The Brief

California’s powerful health care industry just notched a historic win: The state is going to give it an $11.1 billion infusion to improve care for millions of low-income Medicaid patients.

But the intense jockeying over the money is only beginning.

Top state health officials say they plan to plow most of the money into higher payments for doctors, hospitals, and other healthcare providers who serve Californians covered by Medi-Cal, the state’s Medicaid program. But the framework, hammered out this summer as part of state budget negotiations, lacks critical details, which has set off a lobbying frenzy among health industry groups seeking a cut.

Even as they battle for their share, industry leaders are quietly plotting a November 2024 ballot initiative to lock in the Medi-Cal payment increases, which they argue are needed to sustain the safety-net program that covers nearly 16 million Californians — a staggering 40% of the state’s population.

“We are addressing decades of systemic underfunding in Medicaid that has exacerbated inequity and health care provider deserts, where patients are often forced to get their care in emergency departments,” said Dustin Corcoran, the CEO of the influential California Medical Association, which represents doctors.

Corcoran also leads the coalition negotiating with Gov. Gavin Newsom and fellow Democratic lawmakers in Sacramento over how the money — a combination of state and federal funding to be doled out over six years — will be spent.

“Even with this historic deal, there are still parts of the health care system that are going to struggle to provide the care that patients need,” Corcoran said. “The coalition is dedicated to ensuring long-term stability and predictability in reimbursement rates in California.”

California has among the lowest Medicaid reimbursement rates in the country, which is often cited as a key reason many low-income patients can’t get care and often face excruciating wait times, especially for primary care, obstetric, and mental health appointments, said Kathryn Phillips, the associate director for improving access to care at the California Health Care Foundation. (KFF Health News publishes California Healthline, an editorially independent service of the California Health Care Foundation.)

“That’s where the state is struggling the most,” she said. “Low rates are why a physician may not accept Medi-Cal patients, or only accept a low number of patients.”

This deal funds the largest increase in base Medi-Cal reimbursement rates in at least 25 years, said Jennifer Kent, a former director of the state Medicaid agency.

The money will come from the managed care organization tax, which has been levied since 2005 on health insurers that do business in California. Revenue from the tax, which allows the state to secure billions in federal health care dollars it wouldn’t otherwise receive, has previously been funneled into the state general fund, which can be used for anything state leaders want.

Under the deal, and for the first time, Newsom and the legislature have agreed to use the money to improve care for poor Californians. Of the $19.4 billion projected to be raised by the tax between 2023 and 2026, $11.1 billion will go directly to Medi-Cal and $8.3 billion to the general fund to offset state spending on Medi-Cal, according to state Department of Finance spokesperson H.D. Palmer.

The new funding will start flowing next year, with $820 million earmarked for initial rate increases in primary care, obstetric care, and mental health care, Palmer said.

From 2025 through 2029, the state plans to allocate nearly $2.7 billion a year, according to the department. State and industry officials said they plan to direct some of the money to expand medical residency programs for doctors serving low-income people, fund new beds for psychiatric patients, and increase the workforce of other providers such as nurses, mental health therapists, and community health workers.

But the bulk will go to rate increases for primary care and an array of providers and services, including hospitals and long-term care facilities, abortion care, and emergency services. Higher rates for specialists, such as psychiatrists and dentists, are also desperately needed.

Although Newsom and state health officials have promised to direct the money to health care providers, they haven’t specified which ones will get increases — and there’s no guarantee the money won’t be diverted to another program. Medi-Cal, a massive and ballooning program with a budget of $152 billion this fiscal year, is under tremendous pressure. The state continues to expand the program to more people and offers a growing list of expensive services, despite the threat of budget deficits.

“There has to be more guardrails,” said Assemblymember Vince Fong (R-Bakersfield) during a June legislative debate. “This should not be seen as a revenue grab.”

Mark Ghaly, Newsom’s health and human services secretary, acknowledged that even though some providers and treatments may be left out initially, the payment boosts represent a critical step toward better access.

“The core providers in Medicaid will benefit,” Ghaly told KFF Health News. “There’s always going to be someone out there with a question and a concern, and I hope that as we learn about them and we hear them, we address them.”

Ghaly said the tax will bring some Medicaid rates in California from the bottom in the country to the top. While he acknowledged concerns that the money might be diverted in future years, he said Newsom is committed to spending it on Medi-Cal. “Who knows about the uncertainty of the future?” he said. “But we have basically done as much as you can to hard-wire these changes into the way we design Medicaid. The man with the pen — the governor of California — is committed to this.”

Even though the tax deal isn’t big enough to fix all the problems in Medi-Cal, it will improve patient care, said Charles Bacchi, president and CEO of the California Association of Health Plans, which represents private and public insurers.

“There’s a lot more work to do hammering out the rate increases and where they should go,” Bacchi said. “We have to make sure that the funding actually survives the budget process next year.”

Some providers worry they may be left out.

“We’ve argued hard for optometrists to be included,” said Kristine Schultz, executive director of the California Optometric Association, noting that optometrists can’t afford to treat poor patients because of low rates. For example, optometrists get about $39, on average, to conduct an eye exam on a new Medi-Cal patient, while Medicare reimburses $158, she said.

As a result, she said, patients “are not able to get in for months.”

Ann Rivello, a therapist in San Mateo County specializing in trauma, also cited low rates — and complicated medical billing demands — as the reasons she doesn’t accept Medi-Cal patients.

“I’ve been practicing over 20 years and I do not accept Medi-Cal even though it’s within my values,” she said.

Detailed rates for most health care treatments for Medi-Cal patients are not publicly available because they are negotiated privately by insurance companies and vary by geography and health insurance plan. And the state has a slew of bonus payments it uses to supplement base Medi-Cal rates, further obfuscating how much health care providers receive.

While Medi-Cal rates vary widely, on average, California reimburses 76% of Medicare rates, Phillips said. Next year, the state plans to raise that base payment rate to 87.5% of Medicare in three target areas — primary care, obstetrics, and mental health.

As health care providers battle for their slice of the tax revenue, they say they want to avoid the same lobbying fight each time the state renews the tax, which happens every few years. One option they are considering: a ballot initiative next year that would lock the Medi-Cal funding into the state constitution.

Bacchi declined to take a position on the concept but said insurers are “taking a look at it.” He argues that California “needs to make a long-term commitment to the Medi-Cal program.”

John Baackes, the CEO of L.A. Care, the largest Medi-Cal insurer, supports the idea. He argues that a permanent increase in Medi-Cal rates would help address the disparities between Medi-Cal and private insurance coverage.

“The pandemic showed us that inequality is a life-and-death matter, because if you look at the people who got sick the most and died, they were people of color,” he said. “If we continue to ignore that, we’re idiots.”

A criminal investigation is underway Tuesday at the burned Lineage Logistics warehouse in Boyle Heights.

Agents with California’s Department of Toxic Substances Control Criminal Investigations Bureau, a law-enforcement unit that investigates potential violations of the state’s hazardous-waste laws, are serving a search warrant at the site. Surveillance video showed law enforcement arriving around 7:30 a.m., and some remained on scene as of midday Tuesday.

An agent with the department confirmed that the Office of Criminal Investigations is the lead agency but declined to comment further. Several investigators with badges from the LA County District Attorney’s office were also present. The office later confirmed it assisted DTSC in serving the search warrant and is supporting the department’s ongoing investigation.

In a statement, Lineage — which operates cold-storage facilities around the world — said that it works collaboratively with various regulatory agencies.

“To be clear, we do not store hazardous chemicals or products in this facility. We store food. Further, the facility’s ammonia refrigeration system was safely pumped out shortly after the fire began and before the fire reached the refrigeration system. The ammonia was subsequently removed from the site. The Los Angeles Fire Department reported no ammonia was detected during its response, and subsequent environmental monitoring has consistently shown results within normal levels for the neighborhood and no ammonia concentrations above health-based action levels. We have shared relevant testing and monitoring information on our website and with regulatory agencies and will continue to do so,” the statement said.

In the weeks after the fire, community testing as well as data from Lineage and the South Coast Air Quality Management District showed elevated levels of ammonia near the warehouse. Community members found the results alarming, though Lineage and regulators stressed the levels didn’t meet the threshold to take action to protect public health.

Last week, Eastside Padres held a press conference outside the warehouse,calling on the Los Angeles County District Attorney’s Office to open a criminal investigation of the warehouse fire after the Los Angeles Fire Department reported that the cause of the fire could not be determined.

A person who works at the facility said the operation started earlier Tuesday morning. Employees initially believed Immigration and Customs Enforcement agents were involved, but soon found they were not.

Anna Rivas works at Ciclon Pallets across the street from the Lineage parking lot where agents served the search warrant. A man driving a truck and a large trailer had to expertly back into her garage to pick up a load of pallets, dodging the law enforcement vehicles parked nearby.

The business’s surveillance cameras captured a police vehicle with lights and siren pulling up to the facility at about 7:30 a.m., with about 20 unmarked vehicles approaching soon after and entering the parking lot or stopping to block the entrance.

Rivas said the pallet company had to shut down for about a month and a half around the time of the fire, citing respiratory problems for workers and a loss of business.

“We thought we finally had our space back to do our work,” Rivas said. “But no, here we go again.”

She said the police did not question her or her colleagues, and she added she hopes the neighborhood gets the justice it deserves after months of disruption related to the fire.

In a statement, Councilmember Ysabel Jurado said she welcomed the investigation “as a positive step toward the transparency and answers Boyle Heights residents deserve.”

“This community has lived with the consequences of the Lineage warehouse fire for months. Residents deserve to know what happened, what risks remain, and who must be held accountable.”

“Investigators must be able to follow the evidence wherever it leads, and their findings should help give residents the information they need about their health, safety, and the future of this site. I will continue pushing for those answers, a safe and complete cleanup, and accountability for any violations uncovered. Boyle Heights should not be left to shoulder the consequences of this disaster.”

The office of Mayor Karen Bass also acknowledged the investigation, stating:

“The residents of Boyle Heights and East L.A. deserve environmental justice and corporate accountability. Mayor Bass has been working with many agencies to protect this community. In her emergency executive order, Mayor Bass called for the California Department of Toxic Substances Control (DTSC) to investigate and pursue enforcement action at the Lineage warehouse.”

The fire at the cold storage warehouse broke out on June 17 and burned for eight days. The fire and cleanup of millions of pounds of rotting food caused a flood of issues for residents living in Boyle Heights, East LA and surrounding communities, including an infestation of flies and pests, nausea and headaches, higher utility bills and other health concerns.

The Los Angeles Fire Department could not determine the cause of the fire but said solar panels could not be ruled out as an ignition and fuel source.

Boyle Heights Beat reporter Laura Anaya-Morga contributed to this report.

Eva Marie Saint, the pale, willowy actor who won an Academy Award for her first movie, “On the Waterfront,” and starred opposite Cary Grant in the Alfred Hitchcock thriller “North by Northwest,” has died. She was 102.

Saint, whose acting work lasted well into her 90s, died at her home in Los Angeles on Tuesday, confirmed family representative Jeff Sanderson.

Saint had one of the most spectacular debuts in Hollywood history, as the love interest of Marlon Brando’s tormented Terry Malloy in “On the Waterfront,” and her first trip to the Academy Awards was memorable too. Pregnant with her first child, Saint accepted her Oscar from Frank Sinatra and smilingly murmured a unique winner’s speech: “I think I may have the baby right here.” (Her son, Darrell, was born two days later.)

The award for the 1954 classic made her an instant star, but she soon astonished Hollywood with a firm independence that would mark her career. She refused offers of studio contracts and declined chances to follow up on her great success, explaining that she was taking time off to become acquainted with her new son. (A daughter, Laurette, was born in 1958.)

A curated career

In her first decade in Hollywood, Saint appeared in a mere seven films. She declined such top-level productions as “The Man in the Gray Flannel Suit” with Gregory Peck, “Summer and Smoke” with Laurence Harvey and “The Rainmaker” with Burt Lancaster. She credited her husband, TV and stage director Jeffrey Hayden, with persuading her to star in Hitchcock’s “North by Northwest,” the classic 1959 thriller in which Saint plays a spy who seduces Grant, but ends up falling for him.

“I vividly remember him saying, ‘Honey, I think you should find a quiet spot. I’ll take care of the children and I want you to really think about this and reread this script,’” she told Vanity Fair in 2014. “He was so right. And that’s what husbands are for.”

Instead of being put off by her selectivity, studios continued offering her starring roles in such films as “Exodus” (with Newman), “Raintree County” (Elizabeth Taylor, Montgomery Clift) and “All Fall Down,” with Warren Beatty.

She turned more to television in the 1970s and enjoyed renewed popularity in the 1980s as the mother of Cybill Shepherd in the hit sitcom “Moonlighting” and as Tom Hanks’ mother in the film comedy “Nothing in Common.” She won an Emmy for the 1990 miniseries “People Like Us,” and had roles in such 21st century movies as “Because of Winn-Dixie,” “Superman Returns” and “Winter’s Tale,” adapted from Mark Helprin’s novel of the same name. In 2021, she played Marisa Tomei’s aunt in the brief audio play “The Bus Ride,” part of “The Pack Podcast.”

Saint was married to Hayden for 55 years, until his death in 2016.

That was her real name

When Saint emerged in the public consciousness, many believed her theatrical-sounding name must have been invented. She was born with it on July 4, 1924, in Newark, New Jersey. The family moved to Delmar, a small town near Albany, New York, where her father was a Goodrich Rubber Co. manager. Eva’s goal was to become a third-grade teacher like her mother, but at Bowling Green State University in Ohio she tried out for a play and won the leading role.

After graduation she lived with her parents in Flushing, Long Island, and began hunting for acting jobs in Manhattan. After a fruitless year, she landed a two-line role as a telephone operator on a radio drama and soon was working steadily on soap operas and nighttime dramas, appearing for two years as Claudia on “One Man’s Family.” Network television was booming in the early 1950s, and her looks and dramatic sense made her a favorite with casting people and producers.

She credited Lee Strasberg with helping her overcome shyness

A critical turn in Saint’s career came when she auditioned before Elia Kazan and was accepted into the Actors Studio, which shaped a generation of method-actor stars. She credited acting coach Lee Strasberg with helping her overcome her shyness.

“Lee Strasberg, when he got to know me a little bit, gave me a scene to do where I had to cry in front of my peers,” she told The Santa Barbara Independent in 2009. “I worried about it, I worked on it, I tried to use what I was learning at the studio. I finally did the scene, and I cried, and my peers were crying with me. It was just an incredible moment for me.”

Saint was rejected for the single female role in the play “Mister Roberts,” but was hired to understudy the actor chosen, Jocelyn Brando, Marlon’s sister. In six frustrating months Saint never got to substitute for Brando. She finally made it to Broadway in “A Trip to Bountiful,” which she had played on television.

Kazan invited her to try out for the female lead in “On the Waterfront” by improvising a scene with Brando. She was told to try to stop a young man from entering her apartment. She told the Los Angeles Times in 2001: “All I know is that Marlon got in the door and turned on the music. We started dancing. He flicked my skirt. Kazan saw the sparks fly, and that’s how I got the part.”

Thomas, a former Associated Press Hollywood correspondent who died in 2014, was the primary writer of this obituary.

California’s school finance watchdog agency has found the Los Angeles Unified School District is at high risk of financial insolvency.

The Financial Crisis and Management Assistance Team presented its analysis at Tuesday’s school board meeting.

A July assessment from the Los Angeles County Office of Education found LAUSD was at risk of becoming insolvent, which triggered FCMAT’s evaluation.

“FCMAT’s role is not to determine which programs the district should preserve, which reductions it should make or what agreements it should reach with the labor [unions],” Jennifer Noga, an intervention specialist with the agency, told the board. “That is 100% a local decision. Our goal is to help identify the fiscal risk and help the district understand what needs to be addressed to restore fiscal stability.”

The analysis found that LAUSD's deficit spending, declining enrollment and increasing costs of employee salaries and special education put the district at risk of exhausting its reserves by the end of next school year.

United Teachers Los Angeles, the union that represents LAUSD educators, said in a memo to the board and in public comments that FCMAT’s analysis penalized the district for paying teachers more and overstated financial risk.

“There are different ways to tell a story with numbers and statistics and data, and we just think that FCMAT is presenting the most austere version of that and we have to fight back against that,” said Julie Van Winkle, the union's vice president. “There is declining enrollment in the district, and who is going to want to put their kids in schools if we keep cutting programs because of austerity?"

The district has a plan to cut spending, which includes eliminating thousands of jobs and funding for high-needs schools. The district must also bargain with employee unions before implementing furlough days planned for the 2027-28 school year.

More than 100 cannabis businesses in L.A. that were expected to lose their licenses at the end of the year may be able to stay open after a City Council vote Tuesday.

A city ordinance that took effect in August would only have allowed cannabis businesses to renew their licenses if they owed less than $1 million in unpaid city taxes and had been delinquent on their taxes for less than four years.

The limits were set to get more strict each year until 2030, when businesses would need to owe less than $100,000 in unpaid taxes.

The City Council voted to delay the restrictions for one year because a separate program intended to provide an exception to businesses who agreed to follow a tax payment plan could not begin on time.

There are more than 1,000 licensed cannabis businesses in the city of L.A., according to the Department of Cannabis Regulation, and 125 of those would not have been eligible to renew their licenses had Tuesday’s vote not passed.

In October 2025, City Treasurer Diana Mangioglu reported that 500 cannabis businesses owed a total of $500 million in unpaid taxes, interest and penalties. Of those businesses, 48 owed more than $2 million.

Owners of many cannabis retailers, manufacturers and distributors have asked local government leaders for help as they face higher taxes than most industries and strong competition from unlicensed businesses — which pay no taxes and typically sell at a lower price in the illicit market.

Evelyn Scott gave public comment during the City Council meeting and said these challenges led her business to close.

“Losing our license will make it even harder to reopen, generate revenue, create jobs and meet our obligations to the city,” Scott said.

What is the tax amnesty program?

When the city enacted licensing restrictions based on cannabis businesses’ unpaid taxes, local officials also intended to make a pathway for delinquent businesses to come back into compliance.

The cannabis tax amnesty program allowed for some businesses that would otherwise be prevented from renewing their licenses to agree to a payment plan that could last up to five years. If the businesses kept to the agreement, they could continue to renew their licenses, would have penalties and interest on unpaid taxes forgiven and wouldn’t face criminal charges for not paying those taxes on time.

Could the agreements help the city?

L.A.’s Office of Finance, which is in charge of the program, estimates it could bring in $10 million in city tax revenue in the first year.

But it wasn’t possible to start the program for 2027 licenses, according to Matthew Crawford, assistant director of the finance office.

He told LAist in an email that the office wouldn’t be able to begin the program in time without exposing the city to “unacceptable levels of risk to both [a tax administration] system replacement project and the integrity of the amnesty program.”

Crawford said the finance office still expects the city to receive the same amount of revenue once the program begins.