October 9, 2015 - This is the first in a series of policy posts on upcoming changes in Medi-Cal and the fiscal and policy uncertainty the changes create. In this post, we briefly highlight four upcoming major changes: (1) the renewal of the state’s Section 1115 waiver, (2) proposed modifications to the federal government’s regulations for Medicaid managed care plans, (3) the phase-in of state’s share of cost for the Affordable Care Act’s optional expansion population, and (4) the need to restructure the managed care organization tax to meet federal requirements. In the coming weeks and months, we will provide more detail and updates on these changes and their potential implications for the Medi-Cal program and the state’s budget in future policy posts similar to this one and in budget analyses.
November 20, 2019 - This web post provides detail on our projections and assumptions related to General Fund spending in Medi-Cal for the years 2019-20 through 2023-24. In the near term, we project Medi-Cal spending to grow to $23.5 billion in 2020-21. Over the long term, we project General Fund spending in Medi-Cal to grow to up to $27.6 billion.
In addition to this report, you can find the main California's Fiscal Outlook report along with a collection of other fiscal outlook material on our fiscal outlook budget page.
February 11, 2016 - In this report, we provide an analysis of the administration’s caseload projections, as well as a discussion of the impacts of the ACA on the ability to project caseload. We also provide an assessment of several General Fund cost pressures on the horizon in Medi–Cal, including the sunset of the hospital QAF.
February 13, 2019 - In this report, we describe the major changes and proposals in the Governor's proposed $100.7 billion (all funds) Medi-Cal budget. Specifically, we advise the Legislature to seriously consider renewing the managed care organization tax, despite the Governor not proposing to do so; present issues for consideration related to the Governor's proposed expansion of comprehensive Medi-Cal coverage for young adults regardless of immigration status; and provide an initial assessment of the Governor's proposals to use Proposition 56 funding in Medi-Cal to extend and expand provider payment increases. We recommend approval of the Governor's proposals to improve fiscal oversight of the Medi-Cal budget, and also recommend that the Legislature require the administration provide additional information to the Legislature in an effort to improve fiscal oversight and transparency of this very large, complex budget going forward.
May 30, 2023 - Presented to: Assembly Committee on Health Assembly Budget Subcommittee No. 1 on Health and Human Services
February 14, 2024 - This brief provides an overview of the Governor’s proposed budget for Medi-Cal; describes key trends in Medi-Cal caseload; and analyzes proposals around the managed care organization tax, provider payment increases, and other budget solutions.
December 21, 2018 - This post describes recent national developments pertinent to the reauthorization of California’s managed care organization (MCO) tax. The state’s prospects for receiving federal approval—which initially were uncertain—appear to be improved following the recent federal approval of a health insurer tax in Michigan that is structured similarly to California’s MCO tax.
February 16, 2021 - The California Advancing and Innovating Medi-Cal (CalAIM) proposal is a set of reforms to expand, transform, and streamline Medi-Cal service delivery and financing. This post—the second in a series assessing different aspects of the Governor’s proposal—analyzes CalAIM financing issues, including both the Governor’s funding plan for CalAIM as well as CalAIM’s policy changes related to Medi-Cal financing.
June 3, 2019 - Presented to: Budget Conference Committee
May 19, 2020 - Assembly Budget Subcommittee No. 1 on Health and Human Services
October 15, 2020 - From the General Fund, the 2020-21 spending plan provides $26.7 billion for health programs—an increase of 3 percent over estimated 2019-20 General Fund spending for these programs. The year-over-year net increase in General Fund spending is largely due to the projected COVID-19-related increase in the Medi-Cal caseload. The post describes major health-related actions (both policy actions and various budget adjustments) adopted by the Legislature as part of its 2020-21 spending plan. These actions include the offsetting of what would otherwise be General Fund costs with (1) revenues from the federally approved reauthorized tax on managed care organizations and (2) federal Medicaid funds that are being provided to the state at an enhanced level during the term of the public health emergency.
January 13, 2015 - In the Governor's 2015-16 budget proposal, the administration raises its revenue estimates, and this results in a multibillion-dollar influx of new funds for schools and community colleges under the Proposition 98 minimum funding guarantee. The Governor's plan identifies cost pressures and budget risks in health and human services programs, and new program commitments outside of Proposition 98 are limited. The Governor's proposal to pay off the state's retiree health liabilities over the next few decades would, if funded, address the last of state government's large unaddressed liabilities. We conclude the state likely will collect more tax revenue in 2014-15 than the administration now estimates. Barring a sustained stock market drop, an additional 2014-15 revenue gain of $1 billion to $2 billion seems likely in addition to the Governor's budget projection. Even bigger gains of a few billion dollars more are possible in 2014-15. These additional 2014-15 revenues will go largely or entirely to schools and community colleges and could result in a few billion dollars of higher ongoing state payments to schools. Whether tax revenues grow further, stagnate, or, in the worst case, decline in 2015-16 will depend in large part on trends in volatile capital gains and business income.
November 14, 2018 - This web post provides detail on our projections and assumptions related to General Fund spending in Medi-Cal for the years 2018-19 through 2022-23. In the near term, we project Medi-Cal spending to grow to $23.9 billion in 2019-20. Over the long term, we project General Fund spending in Medi-Cal to grow to up to around $28 billion.
In addition to this report, you can find the main California's Fiscal Outlook report along with a collection of other fiscal outlook material on our fiscal outlook budget page.
December 1, 2015 - Conference Committee on SB X2 2 and AB X2 1, Second Extraordinary Session
October 13, 2015 - Earlier this year, California submitted a proposal to renew its Section 1115 waiver, which is due to expire at the end of October. The state is currently negotiating with the federal government over the terms and conditions of this waiver renewal. In this post, we examine key issues and concerns related to the availability of federal funding for California’s proposal. The post provides a primer on how Section 1115 waivers are generally financed, an overview of California’s proposal, and a discussion of the challenges the proposal faces within that financing structure.
February 9, 2022 - This brief analyzes the Governor’s budget proposal for Medi-Cal. We include an analysis of the administration’s caseload projections, provide options for renewing the managed care organization tax (that the Governor proposes to let expire), and provide our assessment of the discretionary budget proposals to provide equity and practice transformation payments and eliminate certain existing provider payment reductions.
February 10, 2023 - This brief provides an overview of the Governor’s proposed budget for Medi-Cal, assesses the administration’s assumptions on caseload and COVID-19-related policies, and analyzes the Governor’s managed care organization tax proposal.
February 12, 2015 - This report analyzes the Governor's 2015-16 human services budget proposals. First, we review major trends in human services programs since 2007-08 (the last state budget developed before the major recession) and find that total spending is up by 11 percent (in inflation-adjusted terms), with major changes in how programs are funded. Our report also analyzes the budgetary impacts and issues for the Legislature to consider given the uncertain legal status of new federal labor regulations affecting In-Home Supportive Services (IHSS) and the Department of Developmental Services. The report includes an analysis of the future of the state's developmental centers (DCs) and an analysis of the Governor's budget proposal to further reform the Community Care Licensing (CCL) program that oversees the licensing of child care, children's residential, and adult and senior care facilities. Finally, the report analyzes the Governor's budget proposal to implement 2 of 19 recommendations of a working group established by the Legislature to recommend reforms to the foster care system.
Proposed SSI/SSP figures corrected 3/11/15
February 12, 2015 - This report analyzes the Governor's 2015-16 state health program budget proposals. In the report, we review trends in the major health programs since 2007-08 (the last budget developed before the most recent recession), analyze the Governor's proposed restructuring of the managed care organization (MCO) tax, and describe the uncertainty regarding continued federal funding for the Children's Health Insurance Program (CHIP). The report also includes an analysis of the Department of State Hospitals budget and an analysis of the Governor's proposals to improve quality and increase staffing for the Licensing and Certification (L&C) Program administered by the Department of Public Health.