Initial Medicaid Implementation: California implemented its Medicaid program on March 1, 1966, a year following the passage of the Medicaid program. The program was signed into law in November of 1965 by then Governor Pat Brown. In the first year of the program, Medicaid in California (known as Medi-Cal) enrolled nearly 1.2 million people. During the first year the program was being implemented, Ronald Reagan was running for California governor and would inherit the early implementation of the program.
Key Medicaid Political Issues: California was the first state to implement the PACE program in San Francisco’s Chinatown neighborhood, a program that would eventually became part of the Medicaid program. The state has been an early adopter in many other areas of Medicaid policy. The state was an early adopter of the Children’s Health Insurance Program and was the first state to implement a mobile application for Medicaid. The state has been active in extending coverage to both children and pregnant women and due to the diverse cultures of the state has been a leader in extending certain flexibilities in terms of language and cultural competencies. The state has consistently debated whether to extend Medi-Cal to undocumented Californians and currently provides ED coverage and coverage for undocumented children through the Medicaid program with the state incurring a large portion of that cost. California has consistently been criticized for the low payment rates to providers, having the lowest reimbursement rate to primary care physicians prior to the temporary increase in primary care payments as part of the Affordable Care Act.
Medicaid expansion Implementation: California’s governor, Jerry Brown, was one of the first governors to pledge to implement the Medicaid expansion following the 2012 Supreme Court decision. The expansion was officially signed into law on June 27, 2013. Starting in 2011, California took advantage of a provision of the Affordable Care Act that allowed states to expand Medicaid early to limited numbers of people. The state extended eligibility to approximately 250,000 individuals making under 200% of the federal poverty level. The state has had three major impediments to a successful implementation of their Medicaid program. Initially, the state had nearly one million applicants whose applications hadn’t been processed. Second, the state ended up enrolling approximately four million Californians that surpassed the state’s initial projections. The state utilized authorities to enroll people already eligible for food nutrition assistance and other programs. Additionally, an investigation found that in the initial years of implementation the state did not quickly unenroll some people who were no longer eligible for Medicaid expansion due to change in employment or other circumstances.
General facts about California Medicaid:
Medicaid program name: Medi-Cal
CHIP Program name: Healthy Families
Separate or combined CHIP: Combination
Medicaid Enrollment: 12,054,906 (April 2018)
Total Medicaid Spending: $81.96 billion (FY 2016)
Share of total population covered by Medicaid: 26%
Share of Children covered by Medicaid: 40% (estimate)
Share of Medicaid that is Children and Adults: 84%
Share of Spending on Elderly and people with disabilities: 60%
Share of Nursing Facility Residents covered by Medicaid: 60% (estimate)
Expansion state: Yes
Number of people in expansion: 3.5 million (2016)
Work Requirement: No