Los Angeles County has the most to gain from Medi-Cal expansion

When California Gov. Jerry Brown committed to fully expand Medi-Cal, the state’s health care program for low-income residents, advocates heaved a collective sigh. 

Soon people who earn up to 138 percent of the federal poverty level will qualify for the program.  That’s an estimated 1.2 million people — 30 percent of them in Los Angeles County.

But the governor also floated a plan that worries county leaders: Brown wants to pay for Medi-Cal expansion by taking back some of the money the state gives counties to care for the poor and uninsured. The thinking goes that most of the indigent will be covered by Medi-Cal.

Not so, says Dr. Mitch Katz, who heads the L.A. County Department of Health Services.

Katz, who still sees patients once a week in a clinic in East L.A., told a Senate budget committee Thursday that only 5 percent of his patients qualify for Medi-Cal now. Of the rest, he said, half will become eligible under the expansion — the other half will not.

“Los Angeles County, like other counties throughout the state, needs to have sufficient resources in order to be able to care for those people,” Katz said.

Katz said L.A. County expects to spend $808 million on care for the uninsured next year, when Medi-Cal is expanded. The money the state’s talking about taking back would cover just $333 million of county costs.

Katz told lawmakers he knows that there will be real costs associated with Medi-Cal expansion, but in the first three years, when the federal government's paying 100 percent of the tab, he said the state's paying “zero, zero, zero.”