Health Care Reform: What Role for Counties?

The Governor has called a “special session” of the Legislature to work on implementing the Affordable Care Act (ACA).  When the ACA takes full effect in January 2014, about a million more people will be eligible for Medi-Cal and the Governor has outlined two possible ways to expand Medi-Cal coverage. Both of them have significant implications for California’s 58 counties so it is imperative that we remain engaged in the process.

In one option, the counties would build the Medi-Cal expansion on existing county Low Income Health Programs and would be responsible for program administration and funding. In the other option, the State would simply expand the existing Medi-Cal program to cover more people. Under the State option, the state would redirect funding for county health programs (1991 health realignment) to other social services programs.

CSAC is still analyzing each path, contemplating alternatives and working hard to ensure the state provides funding that is commensurate to the responsibilities counties are required to shoulder. The discussion is complicated – different counties have different types of delivery systems, and many Californians will get insurance in 2014 and beyond but it’s impossible to know how many. So it is also impossible to know now how many people will remain uninsured and eligible for county programs.

There are still more questions about the ACA implementation in California than there are answers and the devil, as they say, is in the details.  However, CSAC and our member-counties are well-positioned to participate in the ongoing discussions and make sure we continue to assert our interests.


About: Gregg Fishman:
Gregg Fishman is the Communications Coordinator for the California State Association of Counties.

2 Responses to “Health Care Reform: What Role for Counties?”

  1. Gregg Fishman says:

    When the ACA takes full effect many millions more people will be covered by insurance—either through their work or purchased on their own. That may be the “4 times higher” number to which you refer. The Medicaid-MediCal program currently covers adults who fall below the Federal Poverty Level (FPL.) The expansion will cover more adults who are at some level above the FPL—at least 137 percent of FPL, because that’s what the Federal ACA says. However, some Lawmakers in California are proposing that Medi-Cal should cover adults making up to 200 percent of the FPL. That issue could be decided during the special session or as part of the usual budget process.

    Under the ACA, the Federal Government will pay 100 percent of the costs for health care for the first three years. However, whether the Counties or the State will shoulder most administrative burden has not yet been decided.

  2. megrant5 says:

    “When the ACA takes full effect in January 2014, about a million more people will be eligible for Medi-Cal”

    This seems quite low. One report I have read is 4 times higher. How is this determined? And, how are counties going to be supported who are currently struggling even now with capacity?