignored in the discussion over Republican attempts to replace the Affordable Care Act, a new report says.
About 90,000 of those residents in the Northern San Joaquin Valley are at risk of service cuts under the Better Care Reconciliation Act, proposed by Republican leaders in the U.S. Senate.
The vulnerable groups include 18,700 disabled people and 13,700 seniors in Stanislaus County. About 16,500 seniors and disabled people in Merced County and almost 42,000 in San Joaquin County could be affected by the Senate bill, which would make historic changes to federal government funding for Medicaid programs for the poor. California’s Medicaid program is called Medi-Cal.
In releasing the numbers last week, the nonprofit California Health Care Foundation said the state will be under pressure to cut Medi-Cal services for the poorest seniors and the disabled.
Chris Perrone, director of the CHCF’s improving access team, said the national debate over replacing Obamacare has drawn attention to medical needs of working families and low-income adults, but the Senate legislation would have far-reaching consequences for other folks.
While most seniors use Medicare benefits for health care, the Medi-Cal program covers out-of-pocket medical costs for low-income seniors and pays for long-term care for seniors with no financial resources.
Medi-Cal, which is jointly funded by the state and federal government, also is a safety net for almost a million adults and children who suffer from multiple sclerosis, epilepsy, blindness, AIDS, mental disorders and disabilities such as autism and Down syndrome.
By imposing caps on federal Medicaid funding for states, the GOP Senate bill would shift $3 billion in Medi-Cal costs to California in 2020, and the cost burden for the state would grow to $30 billion in 2027, said the CHCF, a nonprofit research and education group.
California would receive far less federal support for funding programs for its 13.5 million Medi-Cal recipients such as health services, nursing home care, in-home care and services for the developmentally disabled.
Tony Anderson, executive director of Valley Mountain Regional Center, said the state’s Medi-Cal budget would be more constrained than it was in the 2008 recession. Valley Mountain is a regional agency that provides services for about 14,000 developmentally disabled clients in Stanislaus, San Joaquin, Calaveras, Amador and Tuolumne counties.
“There is no target for what specifically would be cut,” Anderson said. “It would be across the board in all Medicaid-funded programs.”
Anderson said that bailouts from the Obama administration prevented the total collapse of some Medi-Cal services during the last recession. Most likely the cuts under the Better Care Reconciliation Act would fall on the backs of low-wage workers who care for disabled people at home as an alternative to placing those clients in long-term care facilities, he said.
The number of clients served by Valley Mountain grows at about 7 percent a year, Anderson said.
Last week, the California Department of Health Care Services said the Senate bill would eliminate enhanced Medicaid funding for the In-Home Supportive Services program, which provides care at home for 480,000 elderly and disabled people in the state. The cut would increase California’s costs for IHSS by $400 million, possibly creating another headache for counties that are already shouldering more of those costs.
The options for providing in-home care and community-based care for seniors and the severely disabled now account for more than half of Medicaid spending nationwide, according to the Center on Budget and Policy Priorities.
California bought into the Affordable Care Act’s expansion of Medi-Cal eligibility like no other state, providing health benefits to 3.7 million working poor adults at federal expense. Now, the state’s Democratic leaders are expecting their political foes in Washington to keep the money flowing.
Almost one-fifth of the nation’s Medicaid recipients live in California. Some conservatives say that services for the most vulnerable residents would not be threatened if the state had some control over Medi-Cal spending.
“There is never enough money for the Democrats,” said Jim DeMartini, a county supervisor and chairman of the Republican Central Committee of Stanislaus. “Medi-Cal is supposed to be for the poorest of the poor. Somebody has to put the brakes on this because there is not enough money to give away health care to everybody.”
Ken Carlson: 209-578-2321, @KenCarlson16
Seniors and people with disabilities enrolled in Medi-Cal by county
County Disabled Age 65 & older
Stanislaus 18,737 13,720
San Joaquin 23,926 18,054
Merced 9,154 7,378
State total 952,303 1,050,105
Source: California Department of Health Care Services