Medi-Cal Could Grow to 10.5M Enrollees by 2019, Report Finds


The federal health reform law could expand Medi-Cal eligibility and enrollment to cover as many as 10.5 million Californians by 2019, according to a new report by the California Budget Project, "California Watch Blog" reports. Medi-Cal is California's Medicaid program.

The health reform law allows Californians with annual incomes at or below 138% of the federal poverty level to enroll in Medi-Cal starting in 2014.

Adding Up the Medi-Cal Growth

Medi-Cal currently covers more than 7 million state residents. The CBP report predicts that the program will grow over the next nine years to cover an additional:

  • 1.5 million residents through regular program growth;
  • 1 million Californians who previously were not eligible for Medi-Cal;
  • More than 500,000 residents who currently are eligible for Medi-Cal but are not enrolled in the program; and
  • More than 300,000 children who currently are enrolled in other public programs.

Funding the Expansion

The report predicts that the Medi-Cal expansion will cost about $37.1 billion between 2010 and 2019, with the federal government covering the bulk of the expansion costs. According to the report, California will receive more than $6 from the federal government for every dollar it spends on Medi-Cal.

Between 2014 and 2016, federal funds will entirely cover the cost of enrolling newly eligible adults in Medi-Cal. Federal payments will decline over subsequent years to cover 90% of coverage costs by 2020 and thereafter.

Some Concerns Linger

Although the Medi-Cal expansion will reduce the number of uninsured Californians, it also raises concerns about access to physicians and reimbursement levels, according to "California Watch Blog."

Many California physicians do not participate in Medi-Cal. A recent report from the California HealthCare Foundation found that about 25% of California physicians provide care for about 80% of the state's Medi-Cal beneficiaries. CHCF is the publisher of California Healthline.

The CHCF report also noted that California has one of the lowest Medicaid reimbursement rates in the nation.

The federal health reform law aims to increase physician participation in Medi-Cal. Between 2013 and 2014, the law requires states to provide Medicaid reimbursements at Medicare rates for comparable primary care services, with the federal government covering the difference in costs. States will have the ability to determine reimbursement rates following the two-year period (Lin, "California Watch Blog," 10/27).

James Roache
Lisa, You won't see any benefit for the doctors from Medi-Cal or Health Care Reform. Their benefit will come from treating patients in their office who either pay the bill themselves or have an insurance company that pays them a fair rate.The regulators fail to understand, among a lot of other things, health care is a market driven business. You will deploy your assets where you will get the most return. Medi-Cal and Medicare do not give you a return at all. Consider also, that a great number of physicians are baby boomers themselves and would just as soon as retire as to try and practice at their historical level of care while being paid at the low standard of care that Obamacare will eventually erode the reimbursement to. How long have we been hearing about the 20% cut from Medicare for doctors. Now its 23% and due on November 1.
James Roache
In a meeting with Secretary HHS Belshe' last week, it was revealed that as many as 4 million new Medi-Cal beneficiaries will be enrolled under Federal Health Care Reform rollout by January 1, 2014. That puts us well above the 10.5 million being project for 2019. What would be your best estimate for the total 2019 enrollment considering this new fact. In reference to physician fees, the last paragraph makes no sense to me at all. The feds say pay over the next two years according to comparable services rates, yet it says the state has the ability to determine rates after the same two year period. Make up your mind, one or the other, not both. Lastly DME providers of life support ventilators have not seen a rate increase since 1999. The state does not appear to even follow the bi annual rate review requirement at all in their case. Rates for pharmacy servics have been on the decline as well. Why would any physician trust this system? I have concern for the provider network to sustain.
Lisa Fujimoto
So I am not seeing the benefit if doctors wont provide the care to Medical patients?

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