Governor Brown’s budget proposal for Medi-Cal expansion means county and state government will be busy negotiating new risks and responsibilities in the coming months.
People who qualify for the public health program under the
Affordable Care Act will either go under an expanded state program
or be under the purview of county government.
California Health and Human Services Secretary Diana Dooley
says the state and the counties must still work that out.
DOOLEY: "This fundamentally changes the relationship
between the state and counties for the long term."
Farrah McDaid-Ting of the California State Association of
Counties says both options present challenges.
The counties are already providing health care to some of the
newly eligible, but making all 58 counties responsible under the
new federal health law would be a different story.
MCDAID-TING: "The challenge
would be securing adequate reimbursement in an adequate time, and
also complying with all the requirements and mandates of federal
Currently, counties spend 3 to 4 billion dollars on health
care for low-income adults who don't qualify for
McDaid-Ting says a state-based Medi-Cal expansion could
take on these clients, and pose billion dollar questions for
MCDAID-TING: "Do you want to keep serving
that population, and keep that 3-4 billion, and take on the
Medicaid expansion -, that would be the county option - or do you
want to contribute some of that money to the state, for the state
Counties may also take responsibility for social programs such
as child care as a trade-off for a state-based Medi-Cal
In either scenario says McDaid-Ting, the governments will have
to make sure the new enrollees can see a provider when they need