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Impact of COVID-19 on Health Care Access


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The 2021-22 Budget: Analysis of the Medi-Cal Budget

February 16, 2021 - This post analyzes the major adjustments to the Medi-Cal budget in 2020-21 and 2021-22, with a focus on the technical adjustments such as the administration’s caseload estimates. We will further analyze the major discretionary Medi-Cal proposals in separate publications and communications to the Legislature.

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[PDF] The 2021-22 Budget: Medi-Cal Fiscal Outlook

November 18, 2020 - Medi‑Cal, the state’s Medicaid program, provides health care coverage to about 13 million of the state’s low‑income residents. Medi‑Cal costs generally are shared between the federal and state governments. In a typical year, the General Fund covers a little more than 20 percent of total Medi‑Cal costs, with federal funds and other state and local funds respectively covering the remaining 65 percent and 15 percent of total costs. In this web post, we describe the major factors that we expect to drive changes in General Fund spending in Medi‑Cal over the near term—in 2020‑21 and 2021‑22—and over the longer term through 2024‑25. We also describe a number of key assumptions that we made in our spending projections.

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Estimated Cost of Expanding Full-Scope Medi-Cal Coverage to All Otherwise-Eligible Californians Regardless of Immigration Status

May 5, 2021 - This budget and policy post responds to legislative requests for our office to estimate the costs of expanding comprehensive Medi-Cal coverage to all otherwise eligible Californians regardless of their immigration status. We estimate that nearly one million undocumented immigrants would gain full coverage under this expansion. Assuming a January 1, 2022 implementation, we estimate that the additional cost of expansion would be $790 million General Fund ($870 million total funds) in 2021-22. On an ongoing basis, we estimate the additional cost of the expansion would be $2.1 billion General Fund (nearly $2.4 billion total funds). Both our caseload and cost estimates are subject to significant uncertainty and rest on a number of key assumptions. Moreover, our ongoing estimates would be expected to change over time with medical inflation and changes in caseload and utilization.

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The 2020-21 Spending Plan: Health Budget and Policy

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.

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The 2021-22 Spending Plan: Health

October 22, 2021 - The spending plan provides $33.7 billion General Fund for health programs. This is an increase of $6.7 billion, or 25 percent, compared to the revised 2020‑21 spending level. This year-over-year increase primarily is due to significant growth in projected General Fund spending in Medi-Cal. About two-thirds of the increase in General Fund Medi-Cal spending reflects technical budget adjustments (for example, adjustments due to projected caseload increases), while the remaining one-third reflects a large number of discretionary policy augmentations.

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[PDF] The 2021-22 Budget: LAO Preliminary Comments on the May Revision Medi-Cal Budget

May 21, 2021 - In this post, we provide our preliminary comments on the Governor’s 2021‑22 May Revision proposal for Medi‑Cal. We first provide an overview of the proposal, noting the major changes made relative to the Governor’s January budget, as well as changes made to estimated 2020‑21 spending relative to the January estimates. We then describe, and provide our comments on, the Governor’s proposal to augment the January proposal for the California Advancing and Innovating Medi‑Cal (CalAIM) package. We follow with descriptions of, and comments on, the Governor’s modified telehealth policy proposal, the proposal to extend full‑scope Medi‑Cal coverage to older undocumented immigrants, and the proposal to use American Rescue Plan Act funding to provide financial relief for designated public hospitals.

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COVID-19: American Rescue Plan’s Major Health-Related Funding Provisions

May 6, 2021 - On March 11, 2021, the President signed into law the American Rescue Plan Act of 2021 (ARP Act)—a $1.9 trillion coronavirus disease 2019 relief package. This post highlights the health-related provisions of the ARP Act that provide significant funding directly to state/local health care and public health agencies, rural hospitals, home- and community-based services programs, subsidized individual market health coverage programs, and public behavioral health services. Where possible, based on currently available information, we provide an estimate of the funding allocations to California governments and other entities in the state. While this post reflects our best understanding of the high-level content and implications of this legislation as of late April, we will update the post as new information and clarifications become available.

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[PDF] The 2021-22 Budget: Analysis of the Governor’s Medi-Cal Telehealth Proposal

May 13, 2021 - This budget series post provides an overview of the Governor’s January budget proposal for an ongoing, post-pandemic Medi-Cal telehealth policy; an assessment of the Governor’s proposal; and issues for legislative consideration.

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The 2022-23 Budget: Medi-Cal Fiscal Outlook

November 17, 2021 - This post describes our fiscal outlook for Medi‑Cal, the major factors that we expect to drive changes in General Fund spending in Medi Cal, and a number of our key underlying assumptions. (Specifically, this post concerns projections of Medi‑Cal local assistance spending within the Department of Health Care Services [DHCS].)

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The 2021-22 Budget: CalWORKs Fiscal Outlook

December 8, 2020 - In this post, we describe our most recent forecast for California Work Opportunity and Responsibility to Kids (CalWORKs) program costs and discuss recent caseload trends. With this post we intend to provide information but do not include any explicit recommendations to the Legislature. This post is part of our 2021-2022 Fiscal Outlook series of publications.