The Brief

On a brisk January morning, physician assistant Brett Feldman searched the streets of Los Angeles for patients, knocking on car windows and peering into tents. It was the day after a winter storm had doused the city, and many of the unhoused people Feldman usually treats had moved to find somewhere dry.

Feldman leads the street medicine team at the USC Keck School of Medicine, providing primary care to thousands of L.A.’s homeless individuals. Many have chronic conditions, mental health disorders, wounds or other medical issues; they need health care desperately.

But Feldman and other street medicine providers across the state are worried that changes made to Medi-Cal eligibility by President Donald Trump’s “One Big Beautiful Bill” will cause a majority of unhoused people to lose insurance, limiting their options for care.

“It’s very possible over 90% of people experiencing unsheltered homelessness will lose insurance,” Feldman said of his L.A. patients.

Medi-Cal, also known as Medicaid federally, provides health insurance for low-income people and those with disabilities. The new law requires states starting in 2027 to verify that able-bodied adults younger than 65 without dependent children are performing 80 hours or more of work each month in order to qualify for Medicaid. It also requires states to verify income and other eligibility criteria every six months as opposed to once per year.

State officials estimate up to 2 million people – about 14% of the state’s 14 million Medi-Cal recipients – will lose coverage, either because they don’t meet the work requirements or because they get overwhelmed by the paperwork.

Meeting those requirements will be particularly challenging for the state’s roughly 180,000 homeless people. They often have no phones or internet to complete a job application. They have limited access to meals, showers or clean clothes. They commonly struggle with addiction or mental health conditions and often don’t have the ability to work. Research shows that homeless individuals have far worse health outcomes and a lifespan nearly 20 years shorter than the general population.

Often those who need health care the most are the ones who are least able to work, Feldman said.

Physician’s assistant Brett Feldman checks his patient Gary Dela Cruz on the side of the road near his homeless encampment in downtown Los Angeles in November.

(

Larry Valenzuela

/

CalMatters/Catchlight Local

)

Without insurance, people who are unhoused won’t be able to pick up medications or find primary care providers. Their health conditions will worsen, and they’ll rely on emergency rooms more.

“This is going to be a huge issue for the unhoused,” said Kelly Bruno-Nelson, an executive director with CalOptima, an Orange County Medi-Cal plan that provides health insurance for an estimated 11,000 members with unstable housing.

Work exemptions

The law carves out exemptions for people who can’t work: those with substance use disorders, disabling mental health conditions, complex medical conditions and other disabilities. Children, people who are pregnant, foster youth and those with disabilities are also exempt from working, though they will be required to renew their Medi-Cal eligibility every six months.

On paper, many homeless Californians likely qualify for work exemptions. Nearly half of homeless Californians have a complex behavioral health need, including regular drug or heavy alcohol use, hallucinations or recent psychiatric hospitalization, according to recent reports from the UCSF Benioff Housing and Homelessness Initiative. About 60% report at least one chronic condition, and roughly a third have conditions that make bathing, dressing or eating difficult.

But to claim an exemption, a patient needs a doctor to certify it. Only half of insured and unhoused Californians regularly get care and only 39% have a primary care provider, Benioff data shows.

In L.A., even fewer unhoused people have a primary care provider. Just 7% of the population had seen a provider in the past year between 2022 and 2023, according to a study published by the USC Street Medicine program, meaning very few people would have medical exemptions certified under the new law.

That means many eligible people could lose Medi-Cal: people like Samantha Randolph.

The 37-year-old has lived the streets of L.A. for more than five years. She wouldn’t even know where to begin finding a job if she had to, she said. Her ID cracked in half, so she threw it away. Someone stole her phone months ago, and she has no recent work experience.

“I’m on my own. I’m doing this by myself,” Randolph said on that same January morning.

Randolph, who is seven months pregnant, would qualify for an exemption from the work requirements come 2027. Feldman’s team also checks on her regularly to monitor the baby and could certify an exemption if necessary. But even that’s no guarantee that Randolph wouldn’t inadvertently lose Medi-Cal.

Her health insurance expired six weeks prior to Feldman’s visit because the county enrollment office mailed the paperwork to an address where Randolph doesn’t live. Without Medi-Cal, which pays for maternity housing in the city, Feldman can’t get her inside.

“I’d love to get you out of here as soon as possible,” Feldman said to Randolph as he listened to her breathing and examined a bump on her head. “I’d love to get you somewhere safe and cozy.”

His benefits team has been working diligently in the background to re-enroll Randolph in Medi-Cal. Without identification and other documents, it has been a slow process.

State tries to automate eligibility checks

State Medi-Cal officials are working to launch an eligibility verification system that will automatically check for work requirement compliance and exemptions. They hope to spare the estimated 3.5 million Californians like Randolph who will need to comply with the law’s new requirements the headache of having to prove their qualifications on paper.

“This is a top priority for us in the department, really seeking to minimize the harm to members to the greatest extent that we can,” said Tyler Sadwith, state Medicaid director at the Department of Health Care Services.

The department is looking to purchase workforce data that will capture gig workers and more timely information about income than tax returns. The state already uses IRS data and information from other welfare programs like food stamps and cash assistance programs to verify Medi-Cal eligibility.

To exempt income-eligible students, the department wants to pull information from the state’s universities and colleges. And it is working to identify medical diagnosis codes that could be used to exempt people with disabilities or other qualifying conditions like mental health or substance use disorders.

If the state can link all of the data together, some qualifying and exempt Medi-Cal recipients won’t need to provide additional information.

“They won’t have to take action. They will receive a notification that they have been successfully renewed,” Sadwith said.

But there are gaps that will be difficult for the state to fill with automated data and questions left unanswered by the federal government. Evidence of volunteer work, for example, doesn’t exist in a large database, and it’s unclear if the federal government will require the medical diagnosis codes that could signal a qualifying exemption be reverified by a provider every six months. If they do, many unhoused Californians who don’t see a provider in time could still get kicked off of Medi-Cal.

Department officials also acknowledge that in states that have previously tried to implement work requirements, eligible people always fall through the cracks.

Matt Beare, a street medicine physician in Kern County, said falling through the cracks is the norm for people who are unhoused. Already, people like Randolph lose Medi-Cal all the time.

The law’s new requirements will only make that more likely.

Not even street medicine providers who work daily to find and follow up with unhoused patients can guarantee that they can locate them. Encampment sweeps, violent crime and weather force people to move frequently.

“The cost of falling through the cracks is likely human life,” Beare said.

Homeless could lose access, housing

California has invested significantly in street medicine teams over the past five years.

Street teams deliver comprehensive primary care services wherever unhoused people are: under bridges, on the side of the road, in encampments. They administer antipsychotic injections and contraceptives, provide wound care, deliver medications and help with substance use disorder treatment. Perhaps most importantly, they often travel with benefits counselors, social workers and housing specialists.

That and other Medi-Cal investments have helped the state chip away at its homelessness problem.

But with droves of patients expected to fall off of Medi-Cal, some providers predict that street medicine teams may also disappear, worsening the chance that unhoused Californians have a provider who can certify their work requirement exemptions.

“It's going to be very fiscally difficult for those programs to be able to sustain themselves,” Bruno-Nelson with CalOptima said.

Without Medi-Cal, unhoused people won’t be able to see specialists, get diagnostic testing or obtain most medications. They’ll rely more on emergency rooms. And because California policymakers have tied some housing and other social services to Medi-Cal, many experts worry members of this vulnerable population will lose their best chance at stability.

“These people are spinning through — some with 50 emergency room visits a year because they’re so sick — a vortex,” said Gray Miller, chief executive of Titanium Healthcare, a case management company that helps Medi-Cal recipients coordinate health appointments, find housing and manage chronic conditions.

Back in L.A. hours after he found Randolph again, Feldman takes a call and smiles. The county has finally approved her Medi-Cal application, which means Randolph now qualifies for maternity housing. He sends a colleague to pick her up.

“I’m so happy we got Sam inside.”

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.

This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.

After months of debate and false starts, the Los Angeles City Council voted Wednesday in favor of developing a potential November ballot measure that would ask voters to rein in the city’s controversial “mansion tax.”

Ahead of the 9-5 vote to proceed with proposed tax breaks for new apartment buildings, Council President Marqueece Harris-Dawson said he has seen affordable housing construction decline in his district after the policy — called Measure ULA — took effect in 2023.

“I can tell you with certainty ULA has not helped,” Harris-Dawson said. “Housing starts are as low in my district as they’ve been the entire time I’ve been in office.”

Harris-Dawson said neighboring cities, such as Inglewood and Gardena, where new apartment buildings are not subject to L.A.’s tax, have not seen similar declines.

While a majority of the council voted to proceed with a possible ballot measure, Councilmembers Ysabel Jurado, Imelda Padilla, Monica Rodriguez, Eunisses Hernandez and Hugo Soto-Martinez voted against the proposal.

Reform advocates cheered the vote, but said more work is needed. Miguel Santana, president of the California Community Foundation, has pushed for changes with the “Mend It, Don’t End It” coalition, a group of affordable housing developers, labor organizations and business leaders.

“Today the City Council took another important step towards reforming Measure ULA in a way that will allow us to start building housing again while saving a critical funding source that we desperately need," Santana said in a written statement.

‘Mansion tax’ nuts and bolts

Measure ULA taxes the sale of real estate worth $5.3 million or more. That includes large, luxury single-family homes, which is why the measure is often called the city’s “mansion tax.”

However, the tax also applies to apartment buildings and other commercial real estate. Economists have said that’s causing a slow-down in new multi-family construction at a time when L.A. needs more housing supply to keep up with demand and prevent rents from spiking.

During Wednesday’s meeting, Councilmembers Tim McOsker and Katy Yaroslavsky put forward a motion asking the City Attorney to draft a ballot measure that would ask voters to cancel the tax on sales of multifamily and residential mixed-use buildings within the first 10 years of their construction.

That reform proposal is somewhat similar to earlier failed attempts at changing the tax, including from Councilmember (and now mayoral candidate) Nithya Raman and a separate effort from state legislators.

What happens next? 

The council’s proposed measure is still far from officially qualifying for the November ballot. Sending final language to the ballot will require another council vote, and the council could potentially decide later this summer to pull the measure.

If it does appear on the ballot, a majority of L.A. voters would need to approve the changes before new apartment buildings would be exempt. Close to 58% of the city’s voters supported Measure ULA when it first came up for a vote in November 2022.

In a separate vote Wednesday, the council moved forward with another potential ballot measure that would ask voters to exempt Pacific Palisades homeowners from the tax if they sell their properties after the January 2025 Palisades Fire.

To complicate matters further, voters are likely to encounter yet another measure on the November ballot related to the city’s “mansion tax.”

The Howard Jarvis Taxpayers Association has qualified a measure that would repeal L.A.’s tax, and similar taxes across the state, while simultaneously raising the voter-approval threshold for new taxes.

How we got here

Though reforms are tentative at this point, the council’s decision to pursue a ballot measure is an about-face from a committee’s earlier decision to keep changes off the November ballot.

Jurado, the chair of that committee, repeated her argument that it’s too soon to conclude the tax has caused apartment developers to retreat from L.A.

“When we focus just on housing production alone, we’re missing the mark about what this measure was actually intended to do, which is to keep Angelenos housed,” Jurado said during Wednesday’s meeting.

What has tax revenue funded so far? 

Measure ULA has raised $1.2 billion over the last three years, far less than the $1.1 billion in annual funding supporters said the tax could raise. That funding has gone toward affordable housing construction and tenant aid programs, such as rent relief and eviction defense.

However, the city has encountered trouble spending the money on its intended purposes.

City Attorney Hydee Feldstein Soto has refused to sign contracts approved by the city council and the mayor in April for $177 million in tenant aid. And the measure’s strict rules on how tax revenue can be spent to support affordable housing projects have required city leaders to pursue changes to funding restrictions.

We asked the United to House L.A. coalition, supporters of the tax, for reaction to the city council vote, but did not receive an immediate response.

A fire at a Boyle Heights commercial building sent massive plumes of black smoke up Wednesday and prompted a shelter-in-place order.

The fire broke out around 2:35 p.m. at 1400 S. Los Palos St., according to the Los Angeles Fire Department. Aerial footage from KTLA showed the fire involving solar panels on the roof of the storage facility.

Heavy smoke was visible around Boyle Heights and into other parts of LA, and the LAFD said people near the fire should immediately shelter in place.

“Get inside IMMEDIATELY and close all windows and doors. Turn off air conditioning/heating. Bring all people and pets to an inside room until you receive more instructions,” an LAFD alert said.

The shelter-in-place order was in effect for the area south of Interstate 5, east of Soto Street, north of Washington Boulevard and west of Indiana Street.

According to East Yard Communities for Environmental Justice, the structure is an industrial freezer facility. In a series of Instagram stories, the organization urged residents to close their windows and stay inside.

This is a breaking story. Check back for updates, or follow us on Instagram.

The post Massive fire breaks out at Boyle Heights commercial building, LAFD orders shelter in place appeared first on LA Local.

Air quality regulators say an oil recycling facility in Compton violated pollution rules and improperly maintained some of its equipment.

The South Coast Air Quality Management District issued four notices of violation to World Oil Recycling in Compton, and one notice of violation to a contractor operating leaky equipment on its property.

The Compton facility “receives used oils, glycol and wastewater and re-refines these materials into engine oil and glycol products for reuse,” according to the air district. The largest oil recycler in the state, it’s located in some of the most pollution-burdened and low-income neighborhoods in California, as well, where asthma rates are higher than 95% of census tracts, according to state data.

The violations came after the air district started receiving odor complaints from residents at the start of this year. The agency received more than 70 complaints of strong odors of gas, including from the nearby Jefferson Elementary School, the agency said in a news release.

Officials then carried out more than a dozen on-site inspections, including using an infrared camera to identify gas leaks. They found hydrocarbons leaking from a wastewater storage tank, as well as a centrifuge pump. A small fire at the facility in late May also led to nuisance notices from the agency.

The company told LAist it is working to remove the leaky storage tank that may have caused the odors.

“World Oil Recycling provides an essential environmental service by recycling used oil and other materials, helping to keep them out of landfills and waterways,” a spokesperson for the company said in a statement. “We are committed to meeting or exceeding the highest standards at our facility in Compton, where we have operated safely for more than 40 years and serve as a major local employer.”

If World Oil Recycling doesn’t comply, it could face fines or litigation.

The company has faced such issues in the past. In 2019, the Environmental Protection Agency reached a settlement with World Oil’s Compton and Vernon facilities for violating hazardous waste regulations. The agreement required the companies to pay a $39,092 penalty and spend $167,967 on air filtration systems in nearby schools to reduce indoor air pollution.

The facility has received dozens of violation notices from the air district over the years, as well, mostly for minor maintenance issues.

In a statement to LAist, Compton Mayor Emma Sharif said the city “is working with the appropriate regulatory agencies as they continue their investigation.”

California will not consider the city of Los Angeles’ request for a time extension on three mobility projects in underinvested communities that are largely funded by more than $100 million from the state.

The exclusion of the request from the California Transportation Commission's June agenda spells an uncertain fate for the projects in Boyle Heights, Skid Row and Wilmington, which involve repairing sidewalks, adding bike lanes and installing traffic-calming measures to make streets friendlier to non-vehicular modes of transportation.

In April, the city formally requested a six-year extension on state-mandated deadlines to complete pre-construction work on the projects, saying recent staffing and funding constraints in the public works and transportation departments have hampered progress.

Justin Behrens, the spokesperson for the commission, said that while the state grant program offers time extensions in certain cases, “The requested time exceeded what is allowable under the guidelines,” and extensions were ultimately not recommended to be considered by the commission.

The state funds for pre-construction work, including environmental review and design, are set to lapse at the end of June.

L.A. officials said in a March report that without the time extension, “The city will be unable to meet these deadlines and lose the opportunity to provide these critical improvements for the city.”

The Bureau of Street Services, which is the lead agency on the three projects, did not respond to requests for comment.

'A deeply disappointing moment'

A statement from the office of L.A. City Councilmember Ysabel Jurado said the situation is “disappointing” and that the councilmember is taking time to “fully understand” what the California Transportation Commission’s decision means for the projects in her district.

“What we can say clearly is this: We are not giving up,” the statement read. “Boyle Heights and Skid Row have waited far too long for safer, more accessible streets, and the residents who organized for these improvements deserve more than a setback and a closed door.”

Jurado advocated for additional staffing resources across the bureaus of Street Services, Street Lighting and Engineering, as well as the Department of Transportation, to deliver the projects.

For Jens Midthun, the president of the DTLA Neighborhood Council, any investment in improving the walkability of downtown L.A. is a worthy one.

“People in downtown L.A. are here because they want to be,” Midthun said about the neighborhood’s transition from a business hub to a residential destination. “People want to be part of a vibrant city center.”

L.A. City Councilmember Tim McOsker's office said in a statement that infrastructure improvements in Wilmington “remain a priority.”

“We will continue exploring funding opportunities and other available options to advance as much of the project as possible,” McOsker's office said.

The grant program

Since its launch in 2013, the state’s Active Transportation Program has funded capital projects that promote walking, cycling or other non-motorized ways to get around. Behrens said the program is competitive and over-subscribed, meaning the applications for funds “far exceeds the available resources.”

Over the course of the grant program, L.A. has secured $500 million to fund 46 transportation projects across the city, according to a June report from Laura Rubio-Cornejo, the general manager of the city’s Department of Transportation.

Twenty of those projects have been constructed and staff is actively working on designing, implementing or closing out another 22.

Jurisdictions that win the funds have to adhere to strict timelines to retain the money, which is allocated based on different phases of a capital project. Failing to meet the program’s deadlines can jeopardize a city or county’s likelihood of clinching future grants.

The program’s deadlines require the city to allocate funds for construction for the three projects in question by the end of June 2027. In its request for a time extension, the city said it would need an additional six years to get to that point.

Absent a time extension, it’s unclear what the path forward is for the three projects.

The city in June submitted its application for the next round of Active Transportation Program grants, though its ambitions were tempered by “staff resource limitations and the city’s existing grant commitments.”

The projects it submitted for consideration to the state include extending the LARiverWay bike path and enhancing mobility along Huntington Drive.