Local government was glad to let the state, instead of counties, administer the Medi-Cal expansion under the Affordable Care Act. But counties have fought to keep the state from redirecting funding that’s needed for local public health programs.
Stanislaus County’s Health Services Agency has received $14 million annually in what’s known as 1991 health realignment revenue, and combined it with a $3.5 million local match, to fund health care for 9,000 indigent adults and also safeguard county residents from contagious diseases. Next year, childless adults with income up to 138 percent of poverty level ($15,860 a year) will be eligible for Medi-Cal, so the HSA won’t need as much funding for indigent health care.
It’s estimated that up to 90 percent of medically indigent adults will shift to the Medi-Cal program as a result of federal health reform. Gov. Jerry Brown had proposed taking as much as $1.3 billion from counties
This week, county supervisors opted for a simple formula that will give the state 60 percent of the revenue while the county holds onto 40 percent. Beside the so-called 60-40 split, the state has allowed a second option for counties that involves cost-accounting which I won’t try to explain. Staff members believe that Stanislaus County will get an extra $1.5 million from choosing Door No. 1 (the 60-40 split) instead of Door No. 2.
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The county will transfer 13 positions from the Health Services Agency work force to its Community Services Agency, which is flush with federal funding to enroll people who are newly eligible for Medi-Cal. Public health programs will remain intact, because officials believe they have chosen the right formula for that realignment funding.