Legislative analyst, counties wary of Governor's plan to fund Medi-Cal expansion

Governor Jerry Brown is committed to expanding Medi-Cal — the state’s health care for low-income Californians — and he's committed to finding a sustainable way to fund it. 

One proposal would be to swap costs with counties — have the state pay for treating indigent patients and have counties assume equivalent costs for other medical services. 

In a report issued Monday, the state’s legislative analyst cautioned it’s not clear that would be a fair deal for counties.

Counties, by law, must provide healthcare to low-income people who lack health insurance.  The state helps to fund the care, an estimated $3-to-4 billion in the last fiscal year.

Governor Brown proposes to hold onto some of the money to pay for an expansion of Medi-Cal to childless adults: "So we don’t find ourselves in a big hole in a couple years."

Counties are expected to save some money after Medi-Cal is expanded, but they’re still worried about being saddled with related costs. Matthew Cate, who heads California’s State Association of Counties, says he’ll be lobbying aggressively to make sure local governments retain the funds needed to fulfill their obligations.

"It’s the county hospitals who provide indigent care. For example, in Los Angeles there are four county hospitals, and they don’t have any choice but to provide care to indigent people." 

Not all low-income people in California will qualify for Medi-Cal. Undocumented people, for example, won’t be covered.

The Legislative Analyst recommends that the legislature wait to see how the Medi-Cal expansion pans out before fundamentally changing the state-county relationship.