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"content": "\u003cp>BAKERSFIELD — In 2021, \u003ca href=\"https://www.kqed.org/news/tag/bakersfield\">Bakersfield\u003c/a> resident Elizabeth Ramirez’s mother broke three bones in a fall, leaving Ramirez with a new set of responsibilities: cooking and cleaning for her mom, bathing her and driving her to appointments.\u003c/p>\n\u003cp>“So I was caregiving for her on top of my kids,” Ramirez said. “It was just a lot.”\u003c/p>\n\u003cp>After a few years of juggling, Ramirez became a registered care provider for her mother through the state’s In-Home Supportive Services, a program provided \u003ca href=\"https://www.kqed.org/news/12032878/gop-cuts-to-medicaid-snap-would-shrink-californias-economy-by-17-billion-and-kill-nearly-140000-jobs-new-study-finds\" target=\"_blank\" rel=\"noopener\">through Medi-Cal\u003c/a>.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“So the work I put into making sure she’s safe and healthy, I get paid for it now,” Ramirez said. “It’s such a good support system that keeps people from drowning.”\u003c/p>\n\u003cp>No congressional seat in California relies more on Medi-Cal than the 22nd District, which follows Interstate 5 and Highway 99 as they stretch southeast from Avenal and Delano, through almond and pistachio orchards, to Bakersfield.\u003c/p>\n\u003cp>Two-thirds of residents are enrolled in Medi-Cal, the state’s Medicaid program, which provides health care to low-income residents, people with disabilities and those living in nursing homes or need of a personal caregiver.\u003c/p>\n\u003cfigure id=\"attachment_11933948\" class=\"wp-caption aligncenter\" style=\"max-width: 1024px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11933948 size-full\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/GettyImages-1245162773.jpg\" alt=\"oil pumps in a field\" width=\"1024\" height=\"683\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/GettyImages-1245162773.jpg 1024w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/GettyImages-1245162773-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/GettyImages-1245162773-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/GettyImages-1245162773-160x107.jpg 160w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\">\u003cfigcaption class=\"wp-caption-text\">Oil wells are seen at an oil facility by Interstate 5 near Bakersfield. \u003ccite>(Tayfun Coskun/Anadolu Agency via Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The 22nd District is also experiencing an intense political shift.\u003c/p>\n\u003cp>Back in 2020, voters here supported Joe Biden over Donald Trump in the presidential election by a 55%-42% margin. In November, Trump won the 22nd District, 52%-46% over Kamala Harris. The 19-point shift between 2020 and 2024 was the largest in California, securing incumbent Rep. David Valadao a comfortable victory that helped the GOP maintain control of the House of Representatives.\u003c/p>\n\u003cp>Connie Conway, the chair of the Republican Party of Tulare County, said Trump drew support from new voters — enough to start a young Republicans chapter in the county — and disaffected Democrats.\u003c/p>\n\u003cp>“I say this to people all the time, and I know because I’m a lifelong Central Valley girl, ‘We’re pretty conservative no matter what your party registration is,” Conway said.\u003c/p>\n\u003cp>Across California, Trump made his largest gains in districts like the 22nd — inland, working class, majority-Latino and, according to a KQED analysis, heavily reliant on Medi-Cal.\u003c/p>\n\u003cp>“We’re not known for our excess wealth, at least in our part of the Central Valley. We’re just hard-working people that share a lot of the same values: family, faith,” Conway said. “I think in this past election, that really resonated with a lot of folks.”\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" title=\"GOP Gains and Medi-Cal Enrollment\" aria-label=\"Scatter Plot\" id=\"datawrapper-chart-svLzI\" src=\"https://datawrapper.dwcdn.net/svLzI/6/\" scrolling=\"no\" frameborder=\"0\" style=\"width: 0; min-width: 100% !important; border: none;\" height=\"576\" data-external=\"1\" width=\"100%\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>Now, Republicans in Congress are moving ahead with plans to slash the health care program.\u003c/p>\n\u003cp>House Republicans passed a budget resolution in February that set a goal of $2 trillion in spending cuts. It was the first step toward passing a budget that party leaders hope will include over $4.5 trillion in new spending and tax cuts.\u003c/p>\n\u003cp>Top Republicans ruled out reductions to Social Security, Medicare and defense, leaving Medicaid as the most expensive program on the chopping block.\u003c/p>\n\u003cp>The path to achieving the centerpiece of Trump’s legislative agenda could go straight through the pocketbooks of the voters who powered GOP progress in 2024. Cuts to Medicaid, which has enjoyed bipartisan support, could imperil representatives like Valadao and give \u003ca href=\"https://www.kqed.org/news/12032994/democrats-focus-their-message-on-gop-cuts-to-medicaid\">new life to Democrats\u003c/a> looking for ways to reverse their decline in California’s working class communities.\u003c/p>\n\u003cp>[aside postID=news_12033446 hero='https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/DonaldTrump100DaysGetty-1020x680.jpg']\u003c/p>\n\u003cp>“I don’t want to say that there is an opportunity, since nothing good will come out of this budget, but the opportunity to clarify and define what we as a party are doing in this term of Trump is going to be critical,” said Orrin Evans, a Democratic strategist who has worked on multiple House campaigns in the state. “We have to be united in standing against this.”\u003c/p>\n\u003cp>KQED cross-referenced district-by-district Medicaid enrollment numbers from the UC Berkeley Labor Center with presidential vote totals from the 2020 and 2024 elections in each of the state’s 52 congressional districts, compiled by the California Target Book.\u003c/p>\n\u003cp>Of the 13 seats with the largest shift toward Trump in 2024 — the top quartile of districts — eight were among the top quartile in Medi-Cal reliance. Twelve of the 13 had Medi-Cal populations above the state average.\u003c/p>\n\u003cp>While Valadao voted for the budget resolution, he has expressed concerns for his constituents who benefit from Medi-Cal and said he would not vote for a final budget bill “that risks leaving them behind.” It’s unclear how the party would offset the costs of tax cuts without targeting Medicaid.\u003c/p>\n\u003cp>Doing so could bring political risk for California Republicans beyond just vulnerable incumbents like Valadao. The GOP made \u003ca href=\"https://www.kqed.org/news/12025617/confronting-trump-gotten-harder-california-legislature\">significant inroads\u003c/a> in communities still represented by Democrats in Congress — in the Central Valley, Inland Empire and along the state’s southern border — which fueled Republican gains further down the ballot in 2024.\u003c/p>\n\u003cp>The shifts reflect the acceleration of a yearslong \u003ca href=\"https://www.kqed.org/news/12011642/how-the-diploma-divide-is-reshaping-politics-in-a-key-california-house-race\">political realignment\u003c/a> along \u003ca href=\"https://www.kqed.org/forum/2010101908312/how-the-diploma-divide-polarizes-the-u-s-electorate\">educational lines\u003c/a>. During the Trump era, Democrats have gained ground in highly-educated suburban areas, such as coastal Orange and San Diego counties, and lost support in more working-class counties further inland.\u003c/p>\n\u003cfigure id=\"attachment_12010091\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-12010091 size-full\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/GettyImages-1255046550-1-scaled-e1743452454384.jpg\" alt=\"\" width=\"2000\" height=\"1334\">\u003cfigcaption class=\"wp-caption-text\">Republican Rep. David Valadao of California’s 22nd Congressional District, pictured in 2022. \u003ccite>(Irfan Khan/Los Angeles Times via Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In November, Republicans scored \u003ca href=\"https://www.kqed.org/news/12016328/special-session-to-trump-proof-california-opens-in-sacramento\">two shocking victories\u003c/a> in state Assembly districts long held by Democrats in Imperial and Riverside counties.\u003c/p>\n\u003cp>Valadao’s Bakersfield seat fits the profile of these areas in political transition. According to estimates from the U.S. Census’ American Community Survey, nearly 60% of the citizen voting-age population is Latino, the most of any district in California. Meanwhile, fewer than one in 10 residents over age 24 hold a college degree, the lowest share of any district in the state.\u003c/p>\n\u003cp>“That particular district, President Trump did far better than other Republican candidates had done at the top of the ticket,” said Tal Eslick, Valadao’s former chief of staff, on KQED’s \u003ca href=\"https://www.kqed.org/news/12030830/could-gop-spending-cuts-cost-republicans-the-house\">\u003cem>Political Breakdown\u003c/em>\u003c/a>. “So I think this is an example of a district that’s changing, especially among, I would say, Hispanic males.”\u003c/p>\n\u003cp>Eslick and Conway attributed the GOP’s 2024 turnaround in the area to a mix of economic concerns, such as the cost of living, and social issues, including the debate over transgender rights.\u003c/p>\n\u003cp>“If you can imagine a 70-year-old Hispanic female from Corcoran, I don’t think the trans issues or other issues like that resonated with her,” Eslick said. “I think [Democrats] lost many of those folks, and those folks went towards President Trump.”\u003c/p>\n\u003cp>But it’s exactly in these areas of the state that the health care coverage provided by Medi-Cal is a lifeline for residents, said Scott Graves, budget director at the California Budget & Policy Center.\u003c/p>\n\u003cp>“In the more rural areas of the state, in farming communities, they’re doing some pretty backbreaking jobs,” Graves said. “They’re not getting very well compensated for it, and they’re very unlikely to be offered a health coverage plan.”\u003c/p>\n\u003cp>The federal government covers roughly half of most Medicaid costs in California, splitting the expense with the state government. Under the Affordable Care Act, Medicaid expanded to cover Californians making up to 138% of the federal poverty level ($21,597 for a single adult in 2025), with the federal government covering 90% of the new costs.\u003c/p>\n\u003cfigure id=\"attachment_12032710\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-12032710 size-full\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/250323-DEM-TOWN-HALLS-MD-16-KQED-3.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/250323-DEM-TOWN-HALLS-MD-16-KQED-3.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/250323-DEM-TOWN-HALLS-MD-16-KQED-3-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/250323-DEM-TOWN-HALLS-MD-16-KQED-3-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/250323-DEM-TOWN-HALLS-MD-16-KQED-3-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/250323-DEM-TOWN-HALLS-MD-16-KQED-3-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/250323-DEM-TOWN-HALLS-MD-16-KQED-3-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Elizabeth Ramirez outside the MLK Community Center in Bakersfield, where Rep. Ro Khanna held a town hall meeting on March 23, 2025, the first of three town hall events Khanna was set to hold in Republican-held congressional districts across the state. \u003ccite>(Martin do Nascimento/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Medi-Cal dollars are inextricably woven into the local economy in this part of the state. Kaweah Health Medical Center in Visalia is the largest hospital in Tulare County. It’s also the county’s largest employer.\u003c/p>\n\u003cp>The hospital receives more than 30% of its revenue through Medi-Cal, according to Gary Herbst, Kaweah’s CEO, compared to less than 20% from private insurance. When Herbst first arrived at Kaweah in 1992, that ratio was reversed.\u003c/p>\n\u003cp>Herbst has begun planning for various scenarios of cuts to Medicaid. If the federal government were to lower its cost-sharing to 45% for both traditional and expansion Medi-Cal enrollees, the loss for Kaweah would be around $60 million a year.\u003c/p>\n\u003cp>“If we were to lose 50, 60 million dollars a year in Medi-Cal funding, then where would I cut? How many hundreds of people would I have to lay off? How many services would I have to close?” he said. “We’ve never faced losses of this magnitude.”[aside postID=news_12022068 hero='https://cdn.kqed.org/wp-content/uploads/sites/10/2024/11/GettyImages-536950177-1020x680.jpg']Doctors and nurses at Kaweah would still be required to provide emergency services to anyone who shows up at the hospital, regardless of their ability to pay. So the cuts could potentially come to services such as colonoscopy screenings, surgeries for hip and knee replacements or primary care visits.\u003c/p>\n\u003cp>“It’s not possible to cover a $50- to $60-million reduction in funding and say, ‘Oh, we’re just going to stop providing services to Medi-Cal patients,’” Herbst said. “We would literally be forced to close an entire service, probably multiple services, so it would affect all patients that are receiving those services.”\u003c/p>\n\u003cp>The consequences appeared to be on Valadao’s mind when he spoke on the House floor before voting to advance the GOP budget framework.\u003c/p>\n\u003cp>“I’ve heard from countless constituents who tell me the only way they can afford health care is through programs like Medicaid, and I will not support a final reconciliation bill that risks leaving them behind,” he said.\u003c/p>\n\u003cp>Valadao said Congress is faced with “a historic opportunity to advance the key priorities of this administration.” By cutting spending, Congress would be able to extend crucial provisions of the 2017 Tax Cuts and Jobs Act, such as the doubling of the standard deduction and the child tax credit.\u003c/p>\n\u003cp>After Valadao spoke, Rep. Steve Scalise, the House Majority Leader, said California’s 22nd District “is going to have a very loud voice as this process moves forward.” He said Medicaid could be strengthened by weeding out “waste, fraud and abuse,” without providing details on where that exists in the program.\u003c/p>\n\u003cfigure id=\"attachment_11930872\" class=\"wp-caption aligncenter\" style=\"max-width: 1024px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11930872 size-full\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/GettyImages-1231769719.jpg\" alt=\"A white man in a blue suit.\" width=\"1024\" height=\"683\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/GettyImages-1231769719.jpg 1024w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/GettyImages-1231769719-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/GettyImages-1231769719-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/GettyImages-1231769719-160x107.jpg 160w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\">\u003cfigcaption class=\"wp-caption-text\">Rep. David Valadao (R-Calif.) speaks during a news conference with other House Republican members on immigration in Washington in 2021. \u003ccite>(Caroline Brehman/CQ-Roll Call, Inc via Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Valadao declined an interview for this story. Longtime allies such as Eslick and Conway were skeptical that Republicans in Congress would actually carry out large cuts to Medicaid.\u003c/p>\n\u003cp>“I don’t see a scenario in which Republicans, or for that matter any politician, go after an entitlement program that is pretty popular and obviously a key issue for a large swath of people,” Eslick said.\u003c/p>\n\u003cp>It seems impossible for Republicans to achieve their ambitious goals for cutting spending without touching Medicaid. The budget plan passed by the House called for $880 billion in cuts over the next 10 years from programs overseen by the Committee on Energy and Commerce. Just $581 billion of spending \u003ca href=\"https://www.cbo.gov/system/files/2025-03/61235-Boyle-Pallone.pdf\">under the committee’s\u003c/a> jurisdiction is for programs other than Medicaid, according to the Congressional Budget Office.[aside postID=news_12032718 hero='https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/250323-DEM-TOWN-HALLS-MD-21-KQED-5-1020x680.jpg']Valadao is a political survivor, one of just two Republicans left in the House who voted to impeach Trump in 2021, but he’s not immune to the high-stakes politics of health care. In 2017, he voted to repeal the Affordable Care Act. A year later, he lost his campaign for re-election.\u003c/p>\n\u003cp>“David Valadao has a very clear choice: he can vote on behalf of his district or he can take another step towards a successful lobbying career which he will assume as soon as he is defeated,” said Evans, the Democratic strategist. “Voting for this draconian budget, there is no argument in how it would advance or help constituents in his district.”\u003c/p>\n\u003cp>Another clue about Medicaid’s political potency lies in a little-noticed ballot measure passed in November by California voters. Proposition 35 extended a state tax on providers of health care plans and restricted the revenue to fund Medi-Cal.\u003c/p>\n\u003cp>The initiative passed overwhelmingly with 68% of the vote — outpacing other ballot measures with similar levels of bipartisan support — and it tallied 70% approval in those 13 seats that saw the largest shift toward Trump.\u003c/p>\n\u003cp>Dustin Corcoran, CEO of the California Medical Association, which represents physicians in the state, said Medicaid is often a blind spot for policymakers and elected officials, who typically receive health coverage on the private market.\u003c/p>\n\u003cp>Corcoran saw a different reality as he traveled the state as co-chair of the Proposition 35 campaign. One stop took him to the campus of the UC Merced, in the heart of the 13th Congressional District, which has the third-highest Medi-Cal population and fourth-largest shift toward Trump.\u003c/p>\n\u003cp>He asked this icebreaker: Who knows what Medicaid is?\u003c/p>\n\u003cp>“Every hand went up,” Corcoran said. “Every single hand in the room.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"title": "Here’s How Cuts to Medicaid Could Blunt Republican Gains in California | KQED",
"description": "A KQED analysis found the Congressional Districts that shifted most toward President Donald Trump also rely disproportionately on Medi-Cal.",
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"headline": "Here’s How Cuts to Medicaid Could Blunt Republican Gains in California",
"datePublished": "2025-04-01T07:00:08-07:00",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>BAKERSFIELD — In 2021, \u003ca href=\"https://www.kqed.org/news/tag/bakersfield\">Bakersfield\u003c/a> resident Elizabeth Ramirez’s mother broke three bones in a fall, leaving Ramirez with a new set of responsibilities: cooking and cleaning for her mom, bathing her and driving her to appointments.\u003c/p>\n\u003cp>“So I was caregiving for her on top of my kids,” Ramirez said. “It was just a lot.”\u003c/p>\n\u003cp>After a few years of juggling, Ramirez became a registered care provider for her mother through the state’s In-Home Supportive Services, a program provided \u003ca href=\"https://www.kqed.org/news/12032878/gop-cuts-to-medicaid-snap-would-shrink-californias-economy-by-17-billion-and-kill-nearly-140000-jobs-new-study-finds\" target=\"_blank\" rel=\"noopener\">through Medi-Cal\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“So the work I put into making sure she’s safe and healthy, I get paid for it now,” Ramirez said. “It’s such a good support system that keeps people from drowning.”\u003c/p>\n\u003cp>No congressional seat in California relies more on Medi-Cal than the 22nd District, which follows Interstate 5 and Highway 99 as they stretch southeast from Avenal and Delano, through almond and pistachio orchards, to Bakersfield.\u003c/p>\n\u003cp>Two-thirds of residents are enrolled in Medi-Cal, the state’s Medicaid program, which provides health care to low-income residents, people with disabilities and those living in nursing homes or need of a personal caregiver.\u003c/p>\n\u003cfigure id=\"attachment_11933948\" class=\"wp-caption aligncenter\" style=\"max-width: 1024px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11933948 size-full\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/GettyImages-1245162773.jpg\" alt=\"oil pumps in a field\" width=\"1024\" height=\"683\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/GettyImages-1245162773.jpg 1024w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/GettyImages-1245162773-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/GettyImages-1245162773-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/GettyImages-1245162773-160x107.jpg 160w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\">\u003cfigcaption class=\"wp-caption-text\">Oil wells are seen at an oil facility by Interstate 5 near Bakersfield. \u003ccite>(Tayfun Coskun/Anadolu Agency via Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The 22nd District is also experiencing an intense political shift.\u003c/p>\n\u003cp>Back in 2020, voters here supported Joe Biden over Donald Trump in the presidential election by a 55%-42% margin. In November, Trump won the 22nd District, 52%-46% over Kamala Harris. The 19-point shift between 2020 and 2024 was the largest in California, securing incumbent Rep. David Valadao a comfortable victory that helped the GOP maintain control of the House of Representatives.\u003c/p>\n\u003cp>Connie Conway, the chair of the Republican Party of Tulare County, said Trump drew support from new voters — enough to start a young Republicans chapter in the county — and disaffected Democrats.\u003c/p>\n\u003cp>“I say this to people all the time, and I know because I’m a lifelong Central Valley girl, ‘We’re pretty conservative no matter what your party registration is,” Conway said.\u003c/p>\n\u003cp>Across California, Trump made his largest gains in districts like the 22nd — inland, working class, majority-Latino and, according to a KQED analysis, heavily reliant on Medi-Cal.\u003c/p>\n\u003cp>“We’re not known for our excess wealth, at least in our part of the Central Valley. We’re just hard-working people that share a lot of the same values: family, faith,” Conway said. “I think in this past election, that really resonated with a lot of folks.”\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" title=\"GOP Gains and Medi-Cal Enrollment\" aria-label=\"Scatter Plot\" id=\"datawrapper-chart-svLzI\" src=\"https://datawrapper.dwcdn.net/svLzI/6/\" scrolling=\"no\" frameborder=\"0\" style=\"width: 0; min-width: 100% !important; border: none;\" height=\"576\" data-external=\"1\" width=\"100%\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>Now, Republicans in Congress are moving ahead with plans to slash the health care program.\u003c/p>\n\u003cp>House Republicans passed a budget resolution in February that set a goal of $2 trillion in spending cuts. It was the first step toward passing a budget that party leaders hope will include over $4.5 trillion in new spending and tax cuts.\u003c/p>\n\u003cp>Top Republicans ruled out reductions to Social Security, Medicare and defense, leaving Medicaid as the most expensive program on the chopping block.\u003c/p>\n\u003cp>The path to achieving the centerpiece of Trump’s legislative agenda could go straight through the pocketbooks of the voters who powered GOP progress in 2024. Cuts to Medicaid, which has enjoyed bipartisan support, could imperil representatives like Valadao and give \u003ca href=\"https://www.kqed.org/news/12032994/democrats-focus-their-message-on-gop-cuts-to-medicaid\">new life to Democrats\u003c/a> looking for ways to reverse their decline in California’s working class communities.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I don’t want to say that there is an opportunity, since nothing good will come out of this budget, but the opportunity to clarify and define what we as a party are doing in this term of Trump is going to be critical,” said Orrin Evans, a Democratic strategist who has worked on multiple House campaigns in the state. “We have to be united in standing against this.”\u003c/p>\n\u003cp>KQED cross-referenced district-by-district Medicaid enrollment numbers from the UC Berkeley Labor Center with presidential vote totals from the 2020 and 2024 elections in each of the state’s 52 congressional districts, compiled by the California Target Book.\u003c/p>\n\u003cp>Of the 13 seats with the largest shift toward Trump in 2024 — the top quartile of districts — eight were among the top quartile in Medi-Cal reliance. Twelve of the 13 had Medi-Cal populations above the state average.\u003c/p>\n\u003cp>While Valadao voted for the budget resolution, he has expressed concerns for his constituents who benefit from Medi-Cal and said he would not vote for a final budget bill “that risks leaving them behind.” It’s unclear how the party would offset the costs of tax cuts without targeting Medicaid.\u003c/p>\n\u003cp>Doing so could bring political risk for California Republicans beyond just vulnerable incumbents like Valadao. The GOP made \u003ca href=\"https://www.kqed.org/news/12025617/confronting-trump-gotten-harder-california-legislature\">significant inroads\u003c/a> in communities still represented by Democrats in Congress — in the Central Valley, Inland Empire and along the state’s southern border — which fueled Republican gains further down the ballot in 2024.\u003c/p>\n\u003cp>The shifts reflect the acceleration of a yearslong \u003ca href=\"https://www.kqed.org/news/12011642/how-the-diploma-divide-is-reshaping-politics-in-a-key-california-house-race\">political realignment\u003c/a> along \u003ca href=\"https://www.kqed.org/forum/2010101908312/how-the-diploma-divide-polarizes-the-u-s-electorate\">educational lines\u003c/a>. During the Trump era, Democrats have gained ground in highly-educated suburban areas, such as coastal Orange and San Diego counties, and lost support in more working-class counties further inland.\u003c/p>\n\u003cfigure id=\"attachment_12010091\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-12010091 size-full\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/GettyImages-1255046550-1-scaled-e1743452454384.jpg\" alt=\"\" width=\"2000\" height=\"1334\">\u003cfigcaption class=\"wp-caption-text\">Republican Rep. David Valadao of California’s 22nd Congressional District, pictured in 2022. \u003ccite>(Irfan Khan/Los Angeles Times via Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In November, Republicans scored \u003ca href=\"https://www.kqed.org/news/12016328/special-session-to-trump-proof-california-opens-in-sacramento\">two shocking victories\u003c/a> in state Assembly districts long held by Democrats in Imperial and Riverside counties.\u003c/p>\n\u003cp>Valadao’s Bakersfield seat fits the profile of these areas in political transition. According to estimates from the U.S. Census’ American Community Survey, nearly 60% of the citizen voting-age population is Latino, the most of any district in California. Meanwhile, fewer than one in 10 residents over age 24 hold a college degree, the lowest share of any district in the state.\u003c/p>\n\u003cp>“That particular district, President Trump did far better than other Republican candidates had done at the top of the ticket,” said Tal Eslick, Valadao’s former chief of staff, on KQED’s \u003ca href=\"https://www.kqed.org/news/12030830/could-gop-spending-cuts-cost-republicans-the-house\">\u003cem>Political Breakdown\u003c/em>\u003c/a>. “So I think this is an example of a district that’s changing, especially among, I would say, Hispanic males.”\u003c/p>\n\u003cp>Eslick and Conway attributed the GOP’s 2024 turnaround in the area to a mix of economic concerns, such as the cost of living, and social issues, including the debate over transgender rights.\u003c/p>\n\u003cp>“If you can imagine a 70-year-old Hispanic female from Corcoran, I don’t think the trans issues or other issues like that resonated with her,” Eslick said. “I think [Democrats] lost many of those folks, and those folks went towards President Trump.”\u003c/p>\n\u003cp>But it’s exactly in these areas of the state that the health care coverage provided by Medi-Cal is a lifeline for residents, said Scott Graves, budget director at the California Budget & Policy Center.\u003c/p>\n\u003cp>“In the more rural areas of the state, in farming communities, they’re doing some pretty backbreaking jobs,” Graves said. “They’re not getting very well compensated for it, and they’re very unlikely to be offered a health coverage plan.”\u003c/p>\n\u003cp>The federal government covers roughly half of most Medicaid costs in California, splitting the expense with the state government. Under the Affordable Care Act, Medicaid expanded to cover Californians making up to 138% of the federal poverty level ($21,597 for a single adult in 2025), with the federal government covering 90% of the new costs.\u003c/p>\n\u003cfigure id=\"attachment_12032710\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-12032710 size-full\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/250323-DEM-TOWN-HALLS-MD-16-KQED-3.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/250323-DEM-TOWN-HALLS-MD-16-KQED-3.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/250323-DEM-TOWN-HALLS-MD-16-KQED-3-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/250323-DEM-TOWN-HALLS-MD-16-KQED-3-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/250323-DEM-TOWN-HALLS-MD-16-KQED-3-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/250323-DEM-TOWN-HALLS-MD-16-KQED-3-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/250323-DEM-TOWN-HALLS-MD-16-KQED-3-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Elizabeth Ramirez outside the MLK Community Center in Bakersfield, where Rep. Ro Khanna held a town hall meeting on March 23, 2025, the first of three town hall events Khanna was set to hold in Republican-held congressional districts across the state. \u003ccite>(Martin do Nascimento/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Medi-Cal dollars are inextricably woven into the local economy in this part of the state. Kaweah Health Medical Center in Visalia is the largest hospital in Tulare County. It’s also the county’s largest employer.\u003c/p>\n\u003cp>The hospital receives more than 30% of its revenue through Medi-Cal, according to Gary Herbst, Kaweah’s CEO, compared to less than 20% from private insurance. When Herbst first arrived at Kaweah in 1992, that ratio was reversed.\u003c/p>\n\u003cp>Herbst has begun planning for various scenarios of cuts to Medicaid. If the federal government were to lower its cost-sharing to 45% for both traditional and expansion Medi-Cal enrollees, the loss for Kaweah would be around $60 million a year.\u003c/p>\n\u003cp>“If we were to lose 50, 60 million dollars a year in Medi-Cal funding, then where would I cut? How many hundreds of people would I have to lay off? How many services would I have to close?” he said. “We’ve never faced losses of this magnitude.”\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Doctors and nurses at Kaweah would still be required to provide emergency services to anyone who shows up at the hospital, regardless of their ability to pay. So the cuts could potentially come to services such as colonoscopy screenings, surgeries for hip and knee replacements or primary care visits.\u003c/p>\n\u003cp>“It’s not possible to cover a $50- to $60-million reduction in funding and say, ‘Oh, we’re just going to stop providing services to Medi-Cal patients,’” Herbst said. “We would literally be forced to close an entire service, probably multiple services, so it would affect all patients that are receiving those services.”\u003c/p>\n\u003cp>The consequences appeared to be on Valadao’s mind when he spoke on the House floor before voting to advance the GOP budget framework.\u003c/p>\n\u003cp>“I’ve heard from countless constituents who tell me the only way they can afford health care is through programs like Medicaid, and I will not support a final reconciliation bill that risks leaving them behind,” he said.\u003c/p>\n\u003cp>Valadao said Congress is faced with “a historic opportunity to advance the key priorities of this administration.” By cutting spending, Congress would be able to extend crucial provisions of the 2017 Tax Cuts and Jobs Act, such as the doubling of the standard deduction and the child tax credit.\u003c/p>\n\u003cp>After Valadao spoke, Rep. Steve Scalise, the House Majority Leader, said California’s 22nd District “is going to have a very loud voice as this process moves forward.” He said Medicaid could be strengthened by weeding out “waste, fraud and abuse,” without providing details on where that exists in the program.\u003c/p>\n\u003cfigure id=\"attachment_11930872\" class=\"wp-caption aligncenter\" style=\"max-width: 1024px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11930872 size-full\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/GettyImages-1231769719.jpg\" alt=\"A white man in a blue suit.\" width=\"1024\" height=\"683\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/GettyImages-1231769719.jpg 1024w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/GettyImages-1231769719-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/GettyImages-1231769719-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/GettyImages-1231769719-160x107.jpg 160w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\">\u003cfigcaption class=\"wp-caption-text\">Rep. David Valadao (R-Calif.) speaks during a news conference with other House Republican members on immigration in Washington in 2021. \u003ccite>(Caroline Brehman/CQ-Roll Call, Inc via Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Valadao declined an interview for this story. Longtime allies such as Eslick and Conway were skeptical that Republicans in Congress would actually carry out large cuts to Medicaid.\u003c/p>\n\u003cp>“I don’t see a scenario in which Republicans, or for that matter any politician, go after an entitlement program that is pretty popular and obviously a key issue for a large swath of people,” Eslick said.\u003c/p>\n\u003cp>It seems impossible for Republicans to achieve their ambitious goals for cutting spending without touching Medicaid. The budget plan passed by the House called for $880 billion in cuts over the next 10 years from programs overseen by the Committee on Energy and Commerce. Just $581 billion of spending \u003ca href=\"https://www.cbo.gov/system/files/2025-03/61235-Boyle-Pallone.pdf\">under the committee’s\u003c/a> jurisdiction is for programs other than Medicaid, according to the Congressional Budget Office.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Valadao is a political survivor, one of just two Republicans left in the House who voted to impeach Trump in 2021, but he’s not immune to the high-stakes politics of health care. In 2017, he voted to repeal the Affordable Care Act. A year later, he lost his campaign for re-election.\u003c/p>\n\u003cp>“David Valadao has a very clear choice: he can vote on behalf of his district or he can take another step towards a successful lobbying career which he will assume as soon as he is defeated,” said Evans, the Democratic strategist. “Voting for this draconian budget, there is no argument in how it would advance or help constituents in his district.”\u003c/p>\n\u003cp>Another clue about Medicaid’s political potency lies in a little-noticed ballot measure passed in November by California voters. Proposition 35 extended a state tax on providers of health care plans and restricted the revenue to fund Medi-Cal.\u003c/p>\n\u003cp>The initiative passed overwhelmingly with 68% of the vote — outpacing other ballot measures with similar levels of bipartisan support — and it tallied 70% approval in those 13 seats that saw the largest shift toward Trump.\u003c/p>\n\u003cp>Dustin Corcoran, CEO of the California Medical Association, which represents physicians in the state, said Medicaid is often a blind spot for policymakers and elected officials, who typically receive health coverage on the private market.\u003c/p>\n\u003cp>Corcoran saw a different reality as he traveled the state as co-chair of the Proposition 35 campaign. One stop took him to the campus of the UC Merced, in the heart of the 13th Congressional District, which has the third-highest Medi-Cal population and fourth-largest shift toward Trump.\u003c/p>\n\u003cp>He asked this icebreaker: Who knows what Medicaid is?\u003c/p>\n\u003cp>“Every hand went up,” Corcoran said. “Every single hand in the room.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"slug": "californias-medi-cal-shortfall-hits-6-2-billion-with-unprecedented-cost-increases",
"title": "California’s Medi-Cal Shortfall Hits $6.2 billion With ‘Unprecedented’ Cost Increases",
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"headTitle": "California’s Medi-Cal Shortfall Hits $6.2 billion With ‘Unprecedented’ Cost Increases | KQED",
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"content": "\u003cp>The hole in California’s \u003ca href=\"https://calmatters.org/tag/medi-cal/\">Medi-Cal\u003c/a> budget seems to be bigger than what state officials reported just last week.\u003c/p>\n\u003cp>California health care officials told the Legislature on Monday that the state will need another $2.8 billion to be able to pay Medi-Cal providers through the end of the fiscal year.\u003c/p>\n\u003cp>That’s on top of a $3.4 billion loan that the administration told lawmakers last week it needed to make \u003ca href=\"https://calmatters.org/health/2025/03/medi-cal-budget-shortfall/\">“critical” payments for Medi-Cal\u003c/a>, the state-federal health insurance program for people with low income.\u003c/p>\n\u003cp>Combined, that’s $6.2 billion in spending above what was projected in the budget Gov. Gavin Newsom signed last summer. Almost 15 million Californians have health care coverage through Medi-Cal, also known as Medicaid.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“With the loan and these additional funds, the administration anticipates being able to manage expenditures for the remainder of the current year,” said Michelle Bass, director of the Department of Health Care Services, which oversees Medi-Cal.\u003c/p>\n\u003cp>Bass told legislators in a budget hearing that several factors are contributing to the higher-than-anticipated spending, including an increase in pharmacy costs, but also more growth in enrollment than the state projected. For one, the state underestimated the \u003ca href=\"https://calmatters.org/health/2023/12/undocumented-health-insurance-new-california-laws-2024/\">number of immigrants without legal status\u003c/a> who would sign up to the program in the last year.\u003c/p>\n\u003cp>Bass said the department had about one month of data regarding new policies before it had to make projections for the budget Newsom signed.\u003c/p>\n\u003cp>“These changes were unprecedented, and all happened at once,” Bass said.\u003c/p>\n\u003cp>The developments include:\u003c/p>\n\u003cul class=\"wp-block-list\">\n\u003cli>More immigrants without legal status enrolled in the program than expected. Over the last 10 years, California has \u003ca href=\"https://calmatters.org/explainers/california-health-care-coverage/\">expanded Medi-Cal coverage\u003c/a> to undocumented people in different age groups. The final group, adults ages 26 to 49, were allowed to apply for Medi-Cal starting Jan. 1, 2024. In January, Bass’ department estimated California would be spending \u003ca href=\"https://www.dhcs.ca.gov/Documents/Budget-Highlights/DHCS-FY-2025-26-Governors-Budget-Highlights.pdf\">$2.7 billion beyond what it budgeted (PDF)\u003c/a> due to the cost of covering care and prescriptions for newly enrolled immigrants. According to updated estimates from the administration, it costs the state about $8.5 billion from the general fund to cover immigrants who are in the country without legal authorization.\u003c/li>\n\u003cli>Also starting on Jan. 1, 2024, more seniors were able to sign up for Medi-Cal after the state stopped counting certain assets, such as cars, homes and savings when considering someone’s eligibility. Now, like everyone else, seniors’ eligibility is based on their income.\u003c/li>\n\u003cli>The program has seen higher overall enrollment due to pandemic-related flexibilities. California’s overall Medi-Cal population ballooned during the COVID-19 pandemic when the federal government temporarily suspended income eligibility checks to keep people insured during the national emergency. The number of people who dropped off the program after the pandemic was smaller than the department assumed.\u003c/li>\n\u003c/ul>\n\u003cp>Bass said other states are also going over budget, noting health care spending in general is increasing across the U.S.\u003c/p>\n\u003cp>Going over budget has vexed some state Republicans who say the governor and Democrats over-promised when they decided to expand Medi-Cal services to all immigrants with low income. Democrats have come out in defense of the expansion and the state’s efforts to keep people covered during the pandemic.[aside postID=news_12022068 hero='https://cdn.kqed.org/wp-content/uploads/sites/10/2024/11/GettyImages-536950177-1020x680.jpg']“The things that you’re talking about means that we have been successful,” Assemblymember Pilar Schiavo, a Santa Clarita Democrat, told Bass during Monday’s hearing. “We have been successful about keeping people covered, about making sure that they have access to health care.”\u003c/p>\n\u003cp>Schiavo added that California’s current shortfall is solvable, but less so are the potential cuts to Medicaid that Congress is currently weighing.\u003c/p>\n\u003cp>House Republicans recently voted to advance a proposal that could result in cuts of\u003ca href=\"https://calmatters.org/health/2025/02/medicaid-medi-cal-trump-cuts/\"> $880 billion to a group of programs\u003c/a>, largely Medicaid, over the next 10 years. According to some estimates, that could translate into annual losses of \u003ca href=\"https://calbudgetcenter.org/resources/california-at-risk-proposed-federal-funding-cuts-jeopardize-key-services/\">$10 billion to $20 billion a year\u003c/a> for California, an amount that state officials have said the state would not be able to backfill.\u003c/p>\n\u003cp>\u003cem>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.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n",
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"excerpt": "California is spending billions more than planned for Medi-Cal. Some of the cost drivers include higher enrollment among immigrants without legal status as well as pharmacy costs.",
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"title": "California’s Medi-Cal Shortfall Hits $6.2 billion With ‘Unprecedented’ Cost Increases | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The hole in California’s \u003ca href=\"https://calmatters.org/tag/medi-cal/\">Medi-Cal\u003c/a> budget seems to be bigger than what state officials reported just last week.\u003c/p>\n\u003cp>California health care officials told the Legislature on Monday that the state will need another $2.8 billion to be able to pay Medi-Cal providers through the end of the fiscal year.\u003c/p>\n\u003cp>That’s on top of a $3.4 billion loan that the administration told lawmakers last week it needed to make \u003ca href=\"https://calmatters.org/health/2025/03/medi-cal-budget-shortfall/\">“critical” payments for Medi-Cal\u003c/a>, the state-federal health insurance program for people with low income.\u003c/p>\n\u003cp>Combined, that’s $6.2 billion in spending above what was projected in the budget Gov. Gavin Newsom signed last summer. Almost 15 million Californians have health care coverage through Medi-Cal, also known as Medicaid.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“With the loan and these additional funds, the administration anticipates being able to manage expenditures for the remainder of the current year,” said Michelle Bass, director of the Department of Health Care Services, which oversees Medi-Cal.\u003c/p>\n\u003cp>Bass told legislators in a budget hearing that several factors are contributing to the higher-than-anticipated spending, including an increase in pharmacy costs, but also more growth in enrollment than the state projected. For one, the state underestimated the \u003ca href=\"https://calmatters.org/health/2023/12/undocumented-health-insurance-new-california-laws-2024/\">number of immigrants without legal status\u003c/a> who would sign up to the program in the last year.\u003c/p>\n\u003cp>Bass said the department had about one month of data regarding new policies before it had to make projections for the budget Newsom signed.\u003c/p>\n\u003cp>“These changes were unprecedented, and all happened at once,” Bass said.\u003c/p>\n\u003cp>The developments include:\u003c/p>\n\u003cul class=\"wp-block-list\">\n\u003cli>More immigrants without legal status enrolled in the program than expected. Over the last 10 years, California has \u003ca href=\"https://calmatters.org/explainers/california-health-care-coverage/\">expanded Medi-Cal coverage\u003c/a> to undocumented people in different age groups. The final group, adults ages 26 to 49, were allowed to apply for Medi-Cal starting Jan. 1, 2024. In January, Bass’ department estimated California would be spending \u003ca href=\"https://www.dhcs.ca.gov/Documents/Budget-Highlights/DHCS-FY-2025-26-Governors-Budget-Highlights.pdf\">$2.7 billion beyond what it budgeted (PDF)\u003c/a> due to the cost of covering care and prescriptions for newly enrolled immigrants. According to updated estimates from the administration, it costs the state about $8.5 billion from the general fund to cover immigrants who are in the country without legal authorization.\u003c/li>\n\u003cli>Also starting on Jan. 1, 2024, more seniors were able to sign up for Medi-Cal after the state stopped counting certain assets, such as cars, homes and savings when considering someone’s eligibility. Now, like everyone else, seniors’ eligibility is based on their income.\u003c/li>\n\u003cli>The program has seen higher overall enrollment due to pandemic-related flexibilities. California’s overall Medi-Cal population ballooned during the COVID-19 pandemic when the federal government temporarily suspended income eligibility checks to keep people insured during the national emergency. The number of people who dropped off the program after the pandemic was smaller than the department assumed.\u003c/li>\n\u003c/ul>\n\u003cp>Bass said other states are also going over budget, noting health care spending in general is increasing across the U.S.\u003c/p>\n\u003cp>Going over budget has vexed some state Republicans who say the governor and Democrats over-promised when they decided to expand Medi-Cal services to all immigrants with low income. Democrats have come out in defense of the expansion and the state’s efforts to keep people covered during the pandemic.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“The things that you’re talking about means that we have been successful,” Assemblymember Pilar Schiavo, a Santa Clarita Democrat, told Bass during Monday’s hearing. “We have been successful about keeping people covered, about making sure that they have access to health care.”\u003c/p>\n\u003cp>Schiavo added that California’s current shortfall is solvable, but less so are the potential cuts to Medicaid that Congress is currently weighing.\u003c/p>\n\u003cp>House Republicans recently voted to advance a proposal that could result in cuts of\u003ca href=\"https://calmatters.org/health/2025/02/medicaid-medi-cal-trump-cuts/\"> $880 billion to a group of programs\u003c/a>, largely Medicaid, over the next 10 years. According to some estimates, that could translate into annual losses of \u003ca href=\"https://calbudgetcenter.org/resources/california-at-risk-proposed-federal-funding-cuts-jeopardize-key-services/\">$10 billion to $20 billion a year\u003c/a> for California, an amount that state officials have said the state would not be able to backfill.\u003c/p>\n\u003cp>\u003cem>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.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>",
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"slug": "providing-health-care-for-immigrants-is-costing-california-more-than-expected-is-coverage-at-risk",
"title": "Providing Health Care for Immigrants Is Costing California More Than Expected. Is Coverage at Risk?",
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"content": "\u003cp>The California health care program that covers almost 15 million people is costing more money than Gov. Gavin Newsom projected, creating a \u003ca href=\"https://calmatters.org/tag/california-budget/\">new budget problem\u003c/a> in a lean year.\u003c/p>\n\u003cp>Now his administration is borrowing $3.4 billion from the state’s general fund to cover the unexpected cost increase. It’s unclear when the administration plans to restore the money.\u003c/p>\n\u003cp>The administration acknowledged that more people are enrolled in the program than the state anticipated, and that the state is spending $2.7 billion more than it planned on coverage expansions for immigrants without legal status.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Roughly 1.6 million immigrants without legal status are enrolled in \u003ca href=\"https://calmatters.org/tag/medi-cal/\">Medi-Cal\u003c/a>, according to state data. The program is a lifeline to people who traditionally have not had access to health insurance, and California is one of six states that \u003ca href=\"https://www.kff.org/racial-equity-and-health-policy/press-release/more-states-are-providing-fully-state-funded-health-coverage-to-some-individuals-regardless-of-immigration-status/\">offer coverage to immigrant adults \u003c/a>regardless of whether they are in the country legally.\u003c/p>\n\u003cp>Senate Minority Leader Brian Jones said Newsom has overpromised and under-delivered on health care at a time when all Californians are struggling to afford the cost of living in the state.\u003c/p>\n\u003cp>“Democrats and the governor are picking priorities, and they’re prioritizing people that have come into our country illegally over people who immigrated here legally, people that are citizens,” Jones said.\u003c/p>\n\u003cp>The state’s Medi-Cal expansion for undocumented immigrants costs about $8.5 billion from the state general fund annually, according to \u003ca href=\"https://calmatters.digitaldemocracy.org/hearings/258448\">a recent budget hearing\u003c/a>.\u003c/p>\n\u003cp>“If we weren’t spending eight-and-a-half billion dollars on illegal immigrants, we wouldn’t need to borrow $3.4 billion to cover the difference,” Jones said.\u003c/p>\n\u003cp>H.D. Palmer, a spokesperson for the state’s finance department, acknowledged that the rise in spending is partially attributable to higher-than-projected costs associated with larger enrollment numbers for California’s undocumented population. In January,\u003cstrong> \u003c/strong>the \u003ca href=\"https://www.dhcs.ca.gov/Documents/Budget-Highlights/DHCS-FY-2025-26-Governors-Budget-Highlights.pdf\">Department of Health Care Services (PDF)\u003c/a>, which oversees Medi-Cal, estimated California is spending $2.7 billion beyond what it budgeted due to the cost of covering care and prescriptions for newly enrolled immigrants.\u003c/p>\n\u003cp>But immigrants aren’t the only population that is using Medi-Cal more than the state expected.\u003c/p>\n\u003cp>California’s Medi-Cal population in general ballooned during the COVID-19 pandemic when the federal government temporarily suspended income eligibility checks to keep people insured during the national emergency. Before the pandemic about 13 million people used Medi-Cal. That number peaked at 15.6 million in 2023 when \u003ca href=\"https://www.chcf.org/collection/medi-cal-end-public-health-emergency/#:~:text=The%20requirement%20ended%20on%20March,Californians%20may%20leave%20the%20program.\">eligibility checks resumed\u003c/a>. Today 14.9 million people are enrolled, according to \u003ca href=\"https://lao.ca.gov/Publications/Report/5010\">state data\u003c/a>.[aside postID=news_12022068 hero='https://cdn.kqed.org/wp-content/uploads/sites/10/2024/11/GettyImages-536950177-1020x680.jpg']The Legislative Analyst’s Office has also noted \u003ca href=\"https://lao.ca.gov/reports/2025/5010/Understanding-Recent-Increases-Medi-Cal-Senior-Caseload-030525.pdf\">a 40% growth over the last four years (PDF)\u003c/a> in the number of seniors enrolled in Medi-Cal. While seniors make up only about 10% of the program’s enrollees, they account for a large part of the program’s spending because benefits such as long-term care are among the most expensive.\u003c/p>\n\u003cp>Medi-Cal spends about $15,000 a year per senior. That compares to the $8,000 a year the program spends on average on other enrollees.\u003c/p>\n\u003cp>Newsom’s office said these issues are neither new nor unique to California. Medi-Cal is California’s version of Medicaid, the federal-state program that provides health coverage nationwide to low-income households.\u003c/p>\n\u003cp>“Rising Medicaid costs are a national challenge, affecting both red and blue states alike,” Elana Ross, a spokesperson for the governor’s office, said in an email.\u003c/p>\n\u003ch2>Democrats pledge to protect immigrant health care\u003c/h2>\n\u003cp>Sen. Roger Niello, a long-time critic of the state’s closed-door budgeting process, which is typically hashed out between Democratic leaders and the governor, acknowledged that other factors like senior enrollment and high drug costs could be contributing to the high expenses. He said Republicans are worried about increasing spending on immigrant health care.\u003c/p>\n\u003cp>The Republican from Roseville criticized the lack of transparency from Newsom’s finance department.\u003c/p>\n\u003cp>“The completely opaque nature of the request, which says nothing about any of that, is entirely inappropriate,” Niello said.\u003c/p>\n\u003cfigure id=\"attachment_12031546\" class=\"wp-caption aligncenter\" style=\"max-width: 1568px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12031546\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/031327_Niello-MediCal_FG_CM_05-copy.jpg\" alt=\"\" width=\"1568\" height=\"1045\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/031327_Niello-MediCal_FG_CM_05-copy.jpg 1568w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/031327_Niello-MediCal_FG_CM_05-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/031327_Niello-MediCal_FG_CM_05-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/031327_Niello-MediCal_FG_CM_05-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/031327_Niello-MediCal_FG_CM_05-copy-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1568px) 100vw, 1568px\">\u003cfigcaption class=\"wp-caption-text\">State Sen. Roger Niello holds a news conference in the rotunda of the state Capitol in Sacramento on March 13, 2025. Niello requested more transparency from Gov. Newsom as to why the state needs $3.5 billion to keep Medi-Cal solvent. \u003ccite>(Fred Greaves for CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Democratic lawmakers said they need more information about what exactly is behind the unexpected spending increases, but pushed back on the idea that the state would need to roll back coverage for its undocumented population.\u003c/p>\n\u003cp>“Immigrant workers and families, who pay billions in taxes, deserve access to care, and I am proud to protect California’s progress expanding Medi-Cal,” Assembly Speaker Robert Rivas said in a statement. “There are tough choices ahead, and Assembly Democrats will closely examine any proposal from the governor. But let’s be clear: We will not roll over and leave our immigrants behind.”[aside postID=news_12029294 hero='https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/072820-Doctor-Pediatrician-Kid-GETTY-CM-01-copy-1020x680.jpg']Immigrants lacking permanent status contribute approximately \u003ca href=\"https://calbudgetcenter.org/news/new-study-undocumented-immigrants-contribute-8-5-billion-in-california-taxes-a-year/\">$8.5 billion in state and local taxes a year\u003c/a>, according to an analysis by the California Budget and Policy Center, a nonprofit research group. That’s about the same amount it’s costing the state to give them Medi-Cal.\u003c/p>\n\u003cp>State lawmakers first allowed undocumented children to enroll in Medi-Cal in 2016 under Gov. Jerry Brown. Since then Newsom has approved adding young adults up to age 25 in 2020 and older adults and seniors in 2022. Adults ages 26–49 were the final group added in 2024. Throughout those years, even \u003ca href=\"https://calmatters.org/health/2024/01/undocumented-health-care-politics/\">some Republican lawmakers supported covering this population.\u003c/a>\u003c/p>\n\u003cp>“The Republicans need to take a better and keen-eyed look at the timeline associated with those expansions,” said Assemblymember Mia Bonta, an Oakland Democrat who leads the Health Committee. “For them to just try to play the blame game and put it all at the feet of California values to ensure that we have universal health coverage for all with this particular age group being included is just specious.”\u003c/p>\n\u003ch2>Billions more in potential Medicaid cuts\u003c/h2>\n\u003cp>Assemblymember Dawn Addis, who chairs a budget subcommittee on health, said she will be questioning Newsom officials closely about the spending increase in an upcoming hearing.\u003c/p>\n\u003cp>“We really need to understand the details of what the Department of Finance is saying, what the executive is seeing, and how they’re calculating this information,” Addis, a Democrat from San Luis Obispo, said.\u003c/p>\n\u003cp>Addis emphasized that the biggest threat to Medi-Cal right now is coming from the federal government.\u003c/p>\n\u003cp>House Republicans recently voted to advance a proposal that could result in cuts of \u003ca href=\"https://calmatters.org/health/2025/02/medicaid-medi-cal-trump-cuts/\">$880 billion to a group of programs\u003c/a>, largely Medicaid, over the next 10 years. The California Budget and Policy Center has estimated that the proposals currently at play in Congress could translate into annual losses of $10 billion to $20 billion a year for the state.\u003c/p>\n\u003cp>“The reason why it’s so important for us to fight back against cuts at the federal level to Medicaid is because there is no easy or painless solution to fill that budget hole,” said Amanda McAllister-Wallner, interim executive director of Health Access California.\u003c/p>\n\u003cp>Health Access California along with the California Immigrant Policy Center spearheaded the campaign nearly a decade ago to insure all immigrants in the state.\u003c/p>\n\u003cp>McAllister-Wallner said it was unfair and unreasonable to pin the state budget shortfall on the immigrant expansions. Over the same time period, the state has added benefits, such as \u003ca href=\"https://www.chcf.org/wp-content/uploads/2023/08/MediCalExplainedNewServicesGlance20202023.pdf\">doula services and family therapy (PDF)\u003c/a>, and invested heavily in reforming the system through a multibillion-dollar initiative called CalAIM.\u003c/p>\n\u003cp>“Those changes that we’ve made in Medi-Cal made the program stronger (and) have made the state healthier,” McAllister-Wallner said.\u003c/p>\n\u003cp>\u003cem>CalMatters reporter Alexei Koseff contributed to this story.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"nprByline": "\u003ca href=\"https://calmatters.org/author/anaibarra/\">Ana B. Ibarra\u003c/a> and \u003ca href=\"https://calmatters.org/author/kristen-hwang/\">Kristen Hwang\u003c/a>, CalMatters",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The California health care program that covers almost 15 million people is costing more money than Gov. Gavin Newsom projected, creating a \u003ca href=\"https://calmatters.org/tag/california-budget/\">new budget problem\u003c/a> in a lean year.\u003c/p>\n\u003cp>Now his administration is borrowing $3.4 billion from the state’s general fund to cover the unexpected cost increase. It’s unclear when the administration plans to restore the money.\u003c/p>\n\u003cp>The administration acknowledged that more people are enrolled in the program than the state anticipated, and that the state is spending $2.7 billion more than it planned on coverage expansions for immigrants without legal status.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Roughly 1.6 million immigrants without legal status are enrolled in \u003ca href=\"https://calmatters.org/tag/medi-cal/\">Medi-Cal\u003c/a>, according to state data. The program is a lifeline to people who traditionally have not had access to health insurance, and California is one of six states that \u003ca href=\"https://www.kff.org/racial-equity-and-health-policy/press-release/more-states-are-providing-fully-state-funded-health-coverage-to-some-individuals-regardless-of-immigration-status/\">offer coverage to immigrant adults \u003c/a>regardless of whether they are in the country legally.\u003c/p>\n\u003cp>Senate Minority Leader Brian Jones said Newsom has overpromised and under-delivered on health care at a time when all Californians are struggling to afford the cost of living in the state.\u003c/p>\n\u003cp>“Democrats and the governor are picking priorities, and they’re prioritizing people that have come into our country illegally over people who immigrated here legally, people that are citizens,” Jones said.\u003c/p>\n\u003cp>The state’s Medi-Cal expansion for undocumented immigrants costs about $8.5 billion from the state general fund annually, according to \u003ca href=\"https://calmatters.digitaldemocracy.org/hearings/258448\">a recent budget hearing\u003c/a>.\u003c/p>\n\u003cp>“If we weren’t spending eight-and-a-half billion dollars on illegal immigrants, we wouldn’t need to borrow $3.4 billion to cover the difference,” Jones said.\u003c/p>\n\u003cp>H.D. Palmer, a spokesperson for the state’s finance department, acknowledged that the rise in spending is partially attributable to higher-than-projected costs associated with larger enrollment numbers for California’s undocumented population. In January,\u003cstrong> \u003c/strong>the \u003ca href=\"https://www.dhcs.ca.gov/Documents/Budget-Highlights/DHCS-FY-2025-26-Governors-Budget-Highlights.pdf\">Department of Health Care Services (PDF)\u003c/a>, which oversees Medi-Cal, estimated California is spending $2.7 billion beyond what it budgeted due to the cost of covering care and prescriptions for newly enrolled immigrants.\u003c/p>\n\u003cp>But immigrants aren’t the only population that is using Medi-Cal more than the state expected.\u003c/p>\n\u003cp>California’s Medi-Cal population in general ballooned during the COVID-19 pandemic when the federal government temporarily suspended income eligibility checks to keep people insured during the national emergency. Before the pandemic about 13 million people used Medi-Cal. That number peaked at 15.6 million in 2023 when \u003ca href=\"https://www.chcf.org/collection/medi-cal-end-public-health-emergency/#:~:text=The%20requirement%20ended%20on%20March,Californians%20may%20leave%20the%20program.\">eligibility checks resumed\u003c/a>. Today 14.9 million people are enrolled, according to \u003ca href=\"https://lao.ca.gov/Publications/Report/5010\">state data\u003c/a>.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>The Legislative Analyst’s Office has also noted \u003ca href=\"https://lao.ca.gov/reports/2025/5010/Understanding-Recent-Increases-Medi-Cal-Senior-Caseload-030525.pdf\">a 40% growth over the last four years (PDF)\u003c/a> in the number of seniors enrolled in Medi-Cal. While seniors make up only about 10% of the program’s enrollees, they account for a large part of the program’s spending because benefits such as long-term care are among the most expensive.\u003c/p>\n\u003cp>Medi-Cal spends about $15,000 a year per senior. That compares to the $8,000 a year the program spends on average on other enrollees.\u003c/p>\n\u003cp>Newsom’s office said these issues are neither new nor unique to California. Medi-Cal is California’s version of Medicaid, the federal-state program that provides health coverage nationwide to low-income households.\u003c/p>\n\u003cp>“Rising Medicaid costs are a national challenge, affecting both red and blue states alike,” Elana Ross, a spokesperson for the governor’s office, said in an email.\u003c/p>\n\u003ch2>Democrats pledge to protect immigrant health care\u003c/h2>\n\u003cp>Sen. Roger Niello, a long-time critic of the state’s closed-door budgeting process, which is typically hashed out between Democratic leaders and the governor, acknowledged that other factors like senior enrollment and high drug costs could be contributing to the high expenses. He said Republicans are worried about increasing spending on immigrant health care.\u003c/p>\n\u003cp>The Republican from Roseville criticized the lack of transparency from Newsom’s finance department.\u003c/p>\n\u003cp>“The completely opaque nature of the request, which says nothing about any of that, is entirely inappropriate,” Niello said.\u003c/p>\n\u003cfigure id=\"attachment_12031546\" class=\"wp-caption aligncenter\" style=\"max-width: 1568px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12031546\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/031327_Niello-MediCal_FG_CM_05-copy.jpg\" alt=\"\" width=\"1568\" height=\"1045\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/031327_Niello-MediCal_FG_CM_05-copy.jpg 1568w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/031327_Niello-MediCal_FG_CM_05-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/031327_Niello-MediCal_FG_CM_05-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/031327_Niello-MediCal_FG_CM_05-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/031327_Niello-MediCal_FG_CM_05-copy-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1568px) 100vw, 1568px\">\u003cfigcaption class=\"wp-caption-text\">State Sen. Roger Niello holds a news conference in the rotunda of the state Capitol in Sacramento on March 13, 2025. Niello requested more transparency from Gov. Newsom as to why the state needs $3.5 billion to keep Medi-Cal solvent. \u003ccite>(Fred Greaves for CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Democratic lawmakers said they need more information about what exactly is behind the unexpected spending increases, but pushed back on the idea that the state would need to roll back coverage for its undocumented population.\u003c/p>\n\u003cp>“Immigrant workers and families, who pay billions in taxes, deserve access to care, and I am proud to protect California’s progress expanding Medi-Cal,” Assembly Speaker Robert Rivas said in a statement. “There are tough choices ahead, and Assembly Democrats will closely examine any proposal from the governor. But let’s be clear: We will not roll over and leave our immigrants behind.”\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Immigrants lacking permanent status contribute approximately \u003ca href=\"https://calbudgetcenter.org/news/new-study-undocumented-immigrants-contribute-8-5-billion-in-california-taxes-a-year/\">$8.5 billion in state and local taxes a year\u003c/a>, according to an analysis by the California Budget and Policy Center, a nonprofit research group. That’s about the same amount it’s costing the state to give them Medi-Cal.\u003c/p>\n\u003cp>State lawmakers first allowed undocumented children to enroll in Medi-Cal in 2016 under Gov. Jerry Brown. Since then Newsom has approved adding young adults up to age 25 in 2020 and older adults and seniors in 2022. Adults ages 26–49 were the final group added in 2024. Throughout those years, even \u003ca href=\"https://calmatters.org/health/2024/01/undocumented-health-care-politics/\">some Republican lawmakers supported covering this population.\u003c/a>\u003c/p>\n\u003cp>“The Republicans need to take a better and keen-eyed look at the timeline associated with those expansions,” said Assemblymember Mia Bonta, an Oakland Democrat who leads the Health Committee. “For them to just try to play the blame game and put it all at the feet of California values to ensure that we have universal health coverage for all with this particular age group being included is just specious.”\u003c/p>\n\u003ch2>Billions more in potential Medicaid cuts\u003c/h2>\n\u003cp>Assemblymember Dawn Addis, who chairs a budget subcommittee on health, said she will be questioning Newsom officials closely about the spending increase in an upcoming hearing.\u003c/p>\n\u003cp>“We really need to understand the details of what the Department of Finance is saying, what the executive is seeing, and how they’re calculating this information,” Addis, a Democrat from San Luis Obispo, said.\u003c/p>\n\u003cp>Addis emphasized that the biggest threat to Medi-Cal right now is coming from the federal government.\u003c/p>\n\u003cp>House Republicans recently voted to advance a proposal that could result in cuts of \u003ca href=\"https://calmatters.org/health/2025/02/medicaid-medi-cal-trump-cuts/\">$880 billion to a group of programs\u003c/a>, largely Medicaid, over the next 10 years. The California Budget and Policy Center has estimated that the proposals currently at play in Congress could translate into annual losses of $10 billion to $20 billion a year for the state.\u003c/p>\n\u003cp>“The reason why it’s so important for us to fight back against cuts at the federal level to Medicaid is because there is no easy or painless solution to fill that budget hole,” said Amanda McAllister-Wallner, interim executive director of Health Access California.\u003c/p>\n\u003cp>Health Access California along with the California Immigrant Policy Center spearheaded the campaign nearly a decade ago to insure all immigrants in the state.\u003c/p>\n\u003cp>McAllister-Wallner said it was unfair and unreasonable to pin the state budget shortfall on the immigrant expansions. Over the same time period, the state has added benefits, such as \u003ca href=\"https://www.chcf.org/wp-content/uploads/2023/08/MediCalExplainedNewServicesGlance20202023.pdf\">doula services and family therapy (PDF)\u003c/a>, and invested heavily in reforming the system through a multibillion-dollar initiative called CalAIM.\u003c/p>\n\u003cp>“Those changes that we’ve made in Medi-Cal made the program stronger (and) have made the state healthier,” McAllister-Wallner said.\u003c/p>\n\u003cp>\u003cem>CalMatters reporter Alexei Koseff contributed to this story.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "Californians in Republican Districts Feel Betrayed by Looming Health Care Cuts",
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"content": "\u003cp>Natalie Padilla signed up for Medicaid 17 years ago. She had just given birth and needed insurance to bring her son to the doctor. The Bakersfield resident was still in school, and her husband’s work didn’t offer insurance. She was on the program for six months.\u003c/p>\n\u003cp>About an hour north of Bakersfield, Rodolfo Morales-Ayon, a 21-year-old community college student, relies on Medicaid today. He’s studying political science and wants to go to law school. Morales-Ayon grew up in Pixley, a small Central Valley town where air quality is poor and asthma and respiratory infections are common.\u003c/p>\n\u003cp>Farther south in Orange County, Josephine Rios’ 7-year-old grandson has cerebral palsy and needs Medicaid to pay for his medication and specialized wheelchair, which cost $22,000. Elijah is a lively boy, Rios said, but his disability means he’ll likely need Medicaid for his entire life.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>All three live in areas of California where their Republican representatives recently voted on a federal budget bill that would all but guarantee cuts to the Medicaid insurance program, which is known in California as \u003ca href=\"https://calmatters.org/tag/medi-cal/\">Medi-Cal\u003c/a>.\u003c/p>\n\u003cp>Although the details will take months to iron out, the nonpartisan \u003ca href=\"https://www.cbo.gov/system/files/2025-03/61235-Boyle-Pallone.pdf\">Congressional Budget Office released a report (PDF)\u003c/a> last week indicating that it was impossible for House Republicans to meet their \u003ca href=\"https://www.washingtonpost.com/business/2025/03/05/gop-budget-medicaid-cuts/\">goal of eliminating $880 billion in spending\u003c/a> over the next 10 years from the committee that oversees Medicaid and Medicare without cutting from either of the social safety net programs. Medicaid provides health insurance for people with disabilities and low income. Medicare insures seniors over 65.\u003c/p>\n\u003cp>The Senate voted on a narrower budget bill that is less likely to hit Medicaid, but the chamber will have to come to an agreement with the House later in the year. President Donald Trump has praised both budget bills, while at the same time indicating he doesn’t want to cut safety net programs for the poor. Congress is also rushing to \u003ca href=\"https://www.usnews.com/news/national-news/articles/2025-03-10/are-we-headed-for-a-government-shutdown-3-things-to-watch\">avert a government shutdown Friday with a separate budget bill\u003c/a>.\u003c/p>\n\u003cp>“Medicare, Medicaid — none of that stuff is going to be touched,” Trump said in a February \u003ca href=\"https://fox59.com/hill-politics/trumps-vow-to-preserve-medicaid-collides-with-house-gop-plan-for-tax-cuts/\">interview with Sean Hannity on Fox News\u003c/a>.\u003c/p>\n\u003cp>But Republican lawmakers want a deal that would offset the cost of extending Trump’s first-term tax cuts that are set to expire at the end of this year, and \u003ca href=\"https://rollcall.com/2025/02/13/medicaid-overhaul-proves-to-be-politically-perilous-proposition/\">Medicaid represents the largest share of federal funding\u003c/a> to states.\u003c/p>\n\u003cp>California’s behemoth Medicaid program insures 14.9 million people, more than one-third of the state’s population. Republicans hold nine House seats in California and represent 2.5 million Medicaid enrollees. All nine voted to approve the House GOP budget bill at the end of February.[aside postID=news_12028454 hero='https://cdn.kqed.org/wp-content/uploads/sites/10/2025/02/GettyImages-2177324845-1020x680.jpg']Some of the state’s most conservative areas benefit disproportionately from Medicaid, including Rep. Jay Obernolte’s district in San Bernardino County’s high desert and Rep. Doug LaMalfa’s district in the far northern counties, where 48% and 43% of the population have Medicaid respectively.\u003c/p>\n\u003cp>Other Republicans represent swing districts where \u003ca href=\"https://apnews.com/article/medicaid-cuts-budget-republicans-health-care-4a13fc3528d7bf20ea52db4a5551c8bf\">voting against Medicaid \u003c/a>could be risky politically. Rep. \u003ca href=\"https://www.politico.com/newsletters/california-playbook-pm/2024/11/13/valadao-house-win-00189478\">David Valadao\u003c/a> in the San Joaquin Valley represents the greatest share of Medicaid enrollees in the state at 67%. He voted to advance the House bill. Six years ago, his \u003ca href=\"https://www.politico.com/news/2025/02/20/david-valadao-medicaid-cuts-congress-00205072\">vote to eliminate the Affordable Care Act\u003c/a> likely cost his reelection for a term.\u003c/p>\n\u003cp>In contrast, California’s Democratic state lawmakers have taken every opportunity to \u003ca href=\"https://calmatters.org/explainers/california-health-care-coverage/\">expand the Medicaid program\u003c/a>, which grants full-scope health coverage to people with low income (for instance: an individual making less than $20,783 or a family of four making less than $43,056 annually).\u003c/p>\n\u003cp>The number of people with Medicaid in California has increased 31% since 2014 when the Affordable Care Act allowed states to enroll people who made slightly more than the federal poverty threshold. California has also expanded in other categories, using about $8 billion annually of state \u003ca href=\"https://calmatters.org/health/2023/12/undocumented-health-insurance-new-california-laws-2024/\">money to insure undocumented immigrants\u003c/a>.\u003c/p>\n\u003cp>Today, the state spends \u003ca href=\"https://ebudget.ca.gov/2024-25/pdf/Enacted/BudgetSummary/HealthandHumanServices.pdf\">$161 billion on Medicaid (PDF)\u003c/a>, the \u003ca href=\"https://calbudgetcenter.org/resources/federal-funds-drive-one-third-of-californias-state-budget/\">majority of which comes from the federal government\u003c/a>.\u003c/p>\n\u003cp>Republicans have focused talks on \u003ca href=\"https://www.statnews.com/2025/03/03/medicaid-cuts-republicans-paragon-say-to-focus-on-waste-fraud-and-abuse/\">rooting out “waste” and “fraud”\u003c/a> in federal programs, but \u003ca href=\"https://www.nytimes.com/interactive/2025/01/23/us/politics/republican-tax-spending-cuts-options.html\">early proposals\u003c/a> appear to aim at the fundamental payment structure of Medicaid. Experts say those types of cuts may require states to pay more for the programs, putting the political and financial onus on state lawmakers.\u003c/p>\n\u003cp>“Many of these proposals are about having states be left holding the bag,” said Edwin Park, a public policy research professor at Georgetown University. “If states have less funding available, then it’s impossible for them to sustain their current levels of spending.”\u003c/p>\n\u003cp>‘Some people will die without it’In a \u003ca href=\"https://www.youtube.com/watch?v=sKZxE-aaRoU\">statement on the House floor\u003c/a> following the initial budget vote, Valadao said extending Trump’s 2017 tax cuts would make a real difference for “working families, farmers, and small business owners” but acknowledged that many of his constituents need Medicaid.\u003cbr>\n“I’ve heard from countless constituents who tell me the only way they can afford health care is through programs like Medicaid,” Valadao said that day, indicating he could vote differently later in the year on a final proposal. “And I will not support a final reconciliation bill that risks leaving them behind.”\u003c/p>\n\u003cp>But some California voters still feel like their representatives have failed them by advancing a bill that will likely lead to Medicaid cuts.\u003c/p>\n\u003cfigure id=\"attachment_12031054\" class=\"wp-caption aligncenter\" style=\"max-width: 1568px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12031054\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/030425_Medicaid-Pixley_LV_CM_06-copy.jpg\" alt=\"\" width=\"1568\" height=\"1045\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/030425_Medicaid-Pixley_LV_CM_06-copy.jpg 1568w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/030425_Medicaid-Pixley_LV_CM_06-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/030425_Medicaid-Pixley_LV_CM_06-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/030425_Medicaid-Pixley_LV_CM_06-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/030425_Medicaid-Pixley_LV_CM_06-copy-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1568px) 100vw, 1568px\">\u003cfigcaption class=\"wp-caption-text\">Rudolpho Morales-Ayon, a community college student, in Pixley Park in Pixley on March 4, 2025. Morales enrolled in Medicaid as a child and continues the health insurance program. \u003ccite>(Larry Valenzuela/CalMatters/CatchLight Local)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“For our representative David Valadao, this is a betrayal. It’s nothing less than that,” Morales-Ayon, a district voter, said. Morales-Ayon voted for Valadao’s Democratic opponent last fall.\u003c/p>\n\u003cp>Morales-Ayon had Medicaid as a child because his parents’ jobs didn’t provide insurance. Per capita earnings in Valadao’s district are about half as much as statewide earnings, according to census data.\u003c/p>\n\u003cp>“People need these resources to manage their day-to-day lives,” Morales-Ayon said.\u003c/p>\n\u003cp>Padilla, who also lives in Valadao’s district, now works as a pharmacy technician at Mercy Hospital Southwest in Bakersfield. She traveled with her union to Washington, D.C. several weeks ago to try and make an appeal to Valadao not to vote for any Medicaid cuts. Staff told the group that he was too busy to see them, Padilla said.\u003c/p>\n\u003cp>Padilla grew up in the district and said multiple family members, including cousins and her 84-year-old grandmother, have Medicaid. Her family who rely on Medicaid have low-paying or part time jobs that don’t offer health insurance. Any reductions in coverage would be “devastating,” she said.\u003c/p>\n\u003cp>“This is the raw, honest truth of hardworking people,” Padilla said.\u003c/p>\n\u003cp>In Orange County, Rios, a certified nursing assistant for Kaiser Permanente, voted and rallied for Republican Rep. Young Kim, but these days she’s consumed by the thought of what will happen if Medicaid is cut. She’s worried that she’ll lose her job and that patients will lose access to health care.\u003c/p>\n\u003cp>Most importantly to her, Rios said, her grandson Elijah with cerebral palsy might lose insurance. Elijah’s cerebral palsy medication costs $5,000 each month, she said.\u003c/p>\n\u003cp>“It’s not a Republican thing. It’s not a Democratic thing. Forget the political BS, this is a human thing,” Rios said. “Some people will die without it. Some people’s lives like my grandson’s are at risk without it.”\u003c/p>\n\u003cfigure id=\"attachment_12031061\" class=\"wp-caption aligncenter\" style=\"max-width: 1333px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12031061\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/Elijah_CM_01-copy-e1741817598485.jpg\" alt=\"\" width=\"1333\" height=\"1020\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/Elijah_CM_01-copy-e1741817598485.jpg 1333w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/Elijah_CM_01-copy-e1741817598485-800x612.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/Elijah_CM_01-copy-e1741817598485-1020x780.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/Elijah_CM_01-copy-e1741817598485-160x122.jpg 160w\" sizes=\"auto, (max-width: 1333px) 100vw, 1333px\">\u003cfigcaption class=\"wp-caption-text\">Josephine Rios’ 7-year-old grandson, Elijah, needs Medicaid to manage his cerebral palsy, the certified nursing assistant from Orange County said. \u003ccite>(Photo courtesy of Josephine Rios)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Rios, who has worked in health care for more than two decades, said she voted for Kim because Kim spoke compassionately about her constituents during her election campaign and also supported health care workers. But the budget vote was a “slap in the face.”\u003c/p>\n\u003cp>“I’m very disappointed and very frustrated that she voted and she didn’t fight harder to keep Medi-Cal uncapped not only for her constituents like myself but for the young children who need it,” Rios said. “She needs to remember why we elected her into office.”\u003c/p>\n\u003cp>In a \u003ca href=\"https://youngkim.house.gov/2025/02/26/rep-young-kim-statement-on-h-con-res-14/\">statement\u003c/a> on her website, Kim joined other Congressional Republicans in emphasizing that the bill passed was procedural and \u003ca href=\"https://calvert.house.gov/media/press-releases/rep-calvert-votes-advance-budget-resolution-protect-taxpayers-massive-tax\">didn’t make cuts to any specific programs\u003c/a>. The vote simply allowed the GOP to “move the ball forward,” Kim said in the statement.\u003c/p>\n\u003cp>“As this process moves forward, I will continue to make clear that a budget that does not protect vital Medicaid services for the most vulnerable, provide tax relief for small businesses, and address the cap on state and local tax (SALT) deductions will not receive my vote,” Kim said in the statement.\u003c/p>\n\u003cp>In her district, which covers portions of Orange County and the Inland Empire, 21% of people use Medicaid.\u003c/p>\n\u003ch2>An ‘existential threat’ to health clinics\u003c/h2>\n\u003cp>But some health care providers say even the procedural vote was “too risky” for their liking.\u003c/p>\n\u003cp>“It is an existential threat from our perspective,” said Francisco Silva, chief executive of the California Primary Care Association, which represents more than 1,200 community health centers in California.\u003c/p>\n\u003cp>Community health centers, also known as federally qualified health centers, predominantly serve communities with low income. In some areas of the state, Medicaid is the only reason why health centers and hospitals can piece together enough revenue to stay open, Silva said.\u003c/p>\n\u003cp>Marisol De La Vega Cardoso said any Medicaid cuts risk destabilizing community health centers at a time when poverty is increasing. De La Vega Cardoso is a senior vice president at Family HealthCare Network, the second-largest community health center network in the country.\u003c/p>\n\u003cp>“Unfortunately we might be forced to cut back on services that are so needed,” De La Vega Cardoso said.\u003c/p>\n\u003cp>Dr. Richard Thorp, a longtime internal medicine specialist in Paradise, is very concerned about how Medicaid cuts may destabilize the workforce in an area that already struggles to recruit doctors. Republican LaMalfa has represented the district that includes Paradise since 2013.\u003c/p>\n\u003cp>The once idyllic town in the Sierra Nevada foothills outside of Chico was the site of California’s deadliest wildfire in 2018, which also destroyed the local hospital. More than 80% of the population never returned to live in Paradise, and Thorp’s medical group dropped from 15 primary care doctors to one full-time doctor supported by four advanced practice staff.\u003c/p>\n\u003cp>“We have significant manpower and pipeline issues,” Thorp said. “As you make these cuts it makes it less and less feasible to practice in Butte county.”\u003c/p>\n\u003cp>LaMalfa said in a statement online that the House budget bill was a first step in “reining in Washington’s out-of-control spending” and that a “typical family in NorCal” would see taxes go up without the federal government cutting spending. The statement made no mention of Medicaid.\u003c/p>\n\u003cp>“It’s time to prioritize policies that grow the economy, cut waste, and ensure a stronger financial future for the American people.”\u003c/p>\n\u003cp>\u003cem>Supported by the California Health Care Foundation (CHCF).\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "Several California Republicans represent communities that rely on Medicaid for health care coverage. Their recent budget-cutting votes angered some constituents.",
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"title": "Californians in Republican Districts Feel Betrayed by Looming Health Care Cuts | KQED",
"description": "Several California Republicans represent communities that rely on Medicaid for health care coverage. Their recent budget-cutting votes angered some constituents.",
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"nprByline": "\u003ca href=\"https://calmatters.org/author/kristen-hwang/\">Kristen Hwang\u003c/a>, CalMatters",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Natalie Padilla signed up for Medicaid 17 years ago. She had just given birth and needed insurance to bring her son to the doctor. The Bakersfield resident was still in school, and her husband’s work didn’t offer insurance. She was on the program for six months.\u003c/p>\n\u003cp>About an hour north of Bakersfield, Rodolfo Morales-Ayon, a 21-year-old community college student, relies on Medicaid today. He’s studying political science and wants to go to law school. Morales-Ayon grew up in Pixley, a small Central Valley town where air quality is poor and asthma and respiratory infections are common.\u003c/p>\n\u003cp>Farther south in Orange County, Josephine Rios’ 7-year-old grandson has cerebral palsy and needs Medicaid to pay for his medication and specialized wheelchair, which cost $22,000. Elijah is a lively boy, Rios said, but his disability means he’ll likely need Medicaid for his entire life.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>All three live in areas of California where their Republican representatives recently voted on a federal budget bill that would all but guarantee cuts to the Medicaid insurance program, which is known in California as \u003ca href=\"https://calmatters.org/tag/medi-cal/\">Medi-Cal\u003c/a>.\u003c/p>\n\u003cp>Although the details will take months to iron out, the nonpartisan \u003ca href=\"https://www.cbo.gov/system/files/2025-03/61235-Boyle-Pallone.pdf\">Congressional Budget Office released a report (PDF)\u003c/a> last week indicating that it was impossible for House Republicans to meet their \u003ca href=\"https://www.washingtonpost.com/business/2025/03/05/gop-budget-medicaid-cuts/\">goal of eliminating $880 billion in spending\u003c/a> over the next 10 years from the committee that oversees Medicaid and Medicare without cutting from either of the social safety net programs. Medicaid provides health insurance for people with disabilities and low income. Medicare insures seniors over 65.\u003c/p>\n\u003cp>The Senate voted on a narrower budget bill that is less likely to hit Medicaid, but the chamber will have to come to an agreement with the House later in the year. President Donald Trump has praised both budget bills, while at the same time indicating he doesn’t want to cut safety net programs for the poor. Congress is also rushing to \u003ca href=\"https://www.usnews.com/news/national-news/articles/2025-03-10/are-we-headed-for-a-government-shutdown-3-things-to-watch\">avert a government shutdown Friday with a separate budget bill\u003c/a>.\u003c/p>\n\u003cp>“Medicare, Medicaid — none of that stuff is going to be touched,” Trump said in a February \u003ca href=\"https://fox59.com/hill-politics/trumps-vow-to-preserve-medicaid-collides-with-house-gop-plan-for-tax-cuts/\">interview with Sean Hannity on Fox News\u003c/a>.\u003c/p>\n\u003cp>But Republican lawmakers want a deal that would offset the cost of extending Trump’s first-term tax cuts that are set to expire at the end of this year, and \u003ca href=\"https://rollcall.com/2025/02/13/medicaid-overhaul-proves-to-be-politically-perilous-proposition/\">Medicaid represents the largest share of federal funding\u003c/a> to states.\u003c/p>\n\u003cp>California’s behemoth Medicaid program insures 14.9 million people, more than one-third of the state’s population. Republicans hold nine House seats in California and represent 2.5 million Medicaid enrollees. All nine voted to approve the House GOP budget bill at the end of February.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Some of the state’s most conservative areas benefit disproportionately from Medicaid, including Rep. Jay Obernolte’s district in San Bernardino County’s high desert and Rep. Doug LaMalfa’s district in the far northern counties, where 48% and 43% of the population have Medicaid respectively.\u003c/p>\n\u003cp>Other Republicans represent swing districts where \u003ca href=\"https://apnews.com/article/medicaid-cuts-budget-republicans-health-care-4a13fc3528d7bf20ea52db4a5551c8bf\">voting against Medicaid \u003c/a>could be risky politically. Rep. \u003ca href=\"https://www.politico.com/newsletters/california-playbook-pm/2024/11/13/valadao-house-win-00189478\">David Valadao\u003c/a> in the San Joaquin Valley represents the greatest share of Medicaid enrollees in the state at 67%. He voted to advance the House bill. Six years ago, his \u003ca href=\"https://www.politico.com/news/2025/02/20/david-valadao-medicaid-cuts-congress-00205072\">vote to eliminate the Affordable Care Act\u003c/a> likely cost his reelection for a term.\u003c/p>\n\u003cp>In contrast, California’s Democratic state lawmakers have taken every opportunity to \u003ca href=\"https://calmatters.org/explainers/california-health-care-coverage/\">expand the Medicaid program\u003c/a>, which grants full-scope health coverage to people with low income (for instance: an individual making less than $20,783 or a family of four making less than $43,056 annually).\u003c/p>\n\u003cp>The number of people with Medicaid in California has increased 31% since 2014 when the Affordable Care Act allowed states to enroll people who made slightly more than the federal poverty threshold. California has also expanded in other categories, using about $8 billion annually of state \u003ca href=\"https://calmatters.org/health/2023/12/undocumented-health-insurance-new-california-laws-2024/\">money to insure undocumented immigrants\u003c/a>.\u003c/p>\n\u003cp>Today, the state spends \u003ca href=\"https://ebudget.ca.gov/2024-25/pdf/Enacted/BudgetSummary/HealthandHumanServices.pdf\">$161 billion on Medicaid (PDF)\u003c/a>, the \u003ca href=\"https://calbudgetcenter.org/resources/federal-funds-drive-one-third-of-californias-state-budget/\">majority of which comes from the federal government\u003c/a>.\u003c/p>\n\u003cp>Republicans have focused talks on \u003ca href=\"https://www.statnews.com/2025/03/03/medicaid-cuts-republicans-paragon-say-to-focus-on-waste-fraud-and-abuse/\">rooting out “waste” and “fraud”\u003c/a> in federal programs, but \u003ca href=\"https://www.nytimes.com/interactive/2025/01/23/us/politics/republican-tax-spending-cuts-options.html\">early proposals\u003c/a> appear to aim at the fundamental payment structure of Medicaid. Experts say those types of cuts may require states to pay more for the programs, putting the political and financial onus on state lawmakers.\u003c/p>\n\u003cp>“Many of these proposals are about having states be left holding the bag,” said Edwin Park, a public policy research professor at Georgetown University. “If states have less funding available, then it’s impossible for them to sustain their current levels of spending.”\u003c/p>\n\u003cp>‘Some people will die without it’In a \u003ca href=\"https://www.youtube.com/watch?v=sKZxE-aaRoU\">statement on the House floor\u003c/a> following the initial budget vote, Valadao said extending Trump’s 2017 tax cuts would make a real difference for “working families, farmers, and small business owners” but acknowledged that many of his constituents need Medicaid.\u003cbr>\n“I’ve heard from countless constituents who tell me the only way they can afford health care is through programs like Medicaid,” Valadao said that day, indicating he could vote differently later in the year on a final proposal. “And I will not support a final reconciliation bill that risks leaving them behind.”\u003c/p>\n\u003cp>But some California voters still feel like their representatives have failed them by advancing a bill that will likely lead to Medicaid cuts.\u003c/p>\n\u003cfigure id=\"attachment_12031054\" class=\"wp-caption aligncenter\" style=\"max-width: 1568px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12031054\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/030425_Medicaid-Pixley_LV_CM_06-copy.jpg\" alt=\"\" width=\"1568\" height=\"1045\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/030425_Medicaid-Pixley_LV_CM_06-copy.jpg 1568w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/030425_Medicaid-Pixley_LV_CM_06-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/030425_Medicaid-Pixley_LV_CM_06-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/030425_Medicaid-Pixley_LV_CM_06-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/030425_Medicaid-Pixley_LV_CM_06-copy-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1568px) 100vw, 1568px\">\u003cfigcaption class=\"wp-caption-text\">Rudolpho Morales-Ayon, a community college student, in Pixley Park in Pixley on March 4, 2025. Morales enrolled in Medicaid as a child and continues the health insurance program. \u003ccite>(Larry Valenzuela/CalMatters/CatchLight Local)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“For our representative David Valadao, this is a betrayal. It’s nothing less than that,” Morales-Ayon, a district voter, said. Morales-Ayon voted for Valadao’s Democratic opponent last fall.\u003c/p>\n\u003cp>Morales-Ayon had Medicaid as a child because his parents’ jobs didn’t provide insurance. Per capita earnings in Valadao’s district are about half as much as statewide earnings, according to census data.\u003c/p>\n\u003cp>“People need these resources to manage their day-to-day lives,” Morales-Ayon said.\u003c/p>\n\u003cp>Padilla, who also lives in Valadao’s district, now works as a pharmacy technician at Mercy Hospital Southwest in Bakersfield. She traveled with her union to Washington, D.C. several weeks ago to try and make an appeal to Valadao not to vote for any Medicaid cuts. Staff told the group that he was too busy to see them, Padilla said.\u003c/p>\n\u003cp>Padilla grew up in the district and said multiple family members, including cousins and her 84-year-old grandmother, have Medicaid. Her family who rely on Medicaid have low-paying or part time jobs that don’t offer health insurance. Any reductions in coverage would be “devastating,” she said.\u003c/p>\n\u003cp>“This is the raw, honest truth of hardworking people,” Padilla said.\u003c/p>\n\u003cp>In Orange County, Rios, a certified nursing assistant for Kaiser Permanente, voted and rallied for Republican Rep. Young Kim, but these days she’s consumed by the thought of what will happen if Medicaid is cut. She’s worried that she’ll lose her job and that patients will lose access to health care.\u003c/p>\n\u003cp>Most importantly to her, Rios said, her grandson Elijah with cerebral palsy might lose insurance. Elijah’s cerebral palsy medication costs $5,000 each month, she said.\u003c/p>\n\u003cp>“It’s not a Republican thing. It’s not a Democratic thing. Forget the political BS, this is a human thing,” Rios said. “Some people will die without it. Some people’s lives like my grandson’s are at risk without it.”\u003c/p>\n\u003cfigure id=\"attachment_12031061\" class=\"wp-caption aligncenter\" style=\"max-width: 1333px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12031061\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/Elijah_CM_01-copy-e1741817598485.jpg\" alt=\"\" width=\"1333\" height=\"1020\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/Elijah_CM_01-copy-e1741817598485.jpg 1333w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/Elijah_CM_01-copy-e1741817598485-800x612.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/Elijah_CM_01-copy-e1741817598485-1020x780.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/Elijah_CM_01-copy-e1741817598485-160x122.jpg 160w\" sizes=\"auto, (max-width: 1333px) 100vw, 1333px\">\u003cfigcaption class=\"wp-caption-text\">Josephine Rios’ 7-year-old grandson, Elijah, needs Medicaid to manage his cerebral palsy, the certified nursing assistant from Orange County said. \u003ccite>(Photo courtesy of Josephine Rios)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Rios, who has worked in health care for more than two decades, said she voted for Kim because Kim spoke compassionately about her constituents during her election campaign and also supported health care workers. But the budget vote was a “slap in the face.”\u003c/p>\n\u003cp>“I’m very disappointed and very frustrated that she voted and she didn’t fight harder to keep Medi-Cal uncapped not only for her constituents like myself but for the young children who need it,” Rios said. “She needs to remember why we elected her into office.”\u003c/p>\n\u003cp>In a \u003ca href=\"https://youngkim.house.gov/2025/02/26/rep-young-kim-statement-on-h-con-res-14/\">statement\u003c/a> on her website, Kim joined other Congressional Republicans in emphasizing that the bill passed was procedural and \u003ca href=\"https://calvert.house.gov/media/press-releases/rep-calvert-votes-advance-budget-resolution-protect-taxpayers-massive-tax\">didn’t make cuts to any specific programs\u003c/a>. The vote simply allowed the GOP to “move the ball forward,” Kim said in the statement.\u003c/p>\n\u003cp>“As this process moves forward, I will continue to make clear that a budget that does not protect vital Medicaid services for the most vulnerable, provide tax relief for small businesses, and address the cap on state and local tax (SALT) deductions will not receive my vote,” Kim said in the statement.\u003c/p>\n\u003cp>In her district, which covers portions of Orange County and the Inland Empire, 21% of people use Medicaid.\u003c/p>\n\u003ch2>An ‘existential threat’ to health clinics\u003c/h2>\n\u003cp>But some health care providers say even the procedural vote was “too risky” for their liking.\u003c/p>\n\u003cp>“It is an existential threat from our perspective,” said Francisco Silva, chief executive of the California Primary Care Association, which represents more than 1,200 community health centers in California.\u003c/p>\n\u003cp>Community health centers, also known as federally qualified health centers, predominantly serve communities with low income. In some areas of the state, Medicaid is the only reason why health centers and hospitals can piece together enough revenue to stay open, Silva said.\u003c/p>\n\u003cp>Marisol De La Vega Cardoso said any Medicaid cuts risk destabilizing community health centers at a time when poverty is increasing. De La Vega Cardoso is a senior vice president at Family HealthCare Network, the second-largest community health center network in the country.\u003c/p>\n\u003cp>“Unfortunately we might be forced to cut back on services that are so needed,” De La Vega Cardoso said.\u003c/p>\n\u003cp>Dr. Richard Thorp, a longtime internal medicine specialist in Paradise, is very concerned about how Medicaid cuts may destabilize the workforce in an area that already struggles to recruit doctors. Republican LaMalfa has represented the district that includes Paradise since 2013.\u003c/p>\n\u003cp>The once idyllic town in the Sierra Nevada foothills outside of Chico was the site of California’s deadliest wildfire in 2018, which also destroyed the local hospital. More than 80% of the population never returned to live in Paradise, and Thorp’s medical group dropped from 15 primary care doctors to one full-time doctor supported by four advanced practice staff.\u003c/p>\n\u003cp>“We have significant manpower and pipeline issues,” Thorp said. “As you make these cuts it makes it less and less feasible to practice in Butte county.”\u003c/p>\n\u003cp>LaMalfa said in a statement online that the House budget bill was a first step in “reining in Washington’s out-of-control spending” and that a “typical family in NorCal” would see taxes go up without the federal government cutting spending. The statement made no mention of Medicaid.\u003c/p>\n\u003cp>“It’s time to prioritize policies that grow the economy, cut waste, and ensure a stronger financial future for the American people.”\u003c/p>\n\u003cp>\u003cem>Supported by the California Health Care Foundation (CHCF).\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "California Has a Lot to Lose if Trump Slashes Medicaid. Seniors, Kids Could Face Coverage Cuts",
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"content": "\u003cp>Perhaps no state has more to lose than California in the federal budget proposal House Republicans passed this week.\u003c/p>\n\u003cp>That spending plan sets up significant cuts to Medicaid, the health insurance program for people with low income. California has taken just about every route and opportunity to expand the Medicaid program. Today, 14.9 million Californians are enrolled in it, and federal funding cuts would almost certainly roll back services and coverage for some of them.\u003c/p>\n\u003cp>Looking for a way to offset the cost of extending President Donald Trump’s 2017 tax cuts, the House advanced a bill Tuesday that directs the Energy and Commerce Committee to find $880 billion in spending cuts over the next 10 years. Those cuts, budget and health policy experts say, would largely have to come from Medicaid, also known as \u003ca href=\"https://calmatters.org/tag/medi-cal/\">Medi-Cal in California\u003c/a>.\u003c/p>\n\u003cp>The Senate voted for its own, narrower budget bill last week. Next, both chambers have to work out their differences and agree on one budget.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>At this point, it’s not clear which Medicaid services would be cut or how many people exactly would lose coverage because lawmakers can hit the spending reductions in a number of ways.\u003c/p>\n\u003cp>Still, enrollees, health advocates and providers in California and across the country are now grappling with what the cuts would mean for them and the people they care for. In press conferences and online meetings, they’ve called the proposed cuts a “five-alarm fire” and Republicans’ vote “the ultimate betrayal” of their constituents.\u003c/p>\n\u003cp>Their outcries echo the first Trump administration, when in 2017 House Republicans voted to repeal the Affordable Care Act. The law ultimately survived, but that health care vote \u003ca href=\"https://calmatters.org/politics/2018/11/hidden-dem-shifts-beneath-blue-wave-california/\">helped stir up the “blue wave”\u003c/a> that flipped Republican House seats in the 2018 election.\u003c/p>\n\u003cp>“These cuts would rip care away from children, seniors, disabled Californians, and more while raising costs for everyone, all to give tax breaks to the ultra-wealthy,” Amanda McAllister-Wallner, interim executive director of Health Access California, a health consumer advocacy group, said in a statement following the House vote. “This is just the beginning — we will be pushing our California congress members at every turn to put the health of their constituents first.”\u003c/p>\n\u003cp>Medicaid is the backbone of California’s social safety net. It covers half of all children and 40% of all births. It \u003ca href=\"https://www.medicare.gov/coverage/long-term-care\">also covers long-term care\u003c/a> services for seniors and disabled people.\u003c/p>\n\u003cp>Since 2014, the state \u003ca href=\"https://calmatters.org/explainers/california-health-care-coverage/\">has expanded the program big time\u003c/a> — first to more adults allowed in the Medicaid expansion under the Affordable Care Act, and gradually to low-income immigrants, regardless of their legal status. Cuts to the scale that Republicans in Congress are proposing, advocates and providers say, would be harmful across the board.\u003c/p>\n\u003cp>Hospitals, doctors and \u003ca href=\"https://news.santaclaracounty.gov/statement-county-executive-james-r-williams-impact-proposed-federal-funding-cuts-santa-clara-county\">county officials\u003c/a> are also speaking out against the proposed cuts because Medicaid is a key payer, especially for those located in rural areas or communities with high poverty rates. If these facilities can’t keep their doors open, entire communities, not just people enrolled in Medicaid, could lose access.\u003c/p>\n\u003cp>House Speaker Mike Johnson, a Louisiana Republican, has said savings could be accomplished through eliminating Medicaid fraud and waste — although that would only get Republicans so far. \u003ca href=\"https://www.washingtonpost.com/politics/2025/02/26/republicans-could-be-touching-third-rail-medicaid/\">Johnson has cited about $50 billion in alleged fraud\u003c/a>, a small slice of the GOP’s goal total, the Washington Post reports.\u003c/p>\n\u003ch2>Cuts would leave big budget hole for state\u003c/h2>\n\u003cp>Medicaid accounts for a significant portion of states’ budgets. The program is jointly funded by the federal government and states, meaning federal cuts would leave major budget gaps that would force reductions in services and enrollment, and also could trigger cuts to other state programs. California’s budget includes \u003ca href=\"https://ebudget.ca.gov/2024-25/pdf/Enacted/BudgetSummary/HealthandHumanServices.pdf\">$161 billion for Medi-Cal (PDF)\u003c/a>, of which more than half is paid for with federal funds.\u003c/p>\n\u003cp>Based on proposals that Republicans in Congress are considering, \u003ca href=\"https://calbudgetcenter.org/resources/california-at-risk-proposed-federal-funding-cuts-jeopardize-key-services/\">California could lose $10 billion to $20 billion a year\u003c/a>, the California Budget Policy Center estimates.\u003c/p>\n\u003cfigure id=\"attachment_12029304\" class=\"wp-caption aligncenter\" style=\"max-width: 1568px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12029304\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/022625-Mike-Johnson-REUTERS-CM-01-copy.jpg\" alt=\"\" width=\"1568\" height=\"1045\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/022625-Mike-Johnson-REUTERS-CM-01-copy.jpg 1568w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/022625-Mike-Johnson-REUTERS-CM-01-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/022625-Mike-Johnson-REUTERS-CM-01-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/022625-Mike-Johnson-REUTERS-CM-01-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/022625-Mike-Johnson-REUTERS-CM-01-copy-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1568px) 100vw, 1568px\">\u003cfigcaption class=\"wp-caption-text\">Speaker of the House Mike Johnson speaks at the Conservative Political Action Conference (CPAC) at the Gaylord National Resort and Convention Center in National Harbor, Maryland on Feb. 20, 2025. \u003ccite>(Jack Gruber/USA TODAY via Reuters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>A big question mark is how exactly Congress will meet its savings goal — Republican lawmakers have floated a number of proposals, but it’s unclear yet what could stick.\u003c/p>\n\u003cp>They’ve proposed imposing work requirements, for example. The idea behind that is enrollment would drop as people who don’t meet the requirements get kicked off the program. But the spending reductions from such a policy would not get Republicans all the way to their target, said Edwin Park, a research professor at the Georgetown University McCourt School of Public Policy.\u003c/p>\n\u003cp>A second proposal would require restructuring the program so that instead of the federal government paying states a fixed percentage of Medicaid costs, it could set a spending cap per enrollee.\u003c/p>\n\u003cp>Under the Affordable Care Act, California opened up its Medi-Cal roll to low-income adults who had previously not been covered. The federal government pays California 90% of the cost for this expansion group — \u003ca href=\"https://www.kff.org/medicaid/state-indicator/federal-matching-rate-and-multiplier/?currentTimeframe=2&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D\">that’s up from the state’s 50% regular match rate\u003c/a>. Republicans may also choose to eliminate the increased match rate for adults covered under this expansion.\u003c/p>\n\u003cp>“One reason that these types of cuts are popular among federal policy makers is because…it really allows the blame to be placed on governors and state legislatures,” Park said. “The federal government is cutting federal funding, making it harder for states to finance their share of the cost of Medicaid, but it’s not actually saying ‘You have to cut eligibility in this way or cut provider rates in this way.’”\u003c/p>\n\u003cp>“It’s really, ‘States, you figure it out, you have to balance your budget,’” Park added. “And you know, there’s only three choices: higher taxes, cutting the rest of the budget, which is primarily education in California, and then, most likely, really dramatically cutting Medi-Cal in the state.”\u003c/p>\n\u003ch2>Coverage for seniors and people with disabilities\u003c/h2>\n\u003cp>President Trump and Republicans have promised to not touch seniors’ Medicare, but millions of seniors also rely on Medicaid. In California, about 2.2 million seniors and people with disabilities are enrolled in Medi-Cal, according to data from the state’s Department of Health Care Services.\u003c/p>\n\u003cp>Traditional Medicare does not cover services including dental, vision and hearing benefits. Seniors typically have to buy into a Medicare Advantage plan to get that covered. Low-income seniors in California can access those services with no or at a low-cost through Medi-Cal.[aside label=\"Related Stories\" postID=\"news_12022068,forum_2010101908967,news_12028454\"]\u003cbr>\nNursing home stays and in-home care are also largely covered by Medicaid. Nationally, \u003ca href=\"https://www.kff.org/medicaid/issue-brief/a-look-at-nursing-facility-characteristics/\">about 6 in 10 nursing home residents\u003c/a> are covered by Medicaid, according to an analysis by KFF, a health polling and research organization.\u003c/p>\n\u003cp>“Medicare has huge gaps in coverage and Medicare is really expensive,” said Amber Christ, managing director of health advocacy at Justice in Aging, which advocates on behalf of older adults. “It is Medicaid, not Medicare, that is the primary payer of long-term care in this country.”\u003c/p>\n\u003cp>Because of their high needs, seniors and people with disabilities are the most costly population. In California, they make up about \u003ca href=\"https://www.dhcs.ca.gov/provgovpart/Documents/SPD-Final-Evaluation-Report.pdf\">15% of the people enrolled in Medi-Cal (PDF)\u003c/a>, but account for roughly half of all the program’s spending.\u003c/p>\n\u003cp>“So if the state wants to go where the money is, that’s seniors and people with disabilities. That’s long-term care, nursing home care, community-based services,” said Park. To protect the coverage of this population, he said, the state would have to consider potentially making larger cuts for other groups of people.\u003c/p>\n\u003ch2>A safety net for California kids\u003c/h2>\n\u003cp>More than 5 million kids in California are insured through Medi-Cal and the accompanying \u003ca href=\"https://www.medicaid.gov/chip/index.html\">Children’s Health Insurance Program\u003c/a>. It pays for their preventive care, such as immunizations and screenings, but it also covers support services, such as counseling and therapy. For about 160,000 children in the foster care system and who have been adopted, it also pays for an array of social services.\u003c/p>\n\u003cp>Getting kids insured has long been a priority for California. When the state began expanding Medi-Cal to undocumented people in 2016, children were first in line.\u003c/p>\n\u003cp>Perhaps less known is that Medi-Cal is also a big player in services provided at schools. It helps fund services and equipment for students with disabilities, such as hearing aids and specialty transportation. It reimburses school districts for certain providers, including psychologists and social workers, for example. Across the state, some districts also provide physical and mental health care to children and their families through school-based health centers that also draw down on Medi-Cal funding.\u003c/p>\n\u003cp>“The rates of depression and anxiety among youth are rising at alarming rates, and for many, Medi-Cal services are their only option for care,” said Michele Cantwell-Copher, the Fresno County Superintendent of Schools, on a media call with advocates and parents on Thursday. “Ensuring that children have access to the mental health support they need is critical to their well-being and their success in schools.”\u003c/p>\n\u003cp>Medi-Cal is a keystone program for many kids but also for their birthing parent — it pays for about 40% of the state’s births. California offers coverage for pregnant people at slightly higher income levels than the regular cut-off, allowing more to qualify. It provides coverage during their pregnancy and 12 months postpartum, paying for standard obstetric visits, prescriptions, laboratory services, doula services and hospital care.\u003c/p>\n\u003cp>“If we want kids to have a healthy start, that means making sure that their birthing parent has access to health care,” said Mike Odeh, health policy director at Children Now. “Those early years really are important for both babies and parents. There are a lot of services in that time period that really are critical, and any reduction in those services could have very bad effects.”\u003c/p>\n\u003cp>\u003cem>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.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "Almost 15 million Californians have health care coverage through Medi-Cal, a program that stands to lose billions of dollars if Republicans follow through on proposed cuts.",
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"title": "California Has a Lot to Lose if Trump Slashes Medicaid. Seniors, Kids Could Face Coverage Cuts | KQED",
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"nprByline": "\u003ca href=\"https://calmatters.org/author/anaibarra/\">Ana B. Ibarra\u003c/a>, CalMatters",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Perhaps no state has more to lose than California in the federal budget proposal House Republicans passed this week.\u003c/p>\n\u003cp>That spending plan sets up significant cuts to Medicaid, the health insurance program for people with low income. California has taken just about every route and opportunity to expand the Medicaid program. Today, 14.9 million Californians are enrolled in it, and federal funding cuts would almost certainly roll back services and coverage for some of them.\u003c/p>\n\u003cp>Looking for a way to offset the cost of extending President Donald Trump’s 2017 tax cuts, the House advanced a bill Tuesday that directs the Energy and Commerce Committee to find $880 billion in spending cuts over the next 10 years. Those cuts, budget and health policy experts say, would largely have to come from Medicaid, also known as \u003ca href=\"https://calmatters.org/tag/medi-cal/\">Medi-Cal in California\u003c/a>.\u003c/p>\n\u003cp>The Senate voted for its own, narrower budget bill last week. Next, both chambers have to work out their differences and agree on one budget.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>At this point, it’s not clear which Medicaid services would be cut or how many people exactly would lose coverage because lawmakers can hit the spending reductions in a number of ways.\u003c/p>\n\u003cp>Still, enrollees, health advocates and providers in California and across the country are now grappling with what the cuts would mean for them and the people they care for. In press conferences and online meetings, they’ve called the proposed cuts a “five-alarm fire” and Republicans’ vote “the ultimate betrayal” of their constituents.\u003c/p>\n\u003cp>Their outcries echo the first Trump administration, when in 2017 House Republicans voted to repeal the Affordable Care Act. The law ultimately survived, but that health care vote \u003ca href=\"https://calmatters.org/politics/2018/11/hidden-dem-shifts-beneath-blue-wave-california/\">helped stir up the “blue wave”\u003c/a> that flipped Republican House seats in the 2018 election.\u003c/p>\n\u003cp>“These cuts would rip care away from children, seniors, disabled Californians, and more while raising costs for everyone, all to give tax breaks to the ultra-wealthy,” Amanda McAllister-Wallner, interim executive director of Health Access California, a health consumer advocacy group, said in a statement following the House vote. “This is just the beginning — we will be pushing our California congress members at every turn to put the health of their constituents first.”\u003c/p>\n\u003cp>Medicaid is the backbone of California’s social safety net. It covers half of all children and 40% of all births. It \u003ca href=\"https://www.medicare.gov/coverage/long-term-care\">also covers long-term care\u003c/a> services for seniors and disabled people.\u003c/p>\n\u003cp>Since 2014, the state \u003ca href=\"https://calmatters.org/explainers/california-health-care-coverage/\">has expanded the program big time\u003c/a> — first to more adults allowed in the Medicaid expansion under the Affordable Care Act, and gradually to low-income immigrants, regardless of their legal status. Cuts to the scale that Republicans in Congress are proposing, advocates and providers say, would be harmful across the board.\u003c/p>\n\u003cp>Hospitals, doctors and \u003ca href=\"https://news.santaclaracounty.gov/statement-county-executive-james-r-williams-impact-proposed-federal-funding-cuts-santa-clara-county\">county officials\u003c/a> are also speaking out against the proposed cuts because Medicaid is a key payer, especially for those located in rural areas or communities with high poverty rates. If these facilities can’t keep their doors open, entire communities, not just people enrolled in Medicaid, could lose access.\u003c/p>\n\u003cp>House Speaker Mike Johnson, a Louisiana Republican, has said savings could be accomplished through eliminating Medicaid fraud and waste — although that would only get Republicans so far. \u003ca href=\"https://www.washingtonpost.com/politics/2025/02/26/republicans-could-be-touching-third-rail-medicaid/\">Johnson has cited about $50 billion in alleged fraud\u003c/a>, a small slice of the GOP’s goal total, the Washington Post reports.\u003c/p>\n\u003ch2>Cuts would leave big budget hole for state\u003c/h2>\n\u003cp>Medicaid accounts for a significant portion of states’ budgets. The program is jointly funded by the federal government and states, meaning federal cuts would leave major budget gaps that would force reductions in services and enrollment, and also could trigger cuts to other state programs. California’s budget includes \u003ca href=\"https://ebudget.ca.gov/2024-25/pdf/Enacted/BudgetSummary/HealthandHumanServices.pdf\">$161 billion for Medi-Cal (PDF)\u003c/a>, of which more than half is paid for with federal funds.\u003c/p>\n\u003cp>Based on proposals that Republicans in Congress are considering, \u003ca href=\"https://calbudgetcenter.org/resources/california-at-risk-proposed-federal-funding-cuts-jeopardize-key-services/\">California could lose $10 billion to $20 billion a year\u003c/a>, the California Budget Policy Center estimates.\u003c/p>\n\u003cfigure id=\"attachment_12029304\" class=\"wp-caption aligncenter\" style=\"max-width: 1568px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12029304\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/022625-Mike-Johnson-REUTERS-CM-01-copy.jpg\" alt=\"\" width=\"1568\" height=\"1045\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/022625-Mike-Johnson-REUTERS-CM-01-copy.jpg 1568w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/022625-Mike-Johnson-REUTERS-CM-01-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/022625-Mike-Johnson-REUTERS-CM-01-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/022625-Mike-Johnson-REUTERS-CM-01-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/03/022625-Mike-Johnson-REUTERS-CM-01-copy-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1568px) 100vw, 1568px\">\u003cfigcaption class=\"wp-caption-text\">Speaker of the House Mike Johnson speaks at the Conservative Political Action Conference (CPAC) at the Gaylord National Resort and Convention Center in National Harbor, Maryland on Feb. 20, 2025. \u003ccite>(Jack Gruber/USA TODAY via Reuters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>A big question mark is how exactly Congress will meet its savings goal — Republican lawmakers have floated a number of proposals, but it’s unclear yet what could stick.\u003c/p>\n\u003cp>They’ve proposed imposing work requirements, for example. The idea behind that is enrollment would drop as people who don’t meet the requirements get kicked off the program. But the spending reductions from such a policy would not get Republicans all the way to their target, said Edwin Park, a research professor at the Georgetown University McCourt School of Public Policy.\u003c/p>\n\u003cp>A second proposal would require restructuring the program so that instead of the federal government paying states a fixed percentage of Medicaid costs, it could set a spending cap per enrollee.\u003c/p>\n\u003cp>Under the Affordable Care Act, California opened up its Medi-Cal roll to low-income adults who had previously not been covered. The federal government pays California 90% of the cost for this expansion group — \u003ca href=\"https://www.kff.org/medicaid/state-indicator/federal-matching-rate-and-multiplier/?currentTimeframe=2&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D\">that’s up from the state’s 50% regular match rate\u003c/a>. Republicans may also choose to eliminate the increased match rate for adults covered under this expansion.\u003c/p>\n\u003cp>“One reason that these types of cuts are popular among federal policy makers is because…it really allows the blame to be placed on governors and state legislatures,” Park said. “The federal government is cutting federal funding, making it harder for states to finance their share of the cost of Medicaid, but it’s not actually saying ‘You have to cut eligibility in this way or cut provider rates in this way.’”\u003c/p>\n\u003cp>“It’s really, ‘States, you figure it out, you have to balance your budget,’” Park added. “And you know, there’s only three choices: higher taxes, cutting the rest of the budget, which is primarily education in California, and then, most likely, really dramatically cutting Medi-Cal in the state.”\u003c/p>\n\u003ch2>Coverage for seniors and people with disabilities\u003c/h2>\n\u003cp>President Trump and Republicans have promised to not touch seniors’ Medicare, but millions of seniors also rely on Medicaid. In California, about 2.2 million seniors and people with disabilities are enrolled in Medi-Cal, according to data from the state’s Department of Health Care Services.\u003c/p>\n\u003cp>Traditional Medicare does not cover services including dental, vision and hearing benefits. Seniors typically have to buy into a Medicare Advantage plan to get that covered. Low-income seniors in California can access those services with no or at a low-cost through Medi-Cal.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cbr>\nNursing home stays and in-home care are also largely covered by Medicaid. Nationally, \u003ca href=\"https://www.kff.org/medicaid/issue-brief/a-look-at-nursing-facility-characteristics/\">about 6 in 10 nursing home residents\u003c/a> are covered by Medicaid, according to an analysis by KFF, a health polling and research organization.\u003c/p>\n\u003cp>“Medicare has huge gaps in coverage and Medicare is really expensive,” said Amber Christ, managing director of health advocacy at Justice in Aging, which advocates on behalf of older adults. “It is Medicaid, not Medicare, that is the primary payer of long-term care in this country.”\u003c/p>\n\u003cp>Because of their high needs, seniors and people with disabilities are the most costly population. In California, they make up about \u003ca href=\"https://www.dhcs.ca.gov/provgovpart/Documents/SPD-Final-Evaluation-Report.pdf\">15% of the people enrolled in Medi-Cal (PDF)\u003c/a>, but account for roughly half of all the program’s spending.\u003c/p>\n\u003cp>“So if the state wants to go where the money is, that’s seniors and people with disabilities. That’s long-term care, nursing home care, community-based services,” said Park. To protect the coverage of this population, he said, the state would have to consider potentially making larger cuts for other groups of people.\u003c/p>\n\u003ch2>A safety net for California kids\u003c/h2>\n\u003cp>More than 5 million kids in California are insured through Medi-Cal and the accompanying \u003ca href=\"https://www.medicaid.gov/chip/index.html\">Children’s Health Insurance Program\u003c/a>. It pays for their preventive care, such as immunizations and screenings, but it also covers support services, such as counseling and therapy. For about 160,000 children in the foster care system and who have been adopted, it also pays for an array of social services.\u003c/p>\n\u003cp>Getting kids insured has long been a priority for California. When the state began expanding Medi-Cal to undocumented people in 2016, children were first in line.\u003c/p>\n\u003cp>Perhaps less known is that Medi-Cal is also a big player in services provided at schools. It helps fund services and equipment for students with disabilities, such as hearing aids and specialty transportation. It reimburses school districts for certain providers, including psychologists and social workers, for example. Across the state, some districts also provide physical and mental health care to children and their families through school-based health centers that also draw down on Medi-Cal funding.\u003c/p>\n\u003cp>“The rates of depression and anxiety among youth are rising at alarming rates, and for many, Medi-Cal services are their only option for care,” said Michele Cantwell-Copher, the Fresno County Superintendent of Schools, on a media call with advocates and parents on Thursday. “Ensuring that children have access to the mental health support they need is critical to their well-being and their success in schools.”\u003c/p>\n\u003cp>Medi-Cal is a keystone program for many kids but also for their birthing parent — it pays for about 40% of the state’s births. California offers coverage for pregnant people at slightly higher income levels than the regular cut-off, allowing more to qualify. It provides coverage during their pregnancy and 12 months postpartum, paying for standard obstetric visits, prescriptions, laboratory services, doula services and hospital care.\u003c/p>\n\u003cp>“If we want kids to have a healthy start, that means making sure that their birthing parent has access to health care,” said Mike Odeh, health policy director at Children Now. “Those early years really are important for both babies and parents. There are a lot of services in that time period that really are critical, and any reduction in those services could have very bad effects.”\u003c/p>\n\u003cp>\u003cem>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.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Two years ago, Gov. Gavin Newsom’s administration unveiled a new plan to help solve the homelessness crisis: It began using health care providers, funded through Medi-Cal, to help people get and stay housed.\u003c/p>\n\u003cp>Now, with President-Elect Donald Trump about to take office, some health care organizations, homeless service providers and other stakeholders throughout California worry the program may fall apart just as it’s starting to make a difference. It’s one of many potential shake ups they’re bracing for as they prepare for a new federal administration unlikely to see eye to eye with the Golden State on many of its social welfare policies.\u003c/p>\n\u003cp>“It makes us all very nervous,” said John Baackes, outgoing CEO of Medi-Cal provider L.A. Care Health Plan.\u003c/p>\n\u003cp>CalAIM, \u003ca href=\"https://calmatters.org/health/2022/02/california-medi-cal-reform/\">launched in 2022\u003c/a>, is an expansion of Medi-Cal that allows health insurance to pay for certain things that aren’t considered traditional medical care — such as services to help homeless Californians find and keep housing. Proponents say it’s brought a much-needed infusion of money into the state’s overburdened homeless services system.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>However, because states aren’t typically allowed to spend Medicaid dollars on those types of services, California had to get special permission from the federal government. That permission, in the form of two waivers, expires at the end of 2026.\u003c/p>\n\u003cp>That means the fate of CalAIM rests in the hands of the Trump administration, which can decide whether to renew the program, scale it back or change it. Trump has yet to give any indication of what he would do (or even whether this specific California program is on his radar) and most stakeholders agree any changes he makes probably wouldn’t come until 2026. But the uncertainty is compounding the stress on already overburdened homeless service providers, who routinely receive \u003ca href=\"https://calmatters.org/housing/homelessness/2023/07/california-homeless-services/\">short-term, one-time grants\u003c/a> instead of permanent funding, making it difficult to plan for the future.\u003c/p>\n\u003cp>“CalAIM has been one of the most important and, I think, under-appreciated policies of the Newsom administration to try to better connect our health system and our housing system,” said Tommy Newman, vice president of public affairs for United Way of Greater Los Angeles. “And the risk of going backwards on that is scary.”\u003c/p>\n\u003cp>Newsom’s administration wouldn’t specify what, if anything, it is doing to safeguard CalAIM.\u003c/p>\n\u003cp>“California will continue to work collaboratively with our federal partners to ensure that families in our state are healthy and our communities are vibrant places to live and work,” Anthony Cava, spokesperson for the Department of Health Care Services, said in a statement. “While we don’t typically speculate on the potential impacts of a new federal administration, we remain committed to protecting Californian’s access to the critical services and programs they need.”\u003c/p>\n\u003ch2>What is CalAIM?\u003c/h2>\n\u003cp>The goal of CalAIM is to address factors known as “social determinants of health” for low-income Californians. It’s hard to stay healthy when you don’t have access to basic necessities, such as housing and nutritious food, for example. Ultimately, it’s supposed to save the state and the feds money by helping people avoid expensive emergency room visits.\u003c/p>\n\u003cp>In 2023, more than 68,600 Californians used the three services known as the “housing trio” under CalAIM. These are services designed to help them find housing, stay housed or pay for move-in costs such as security deposits and first and last month’s rent, according to the most recent \u003ca href=\"https://storymaps.arcgis.com/collections/a07f998dfefa497fbd7613981e4f6117?item=5\">state data\u003c/a> available. Only CalAIM’s “medically tailored meals” service (which helps people with conditions such as diabetes access food that meets their dietary needs) was nearly as popular, with nearly 62,700 users.\u003c/p>\n\u003cp>CalAIM provides a total of 14 of these services, or “community supports,” which also include medical respite care for people who recently left the hospital, asthma remediation — think air filters, dehumidifiers, mold removal — and sobering centers. CalAIM also provides something called “enhanced care management,” which pairs Medi-Cal members with an intensive case manager who can help them access everything from a doctor to a dentist to a social worker.\u003c/p>\n\u003cp>One-time grants, doled out to health plans as an incentive for them to ramp up CalAIM services, also helped fund the \u003ca href=\"https://calmatters.org/housing/homelessness/2024/07/calaim-bakersfield-housing/\">construction of new affordable housing\u003c/a>.\u003c/p>\n\u003cp>Abode Services — a nonprofit that provides shelter, housing and other aid for unhoused people across seven Bay Area counties — serves more than 1,000 Californians through CalAIM, said CEO Vivian Wan. In Napa County, Abode uses CalAIM to provide case management services to help people move from homeless encampments into shelter and housing. In Santa Cruz County, Abode uses CalAIM funds to replace the federal COVID-19 homelessness funds that poured in during the pandemic but have since dried up.\u003c/p>\n\u003cp>Abode and other nonprofits also use CalAIM funds to fill an important gap often left by other grants: services for formerly homeless people living in subsidized housing. State programs such as Homekey offer money to buy or build homeless housing, and vouchers pay for tenants’ rent, but there’s often nothing left to fund the case management, counseling and more that’s crucial to help people with physical and mental health conditions, or addictions — the people Newsom has made a priority in his effort to clear encampments — hold onto their housing.\u003c/p>\n\u003cp>“I shudder to think what would happen if we had all of the mandates from our development side of supporting people through coordinated entry, taking really vulnerable people, and we then reduced the services down to bare bones,” Wan said.\u003c/p>\n\u003ch2>What could Trump do to CalAIM?\u003c/h2>\n\u003cp>It’s difficult to speculate about what the Trump administration will do with CalAIM. Celebrity physician \u003ca href=\"https://www.politico.com/news/2024/11/19/dr-oz-cms-administrator-trump-00189456\">Dr. Mehmet Oz\u003c/a>, Trump’s pick to run the Centers for Medicare & Medicaid Services, has no prior experience with the agency and, therefore, no track record that could provide clues as to how he will act.\u003c/p>\n\u003cp>Any changes likely would be felt at the end of 2026, when California attempts to renew its CalAIM waivers. But it’s not unheard of for a president to terminate a waiver early. After President Joe Biden took office in 2021, he \u003ca href=\"https://www.nytimes.com/2021/02/12/upshot/biden-medicaid-reversing-trump.html\">pulled waivers\u003c/a>, authorized by Trump, that had allowed states to require Medicaid recipients to prove they were working or unable to work. But that was an extreme situation, as multiple courts had already shot down those waivers.\u003c/p>\n\u003cp>“It’s not like CalAIM is going away tomorrow, or even in January,” said Sharon Rapport, director of California state policy for the Corporation for Supportive Housing. “But after that, I think that’s where the questions are: What could happen then? And the fact that it’s California, and not Trump’s favorite state, I think makes people worried.”\u003c/p>\n\u003cp>Plans to expand future coverage also could be at risk. Health plans are rolling out \u003ca href=\"https://www.dhcs.ca.gov/provgovpart/pharmacy/Documents/CalAIM-JI-Policy-and-Operations-Guide-FINAL-October-2023-updated.pdf\">new frameworks\u003c/a> under CalAIM to offer health care to people in jail and prison up to 90 days before they are released. California also has applied to amend one of its federal waivers to \u003ca href=\"https://www.dhcs.ca.gov/services/Documents/MCQMD/Transitional-Rent-Concept-Paper-08222024.pdf\">add rental assistance\u003c/a> to the services CalAIM offers. If that’s approved, the state would be allowed to use Medi-Cal to pay for up to six months of rent for homeless and at-risk people who are leaving settings such as jail, prison, the hospital, or an in-patient mental health or substance abuse facility.\u003c/p>\n\u003cp>But a \u003ca href=\"https://manhattan.institute/article/the-overblown-social-determinants-of-health\">recent article\u003c/a> by conservative think tank the Manhattan Institute questions the use of health care funds to pay for social services — a potential bellwether that suggests the new administration might not be supportive of programs like CalAIM.\u003c/p>\n\u003cp>“Even if a social welfare program is a well-intentioned and wise idea, that does not make it health care,” wrote Manhattan Institute senior fellow Chris Pope. “Health care costs will not be greatly reduced by expanding the meaning of health care to cover every social service; nor would doing so distribute nonmedical assistance to those who need it most.”\u003c/p>\n\u003cp>The Trump administration also could change the waivers before renewing them, forcing California to pare down the services CalAIM offers, or add work requirements.\u003c/p>\n\u003cp>Trump, as well as the Republican-controlled Congress, are likely to support requiring Medicaid recipients to prove they are either working or are unable to work. The last time he was in office, Trump approved 13 state waivers that included work requirements before the Biden administration later withdrew them. \u003ca href=\"https://static.project2025.org/2025_MandateForLeadership_FULL.pdf\">Project 2025\u003c/a>, a conservative governing blueprint written by the Heritage Foundation, also prioritizes work requirements.[aside label=\"Related Stories\" postID=\"news_12013909,news_12013983,news_12014057\"]Work requirements historically lead to people, especially low-income people and people of color, losing benefits, according to \u003ca href=\"https://www.cbpp.org/research/poverty-and-inequality/expanding-work-requirements-would-make-it-harder-for-people-to-meet\">research\u003c/a> by the progressive think tank Center on Budget and Policy Priorities. It found many recipients are working but have a hard time providing the necessary paperwork to prove it, while others can’t work due to obligations as full-time caregivers or a lack of child care.\u003c/p>\n\u003cp>Trump and Congress also could impose more sweeping cuts to Medicaid as a whole, which could affect California’s ability to continue programs such as CalAIM.\u003c/p>\n\u003cp>There are ways California could safeguard at least some of its CalAIM services, by baking them into Medi-Cal as permanent benefits, Rapport said. Her organization is pushing for the state to do that with CalAIM’s three housing services.\u003c/p>\n\u003cp>Staff at L.A. Care already are thinking about how they could continue offering CalAIM services to their members if the Trump administration cuts the program. It would require some significant rearranging of funds, Chief Medical Officer Dr. Sameer Amin said. His organization has nearly 16,800 people enrolled in CalAIM services to help them find and keep housing.\u003c/p>\n\u003cp>“My concern is that the housing crisis in LA County is not something that happened overnight, and it’s not something that can be corrected overnight,” he said. “It really requires a sustained effort over the course of years and a significant amount of investment. And if we don’t do the investment that we need to do, if we have to reprioritize away from some of these programs, my concern is that these folks are not going to get the health care that they need because they are not housed.”\u003c/p>\n\u003cp>\u003cem>CalMatters staff writer Kristen Hwang contributed to this story.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Two years ago, Gov. Gavin Newsom’s administration unveiled a new plan to help solve the homelessness crisis: It began using health care providers, funded through Medi-Cal, to help people get and stay housed.\u003c/p>\n\u003cp>Now, with President-Elect Donald Trump about to take office, some health care organizations, homeless service providers and other stakeholders throughout California worry the program may fall apart just as it’s starting to make a difference. It’s one of many potential shake ups they’re bracing for as they prepare for a new federal administration unlikely to see eye to eye with the Golden State on many of its social welfare policies.\u003c/p>\n\u003cp>“It makes us all very nervous,” said John Baackes, outgoing CEO of Medi-Cal provider L.A. Care Health Plan.\u003c/p>\n\u003cp>CalAIM, \u003ca href=\"https://calmatters.org/health/2022/02/california-medi-cal-reform/\">launched in 2022\u003c/a>, is an expansion of Medi-Cal that allows health insurance to pay for certain things that aren’t considered traditional medical care — such as services to help homeless Californians find and keep housing. Proponents say it’s brought a much-needed infusion of money into the state’s overburdened homeless services system.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>However, because states aren’t typically allowed to spend Medicaid dollars on those types of services, California had to get special permission from the federal government. That permission, in the form of two waivers, expires at the end of 2026.\u003c/p>\n\u003cp>That means the fate of CalAIM rests in the hands of the Trump administration, which can decide whether to renew the program, scale it back or change it. Trump has yet to give any indication of what he would do (or even whether this specific California program is on his radar) and most stakeholders agree any changes he makes probably wouldn’t come until 2026. But the uncertainty is compounding the stress on already overburdened homeless service providers, who routinely receive \u003ca href=\"https://calmatters.org/housing/homelessness/2023/07/california-homeless-services/\">short-term, one-time grants\u003c/a> instead of permanent funding, making it difficult to plan for the future.\u003c/p>\n\u003cp>“CalAIM has been one of the most important and, I think, under-appreciated policies of the Newsom administration to try to better connect our health system and our housing system,” said Tommy Newman, vice president of public affairs for United Way of Greater Los Angeles. “And the risk of going backwards on that is scary.”\u003c/p>\n\u003cp>Newsom’s administration wouldn’t specify what, if anything, it is doing to safeguard CalAIM.\u003c/p>\n\u003cp>“California will continue to work collaboratively with our federal partners to ensure that families in our state are healthy and our communities are vibrant places to live and work,” Anthony Cava, spokesperson for the Department of Health Care Services, said in a statement. “While we don’t typically speculate on the potential impacts of a new federal administration, we remain committed to protecting Californian’s access to the critical services and programs they need.”\u003c/p>\n\u003ch2>What is CalAIM?\u003c/h2>\n\u003cp>The goal of CalAIM is to address factors known as “social determinants of health” for low-income Californians. It’s hard to stay healthy when you don’t have access to basic necessities, such as housing and nutritious food, for example. Ultimately, it’s supposed to save the state and the feds money by helping people avoid expensive emergency room visits.\u003c/p>\n\u003cp>In 2023, more than 68,600 Californians used the three services known as the “housing trio” under CalAIM. These are services designed to help them find housing, stay housed or pay for move-in costs such as security deposits and first and last month’s rent, according to the most recent \u003ca href=\"https://storymaps.arcgis.com/collections/a07f998dfefa497fbd7613981e4f6117?item=5\">state data\u003c/a> available. Only CalAIM’s “medically tailored meals” service (which helps people with conditions such as diabetes access food that meets their dietary needs) was nearly as popular, with nearly 62,700 users.\u003c/p>\n\u003cp>CalAIM provides a total of 14 of these services, or “community supports,” which also include medical respite care for people who recently left the hospital, asthma remediation — think air filters, dehumidifiers, mold removal — and sobering centers. CalAIM also provides something called “enhanced care management,” which pairs Medi-Cal members with an intensive case manager who can help them access everything from a doctor to a dentist to a social worker.\u003c/p>\n\u003cp>One-time grants, doled out to health plans as an incentive for them to ramp up CalAIM services, also helped fund the \u003ca href=\"https://calmatters.org/housing/homelessness/2024/07/calaim-bakersfield-housing/\">construction of new affordable housing\u003c/a>.\u003c/p>\n\u003cp>Abode Services — a nonprofit that provides shelter, housing and other aid for unhoused people across seven Bay Area counties — serves more than 1,000 Californians through CalAIM, said CEO Vivian Wan. In Napa County, Abode uses CalAIM to provide case management services to help people move from homeless encampments into shelter and housing. In Santa Cruz County, Abode uses CalAIM funds to replace the federal COVID-19 homelessness funds that poured in during the pandemic but have since dried up.\u003c/p>\n\u003cp>Abode and other nonprofits also use CalAIM funds to fill an important gap often left by other grants: services for formerly homeless people living in subsidized housing. State programs such as Homekey offer money to buy or build homeless housing, and vouchers pay for tenants’ rent, but there’s often nothing left to fund the case management, counseling and more that’s crucial to help people with physical and mental health conditions, or addictions — the people Newsom has made a priority in his effort to clear encampments — hold onto their housing.\u003c/p>\n\u003cp>“I shudder to think what would happen if we had all of the mandates from our development side of supporting people through coordinated entry, taking really vulnerable people, and we then reduced the services down to bare bones,” Wan said.\u003c/p>\n\u003ch2>What could Trump do to CalAIM?\u003c/h2>\n\u003cp>It’s difficult to speculate about what the Trump administration will do with CalAIM. Celebrity physician \u003ca href=\"https://www.politico.com/news/2024/11/19/dr-oz-cms-administrator-trump-00189456\">Dr. Mehmet Oz\u003c/a>, Trump’s pick to run the Centers for Medicare & Medicaid Services, has no prior experience with the agency and, therefore, no track record that could provide clues as to how he will act.\u003c/p>\n\u003cp>Any changes likely would be felt at the end of 2026, when California attempts to renew its CalAIM waivers. But it’s not unheard of for a president to terminate a waiver early. After President Joe Biden took office in 2021, he \u003ca href=\"https://www.nytimes.com/2021/02/12/upshot/biden-medicaid-reversing-trump.html\">pulled waivers\u003c/a>, authorized by Trump, that had allowed states to require Medicaid recipients to prove they were working or unable to work. But that was an extreme situation, as multiple courts had already shot down those waivers.\u003c/p>\n\u003cp>“It’s not like CalAIM is going away tomorrow, or even in January,” said Sharon Rapport, director of California state policy for the Corporation for Supportive Housing. “But after that, I think that’s where the questions are: What could happen then? And the fact that it’s California, and not Trump’s favorite state, I think makes people worried.”\u003c/p>\n\u003cp>Plans to expand future coverage also could be at risk. Health plans are rolling out \u003ca href=\"https://www.dhcs.ca.gov/provgovpart/pharmacy/Documents/CalAIM-JI-Policy-and-Operations-Guide-FINAL-October-2023-updated.pdf\">new frameworks\u003c/a> under CalAIM to offer health care to people in jail and prison up to 90 days before they are released. California also has applied to amend one of its federal waivers to \u003ca href=\"https://www.dhcs.ca.gov/services/Documents/MCQMD/Transitional-Rent-Concept-Paper-08222024.pdf\">add rental assistance\u003c/a> to the services CalAIM offers. If that’s approved, the state would be allowed to use Medi-Cal to pay for up to six months of rent for homeless and at-risk people who are leaving settings such as jail, prison, the hospital, or an in-patient mental health or substance abuse facility.\u003c/p>\n\u003cp>But a \u003ca href=\"https://manhattan.institute/article/the-overblown-social-determinants-of-health\">recent article\u003c/a> by conservative think tank the Manhattan Institute questions the use of health care funds to pay for social services — a potential bellwether that suggests the new administration might not be supportive of programs like CalAIM.\u003c/p>\n\u003cp>“Even if a social welfare program is a well-intentioned and wise idea, that does not make it health care,” wrote Manhattan Institute senior fellow Chris Pope. “Health care costs will not be greatly reduced by expanding the meaning of health care to cover every social service; nor would doing so distribute nonmedical assistance to those who need it most.”\u003c/p>\n\u003cp>The Trump administration also could change the waivers before renewing them, forcing California to pare down the services CalAIM offers, or add work requirements.\u003c/p>\n\u003cp>Trump, as well as the Republican-controlled Congress, are likely to support requiring Medicaid recipients to prove they are either working or are unable to work. The last time he was in office, Trump approved 13 state waivers that included work requirements before the Biden administration later withdrew them. \u003ca href=\"https://static.project2025.org/2025_MandateForLeadership_FULL.pdf\">Project 2025\u003c/a>, a conservative governing blueprint written by the Heritage Foundation, also prioritizes work requirements.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Work requirements historically lead to people, especially low-income people and people of color, losing benefits, according to \u003ca href=\"https://www.cbpp.org/research/poverty-and-inequality/expanding-work-requirements-would-make-it-harder-for-people-to-meet\">research\u003c/a> by the progressive think tank Center on Budget and Policy Priorities. It found many recipients are working but have a hard time providing the necessary paperwork to prove it, while others can’t work due to obligations as full-time caregivers or a lack of child care.\u003c/p>\n\u003cp>Trump and Congress also could impose more sweeping cuts to Medicaid as a whole, which could affect California’s ability to continue programs such as CalAIM.\u003c/p>\n\u003cp>There are ways California could safeguard at least some of its CalAIM services, by baking them into Medi-Cal as permanent benefits, Rapport said. Her organization is pushing for the state to do that with CalAIM’s three housing services.\u003c/p>\n\u003cp>Staff at L.A. Care already are thinking about how they could continue offering CalAIM services to their members if the Trump administration cuts the program. It would require some significant rearranging of funds, Chief Medical Officer Dr. Sameer Amin said. His organization has nearly 16,800 people enrolled in CalAIM services to help them find and keep housing.\u003c/p>\n\u003cp>“My concern is that the housing crisis in LA County is not something that happened overnight, and it’s not something that can be corrected overnight,” he said. “It really requires a sustained effort over the course of years and a significant amount of investment. And if we don’t do the investment that we need to do, if we have to reprioritize away from some of these programs, my concern is that these folks are not going to get the health care that they need because they are not housed.”\u003c/p>\n\u003cp>\u003cem>CalMatters staff writer Kristen Hwang contributed to this story.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "California Could Lose $300 Million in Medi-Cal Funding Under Project 2025's Abortion Plan",
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"content": "\u003cp>If President-elect Donald Trump goes forward with Project 2025, California could lose out on at least $300 million a year in funding for abortions, family planning and contraception for millions of lower-income residents.\u003c/p>\n\u003cp>Project 2025, a right-wing blueprint for the next president, targeted the state \u003ca href=\"https://calmatters.org/politics/2024/09/project2025-trump-california-abortion-surveillance/\">with an ultimatum\u003c/a> that would require California to start reporting abortion data to the Centers for Disease Control or risk losing critical Medicaid funding.\u003c/p>\n\u003cp>Despite Trump’s attempts to distance himself from the plan during the campaign, at least 140 of his allies produced the report, and \u003ca href=\"https://www.washingtonpost.com/politics/2024/11/20/trump-project-2025-second-administration/\">he’s appointing key figures\u003c/a> from the project to his administration. As California leaders rush to shield the state from a Trump agenda, preserving reproductive freedoms stands as a top priority.\u003c/p>\n\u003cp>Newsom called \u003ca href=\"https://calmatters.org/politics/capitol/2024/11/gavin-newsom-special-session-trump-resistance/\">a special session for next month\u003c/a> to “Trump-proof” California, and he’s hiring lawyers to prepare for Day 1 of the Trump presidency.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“Whether it be our fundamental civil rights, reproductive freedom, or climate action — we refuse to turn back the clock and allow our values and laws to be attacked,” Newsom said in a statement.\u003c/p>\n\u003cp>When CalMatters first reported on the ultimatum in September, the California Department of Health Care Services didn’t provide specific figures detailing how much the state receives in federal reimbursements for reproductive health care provided through \u003ca href=\"https://calmatters.org/tag/medi-cal/\">Medi-Cal\u003c/a>. The department now says the federal government reimbursed California about $310.7 million for reproductive health care last year, according to California Department of Health Care Services figures. In the previous year, the state received $334.5 million. That funding supports Medi-Cal, the \u003ca href=\"https://www.acog.org/advocacy/policy-priorities/medicaid#:~:text=Medicaid%20is%20the%20largest%20single,ensuring%20healthy%20moms%20and%20babies.\">single largest payer\u003c/a> of maternity care in the country. Medi-Cal covers about 14.2 million Californians. All told, the federal government reimbursed the state $90.9 billion for Medi-Cal last year.\u003c/p>\n\u003cp>Under Project 2025, all 50 states would be mandated to report detailed abortion-related data to the federal government, including information such as the reason for the abortion, the fetus’ gestational age, the birthing parent’s state of residence, whether the procedure was surgical or medication-induced, and more.\u003c/p>\n\u003cp>Currently, California, Maryland, and New Hampshire do not require abortion providers to share patient data with the federal government. Shortly after the overturning of Roe v. Wade, the California Department of Public Health said that it does not report abortion data federally because\u003ca href=\"https://calmatters.org/health/2022/06/abortion-data-california/\"> it is not legally obligated to do so\u003c/a>. States that do collect abortion data typically use it for public health analyses, which can help identify gaps in care and improve access to services.\u003c/p>\n\u003cp>Newsom’s office did not provide details on the projected costs of lawyering up but said the governor plans for legislation to give additional resources to the California Department of Justice and other state agencies.\u003c/p>\n\u003cp>These resources are intended “to pursue robust affirmative litigation against any unlawful actions by the incoming Trump administration, as well as defend against federal lawsuits aimed at undermining California’s laws and policies,” the governor’s office said. “The funding will support the ability to immediately file litigation and seek injunctive relief against unlawful federal actions.”\u003c/p>\n\u003cfigure id=\"attachment_12015950\" class=\"wp-caption aligncenter\" style=\"max-width: 779px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12015950\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/11/081423-Project-2025-AP-CM-01-copy.jpg\" alt=\"\" width=\"779\" height=\"519\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/11/081423-Project-2025-AP-CM-01-copy.jpg 779w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/11/081423-Project-2025-AP-CM-01-copy-160x107.jpg 160w\" sizes=\"auto, (max-width: 779px) 100vw, 779px\">\u003cfigcaption class=\"wp-caption-text\">Kristen Eichamer, center, talks to fairgoers at the Project 2025 tent at the Iowa State Fair in Des Moines, Iowa, on Aug. 14, 2023. \u003ccite>(Charlie Neibergall/AP Photo)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Trump tapped two individuals associated with Project 2025 for roles in his administration. Brendan Carr, who authored Project 2025’s section on the Federal Communications Commission, will lead the agency.\u003c/p>\n\u003cp>Tom Homan, an immigration hawk who’s listed in Project 2025’s credits as having assisted in developing and writing the playbook, will serve as the border czar, overseeing immigration policies and implementing mass deportation strategies. The spot is not an official cabinet position.\u003c/p>\n\u003cp>To lead the Department of Health and Human Services, Trump tapped Robert F. Kennedy Jr., an environmental lawyer who \u003ca href=\"https://calmatters.org/health/2024/11/robert-f-kennedy-jr-california-vaccine/\">previously fought California\u003c/a> over vaccine mandates. The department controls oversight of Medicaid spending and plays a critical role in abortion reporting by setting federal guidelines and enforcing privacy protections under HIPAA.\u003c/p>\n\u003cp>Kennedy does not appear to have endorsed Project 2025. His stance on abortion has been notably inconsistent over time. In May, \u003ca href=\"https://www.youtube.com/watch?v=ovu7Hu1oEiQ&t=1s\">he expressed\u003c/a> support for unrestricted abortion access, stating he opposed any government restrictions, “even if it’s full term.”\u003c/p>\n\u003cp>However, he later revised his position, advocating for legal \u003ca href=\"https://calmatters.org/tag/abortion/\">abortion\u003c/a> up to the point of \u003ca href=\"https://www.washingtonexaminer.com/news/campaigns/presidential/3000858/rfk-jr-walks-back-stance-abortion/\">fetal viability\u003c/a>, the stage at which a fetus can potentially survive outside the womb.\u003c/p>\n\u003cp>Roger Severino, who served as the Department of Health and Human Services director of the Office for Civil Rights under Trump, authored Project 2025’s abortion surveillance plan. He is now the vice president of domestic policy at the Heritage Foundation, the conservative think tank behind Project 2025. He declined an interview request.[aside label=\"Related Stories\" postID=\"news_12015752,news_12013882,forum_2010101906159\"]Severino’s vision for remaking the department is a cornerstone of Project 2025’s effort to impose stricter federal oversight on abortion practices, particularly targeting states like California, which offers greater access to abortion services than most other states.\u003c/p>\n\u003cp>“Because liberal states have now become sanctuaries for abortion tourism, [the Department of Health and Human Services] should use every available tool, including the cutting of funds, to ensure that every state reports exactly how many abortions take place within its borders, at what gestational age of the child, for what reason, the mother’s state of residence, and by what method,” reads \u003ca href=\"https://static.project2025.org/2025_MandateForLeadership_CHAPTER-14.pdf\">the chapter (PDF)\u003c/a> on abortion reporting.\u003c/p>\n\u003cp>The potential fallout isn’t limited to California. Experts \u003ca href=\"https://calmatters.org/politics/2024/09/project2025-trump-california-abortion-surveillance/\">have warned\u003c/a> that other states with progressive abortion policies may face similar funding threats, amplifying the national debate over reproductive rights under Trump’s second term.\u003c/p>\n\u003cp>After Election Day, Newsom traveled to Washington, D.C., for meetings with the Biden administration and congressional leaders to “discuss strategies for safeguarding health care access,” said Anthony Cava, a spokesperson for the California Department of Health Care Services.\u003c/p>\n\u003cp>Cava would not elaborate on those strategies. He said the department “cannot speculate on the future of these programs under a new federal administration, but the Newsom administration is working to protect the health and well-being of all Californians.”\u003c/p>\n\u003cp>California has long positioned itself as a national leader in reproductive rights, actively opposing federal restrictions on abortion access. The state’s proactive policies, such as safeguarding providers who serve out-of-state patients, stand in stark contrast to the goals of Project 2025. As policymakers and advocates brace for how Trump plans to “\u003ca href=\"https://truthsocial.com/@realDonaldTrump/posts/113448443776000306\">Make California Great Again\u003c/a>,” they’re treating Project 2025 as a looming possibility.\u003c/p>\n\u003cp>Planned Parenthood, one of California’s leading providers of reproductive health care services for lower-income communities, said the organization is preparing for “a variety of scenarios.”\u003c/p>\n\u003cp>Shelby McMichael, a spokesperson for Planned Parenthood Affiliates of California, said “while specifics remain under wraps,” the group is prioritizing expanding California’s abortion provider workforce, increasing investments in abortion funds and infrastructure as well as analyzing data to “improve abortion care access and education.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>If President-elect Donald Trump goes forward with Project 2025, California could lose out on at least $300 million a year in funding for abortions, family planning and contraception for millions of lower-income residents.\u003c/p>\n\u003cp>Project 2025, a right-wing blueprint for the next president, targeted the state \u003ca href=\"https://calmatters.org/politics/2024/09/project2025-trump-california-abortion-surveillance/\">with an ultimatum\u003c/a> that would require California to start reporting abortion data to the Centers for Disease Control or risk losing critical Medicaid funding.\u003c/p>\n\u003cp>Despite Trump’s attempts to distance himself from the plan during the campaign, at least 140 of his allies produced the report, and \u003ca href=\"https://www.washingtonpost.com/politics/2024/11/20/trump-project-2025-second-administration/\">he’s appointing key figures\u003c/a> from the project to his administration. As California leaders rush to shield the state from a Trump agenda, preserving reproductive freedoms stands as a top priority.\u003c/p>\n\u003cp>Newsom called \u003ca href=\"https://calmatters.org/politics/capitol/2024/11/gavin-newsom-special-session-trump-resistance/\">a special session for next month\u003c/a> to “Trump-proof” California, and he’s hiring lawyers to prepare for Day 1 of the Trump presidency.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Whether it be our fundamental civil rights, reproductive freedom, or climate action — we refuse to turn back the clock and allow our values and laws to be attacked,” Newsom said in a statement.\u003c/p>\n\u003cp>When CalMatters first reported on the ultimatum in September, the California Department of Health Care Services didn’t provide specific figures detailing how much the state receives in federal reimbursements for reproductive health care provided through \u003ca href=\"https://calmatters.org/tag/medi-cal/\">Medi-Cal\u003c/a>. The department now says the federal government reimbursed California about $310.7 million for reproductive health care last year, according to California Department of Health Care Services figures. In the previous year, the state received $334.5 million. That funding supports Medi-Cal, the \u003ca href=\"https://www.acog.org/advocacy/policy-priorities/medicaid#:~:text=Medicaid%20is%20the%20largest%20single,ensuring%20healthy%20moms%20and%20babies.\">single largest payer\u003c/a> of maternity care in the country. Medi-Cal covers about 14.2 million Californians. All told, the federal government reimbursed the state $90.9 billion for Medi-Cal last year.\u003c/p>\n\u003cp>Under Project 2025, all 50 states would be mandated to report detailed abortion-related data to the federal government, including information such as the reason for the abortion, the fetus’ gestational age, the birthing parent’s state of residence, whether the procedure was surgical or medication-induced, and more.\u003c/p>\n\u003cp>Currently, California, Maryland, and New Hampshire do not require abortion providers to share patient data with the federal government. Shortly after the overturning of Roe v. Wade, the California Department of Public Health said that it does not report abortion data federally because\u003ca href=\"https://calmatters.org/health/2022/06/abortion-data-california/\"> it is not legally obligated to do so\u003c/a>. States that do collect abortion data typically use it for public health analyses, which can help identify gaps in care and improve access to services.\u003c/p>\n\u003cp>Newsom’s office did not provide details on the projected costs of lawyering up but said the governor plans for legislation to give additional resources to the California Department of Justice and other state agencies.\u003c/p>\n\u003cp>These resources are intended “to pursue robust affirmative litigation against any unlawful actions by the incoming Trump administration, as well as defend against federal lawsuits aimed at undermining California’s laws and policies,” the governor’s office said. “The funding will support the ability to immediately file litigation and seek injunctive relief against unlawful federal actions.”\u003c/p>\n\u003cfigure id=\"attachment_12015950\" class=\"wp-caption aligncenter\" style=\"max-width: 779px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12015950\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/11/081423-Project-2025-AP-CM-01-copy.jpg\" alt=\"\" width=\"779\" height=\"519\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/11/081423-Project-2025-AP-CM-01-copy.jpg 779w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/11/081423-Project-2025-AP-CM-01-copy-160x107.jpg 160w\" sizes=\"auto, (max-width: 779px) 100vw, 779px\">\u003cfigcaption class=\"wp-caption-text\">Kristen Eichamer, center, talks to fairgoers at the Project 2025 tent at the Iowa State Fair in Des Moines, Iowa, on Aug. 14, 2023. \u003ccite>(Charlie Neibergall/AP Photo)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Trump tapped two individuals associated with Project 2025 for roles in his administration. Brendan Carr, who authored Project 2025’s section on the Federal Communications Commission, will lead the agency.\u003c/p>\n\u003cp>Tom Homan, an immigration hawk who’s listed in Project 2025’s credits as having assisted in developing and writing the playbook, will serve as the border czar, overseeing immigration policies and implementing mass deportation strategies. The spot is not an official cabinet position.\u003c/p>\n\u003cp>To lead the Department of Health and Human Services, Trump tapped Robert F. Kennedy Jr., an environmental lawyer who \u003ca href=\"https://calmatters.org/health/2024/11/robert-f-kennedy-jr-california-vaccine/\">previously fought California\u003c/a> over vaccine mandates. The department controls oversight of Medicaid spending and plays a critical role in abortion reporting by setting federal guidelines and enforcing privacy protections under HIPAA.\u003c/p>\n\u003cp>Kennedy does not appear to have endorsed Project 2025. His stance on abortion has been notably inconsistent over time. In May, \u003ca href=\"https://www.youtube.com/watch?v=ovu7Hu1oEiQ&t=1s\">he expressed\u003c/a> support for unrestricted abortion access, stating he opposed any government restrictions, “even if it’s full term.”\u003c/p>\n\u003cp>However, he later revised his position, advocating for legal \u003ca href=\"https://calmatters.org/tag/abortion/\">abortion\u003c/a> up to the point of \u003ca href=\"https://www.washingtonexaminer.com/news/campaigns/presidential/3000858/rfk-jr-walks-back-stance-abortion/\">fetal viability\u003c/a>, the stage at which a fetus can potentially survive outside the womb.\u003c/p>\n\u003cp>Roger Severino, who served as the Department of Health and Human Services director of the Office for Civil Rights under Trump, authored Project 2025’s abortion surveillance plan. He is now the vice president of domestic policy at the Heritage Foundation, the conservative think tank behind Project 2025. He declined an interview request.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Severino’s vision for remaking the department is a cornerstone of Project 2025’s effort to impose stricter federal oversight on abortion practices, particularly targeting states like California, which offers greater access to abortion services than most other states.\u003c/p>\n\u003cp>“Because liberal states have now become sanctuaries for abortion tourism, [the Department of Health and Human Services] should use every available tool, including the cutting of funds, to ensure that every state reports exactly how many abortions take place within its borders, at what gestational age of the child, for what reason, the mother’s state of residence, and by what method,” reads \u003ca href=\"https://static.project2025.org/2025_MandateForLeadership_CHAPTER-14.pdf\">the chapter (PDF)\u003c/a> on abortion reporting.\u003c/p>\n\u003cp>The potential fallout isn’t limited to California. Experts \u003ca href=\"https://calmatters.org/politics/2024/09/project2025-trump-california-abortion-surveillance/\">have warned\u003c/a> that other states with progressive abortion policies may face similar funding threats, amplifying the national debate over reproductive rights under Trump’s second term.\u003c/p>\n\u003cp>After Election Day, Newsom traveled to Washington, D.C., for meetings with the Biden administration and congressional leaders to “discuss strategies for safeguarding health care access,” said Anthony Cava, a spokesperson for the California Department of Health Care Services.\u003c/p>\n\u003cp>Cava would not elaborate on those strategies. He said the department “cannot speculate on the future of these programs under a new federal administration, but the Newsom administration is working to protect the health and well-being of all Californians.”\u003c/p>\n\u003cp>California has long positioned itself as a national leader in reproductive rights, actively opposing federal restrictions on abortion access. The state’s proactive policies, such as safeguarding providers who serve out-of-state patients, stand in stark contrast to the goals of Project 2025. As policymakers and advocates brace for how Trump plans to “\u003ca href=\"https://truthsocial.com/@realDonaldTrump/posts/113448443776000306\">Make California Great Again\u003c/a>,” they’re treating Project 2025 as a looming possibility.\u003c/p>\n\u003cp>Planned Parenthood, one of California’s leading providers of reproductive health care services for lower-income communities, said the organization is preparing for “a variety of scenarios.”\u003c/p>\n\u003cp>Shelby McMichael, a spokesperson for Planned Parenthood Affiliates of California, said “while specifics remain under wraps,” the group is prioritizing expanding California’s abortion provider workforce, increasing investments in abortion funds and infrastructure as well as analyzing data to “improve abortion care access and education.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>\u003cb>Here are the morning’s top stories on Wednesday, October 30, 2024…\u003c/b>\u003c/p>\n\u003cul>\n\u003cli style=\"font-weight: 400\">\u003cspan style=\"font-weight: 400\">California election officials are bracing for Election Day amidst \u003c/span>\u003ca href=\"https://www.kqed.org/news/12010499/how-california-election-officials-are-bracing-for-misinformation-and-mistrust\">\u003cspan style=\"font-weight: 400\">concerns about distrust.\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> Officials have been investing in outreach and education. One county that’s dealt with a lot of distrust is Shasta County in far northern California. The county’s longtime registrar of voters, Cathy Darling Allen, retired in May this summer. The board appointed a new registrar to replace her.\u003c/span>\u003c/li>\n\u003cli style=\"font-weight: 400\">\u003ca href=\"https://calmatters.org/california-voter-guide-2024/propositions/prop-35-health-care-tax/\">\u003cspan style=\"font-weight: 400\">Proposition 35\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> is one of ten statewide ballot measures that Californians will be voting on this election. It would put new guidelines around Medi-Cal spending to help secure better pay for doctors who serve low-income Californians.\u003c/span>\u003c/li>\n\u003cli>Nearly 5 million Californians have voted in the general election so far, according to \u003ca href=\"https://elections.cdn.sos.ca.gov/statewide-elections/2024-general/vbm-statistics.pdf\">the state secretary of state’s latest snapshot.\u003c/a>\u003c/li>\n\u003c/ul>\n\u003ch2>\u003cb>Election Questions Remain In Shasta County \u003c/b>\u003c/h2>\n\u003cp>\u003cspan style=\"font-weight: 400\">Cathy Darling Allen, the longtime county clerk/registrar of voters in Shasta County, retired in May. The county has been one of the most contentious when it comes to election results. Last year, three members of the Shasta County Board of Supervisors \u003c/span>\u003ca href=\"https://www.ijpr.org/politics-government/2023-03-10/a-california-county-has-dumped-dominion-leaving-its-election-operations-up-in-the-air\">\u003cspan style=\"font-weight: 400\">voted to cancel the county’s contract\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> with Dominion Voting Systems. That’s the company that was at the center of a lot of the conspiracy theories around the 2020 election. And they voted to hand count ballots instead, although that decision was overridden by \u003c/span>\u003ca href=\"https://www.npr.org/2023/09/08/1198395036/shasta-county-hand-counting-ballots-california-legislation\">\u003cspan style=\"font-weight: 400\">a new law in Sacramento.\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The board \u003c/span>\u003ca href=\"https://www.ijpr.org/politics-government/2024-06-20/snubbing-institutional-candidate-shasta-county-appoints-voting-official-without-elections-experience\">\u003cspan style=\"font-weight: 400\">appointed a new registrar\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> to replace Darling Allen. Thomas Toller is a former \u003c/span>\u003cspan style=\"font-weight: 400\">Shasta County Deputy District Attorney and had no experience with elections. He presented himself to the board as someone who would stick up for Shasta County and any potential future conflict with the state of California over how the county runs its elections. He initially said if it were legal, he would consider hand-counting ballots over machines, and that he’s not a big fan of voting machines. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But since taking office, some of his perspective has changed. W\u003c/span>\u003cspan style=\"font-weight: 400\">hen it comes to hand-counting, Toller now says that he thinks it’s too costly and too slow. He says that while any issues that would come up in an election, he might in the past think that something nefarious was going on. Now, he thinks that those were likely the kind of common mistakes that happen due to human error in a high stress environment. “I’m constantly sent emails from people suggesting that I need to stop using this technology or I need to start implementing this other procedure. And my universal response has been I don’t see any evidence of this, but if you can give me credible evidence that it’s happening here in Shasta County, I will definitely look into it,” Toller said. “And if there’s a problem, I will resolve it.” \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Toller says that he now spends a lot of time stressing that the voting machines Shasta uses do not connect to the Internet and coming up with different messaging that he hopes will allay people’s fears and concerns.\u003c/span>\u003c/p>\n\u003ch2>\u003ca href=\"https://calmatters.org/california-voter-guide-2024/propositions/prop-35-health-care-tax/\">\u003cb>Proposition 35 Would Put New Guidelines On Medi-Cal Spending\u003c/b>\u003c/a>\u003c/h2>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003ca href=\"https://www.kqed.org/voterguide/california/proposition-35\">Proposition 35\u003c/a> on the November ballot would require the state to use money from a tax on health insurance plans to boost payments to doctors who serve Medi-Cal patients. \u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Over the last few years, the state has expanded Medi-Cal to cover more Californians than ever, now around 14 million people. But the amount that doctors get paid to treat Medi-Cal patients has not kept up with inflation. As a result, many providers won’t treat them, according to the California Health Care Foundation. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Supporters say Prop 35 will encourage doctors to serve more low-income patients because they’d be getting paid more for their services. Opponents worry putting restrictions on how the state spends this money could mean cuts to other Medi-Cal programs.\u003c/span>\u003c/p>\n\u003ch2>\u003cstrong>Millions Of Californians Have Already Cast Their Ballot\u003c/strong>\u003c/h2>\n\u003cp>Nearly 5 million Californians have voted in the general election so far, \u003ca href=\"https://elections.cdn.sos.ca.gov/statewide-elections/2024-general/vbm-statistics.pdf\">according to the state secretary of state’s latest snapshot\u003c/a>. That’s a little bit less than a quarter of the state’s registered voters.\u003c/p>\n\u003cp>Sierra, Plumas, and Alpine Counties have the highest percentage of returned ballots, but all three have low numbers of registered voters relative to other counties.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>All mail in ballots must be postmarked by Election Day, November 5, to be counted.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cb>Here are the morning’s top stories on Wednesday, October 30, 2024…\u003c/b>\u003c/p>\n\u003cul>\n\u003cli style=\"font-weight: 400\">\u003cspan style=\"font-weight: 400\">California election officials are bracing for Election Day amidst \u003c/span>\u003ca href=\"https://www.kqed.org/news/12010499/how-california-election-officials-are-bracing-for-misinformation-and-mistrust\">\u003cspan style=\"font-weight: 400\">concerns about distrust.\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> Officials have been investing in outreach and education. One county that’s dealt with a lot of distrust is Shasta County in far northern California. The county’s longtime registrar of voters, Cathy Darling Allen, retired in May this summer. The board appointed a new registrar to replace her.\u003c/span>\u003c/li>\n\u003cli style=\"font-weight: 400\">\u003ca href=\"https://calmatters.org/california-voter-guide-2024/propositions/prop-35-health-care-tax/\">\u003cspan style=\"font-weight: 400\">Proposition 35\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> is one of ten statewide ballot measures that Californians will be voting on this election. It would put new guidelines around Medi-Cal spending to help secure better pay for doctors who serve low-income Californians.\u003c/span>\u003c/li>\n\u003cli>Nearly 5 million Californians have voted in the general election so far, according to \u003ca href=\"https://elections.cdn.sos.ca.gov/statewide-elections/2024-general/vbm-statistics.pdf\">the state secretary of state’s latest snapshot.\u003c/a>\u003c/li>\n\u003c/ul>\n\u003ch2>\u003cb>Election Questions Remain In Shasta County \u003c/b>\u003c/h2>\n\u003cp>\u003cspan style=\"font-weight: 400\">Cathy Darling Allen, the longtime county clerk/registrar of voters in Shasta County, retired in May. The county has been one of the most contentious when it comes to election results. Last year, three members of the Shasta County Board of Supervisors \u003c/span>\u003ca href=\"https://www.ijpr.org/politics-government/2023-03-10/a-california-county-has-dumped-dominion-leaving-its-election-operations-up-in-the-air\">\u003cspan style=\"font-weight: 400\">voted to cancel the county’s contract\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> with Dominion Voting Systems. That’s the company that was at the center of a lot of the conspiracy theories around the 2020 election. And they voted to hand count ballots instead, although that decision was overridden by \u003c/span>\u003ca href=\"https://www.npr.org/2023/09/08/1198395036/shasta-county-hand-counting-ballots-california-legislation\">\u003cspan style=\"font-weight: 400\">a new law in Sacramento.\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The board \u003c/span>\u003ca href=\"https://www.ijpr.org/politics-government/2024-06-20/snubbing-institutional-candidate-shasta-county-appoints-voting-official-without-elections-experience\">\u003cspan style=\"font-weight: 400\">appointed a new registrar\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> to replace Darling Allen. Thomas Toller is a former \u003c/span>\u003cspan style=\"font-weight: 400\">Shasta County Deputy District Attorney and had no experience with elections. He presented himself to the board as someone who would stick up for Shasta County and any potential future conflict with the state of California over how the county runs its elections. He initially said if it were legal, he would consider hand-counting ballots over machines, and that he’s not a big fan of voting machines. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But since taking office, some of his perspective has changed. W\u003c/span>\u003cspan style=\"font-weight: 400\">hen it comes to hand-counting, Toller now says that he thinks it’s too costly and too slow. He says that while any issues that would come up in an election, he might in the past think that something nefarious was going on. Now, he thinks that those were likely the kind of common mistakes that happen due to human error in a high stress environment. “I’m constantly sent emails from people suggesting that I need to stop using this technology or I need to start implementing this other procedure. And my universal response has been I don’t see any evidence of this, but if you can give me credible evidence that it’s happening here in Shasta County, I will definitely look into it,” Toller said. “And if there’s a problem, I will resolve it.” \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Toller says that he now spends a lot of time stressing that the voting machines Shasta uses do not connect to the Internet and coming up with different messaging that he hopes will allay people’s fears and concerns.\u003c/span>\u003c/p>\n\u003ch2>\u003ca href=\"https://calmatters.org/california-voter-guide-2024/propositions/prop-35-health-care-tax/\">\u003cb>Proposition 35 Would Put New Guidelines On Medi-Cal Spending\u003c/b>\u003c/a>\u003c/h2>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003ca href=\"https://www.kqed.org/voterguide/california/proposition-35\">Proposition 35\u003c/a> on the November ballot would require the state to use money from a tax on health insurance plans to boost payments to doctors who serve Medi-Cal patients. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Over the last few years, the state has expanded Medi-Cal to cover more Californians than ever, now around 14 million people. But the amount that doctors get paid to treat Medi-Cal patients has not kept up with inflation. As a result, many providers won’t treat them, according to the California Health Care Foundation. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Supporters say Prop 35 will encourage doctors to serve more low-income patients because they’d be getting paid more for their services. Opponents worry putting restrictions on how the state spends this money could mean cuts to other Medi-Cal programs.\u003c/span>\u003c/p>\n\u003ch2>\u003cstrong>Millions Of Californians Have Already Cast Their Ballot\u003c/strong>\u003c/h2>\n\u003cp>Nearly 5 million Californians have voted in the general election so far, \u003ca href=\"https://elections.cdn.sos.ca.gov/statewide-elections/2024-general/vbm-statistics.pdf\">according to the state secretary of state’s latest snapshot\u003c/a>. That’s a little bit less than a quarter of the state’s registered voters.\u003c/p>\n\u003cp>Sierra, Plumas, and Alpine Counties have the highest percentage of returned ballots, but all three have low numbers of registered voters relative to other counties.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>All mail in ballots must be postmarked by Election Day, November 5, to be counted.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Santa Clara County officials are leading the way on a new state initiative to provide Medi-Cal benefits to people incarcerated in county lockups as they prepare to reenter society, part of an effort to improve health outcomes in underserved communities.\u003c/p>\n\u003cp>The \u003ca href=\"https://calmatters.org/health/2022/02/california-medi-cal-reform/\">new program\u003c/a>, known as the Justice-Involved Reentry Initiative, is one part of the state’s push to better streamline and integrate Medi-Cal with other social and health services across California. Through the reentry program, people in jails and youth correctional facilities can now enroll in Medi-Cal 90 days before their release.\u003c/p>\n\u003cp>All counties in California must implement the program by October 2025, but Santa Clara County, along with Inyo and Yuba counties, were among the first to gain approval from the state to begin the work.\u003c/p>\n\u003cp>During the 90-day period, county health agencies, which oversee care for incarcerated people, can work with those preparing for reentry to develop plans for uninterrupted medical care and mental health support.\u003c/p>\n\u003cp>“This means that gains that were made while in custody through mental health services, drug addiction treatment and support for chronic health conditions will not be lost when people leave custody,” county Board of Supervisors President Susan Ellenberg said during a news conference on Tuesday, to mark the county enrolling more than 100 people in the program.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“In short, this initiative will make these residents healthier and our entire community safer.”\u003c/p>\n\u003cp>Ellenberg said about 70% of people in county correctional facilities, a disproportionate number of whom are people of color, are struggling with chronic health issues, mental illness or substance-use disorders.\u003c/p>\n\u003cp>[aside label=\"related coverage\" tag=\"medi-cal\"]“Very often, the triggering behavior or action that lands them in custody was one of those health-related issues or social determinants of health,” she said in an interview. “So being able to address those while they’re in custody is really significant, but only will have a lasting effect if we continue it.”\u003c/p>\n\u003cp>Program participants are also offered case management support for up to one year after their release to help navigate the complex web of available government, private market and nonprofit-provided services.\u003c/p>\n\u003cp>“The medical system, behavioral health systems, as well as connecting them to other services like housing, food, transportation, other things that you need, the fundamentals to be able to manage your health well,” Michelle de la Calle, director of system integration for Santa Clara Valley Healthcare, said in an interview.\u003c/p>\n\u003cp>Dr. Clifford Wang, the interim director of custody health services for the county, said people leaving county facilities would be given a supply of their medications in hand, as well as any needed medical equipment, such as walkers, canes or wheelchairs.\u003c/p>\n\u003cp>“Once you leave custody, you’re thinking about, ‘where am I going to live, where am I going to get my next meal,’ and you may not pick up your prescriptions,” Wang said. “So it’s a bridge, and it’s lessening the burden on them. One less thing they might have to worry about when they get out in the immediate sense.”\u003c/p>\n\u003cp>People who are trying to rebuild their lives face many challenges “including housing instability, homelessness and barriers to gainful employment,” said Ky Le, a deputy county executive.\u003c/p>\n\u003cp>Le said this latest initiative will augment the work the county has already done to provide reentry resource centers, employment programs and peer counseling services.\u003c/p>\n\u003cp>Ellenberg said she’s happy Santa Clara County is “at the vanguard again” for programs and initiatives that help “build a carceral system that is as least traumatizing as possible, as most rehabilitative as possible.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I look forward to learning about the lives that will be improved as a result of this program,” she said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Santa Clara County officials are leading the way on a new state initiative to provide Medi-Cal benefits to people incarcerated in county lockups as they prepare to reenter society, part of an effort to improve health outcomes in underserved communities.\u003c/p>\n\u003cp>The \u003ca href=\"https://calmatters.org/health/2022/02/california-medi-cal-reform/\">new program\u003c/a>, known as the Justice-Involved Reentry Initiative, is one part of the state’s push to better streamline and integrate Medi-Cal with other social and health services across California. Through the reentry program, people in jails and youth correctional facilities can now enroll in Medi-Cal 90 days before their release.\u003c/p>\n\u003cp>All counties in California must implement the program by October 2025, but Santa Clara County, along with Inyo and Yuba counties, were among the first to gain approval from the state to begin the work.\u003c/p>\n\u003cp>During the 90-day period, county health agencies, which oversee care for incarcerated people, can work with those preparing for reentry to develop plans for uninterrupted medical care and mental health support.\u003c/p>\n\u003cp>“This means that gains that were made while in custody through mental health services, drug addiction treatment and support for chronic health conditions will not be lost when people leave custody,” county Board of Supervisors President Susan Ellenberg said during a news conference on Tuesday, to mark the county enrolling more than 100 people in the program.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“Very often, the triggering behavior or action that lands them in custody was one of those health-related issues or social determinants of health,” she said in an interview. “So being able to address those while they’re in custody is really significant, but only will have a lasting effect if we continue it.”\u003c/p>\n\u003cp>Program participants are also offered case management support for up to one year after their release to help navigate the complex web of available government, private market and nonprofit-provided services.\u003c/p>\n\u003cp>“The medical system, behavioral health systems, as well as connecting them to other services like housing, food, transportation, other things that you need, the fundamentals to be able to manage your health well,” Michelle de la Calle, director of system integration for Santa Clara Valley Healthcare, said in an interview.\u003c/p>\n\u003cp>Dr. Clifford Wang, the interim director of custody health services for the county, said people leaving county facilities would be given a supply of their medications in hand, as well as any needed medical equipment, such as walkers, canes or wheelchairs.\u003c/p>\n\u003cp>“Once you leave custody, you’re thinking about, ‘where am I going to live, where am I going to get my next meal,’ and you may not pick up your prescriptions,” Wang said. “So it’s a bridge, and it’s lessening the burden on them. One less thing they might have to worry about when they get out in the immediate sense.”\u003c/p>\n\u003cp>People who are trying to rebuild their lives face many challenges “including housing instability, homelessness and barriers to gainful employment,” said Ky Le, a deputy county executive.\u003c/p>\n\u003cp>Le said this latest initiative will augment the work the county has already done to provide reentry resource centers, employment programs and peer counseling services.\u003c/p>\n\u003cp>Ellenberg said she’s happy Santa Clara County is “at the vanguard again” for programs and initiatives that help “build a carceral system that is as least traumatizing as possible, as most rehabilitative as possible.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I look forward to learning about the lives that will be improved as a result of this program,” she said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "California’s Native Americans Can Soon Get Traditional Healing Covered by Medi-Cal",
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"content": "\u003cp>Emery Tahy of San Francisco knows firsthand the struggles of \u003ca href=\"https://www.kqed.org/news/tag/addiction-treatment\">addiction and recovery\u003c/a> — a journey that, for him, is intertwined with his experience as a Native American.\u003c/p>\n\u003cp>In his twenties, Tahy landed on the streets of Phoenix, battling severe depression and alcohol-induced seizures. About four years ago, Tahy said, he was on the brink of suicide when his siblings intervened and petitioned for court-ordered treatment.\u003c/p>\n\u003cp>While Tahy was detoxing in a psychiatric ward, he learned about the \u003ca href=\"https://www.friendshiphousesf.org/\">Friendship House\u003c/a>, a Native-led recovery treatment program in San Francisco. As soon as he was released from the Arizona hospital, he headed to California.\u003c/p>\n\u003cp>“I knew immediately that I was in the right place,” said Tahy, 43. “A traditional practitioner did prayers for me. They shared some songs with me. They put me in the sweat lodge, and I could identify with those ceremonies. And from that day moving forward, I was able to reconnect to my spiritual and cultural upbringing.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Now, for the first time, \u003ca href=\"https://www.kqed.org/news/tag/medi-cal\">Medi-Cal\u003c/a> is set to cover traditional health practices such as music therapy, sweat lodges and dancing to help the state’s Native American communities battle addiction to drugs and alcohol.\u003c/p>\n\u003cp>The Medi-Cal expansion will cover two new \u003ca href=\"https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ca-calaim-dmnstrn-appvl-10162024.pdf\" target=\"_blank\" rel=\"noopener\">categories of intervention\u003c/a>. People suffering from a substance use disorder can seek therapy from traditional healers who offer ceremonial rituals, or they can work with trusted figures within tribal communities, such as elected officials or spiritual leaders who offer psychological support, trauma counseling and recovery guidance.\u003c/p>\n\u003cp>California is home to the largest \u003ca href=\"https://www.kqed.org/news/tag/native-americans\">Native American\u003c/a> population in the U.S., and Gov. Gavin Newsom said in a press release announcing the expansion this week that the state is “committed to healing the \u003ca href=\"https://www.kqed.org/news/12009426/the-brutal-story-behind-californias-new-native-american-genocide-education-law\">historical wounds inflicted on tribes\u003c/a>, including the health disparities Native communities face.”\u003c/p>\n\u003cfigure id=\"attachment_12009971\" class=\"wp-caption alignright\" style=\"max-width: 1333px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12009971\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/241017-EMERY-TAHY-PHOTO-KQED.jpg\" alt=\"\" width=\"1333\" height=\"2000\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/241017-EMERY-TAHY-PHOTO-KQED.jpg 1333w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/241017-EMERY-TAHY-PHOTO-KQED-800x1200.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/241017-EMERY-TAHY-PHOTO-KQED-1020x1530.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/241017-EMERY-TAHY-PHOTO-KQED-160x240.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/241017-EMERY-TAHY-PHOTO-KQED-1024x1536.jpg 1024w\" sizes=\"auto, (max-width: 1333px) 100vw, 1333px\">\u003cfigcaption class=\"wp-caption-text\">Emery Tahy found healing in the Friendship House, a Native-led recovery treatment program in San Francisco. \u003ccite>(Courtesy of Maira Garcia and AJ Aguilar/Native American Health Center)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Tahy’s battle with alcoholism began when he was a small child. He said he took his first sip of beer when he was 4, surrounded by parents, uncles, aunts and grandparents who all drank heavily on the Navajo Nation.\u003c/p>\n\u003cp>“I’m a full-blooded American Indian,” Tahy said, recounting the difficulties he faced in his youth. “Growing up, I was subjected to a lot of prejudice, racism and segregation. I didn’t have any pride in who I was. I feel like drugs and alcohol were a way to cope with that shame. Alcohol helped me socialize and gave me courage.”\u003c/p>\n\u003cp>During his teenage years, Tahy drank and began dabbling in marijuana, cocaine and crystal meth. All the while, he said, his family instilled a meaningful relationship to his culture.\u003c/p>\n\u003cp>“I was always encouraged by my grandparents, on my mom’s side, to learn and be connected to traditional Navajo ways of life,” Tahy said. “There was a deep connection to family, land and ceremonial activities connected to seasonal changes.”\u003c/p>\n\u003cp>Tahy’s story is not unique. Native American communities suffer from some of the \u003ca href=\"https://americanaddictioncenters.org/addiction-statistics/native-americans\">highest rates\u003c/a> of substance abuse and overdose deaths in the country, and health experts have long argued that Western medicine alone cannot adequately treat substance use disorders in Native American populations.\u003c/p>\n\u003cp>The crisis is compounded by centuries of historical trauma, which is why the U.S. Centers for Medicare & Medicaid Services is also \u003ca href=\"https://www.cms.gov/newsroom/press-releases/biden-harris-administration-takes-groundbreaking-action-expand-health-care-access-covering\">offering coverage\u003c/a> for tribal communities in Arizona, New Mexico and Oregon.\u003c/p>\n\u003cp>Roselyn Tso, who directs the federal Indian Health Service, has championed this work and said that “these practices have sustained our people’s health for generations and continue to serve as a vital link between culture, science and wellness in many of our communities.”\u003c/p>\n\u003ch2>Bridging two worlds: Tradition and modern medicine\u003c/h2>\n\u003cp>While clinical approaches like detox, medication-assisted treatment and behavioral therapy are essential to treating substance use disorders, they often fail to address the cultural and spiritual needs of Native patients.\u003c/p>\n\u003cp>“Traditional practices are, by nature, holistic,” said Damian Chase-Begay, a researcher focused on American Indian health at the University of Montana. “They are treating the person physically, mentally, spiritually and emotionally. They benefit the whole being, not just the physical symptoms.”\u003c/p>\n\u003cp>For years, healthcare practitioners dedicated to Indigenous communities struggled with the limitations of what insurance would cover. Medi-Cal, the state’s Medicaid program for low-income residents, reimburses for medical prescriptions or talk therapy, but traditional healing methods were often excluded from coverage, leaving many Native American patients without access to treatments that aligned with their cultural values.\u003c/p>\n\u003cp>“What California is now covering under Medi-Cal is exactly what our Native communities have been asking to be covered for years,” Chase-Begay said. “This kind of support, had it been in place, could have helped stop some intergenerational trauma and substance use years ago. I’m so thrilled that it’s in place now, but it’s long overdue.”\u003c/p>\n\u003cp>[aside postID=news_12009555 hero='https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/241014-GREAT-REDWOOD-TRAIL-AW-01-1020x764.jpg']\u003c/p>\n\u003cp>\u003ca href=\"https://ncuih.org/wp-content/uploads/03.25.24-FINAL-design-of-2023-TH-Report.pdf\">Studies\u003c/a> have shown that integrating cultural practices into addiction treatment can lead to higher engagement and more positive recovery outcomes, though most of the current research is qualitative, not quantitative.\u003c/p>\n\u003cp>The new Medi-Cal policy is set to take effect next year, with Indian Health Service providers in qualifying counties able to request reimbursement for these services starting in January.\u003c/p>\n\u003cp>“It is vital that we honor our traditional ways of healing,” said Kiana Maillet, a licensed therapist in San Diego and a member of the Lone Pine Paiute-Shoshone Tribe. “Traditional healing is deeply ingrained in our cultures. Without it, we are missing a piece of who we are.”\u003c/p>\n\u003cp>As for Tahy, he hasn’t touched a drop of alcohol since starting therapy at Friendship House.\u003c/p>\n\u003cp>He now holds a full-time job as an evaluator for the Native American Health Center in San Francisco. Soon, he will complete a master’s degree in American Indian studies. And, a few months ago, he completed the San Francisco marathon.\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Emery Tahy of San Francisco knows firsthand the struggles of \u003ca href=\"https://www.kqed.org/news/tag/addiction-treatment\">addiction and recovery\u003c/a> — a journey that, for him, is intertwined with his experience as a Native American.\u003c/p>\n\u003cp>In his twenties, Tahy landed on the streets of Phoenix, battling severe depression and alcohol-induced seizures. About four years ago, Tahy said, he was on the brink of suicide when his siblings intervened and petitioned for court-ordered treatment.\u003c/p>\n\u003cp>While Tahy was detoxing in a psychiatric ward, he learned about the \u003ca href=\"https://www.friendshiphousesf.org/\">Friendship House\u003c/a>, a Native-led recovery treatment program in San Francisco. As soon as he was released from the Arizona hospital, he headed to California.\u003c/p>\n\u003cp>“I knew immediately that I was in the right place,” said Tahy, 43. “A traditional practitioner did prayers for me. They shared some songs with me. They put me in the sweat lodge, and I could identify with those ceremonies. And from that day moving forward, I was able to reconnect to my spiritual and cultural upbringing.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Now, for the first time, \u003ca href=\"https://www.kqed.org/news/tag/medi-cal\">Medi-Cal\u003c/a> is set to cover traditional health practices such as music therapy, sweat lodges and dancing to help the state’s Native American communities battle addiction to drugs and alcohol.\u003c/p>\n\u003cp>The Medi-Cal expansion will cover two new \u003ca href=\"https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ca-calaim-dmnstrn-appvl-10162024.pdf\" target=\"_blank\" rel=\"noopener\">categories of intervention\u003c/a>. People suffering from a substance use disorder can seek therapy from traditional healers who offer ceremonial rituals, or they can work with trusted figures within tribal communities, such as elected officials or spiritual leaders who offer psychological support, trauma counseling and recovery guidance.\u003c/p>\n\u003cp>California is home to the largest \u003ca href=\"https://www.kqed.org/news/tag/native-americans\">Native American\u003c/a> population in the U.S., and Gov. Gavin Newsom said in a press release announcing the expansion this week that the state is “committed to healing the \u003ca href=\"https://www.kqed.org/news/12009426/the-brutal-story-behind-californias-new-native-american-genocide-education-law\">historical wounds inflicted on tribes\u003c/a>, including the health disparities Native communities face.”\u003c/p>\n\u003cfigure id=\"attachment_12009971\" class=\"wp-caption alignright\" style=\"max-width: 1333px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12009971\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/241017-EMERY-TAHY-PHOTO-KQED.jpg\" alt=\"\" width=\"1333\" height=\"2000\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/241017-EMERY-TAHY-PHOTO-KQED.jpg 1333w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/241017-EMERY-TAHY-PHOTO-KQED-800x1200.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/241017-EMERY-TAHY-PHOTO-KQED-1020x1530.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/241017-EMERY-TAHY-PHOTO-KQED-160x240.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/241017-EMERY-TAHY-PHOTO-KQED-1024x1536.jpg 1024w\" sizes=\"auto, (max-width: 1333px) 100vw, 1333px\">\u003cfigcaption class=\"wp-caption-text\">Emery Tahy found healing in the Friendship House, a Native-led recovery treatment program in San Francisco. \u003ccite>(Courtesy of Maira Garcia and AJ Aguilar/Native American Health Center)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Tahy’s battle with alcoholism began when he was a small child. He said he took his first sip of beer when he was 4, surrounded by parents, uncles, aunts and grandparents who all drank heavily on the Navajo Nation.\u003c/p>\n\u003cp>“I’m a full-blooded American Indian,” Tahy said, recounting the difficulties he faced in his youth. “Growing up, I was subjected to a lot of prejudice, racism and segregation. I didn’t have any pride in who I was. I feel like drugs and alcohol were a way to cope with that shame. Alcohol helped me socialize and gave me courage.”\u003c/p>\n\u003cp>During his teenage years, Tahy drank and began dabbling in marijuana, cocaine and crystal meth. All the while, he said, his family instilled a meaningful relationship to his culture.\u003c/p>\n\u003cp>“I was always encouraged by my grandparents, on my mom’s side, to learn and be connected to traditional Navajo ways of life,” Tahy said. “There was a deep connection to family, land and ceremonial activities connected to seasonal changes.”\u003c/p>\n\u003cp>Tahy’s story is not unique. Native American communities suffer from some of the \u003ca href=\"https://americanaddictioncenters.org/addiction-statistics/native-americans\">highest rates\u003c/a> of substance abuse and overdose deaths in the country, and health experts have long argued that Western medicine alone cannot adequately treat substance use disorders in Native American populations.\u003c/p>\n\u003cp>The crisis is compounded by centuries of historical trauma, which is why the U.S. Centers for Medicare & Medicaid Services is also \u003ca href=\"https://www.cms.gov/newsroom/press-releases/biden-harris-administration-takes-groundbreaking-action-expand-health-care-access-covering\">offering coverage\u003c/a> for tribal communities in Arizona, New Mexico and Oregon.\u003c/p>\n\u003cp>Roselyn Tso, who directs the federal Indian Health Service, has championed this work and said that “these practices have sustained our people’s health for generations and continue to serve as a vital link between culture, science and wellness in many of our communities.”\u003c/p>\n\u003ch2>Bridging two worlds: Tradition and modern medicine\u003c/h2>\n\u003cp>While clinical approaches like detox, medication-assisted treatment and behavioral therapy are essential to treating substance use disorders, they often fail to address the cultural and spiritual needs of Native patients.\u003c/p>\n\u003cp>“Traditional practices are, by nature, holistic,” said Damian Chase-Begay, a researcher focused on American Indian health at the University of Montana. “They are treating the person physically, mentally, spiritually and emotionally. They benefit the whole being, not just the physical symptoms.”\u003c/p>\n\u003cp>For years, healthcare practitioners dedicated to Indigenous communities struggled with the limitations of what insurance would cover. Medi-Cal, the state’s Medicaid program for low-income residents, reimburses for medical prescriptions or talk therapy, but traditional healing methods were often excluded from coverage, leaving many Native American patients without access to treatments that aligned with their cultural values.\u003c/p>\n\u003cp>“What California is now covering under Medi-Cal is exactly what our Native communities have been asking to be covered for years,” Chase-Begay said. “This kind of support, had it been in place, could have helped stop some intergenerational trauma and substance use years ago. I’m so thrilled that it’s in place now, but it’s long overdue.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"https://ncuih.org/wp-content/uploads/03.25.24-FINAL-design-of-2023-TH-Report.pdf\">Studies\u003c/a> have shown that integrating cultural practices into addiction treatment can lead to higher engagement and more positive recovery outcomes, though most of the current research is qualitative, not quantitative.\u003c/p>\n\u003cp>The new Medi-Cal policy is set to take effect next year, with Indian Health Service providers in qualifying counties able to request reimbursement for these services starting in January.\u003c/p>\n\u003cp>“It is vital that we honor our traditional ways of healing,” said Kiana Maillet, a licensed therapist in San Diego and a member of the Lone Pine Paiute-Shoshone Tribe. “Traditional healing is deeply ingrained in our cultures. Without it, we are missing a piece of who we are.”\u003c/p>\n\u003cp>As for Tahy, he hasn’t touched a drop of alcohol since starting therapy at Friendship House.\u003c/p>\n\u003cp>He now holds a full-time job as an evaluator for the Native American Health Center in San Francisco. Soon, he will complete a master’s degree in American Indian studies. And, a few months ago, he completed the San Francisco marathon.\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>",
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"title": "Proposition 35 Aims to Improve Health Care for Low-Income Californians. Critics Warn it Could Backfire",
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"content": "\u003cp>Among the blitz of election ads flooding TV, social media and street corners, you won’t see any opposition to a \u003ca href=\"https://calmatters.org/politics/elections/2024/10/california-propositions-november-election/\" target=\"_blank\" rel=\"noreferrer noopener\">ballot measure\u003c/a> proposing to lock in billions of dollars to pay doctors more for treating low-income patients.\u003c/p>\n\u003cp>However, opponents of \u003ca href=\"https://calmatters.org/california-voter-guide-2024/propositions/prop-35-health-care-tax/\" target=\"_blank\" rel=\"noreferrer noopener\">Proposition 35\u003c/a> have a warning, even if they don’t have the money to pay for ads: The measure could backfire and cause the state to lose billions in federal funding.\u003c/p>\n\u003cp>\u003ca href=\"https://calmatters.org/health/2024/07/medi-cal-mco-tax-initiative/\" target=\"_blank\" rel=\"noreferrer noopener\">Proposition 35 would take an existing tax on health insurance plans\u003c/a> and use the money to increase payment to doctors and other providers who see Medi-Cal patients. Its supporters have \u003ca href=\"https://powersearch.sos.ca.gov/advanced.php\" target=\"_blank\" rel=\"noreferrer noopener\">raised $50 million\u003c/a>, drawing from groups representing hospitals, doctors and insurers.\u003c/p>\n\u003cp>\u003ca href=\"https://calmatters.org/tag/medi-cal/\" target=\"_blank\" rel=\"noreferrer noopener\">Medi-Cal\u003c/a>, the subsidized insurance plan serving some 14 million Californians, has ballooned in size over the past decade with increased eligibility and benefits. But those changes haven’t come with a commensurate increase in payment to doctors.\u003c/p>\n\u003cp>As a result, health care providers and advocates say too few doctors accept Medi-Cal, leaving patients with nowhere to turn.\u003c/p>\n\u003cp>According to the \u003ca href=\"https://www.ppic.org/publication/ppic-statewide-survey-californians-and-their-government-september-2024/\" target=\"_blank\" rel=\"noreferrer noopener\">Public Policy Institute of California\u003c/a>, the measure is leading and likely to pass.\u003c/p>\n\u003cp>However, opponents, represented by a small coalition of community health advocates, seniors and activists for good governance, say the details of the proposition put the state at risk of losing billions in federal funding.\u003c/p>\n\u003cp>That’s because the federal government, under both the Biden and Trump administrations, has warned California that its tax on health plans to fund Medi-Cal services takes unfair advantage of a loophole in federal regulations. The federal Centers for Medicare and Medicaid Services intends to close that loophole, \u003ca href=\"https://www.dhcs.ca.gov/Documents/CA-MCO-Tax-Waiver.pdf\">regulators wrote in a letter\u003c/a> to California officials late last year.\u003c/p>\n\u003cp>“This is the fatal flaw of this initiative,” said Kiran Savage-Sangwan, executive director of the California Pan-Ethnic Health Coalition, which is leading the opposition. “We can all have opinions on how to spend the money, but we have to raise the funds first.”\u003c/p>\n\u003cp>The problem, opponents say, lies in how California taxes health plans and how Proposition 35 limits changes in the future.\u003c/p>\n\u003cp>Right now, the Managed Care Organization Tax, also known as the MCO Tax, generates revenue for Medi-Cal by taxing health insurers that serve both Medi-Cal and commercially insured patients. The federal government gives California a dollar-for-dollar match to whatever the tax raises funds. For Proposition 35, that’s an estimated $7 billion to $8 billion annually through 2027.\u003c/p>\n\u003cp>However, California has historically placed the majority of the tax burden on Medi-Cal insurers and not commercial insurers. In its letter to state officials, federal regulators said Medi-Cal plans represent 50% of all insured people but bear “99% of the total tax burden.” That is at odds with the spirit of the law, which is meant to redistribute revenue from commercial insurers to Medi-Cal plans, regulators wrote.\u003c/p>\n\u003cp>Proposition 35 would cap the tax on commercial insurers at a minimal rate. Any attempts to modify the tax would have to go back to the ballot box or be approved by three-fourths of the Legislature. Opponents say that means federal rule changes requiring the commercial tax to be more equal to the Medi-Cal tax will force the state to reduce taxes on the Medi-Cal plans.\u003c/p>\n\u003cp>“The end result of that is when the federal government makes good on their promise to change the rules on this tax, the revenue we raise from this tax will be dramatically reduced, and we would leave billions of dollars on the table,” Savage-Sangwan said.\u003c/p>\n\u003cp>Proponents of the measure said this argument is false but did not provide details. They say Proposition 35 will make the Medi-Cal program more stable and higher rates will encourage more providers to see low-income patients.\u003c/p>\n\u003cp>California’s Medi-Cal reimbursement rates fall in the bottom third compared to all other states, according to the \u003ca href=\"https://www.kff.org/medicaid/state-indicator/medicaid-to-medicare-fee-index/?currentTimeframe=0&sortModel=%7B%22colId%22:%22All%20Services%22,%22sort%22:%22desc%22%7D\" target=\"_blank\" rel=\"noreferrer noopener\">Kaiser Family Foundation\u003c/a>, and \u003ca href=\"https://calmatters.org/health/2024/02/midwife-medi-cal/?series=no-deliveries-maternity-care\" target=\"_blank\" rel=\"noreferrer noopener\">rates for specific services like obstetrics\u003c/a> are among the lowest in the country.[aside label=\"2024 California Voter Guide\" link1='https://www.kqed.org/voterguide,Learn everything you need to cast an informed ballot for the 2024 general election' hero=https://cdn.kqed.org/wp-content/uploads/sites/80/2024/09/Aside-California-Voter-Guide-2024-General-Election-1200x1200-1.png]\u003c/p>\n\u003cp>“Prop. 35 is a critically needed investment to protect and expand access to care for Medi-Cal patients and all Californians,” said Molly Weedn, spokesperson for the Yes on Prop. 35 campaign, in a statement. “The principal purpose behind Prop. 35 is to provide stability and predictability… to address the significant shortfall of providers who can see Medi-Cal patients.”\u003c/p>\n\u003cp>The California Association of Health Plans said that it did not ask for the commercial tax cap in the proposition and that it has historically supported this tax structure to pay for Medi-Cal. A higher tax on commercial plans could increase premiums.\u003c/p>\n\u003ch2>Where is Gov. Newsom on Proposition 35?\u003c/h2>\n\u003cp>The largest donors to the yes campaign are the California Hospital Association, Global Medical Response, and the California Medical Association, which collectively donated $38 million. Opponents have raised no money, according to \u003ca href=\"https://powersearch.sos.ca.gov/advanced.php\" target=\"_blank\" rel=\"noreferrer noopener\">state campaign finance records\u003c/a>.\u003c/p>\n\u003cp>Gov. Gavin Newsom has not taken a formal stance on the measure, although he said at a press conference in July that he’s concerned about how it would lock in tax revenue for a single purpose. The state budget he signed that month shifted most of the tax revenue from the tax on health insurers into the general fund to pay for the Medi-Cal program.[aside label=\"From the 2024 Voter Guide\" link1='https://www.kqed.org/voterguide/california,Learn about the California Propositions' hero=https://cdn.kqed.org/wp-content/uploads/sites/80/2024/09/Aside-California-Propositions-2024-General-Election-1200x1200-1.png]\u003c/p>\n\u003cp>If voters approve Proposition 35, the state would face a $2.6 billion deficit in the current budget, which relies on the tax to fill in gaps. That deficit would increase to $11.9 billion over the next three budget cycles, according to an analysis from the Department of Finance.\u003c/p>\n\u003cp>“This initiative hamstrings our ability to have the kind of flexibility that’s required at the moment we’re living in. I haven’t come out publicly against it. But I’m implying a point of view. Perhaps you can read between those many, many lines,” \u003ca href=\"https://calmatters.org/newsletter/newsom-ballot-measures/\" target=\"_blank\" rel=\"noreferrer noopener\">Newsom said at the press conference\u003c/a>.\u003c/p>\n\u003cp>Newsom’s office did not respond to multiple requests on whether he would formally oppose the measure.\u003c/p>\n\u003cp>Savage-Sangwan said the opposition had not solicited any money for their campaign.\u003c/p>\n\u003cp>“We are using the very small megaphone that we do have to just get the facts out,” she said.\u003c/p>\n\u003ch2>Trade-offs in 2024 health care ballot measure\u003c/h2>\n\u003cp>The political split over Proposition 35 is unusual. The measure’s opponents are often on the same side as its supporters when it comes to health policy issues in the Capitol. But community health advocates say they’re speaking up because the future ramifications of the initiative are too risky.\u003c/p>\n\u003cp>“We want to make clear that the goals of the prop are goals we agree with. We recognize our providers in Medi-Cal are paid far too little, and that disproportionately impacts people of color, children of color especially,” said Mayra Alvarez, president of The Children’s Partnership, another opposing group.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Some lawmakers agree. During multiple budget hearings, Sen. Caroline Menjivar, a Democrat from Van Nuys, came to oppose the proposition in part because the industry organizations that negotiated who would get money from the tax left out “community providers” and those “who don’t have high-paid lobbyists.”\u003c/p>\n\u003cp>“By listening to those with boots on the ground, the legislature developed a plan to equitably address many Medi-Cal concerns over the next few years,” Menjivar said in a statement from the opposition campaign.\u003c/p>\n\u003cp>The tax is expected to generate more than $30 billion over the next four years. The budget Newsom signed puts most of the money in the state’s general spending account but sets aside roughly $2 billion to increase rates for services, including community health workers, private duty nursing, adult and children’s day centers and children at risk of \u003ca href=\"https://calmatters.org/health/2023/07/medi-cal-eligibility-california-review/\" target=\"_blank\" rel=\"noreferrer noopener\">automatic Medi-Cal disenrollment\u003c/a>. If Proposition 35 passes, different groups will get rate increases.\u003c/p>\n\u003cp>Weedn with the Yes on Prop. 35 campaign said the initiative won’t automatically cause cuts if it passes. It would be up to the Legislature to decide how to pay for the programs opponents are worried about, she said, and that the initiative provides about $2 billion of flexible dollars annually for legislative priorities.\u003c/p>\n\u003cp>\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/Screenshot-2024-10-09-at-10.11.15%E2%80%AFAM.png\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-12008728\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/Screenshot-2024-10-09-at-10.11.15%E2%80%AFAM.png\" alt='A screenshot of a graph that reads \"Which California health providers get rate increases under the MCO tax?\"' width=\"1258\" height=\"1346\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/Screenshot-2024-10-09-at-10.11.15 AM.png 1258w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/Screenshot-2024-10-09-at-10.11.15 AM-800x856.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/Screenshot-2024-10-09-at-10.11.15 AM-1020x1091.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/Screenshot-2024-10-09-at-10.11.15 AM-160x171.png 160w\" sizes=\"auto, (max-width: 1258px) 100vw, 1258px\">\u003c/a>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "Proposition 35 would take an existing tax on health insurance plans and use the money to increase payment to doctors who see Medi-Cal patients. Critics say it could backfire and cause the state to lose billions in federal funding.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Among the blitz of election ads flooding TV, social media and street corners, you won’t see any opposition to a \u003ca href=\"https://calmatters.org/politics/elections/2024/10/california-propositions-november-election/\" target=\"_blank\" rel=\"noreferrer noopener\">ballot measure\u003c/a> proposing to lock in billions of dollars to pay doctors more for treating low-income patients.\u003c/p>\n\u003cp>However, opponents of \u003ca href=\"https://calmatters.org/california-voter-guide-2024/propositions/prop-35-health-care-tax/\" target=\"_blank\" rel=\"noreferrer noopener\">Proposition 35\u003c/a> have a warning, even if they don’t have the money to pay for ads: The measure could backfire and cause the state to lose billions in federal funding.\u003c/p>\n\u003cp>\u003ca href=\"https://calmatters.org/health/2024/07/medi-cal-mco-tax-initiative/\" target=\"_blank\" rel=\"noreferrer noopener\">Proposition 35 would take an existing tax on health insurance plans\u003c/a> and use the money to increase payment to doctors and other providers who see Medi-Cal patients. Its supporters have \u003ca href=\"https://powersearch.sos.ca.gov/advanced.php\" target=\"_blank\" rel=\"noreferrer noopener\">raised $50 million\u003c/a>, drawing from groups representing hospitals, doctors and insurers.\u003c/p>\n\u003cp>\u003ca href=\"https://calmatters.org/tag/medi-cal/\" target=\"_blank\" rel=\"noreferrer noopener\">Medi-Cal\u003c/a>, the subsidized insurance plan serving some 14 million Californians, has ballooned in size over the past decade with increased eligibility and benefits. But those changes haven’t come with a commensurate increase in payment to doctors.\u003c/p>\n\u003cp>As a result, health care providers and advocates say too few doctors accept Medi-Cal, leaving patients with nowhere to turn.\u003c/p>\n\u003cp>According to the \u003ca href=\"https://www.ppic.org/publication/ppic-statewide-survey-californians-and-their-government-september-2024/\" target=\"_blank\" rel=\"noreferrer noopener\">Public Policy Institute of California\u003c/a>, the measure is leading and likely to pass.\u003c/p>\n\u003cp>However, opponents, represented by a small coalition of community health advocates, seniors and activists for good governance, say the details of the proposition put the state at risk of losing billions in federal funding.\u003c/p>\n\u003cp>That’s because the federal government, under both the Biden and Trump administrations, has warned California that its tax on health plans to fund Medi-Cal services takes unfair advantage of a loophole in federal regulations. The federal Centers for Medicare and Medicaid Services intends to close that loophole, \u003ca href=\"https://www.dhcs.ca.gov/Documents/CA-MCO-Tax-Waiver.pdf\">regulators wrote in a letter\u003c/a> to California officials late last year.\u003c/p>\n\u003cp>“This is the fatal flaw of this initiative,” said Kiran Savage-Sangwan, executive director of the California Pan-Ethnic Health Coalition, which is leading the opposition. “We can all have opinions on how to spend the money, but we have to raise the funds first.”\u003c/p>\n\u003cp>The problem, opponents say, lies in how California taxes health plans and how Proposition 35 limits changes in the future.\u003c/p>\n\u003cp>Right now, the Managed Care Organization Tax, also known as the MCO Tax, generates revenue for Medi-Cal by taxing health insurers that serve both Medi-Cal and commercially insured patients. The federal government gives California a dollar-for-dollar match to whatever the tax raises funds. For Proposition 35, that’s an estimated $7 billion to $8 billion annually through 2027.\u003c/p>\n\u003cp>However, California has historically placed the majority of the tax burden on Medi-Cal insurers and not commercial insurers. In its letter to state officials, federal regulators said Medi-Cal plans represent 50% of all insured people but bear “99% of the total tax burden.” That is at odds with the spirit of the law, which is meant to redistribute revenue from commercial insurers to Medi-Cal plans, regulators wrote.\u003c/p>\n\u003cp>Proposition 35 would cap the tax on commercial insurers at a minimal rate. Any attempts to modify the tax would have to go back to the ballot box or be approved by three-fourths of the Legislature. Opponents say that means federal rule changes requiring the commercial tax to be more equal to the Medi-Cal tax will force the state to reduce taxes on the Medi-Cal plans.\u003c/p>\n\u003cp>“The end result of that is when the federal government makes good on their promise to change the rules on this tax, the revenue we raise from this tax will be dramatically reduced, and we would leave billions of dollars on the table,” Savage-Sangwan said.\u003c/p>\n\u003cp>Proponents of the measure said this argument is false but did not provide details. They say Proposition 35 will make the Medi-Cal program more stable and higher rates will encourage more providers to see low-income patients.\u003c/p>\n\u003cp>California’s Medi-Cal reimbursement rates fall in the bottom third compared to all other states, according to the \u003ca href=\"https://www.kff.org/medicaid/state-indicator/medicaid-to-medicare-fee-index/?currentTimeframe=0&sortModel=%7B%22colId%22:%22All%20Services%22,%22sort%22:%22desc%22%7D\" target=\"_blank\" rel=\"noreferrer noopener\">Kaiser Family Foundation\u003c/a>, and \u003ca href=\"https://calmatters.org/health/2024/02/midwife-medi-cal/?series=no-deliveries-maternity-care\" target=\"_blank\" rel=\"noreferrer noopener\">rates for specific services like obstetrics\u003c/a> are among the lowest in the country.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Prop. 35 is a critically needed investment to protect and expand access to care for Medi-Cal patients and all Californians,” said Molly Weedn, spokesperson for the Yes on Prop. 35 campaign, in a statement. “The principal purpose behind Prop. 35 is to provide stability and predictability… to address the significant shortfall of providers who can see Medi-Cal patients.”\u003c/p>\n\u003cp>The California Association of Health Plans said that it did not ask for the commercial tax cap in the proposition and that it has historically supported this tax structure to pay for Medi-Cal. A higher tax on commercial plans could increase premiums.\u003c/p>\n\u003ch2>Where is Gov. Newsom on Proposition 35?\u003c/h2>\n\u003cp>The largest donors to the yes campaign are the California Hospital Association, Global Medical Response, and the California Medical Association, which collectively donated $38 million. Opponents have raised no money, according to \u003ca href=\"https://powersearch.sos.ca.gov/advanced.php\" target=\"_blank\" rel=\"noreferrer noopener\">state campaign finance records\u003c/a>.\u003c/p>\n\u003cp>Gov. Gavin Newsom has not taken a formal stance on the measure, although he said at a press conference in July that he’s concerned about how it would lock in tax revenue for a single purpose. The state budget he signed that month shifted most of the tax revenue from the tax on health insurers into the general fund to pay for the Medi-Cal program.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>If voters approve Proposition 35, the state would face a $2.6 billion deficit in the current budget, which relies on the tax to fill in gaps. That deficit would increase to $11.9 billion over the next three budget cycles, according to an analysis from the Department of Finance.\u003c/p>\n\u003cp>“This initiative hamstrings our ability to have the kind of flexibility that’s required at the moment we’re living in. I haven’t come out publicly against it. But I’m implying a point of view. Perhaps you can read between those many, many lines,” \u003ca href=\"https://calmatters.org/newsletter/newsom-ballot-measures/\" target=\"_blank\" rel=\"noreferrer noopener\">Newsom said at the press conference\u003c/a>.\u003c/p>\n\u003cp>Newsom’s office did not respond to multiple requests on whether he would formally oppose the measure.\u003c/p>\n\u003cp>Savage-Sangwan said the opposition had not solicited any money for their campaign.\u003c/p>\n\u003cp>“We are using the very small megaphone that we do have to just get the facts out,” she said.\u003c/p>\n\u003ch2>Trade-offs in 2024 health care ballot measure\u003c/h2>\n\u003cp>The political split over Proposition 35 is unusual. The measure’s opponents are often on the same side as its supporters when it comes to health policy issues in the Capitol. But community health advocates say they’re speaking up because the future ramifications of the initiative are too risky.\u003c/p>\n\u003cp>“We want to make clear that the goals of the prop are goals we agree with. We recognize our providers in Medi-Cal are paid far too little, and that disproportionately impacts people of color, children of color especially,” said Mayra Alvarez, president of The Children’s Partnership, another opposing group.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Some lawmakers agree. During multiple budget hearings, Sen. Caroline Menjivar, a Democrat from Van Nuys, came to oppose the proposition in part because the industry organizations that negotiated who would get money from the tax left out “community providers” and those “who don’t have high-paid lobbyists.”\u003c/p>\n\u003cp>“By listening to those with boots on the ground, the legislature developed a plan to equitably address many Medi-Cal concerns over the next few years,” Menjivar said in a statement from the opposition campaign.\u003c/p>\n\u003cp>The tax is expected to generate more than $30 billion over the next four years. The budget Newsom signed puts most of the money in the state’s general spending account but sets aside roughly $2 billion to increase rates for services, including community health workers, private duty nursing, adult and children’s day centers and children at risk of \u003ca href=\"https://calmatters.org/health/2023/07/medi-cal-eligibility-california-review/\" target=\"_blank\" rel=\"noreferrer noopener\">automatic Medi-Cal disenrollment\u003c/a>. If Proposition 35 passes, different groups will get rate increases.\u003c/p>\n\u003cp>Weedn with the Yes on Prop. 35 campaign said the initiative won’t automatically cause cuts if it passes. It would be up to the Legislature to decide how to pay for the programs opponents are worried about, she said, and that the initiative provides about $2 billion of flexible dollars annually for legislative priorities.\u003c/p>\n\u003cp>\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/Screenshot-2024-10-09-at-10.11.15%E2%80%AFAM.png\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-12008728\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/Screenshot-2024-10-09-at-10.11.15%E2%80%AFAM.png\" alt='A screenshot of a graph that reads \"Which California health providers get rate increases under the MCO tax?\"' width=\"1258\" height=\"1346\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/Screenshot-2024-10-09-at-10.11.15 AM.png 1258w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/Screenshot-2024-10-09-at-10.11.15 AM-800x856.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/Screenshot-2024-10-09-at-10.11.15 AM-1020x1091.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/Screenshot-2024-10-09-at-10.11.15 AM-160x171.png 160w\" sizes=\"auto, (max-width: 1258px) 100vw, 1258px\">\u003c/a>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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"mindshift": {
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"order": 12
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"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
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"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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"perspectives": {
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"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
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"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
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"possible": {
"id": "possible",
"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
"airtime": "SUN 2pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.possible.fm/",
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"source": "Possible"
},
"link": "/radio/program/possible",
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},
"pri-the-world": {
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"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
"airtime": "MON-FRI 2pm-3pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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},
"radiolab": {
"id": "radiolab",
"title": "Radiolab",
"info": "A two-time Peabody Award-winner, Radiolab is an investigation told through sounds and stories, and centered around one big idea. In the Radiolab world, information sounds like music and science and culture collide. Hosted by Jad Abumrad and Robert Krulwich, the show is designed for listeners who demand skepticism, but appreciate wonder. WNYC Studios is the producer of other leading podcasts including Freakonomics Radio, Death, Sex & Money, On the Media and many more.",
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},
"reveal": {
"id": "reveal",
"title": "Reveal",
"info": "Created by The Center for Investigative Reporting and PRX, Reveal is public radios first one-hour weekly radio show and podcast dedicated to investigative reporting. Credible, fact based and without a partisan agenda, Reveal combines the power and artistry of driveway moment storytelling with data-rich reporting on critically important issues. The result is stories that inform and inspire, arming our listeners with information to right injustices, hold the powerful accountable and improve lives.Reveal is hosted by Al Letson and showcases the award-winning work of CIR and newsrooms large and small across the nation. In a radio and podcast market crowded with choices, Reveal focuses on important and often surprising stories that illuminate the world for our listeners.",
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