Medicaid

California Looks to Spend Some Medicaid Money on Housing

March 28, 2023 By Adam Beam 4 Comments

At the start of 2022, Thomas Marshall weighed 311 pounds. He had been hospitalized 10 times in five years, including six surgeries. He had an open wound on his left leg that refused to heal — made worse by living in a dirty, moldy house with five other people, two ball pythons, four Chihuahuas and a cage full of rats.

More than a year later, Marshall has lost nearly 100 pounds. His wound has healed. His blood pressure has returned to normal levels. His foot, which had nerve damage, has improved to the point he goes on regular walks to the park.

Lots of factors are at play in Marshall’s dramatic turnaround, but the one he credits the most is finally having stable housing, after the nonprofit Sacramento Covered helped him get a one-bedroom, 500 square-foot (46.4-square-meter) apartment in a downtown high rise. He has hardwood floors, white pine cabinets and a glass jar on the counter filled with Bit-O-Honeys.

“To me it’s the most important 500 square feet I’ve ever had,” he said. “Living here has just improved my well-being in every possible way.”

Marshall’s story is part of a radical rethinking of the relationship between housing and health care in the U.S. For decades, Medicaid, the joint state and federal health insurance program for people with disabilities or low incomes, would only pay for medical expenses. But last year the Biden administration gave Arizona and Oregon permission to use Medicaid money for housing — a nod to reams of research showing people in stable housing are healthier.

Now California wants to join those states, building on the success of programs like the one that got Marshall housing. Gov. Gavin Newsom has proposed spending more than $100 million per year in the state’s Medicaid program to pay for up to six months of housing for people who are or risk becoming homeless; are coming out of prison or foster care; or are at risk for hospitalization or emergency room visits.

It would be the biggest test yet of using Medicaid money for housing. California has the nation’s largest Medicaid program, with more than 13 million patients — or about a third of the state’s population. California also has nearly a third of the nation’s homeless population, according to federal data.

“It’s a huge step toward breaking down the silos that have gotten in the way of taking care of the whole person rather than limb by limb and illness by illness,” said Anthony Wright, executive director of Health Access California, a consumer advocacy group.

It would also be an expensive step. California is expected to have a $22.5 billion budget deficit this year, and it could get bigger in years to come. Meanwhile the state’s Medicaid spending is projected to increase by $2.5 billion over the next three years, according to the nonpartisan Legislative Analyst’s Office.

“What we’re really doing is expanding the welfare state, which is going to become just a huge financial problem,” said Wayne Winegarden, senior fellow at the Pacific Research Institute, a group that advocates for free-market policies.

California experimented with using Medicaid money for some housing-related expenses in 2016 when it launched a pilot project in 26 counties. While Medicaid did not pay for rent, it paid for things like security deposits and furniture.

In Marshall’s case, he pays his own rent, using some of the $1,153 per month he gets from Social Security and Supplemental Security Income. But Medicaid paid for his security deposit, bed, sofa, table, chairs and nearly 3 1/2 gallons of Pine Sol. Marshall said keeping his apartment clean is one thing that helped his leg wound to finally heal.

Over five years the program has reduced expensive hospital stays and emergency room visits for people on Medicaid, saving taxpayers an average of $383 per patient per year, according to an analysis by researchers at UCLA.

Now California wants to go further by using Medicaid money to directly pay some people’s rent. Democratic Assemblymember Joaquin Arambula, who chairs the budget subcommittee that will vet Newsom’s proposal, said lawmakers are supportive. Arambula spent a decade as an emergency room doctor.

“I became very good at being able to get cockroaches out of people’s ears,” Arambula said. “The living conditions of many of our communities, especially in our rural communities, really can affect a person’s ability to get adequate sleep, to be prepared for the next day and to stay healthy.”

Advocates for homeless people say they welcome such programs but spending more money on rent isn’t enough, noting the state still has a massive shortage of affordable housing.

Kelly Bennett, founder and CEO of Sacramento Covered, said that during California’s first experiment with using Medicaid money for housing services, it would often take up to eight months for workers to place a patient in an apartment. In some cases, people have waited for years to find a place.

“Even when you have the deposit money and you have some rental subsidy, it’s still very, very challenging to find units — and to find units where the landlords will lease to our clients,” Bennett said.

Marshall said he grew up in Sacramento and got a degree in dietic technology and culinary arts. But a 30-year addiction to meth landed him on the streets from the late 1990s through about 2006. He camped at an old landfill, often eating leftovers from people’s picnics at a nearby park.

Click here to read the full article in AP News

Filed Under: Top Stories Tagged With: California Politics, Housing, Medicaid

The reason why California taxes continue to skyrocket

May 30, 2017 By Jon Coupal and Vince Fong 14 Comments

Before the ink on the governor’s signature has dried on the largest gas tax increase in California history, Sacramento Democrats are fully intending to break their promise to dedicate the new revenue to fixing our crumbling roads. In the upcoming budget, there is a proposal to divert 30 percent of this gas tax increase to items and programs completely unrelated to repairing our roads and highways, such as park maintenance and job training for felons.

Regrettably, these bait-and-switch tactics are now so commonplace in Sacramento that few notice. For many years, billions in transportation dollars have been diverted from road building and maintenance to the general fund, which has created the crisis we are currently facing. Why would anyone think things will be different now with the new $52 billion car and gas tax hikes?

There are many other examples of lawmakers misleading the public when promoting new taxes. Sacramento sold the recent tobacco tax increase on the November 2016 ballot to voters as a way to fund Medicaid. After the proposition passed, the revenues were simply swept into the general fund and, as a result, doctors and millions of Californians on Medicaid are not receiving the funds which they were anticipating.

Just last week, we witnessed the annual practice of passing 40 “shell” budget bills that are virtually devoid of written content. The blanks will be filled in as the majority party rams through all the deals it makes behind closed doors. Even with the passage of a new constitutional amendment — Proposition 54, discussed below — requiring bills to be in print for 72 hours, the sheer volume of budgetary language makes it difficult for the public and media to truly know how taxpayer dollars are to be spent.

Sacramento may not know how to manage money and prioritize spending, but legislative leaders do know how to dissemble and divert public attention from the reality of the budget process. They prefer to keep average folks in the dark because they know the public would never approve these budget diversions.

Voters clearly stated they prefer transparency and public participation when they approved Proposition 54 last year. The proposition requires that legislation be in print and available for public view for three days before being voted on. Majority lawmakers opposed this reasonable measure because it blocked them from introducing legislation and immediately passing it, without public comment, often in the dead of night. For Sacramento insiders, secrecy and deception are a way of life.

Californians deserve real budget transparency in order to change this broken process and to reform the bait-and-switch culture that has led to a state that has become simply unaffordable. Ultimately, it is middle class and working class families that are harmed the most by the bad policies coming out of Sacramento. Affordability is one of the biggest and most important issues facing this state, but we are moving in the wrong direction because new taxes and fees continue to be imposed in the false belief that more government and higher taxes are the answer.

It should surprise no one that California ranks dead last in the nation on budget transparency. This needs to change if we want the Legislature to change its focus to promoting the wellbeing of average Californians.

Jon Coupal is president of the Howard Jarvis Taxpayers Association. Vince Fong represents California’s 34th State Assembly district, which includes portions of Bakersfield and the communities of Bear Valley Springs, Oildale, Maricopa, Ridgecrest, Taft and Tehachapi.

This piece was originally published by the Orange County Register and the HJTA

Filed Under: Top Stories Tagged With: Gas tax, Jon Coupal, Medicaid, Sacramento, Vince Fong

As U.S. Moves Right, Will California’s Outlier Status Accelerate Exodus?

November 15, 2016 By Jon Coupal 7 Comments

After recovering from the shock of the presidential race, California pundits began absorbing what all this actually means. There is broad agreement that the rightward movement by the rest of America has only increased the political divide between the nation as a whole and California.

This divide has widened so significantly that Governor Brown joked about building a wall around the state to protect it from nasty conservatives. And a handful of ultra-progressives, distressed at the thought of a Trump presidency, are planning an initiative they hope will lead to California seceding from the United States. (Newsflash for backers of this “Calexit” effort: That a state can’t secede from the Union was resolved in 1865 when General Lee surrendered to General Grant at Appomattox).

Putting the jokes and unrealistic fantasies aside, there are real world implications for the increasing chasm. First, if it were evident prior to the election that California has “go it alone” policies on climate change, it is even clearer now. Sure, Washington will continue to pay lip service to greenhouse gas reductions, but broad, draconian laws and regulations perceived to be damaging to the economy will be shelved.

Second, the High Speed Rail project might have just graduated from being a mere pipedream to a true fantasy. Already Congress had shut the spigot of federal money and the project has been on life support using cap and trade revenue which doesn’t generate a fraction of what it needs for the train to become viable.

Third, perhaps the biggest hit to California will come in the area of health care. While other states have resisted full implementation, California has been held up as Obamacare’s shining example of “success.” But a Republican Congress is likely to repeal major parts of the law, including the funding for Medicaid expansion and elimination of the federal tax credits that lower premiums for most California enrollees.

This enormous gap between right America and left California will result in the state no longer being able to rely on the federal government to finance its left-of-center policies. And that’s bad news for taxpayers.

Without federal support and California’s majority party wanting no slowdown in their agenda, the pressure to raise taxes will grow even stronger. So even though California will have the highest income tax rates in the nation until 2030 – thanks to Prop. 55 – and the highest state sales tax, expect the alligators of the left to be searching for their next meal. No doubt, they will put Prop. 13 on the menu.

The non-stop pursuit of an even higher tax burden has already resulted in millions leaving California. The growing fissure between the rest of nation and the state’s pursuit of destructive progressive policies is giving millions more Californians an excuse to bail out.

It’s not just the hard data from the IRS and the Census Bureau that confirms this. We all know people who have made the choice to escape California’s hostile tax and regulatory environment. A neighbor of mine just left to visit the multi-acre parcel he bought in Texas. When he retires in four years, he will build a home on the property. He is currently an attorney with the state.

A close family relative and her husband left the Bay Area for Oregon in large part for tax reasons. This is especially ironic given that they are both liberals who, as California residents, voted for every tax increase on the state and local ballot.

Another close relative who was visiting her mother on the Gulf Coast of Florida tells of miles and miles of white sand beaches with homes on the ocean that can be purchased for what a 1,200 square-foot condo would cost in San Francisco. Derided as the “Redneck Riviera,” the Gulf Coast is now a favorite of former Californians in large part because there is no income tax.

Can California change course? As long as those interests which rely on government largess own the Legislature, the prognosis is not good. With trillions in public debt of all kinds, an unresponsive and arrogant administrative state and high cost of living, California is bound to see the exodus that has already started to accelerate quickly.

Jon Coupal is president of the Howard Jarvis Taxpayers Association — California’s largest grass-roots taxpayer organization dedicated to the protection of Proposition 13 and the advancement of taxpayers’ rights.

This piece was originally published by HJTA.org

Filed Under: Top Stories Tagged With: Calexit, Cap and trade, high speed rail, Medicaid, Obamacare

Obamacare Sinking Under Weight of Math

August 25, 2016 By Susan Shelley Leave a Comment

The Affordable Care Act is collapsing, and President Obama blames Republicans.

Writing in the Journal of the American Medical Association, the president accused Republicans of undermining the health care law’s implementation. “It has come at a cost for the country,” Obama wrote, “most notably for the estimated 4 million Americans left uninsured because they live in GOP-led states that have yet to expand Medicaid.”

But expanding Medicaid also has come at a cost.

Medi-Cal, as Medicaid is called in California, has enrolled almost 5 million people since January 2014, when the Affordable Care Act expanded eligibility for the safety-net program. In 2010, 7.4 million Californians were covered by Medi-Cal. Today it’s more than 13 million, about one-third of the state population.

Covered California, the health care exchange where federally subsidized policies can be purchased from private insurers, has enrolled just 1.4 million people since it went online in the fall of 2013.

Is the dramatic expansion of Medi-Cal a success story?

Not if you run a hospital. California pays Medi-Cal providers less than it costs to provide the care to patients. The more people they treat, the more money they lose.

In 2009, hospitals in California were losing a total of about $2 billion annually on the care they provided to Medi-Cal patients. Today it’s about $8 billion.

The federal government provides matching funds for state Medicaid programs. To help California bring home every available federal dollar, the hospitals came up with the idea of paying a fee to the state, which would be put into the Medi-Cal program to help it qualify for matching funds. Then the state would have more money and could pay the hospitals for providing care to Medi-Cal patients.

It may sound like a game of three-card monte, but the California Hospital Association says the program has helped hospitals lose only $5 billion on Medi-Cal patients instead of $8 billion.

The hospital fee program was written into state law in 2009 and renewed three more times, most recently in 2013. It was well-supported but still bumpy: The state took a $1 billion annual cut of the hospital fees to pay for children’s health programs, and occasionally some of the hospital fees were diverted to other budget priorities.

So the hospitals are asking the voters of California to lock the hospital fee program into the law permanently. It will be on the Nov. 8 statewide ballot as Proposition 52, the Medi-Cal Funding and Accountability Act.

The measure has the endorsement of …

Click here to read the full article

Filed Under: Top Stories Tagged With: Health care, Medi-Cal, Medicaid, Obamacare, Susan Shelley

Medi-Cal Struggles Leave Politicians Worried, Patients Hurting

February 23, 2015 By James Poulos 1 Comment

A victim of its own success, California’s popular Medi-Cal program has rapidly swelled to a large enough size to malfunction. It’s known as Medicaid in the rest of the country and provides medical care to poor people.

Mounting woes — from applicant backlogs to outdated regulations — have raised serious concerns among analysts and policymakers.

In part, the challenges facing the Medi-Cal system came about because of administrative changes triggered by the federal Affordable Care Act, or Obamacare. Here it’s called Covered California. As CalWatchdog.com reported, a combination of cuts in federal and state budgetary subsidies boosted provider costs.

“A provision of Obamacare hiked the rates for primary care doctors to the substantially higher Medicare rates for two years, but those increases ended on Dec. 31,” reported the San Jose Mercury News. “A second blow came last month when the state cut the Medi-Cal reimbursement rate by another 10 percent, a reduction approved by California lawmakers in 2011 but delayed in a court battle that doctors ultimately lost.”

But the ACA has made an even greater impact on California’s health care challenges by ballooning the population accessing Medi-Cal benefits. As the Mercury News reported, Obamacare opened the floodgates in Jan. 2014, resulting in 2.7 million more recipients to date.

California’s expanded recipient group now makes up 17 percent of total national Obamacare enrollment, even though California’s overall population is just 12 percent of the U.S. total.

State health officials, according to the Mercury News, have concluded that by the middle of 2016, “more than 12.2 million people — nearly a third of all Californians — will be on Medi-Cal.” Meanwhile, the program already consumes about two-thirds of California state-government spending on health and human services overall.

Budgetary fears

For both Gov. Jerry Brown and Sacramento legislators, these trend lines have raised sharp worries, as McKnight’s news servicereported:

“State lawmakers this week said the latest enrollment news is alarming, and that even if a new pending rate request hike goes through, there is concern the state will run out of funding to care for its Medicaid recipients. State Medicaid costs are up 4.3 percent this year while federal share of costs for new enrollees will begin dropping in 2016, according to Gov. Jerry Brown.”

Brown has made an effort to head some costs off at the pass in his budget plan. According to State of Reform, a health-care think tank, “Brown has earmarked $2 billion in total funds ($943.2 million General Fund dollars) to cover mandatory Medi-Cal expansion.”

But pressure to change the budgetary calculus in California’s favor has intensified.

Reducing access

The big picture for Medi-Cal has officeholders and policymakers so nervous because of the ripple effects of increased costs and recipient rolls. State of Reform observed:

“In addition to Medi-Cal primary cuts making it potentially impossible for new patients to find physicians, President Barack Obama’s executive action will make approximately 1 million undocumented immigrants in California eligible for health insurance tax subsidies.”

That has critics warning access to doctors could decrease sharply. In a sobering report issued by the Legislative Analyst’s Office, the impact of the president’s actions was incalculable:

“The benefits received by undocumented immigrants through these programs are almost entirely funded by the state and would therefore result in additional General Fund costs of an unknown amount. The General Fund costs to provide state–funded benefits to this population are unknown at this time.”

With the federal government putting the squeeze on California’s budget, state doctors have become increasingly scarce.

“There are mounting concerns there will not be enough plan doctors to accommodate the enrollment surge,” according to McKnight’s. “One recent study found that only 57 percent of the state’s primary care doctors accept new Medi-Cal patients.”

As a result, increasing numbers of recipients have been winding up in the ER. As the Fresno Bee observed, that transfer of burdens has undermined the claim advanced by Obamacare proponents “that patients with insurance would have primary care doctors to take care of them and less reason to use expensive and overcrowded hospital emergency rooms.”

Although experts have not determined the likely extent of doctors’ unwillingness to treat Medi-Cal patients, California lawmakers have begun to brace for the worst: a substantial budgetary increase that will not be covered by the federal government.

Instead, the higher health tab may have to be absorbed by increased taxes, cuts in other budget areas, or both.

Originally published at CalWatchdog.com

Filed Under: Top Stories Tagged With: ACA, Health care, Jerry Brown, Medi-Cal, Medicaid, Obamacare