The Brief

Perhaps no state has more to lose than California in the federal budget proposal House Republicans passed this week.

That spending plan sets up significant cuts to Medicaid, the health insurance program for low-income people. California has taken just about every route and opportunity to expand the Medicaid program. Today, 14.9 million Californians are enrolled in it, and federal funding cuts would almost certainly roll back services and coverage for some of them.

Looking for a way to offset the cost of extending President Donald Trump’s 2017 tax cuts, the House advanced a bill Tuesday that directs the Energy and Commerce Committee to find $880 billion in spending cuts over the next 10 years. Those cuts, budget and health policy experts say, would largely have to come from Medicaid, also known as Medi-Cal in California.

The Senate voted for its own, narrower budget bill last week. Next, both chambers have to work out their differences and agree on one budget.

At this point, it’s not clear which Medicaid services would be cut or how many people exactly would lose coverage because lawmakers can hit the spending reductions in a number of ways.

Still, enrollees, health advocates and providers in California and across the country are now grappling with what the cuts would mean for them and the people they care for. In press conferences and online meetings, they’ve called the proposed cuts a “five-alarm fire” and Republicans’ vote “the ultimate betrayal” of their constituents.

Their outcries echo the first Trump administration, when in 2017 House Republicans voted to repeal the Affordable Care Act. The law ultimately survived, but that health care vote helped stir up the “blue wave” that flipped Republican House seats in the 2018 election.

“These cuts would rip care away from children, seniors, disabled Californians, and more while raising costs for everyone, all to give tax breaks to the ultra-wealthy,” Amanda McAllister-Wallner, interim executive director of Health Access California, a health consumer advocacy group, said in a statement following the House vote. “This is just the beginning — we will be pushing our California congress members at every turn to put the health of their constituents first.”

Medicaid is the backbone of California’s social safety net. It covers half of all children and 40% of all births. It also covers long-term care services for seniors and disabled people.

Since 2014, the state has expanded the program big time — first to more adults allowed in the Medicaid expansion under the Affordable Care Act, and gradually to low-income immigrants, regardless of their legal status. Cuts to the scale that Republicans in Congress are proposing, advocates and providers say, would be harmful across the board.

Hospitals, doctors and county officials are also speaking out against the proposed cuts because Medicaid is a key payer, especially for those located in rural areas or communities with high poverty rates. If these facilities can’t keep their doors open, entire communities, not just people enrolled in Medicaid, could lose access.

House Speaker Mike Johnson, a Louisiana Republican, has said savings could be accomplished through eliminating Medicaid fraud and waste — although that would only get Republicans so far. Johnson has cited about $50 billion in alleged fraud, a small slice of the GOP’s goal total, the Washington Post reports.

Cuts would leave big budget hole for state

Medicaid accounts for a significant portion of states’ budgets. The program is jointly funded by the federal government and states, meaning federal cuts would leave major budget gaps that would force reductions in services and enrollment, and also could trigger cuts to other state programs. California’s budget includes $161 billion for Medi-Cal, of which more than half is paid for with federal funds.

Based on proposals that Republicans in Congress are considering, California could lose $10 billion to $20 billion a year, the California Budget Policy Center estimates.

Speaker of the House Mike Johnson speaks at the Conservative Political Action Conference (CPAC) at the Gaylord National Resort and Convention Center in National Harbor, Maryland on Feb. 20, 2025.

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Jack Gruber

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USA TODAY via Reuters

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A big question mark is how exactly Congress will meet its savings goal — Republican lawmakers have floated a number of proposals, but it’s unclear yet what could stick.

They’ve proposed imposing work requirements, for example. The idea behind that is enrollment would drop as people who don’t meet the requirements get kicked off the program. But the spending reductions from such a policy would not get Republicans all the way to their target, said Edwin Park, a research professor at the Georgetown University McCourt School of Public Policy.

A second proposal would require restructuring the program so that instead of the federal government paying states a fixed percentage of Medicaid costs, it could set a spending cap per enrollee.

Under the Affordable Care Act, California opened up its Medi-Cal roll to low-income adults who had previously not been covered. The federal government pays California 90% of the cost for this expansion group — that’s up from the state’s 50% regular match rate. Republicans may also choose to eliminate the increased match rate for adults covered under this expansion.

“One reason that these types of cuts are popular among federal policy makers is because…it really allows the blame to be placed on governors and state legislatures,” Park said. “The federal government is cutting federal funding, making it harder for states to finance their share of the cost of Medicaid, but it’s not actually saying ‘You have to cut eligibility in this way or cut provider rates in this way.’”

“It’s really, ‘States, you figure it out, you have to balance your budget,’’” Park added. “And you know, there’s only three choices: higher taxes, cutting the rest of the budget, which is primarily education in California, and then, most likely, really dramatically cutting Medi-Cal in the state.”

Coverage for seniors and people with disabilities

President Trump and Republicans have promised to not touch seniors’ Medicare, but millions of seniors also rely on Medicaid. In California, about 2.2 million seniors and people with disabilities are enrolled in Medi-Cal, according to data from the state’s Department of Health Care Services.

Traditional Medicare does not cover services including dental, vision and hearing benefits. Seniors typically have to buy into a Medicare Advantage plan to get that covered. Low-income seniors in California can access those services with no or at a low-cost through Medi-Cal.

Nursing home stays and in-home care are also largely covered by Medicaid. Nationally, about 6 in 10 nursing home residents are covered by Medicaid, according to an analysis by KFF, a health polling and research organization.

“Medicare has huge gaps in coverage and Medicare is really expensive,” said Amber Christ, managing director of health advocacy at Justice in Aging, which advocates on behalf of older adults. “It is Medicaid, not Medicare, that is the primary payer of long-term care in this country.”

Because of their high needs, seniors and people with disabilities are the most costly population. In California, they make up about 15% of the people enrolled in Medi-Cal, but account for roughly half of all the program’s spending.

“So if the state wants to go where the money is, that’s seniors and people with disabilities. That’s long-term care, nursing home care, community-based services,” said Park. To protect the coverage of this population, he said, the state would have to consider potentially making larger cuts for other groups of people.

A safety net for California kids

More than 5 million kids in California are insured through Medi-Cal and the accompanying Children’s Health Insurance Program. It pays for their preventive care, such as immunizations and screenings, but it also covers support services, such as counseling and therapy. For about 160,000 children in the foster care system, it also pays for an array of social services.

Getting kids insured has long been a priority for California. When the state began expanding Medi-Cal to undocumented people in 2016, children were first in line.

Perhaps less known is that Medi-Cal is also a big player in services provided at schools. It helps fund services and equipment for students with disabilities, such as hearing aids and specialty transportation. It reimburses school districts for certain providers, including psychologists and social workers, for example. Across the state, some districts also provide physical and mental health care to children and their family through school-based health centers that also draw down on Medi-Cal funding.

“The rates of depression and anxiety among youth are rising at alarming rates, and for many, Medi-Cal services are their only option for care,” said Michele Cantwell-Copher, the Fresno County Superintendent of Schools, on a media call with advocates and parents on Thursday. “Ensuring that children have access to the mental health support they need is critical to their well-being and their success in schools.”

Medi-Cal is a keystone program for many kids but also for their birthing parent — it pays for about 40% of the state’s births. California offers coverage for pregnant people at slightly higher income levels than the regular cut-off, allowing more to qualify. It provides coverage during their pregnancy and 12 months postpartum, paying for standard obstetric visits, prescriptions, laboratory services, doula services and hospital care.

“If we want kids to have a healthy start, that means making sure that their birthing parent has access to health care,” said Mike Odeh, health policy director at Children Now. “Those early years really are important for both babies and parents. There are a lot of services in that time period that really are critical, and any reduction in those services could have very bad effects.”

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.

MEXICO CITY — The Mexican army killed the leader of the powerful Jalisco New Generation Cartel, Nemesio Rubén Oseguera Cervantes, "El Mencho, " in an operation Sunday, a federal official said.

The official, who requested anonymity because they were not authorized to speak publicly, said it happened during a military operation in the western state of Jalisco.

It followed several hours of roadblocks with burning vehicles in Jalisco and other states. Such tactics are commonly used by the cartels to block military operations.

Videos circulating social media showed plumes of smoke billowing over the city of Puerto Vallarta, a major city in Jalisco, and sprinting through the airport of the state's capital in panic. On Sunday afternoon, Air Canada announced it was suspending flights to Puerto Vallarta "due to an ongoing security situation" and advised customers not to go to their airport.

The U.S. State Department had offered a reward of up to $15 million for information leading to the arrest of El Mencho. The Jalisco New Generation Cartel, known as CJNG, is one of the most powerful and fasted growing criminal organizations in Mexico and was born in 2009.

In February, the Trump administration designated the cartel as a foreign terrorist organization.

It has been one of the most aggressive cartels in its attacks on the military—including helicopters—and a pioneer in launching explosives from drones and installing mines. In 2020, it carried out a spectacular assassination attempt with grenades and high-powered rifles in the heart of Mexico City against the then head of the capital's police force and now head of federal security.

The DEA considers this cartel to be as powerful as the Sinaloa cartel, one of Mexico's most infamous criminal groups, with a presence in all 50 U.S. states where it distributes tons of drugs. It is one of the main suppliers of cocaine to the U.S. market and, like the Sinaloa cartel, earns billions from the production of fentanyl and methamphetamines.

Since 2017, Oseguera Cervantes has been indicted several times in the United States District Court for the District of Columbia.

The most recent superseding indictment, filed on April 5, 2022, charges Oseguera Cervantes with conspiracy and distribution of controlled substances (methamphetamine, cocaine, and fentanyl) for the purpose of illegal importation into the United States and use of firearms during and in connection with drug trafficking offenses. Oseguera Cervantes is also charged under the Drug Kingpin Enforcement Act for directing a continuing criminal enterprise.
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Hermon — Some shoppers heading into Fresco Market were lost in their phones, but when they momentarily looked up, they were greeted by a flap of brilliant green feathers and a cheery squawk. Phones were put away.

“Pepe! Hey Pepe! So good to see you!”

Perched on the shoulder of T.J. Gonzalez, Pepe the Parrot was in full greeter mode. Wide-eyed and seeming to almost smile as he surveyed the parking lot and his approaching public, Pepe did what he naturally does: make people happy.

A common sight at the Hermon market, near where they live, Gonzalez and Pepe can also be found at community centers, farmers’ markets and local events. They often take the Metro into downtown Los Angeles, Long Beach and other locations.

There’s no money asked, stressed Gonzalez, adding that Pepe simply adores the attention. “People want to see and talk with him more than me,” he joked as he cracked a nut and placed it in his mouth. On cue, the bird reached around Gonzalez’s mouth to retrieve it.

Michael Eagle-Hall of El Sereno is delighted to meet Pepe outside of the Fresco Market in Hermon.

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A mail carrier for 37 years before he retired, Gonzalez found Pepe, a red-crowned Amazon (flocks are often seen in Northeast L.A.) in July 2021. The chick had fallen out of a nest and was flailing on a busy street in San Marino. “He was like roadkill,” said Gonzalez, who watched cars drive over (without striking) the bird.

Gonzalez retrieved the parrot and looked for help, but wildlife rehabbers said they’d euthanize the bird since it had a broken wing. Gonzalez instead brought him to a vet and christened him Pepe.

Since Pepe could not fly, Gonzalez started walking him around the neighborhood. He soon discovered how kids and adults enjoyed interacting with the parrot. Pepe is also a social media darling, with more than 8,600 followers on Instagram.

Pepe is more of a squawker than a talker, but Gonzalez has learned how to art-direct photos of people and the bird, instructing them on how to hold their hands and arms best. “We just want that smile because that’s all that Pepe wants from you,” said Gonzalez.

Crews have now recovered the bodies of all nine backcountry skiers who were killed in an avalanche in Northern California earlier this week. It marks an end to what authorities on Saturday described as an agonizing five-day search and recovery operation complicated by intense winter storms northwest of Lake Tahoe.

"While we wish we could have saved them all, we are grateful that we can bring them home," said Nevada County Sheriff Shannan Moon during a Saturday news conference.

Until Saturday, authorities had not confirmed the death of a ninth victim, a skier who had been missing and presumed dead. Officials say their body was found near the eight other victims that have now been recovered. Authorities said avalanche hazards and weather conditions were too dangerous most of the week to search for the remaining victim or recover the bodies.

Four of the bodies were recovered on Friday, and the rest of the bodies were recovered on Saturday, all in the Castle Peak area where the avalanche – one of the deadliest in California history — struck. Six people from the group of 15 skiers survived Tuesday's disaster, the last day of a three-day backcountry ski trip. One guide and five travelers were among the survivors.

Helicopters with the California National Guard as well as the California Highway Patrol were used to hoist the remaining bodies from the mountain, officials said at the press conference.

On Friday, officials were able to use specialized techniques with the help of Pacific Gas & Electric to reduce the avalanche risk.

The ski trip was organized by Blackbird Mountain Guides, an outdoor tour company based in Truckee, Calif. Moon confirmed the identities of the victims. Three guides were killed: Andrew Alissandratos, 34, from Verdi, Nev.; Michael Henry, 30, from Soda Springs, Calif.; and Nicole Choo, 42, of South Lake Tahoe, Calif. The other victims, who had signed up for the group trip, are: Carrie Atkin, 46, of Soda Springs; Lizabeth Clabaugh, 52, of Boise, Idaho; Danielle Keatley, 44, of Soda Springs and Larkspur, Calif.; Kate Morse, 45, of Soda Springs and Tiburon, Calif.; Caroline Sekar, 45, of Soda Springs and San Francisco; and Katherine Vitt, 43, of Greenbrae, Calif.

The Sierra Avalanche Center classified the avalanche between a D2 and D3 on the avalanche danger scale.

"A D2 would take down a person. A D3 would take down a house, so it was right in between those. It was described by them as a football field length of a path of the avalanche," Sheriff Moon said on Saturday.

Multiple agencies are investigating.

"We are investigating the incident to determine if there were any factors that would be considered criminal negligence," Ashley Quadros with the Nevada County Sheriff's Office said in an email to NPR on Sunday. "It is a standard investigation. It is too early to know if criminal charges will be applicable, as the investigation is preliminary and remains active and ongoing."

The area will be closed to visitors for several weeks.
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