LOS ANGELES, Calif. — County officials today raised concerns about Gov. Jerry Brown’s plans to use anticipated savings under health care reform to pay for other programs for the poor.
Brown, who presented his May revision to the budget this morning, said he wanted California to expand Medi-Cal to those who would otherwise remain uninsured once the Affordable Care Act, often referred to as Obamacare, is fully implemented. That includes as many as 1.3 million people who live in Los Angeles County, according to a UCLA study cited by a county official.
County officials issued a statement saying they were “extremely pleased to see the governor embrace state-based expansion of Medi-Cal.”
However, what they don’t like is Brown’s proposal to pull monies from county budgets. A California Department of Health Care Services spokesman says the numbers are based on savings to counties who once had to pay for providing health care services to the indigent, now covered under the Affordable Care Act.
“As the governor says, we can’t pay twice for the same services,” said Toby Douglas, director of communications for the Department of Health Care Services Federal funding will replace state monies raised through vehicle licensing fees and sales taxes under the Affordable Care Act.
Brown’s initial estimates call for taking $300 million in state funding back from counties this fiscal year, $900 million in 2014-15 and $1.3 billion in the following year.
County health care providers say Brown is jumping to conclusions about the potential for savings.
“The magnitude of that (savings) is unknown,” said Anish Mahajan director of system planning for the county’s Department of Health Services.
Mahajan says Brown is “trying to link (those savings) prematurely” to the state’s commitment to Medi-Cal expansion.
The numbers will be based on actual costs and the mechanism for calculation includes a reset so that any overestimation can be corrected, according to Douglas.
Mahajan disagrees, saying the mechanism relies on historical data and it is impossible to guess at how many of the county’s poor will be eligible and enroll for health care services.
Mahajan and Dr. Mitchell Katz, the director of the department that manages the county’s hospitals, worry that the state’s plan will leave the county unable to provide the very services anticipated by health care reform.
Katz and his team have already enrolled about 257,000 people in Healthy Way L.A., the local delivery system for the ACA. He’s reaching for 300,000 in order to have enough critical mass to make the program viable.
Katz said he had been working with the governor’s office on a 50-50 split of shared savings.
“It turns out that their interpretation of shared is that the state gets 100 percent and we get zero,” Katz told the Board of Supervisors today.
Supervisor Zev Yaroslavsky called Brown’s move “a double cross.”
Katz also said he had proposed that the sharing begin in the 2016-17 fiscal year because it will be difficult to assess the actual cost savings until the program is well underway.
Douglas said current enrollments support the governor’s belief that savings are inevitable. “We do know one thing,” Douglas said. “On day one, (the county) will recover 100 percent of costs” from the federal government for the 257,000 individuals already enrolled.
The argument about funding is likely to continue, but both sides stress their commitment to providing care for those in need.
“We are very committed to maintaining a strong safety net,” said DHCS spokesman Norman Williams.
