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Weighing The Pros And Cons Of Expanding Medi-Cal

Gary Rotto, the director of health policy for Council of Community Clinics San Diego, and Jorge Riquelme, executive director of the Bayside Community Center in Linda Vista, talk to KPBS the pros and cons of expanding Medi-Cal in California.


Dylan Roby, Assistant Professor of Health Policy & Management at UCLA, co-author of a report on how an expansion of the state's Medi-Cal program would affect health coverage in California and at what cost.

Gary Rotto, Director of Health Policy, Council of Community Clinics San Diego

Jorge Riquelme, Executive Director, Bayside Community Center in Linda Vista


Lawmakers assembled in Sacramento this week are expecting Governor Jerry Brown to call a special session on health care issues. Whatever legislation they pass will start this year to coincide with implementation of Obamacare. A key issue on the table is whether to expand California's existing Medi-Cal program for low-income people.

Dylan Roby, a researcher at UCLA, has written a report that says expanding Medi-Cal is a win for the state. Roby told KPBS that the federal government has promised to foot most health care costs for low income people.

“If a state complies, 100 percent of the money would be federal for the first three years and down to 90 percent for the following years," he said. "So it does make sense for a state with high uninsured rates who are low-income to move them into a medicaid program where there wouldn’t actually be a state impact, it would mostly be a federal budget impact.”

Part of that Medi-Cal expansion is the transition of California's Healthy Families program into Medi-Cal.

California's Healthy Families is a subsidized program for families that were above that income level of Medi-Cal, said Gary Rotto, the director of health policy for Council of Community Clinics San Diego. They paid premiums and received some coverage.

"And traditionally, there have been another set of doctors that may not have accepted Medi-Cal but were willing to accept Healthy Families because it paid more and the benefits to the families were more extensive," Rotto said.

Rotto added that the program has been very successful in San Diego.

"Especially as families have been moving up on the income scale, becoming more successful as the economy has been better, but may not have been able to afford healthcare for their families, they have been offered full healthcare coverage," he said. "I coached soccer for a number of years, and one of my other parents that was participating with me, he had his own business. And there were times when he because of income couldn't afford to insure all three kids. But because of the Healthy Families Program, he was able to do that. And they had coverage throughout the year."

Medi-Cal is expanding its qualifications to allow more people into its program, but Jorge Riquelme, executive director of the Bayside Community Center in Linda Vista, said there are still concerns over how Healthy Families will phase out.

"There's not a lot of clarity at least at the community level of how this will impact each family," he said. "Some of the members who are currently enrolled in Healthy Families worry about the excessive bureaucracy involved in enrollment. Some families opted out of Medi-Cal because the process of enrollment with healthy families was significantly simpler. So that is an issue that will be raised as we transition this year as a community-based organization. We're there trying to help the families figure out this process, to make sure that they don't get dropped off the system."

Critics of the change fear huge costs spikes for the state and a lapse in medical care during the transition.

Lawmakers are now waiting for the release of the governor's budget on Thursday to find out where he stands on health care policies.

Claire Trageser contributed to this report.

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