Undocumented Seniors, Low-Income Mothers Could Get Less Help As Coronavirus Shifts California Budget

California Gov. Gavin Newsom had big plans to fix long-standing problems in California’s health system in 2020. Instead, a budget deficit driven by the COVID-19 crisis could lead to reductions in programs for vulnerable groups. 

His proposed May budget revision included some new health care funding. Skilled nursing facilities could see a 10% reimbursement rate increase and public health would get $6 million to expand staffing and lab capacity. But mostly, the governor found places to save by asking to shrink or delay programs he’d proposed in January. 

Here are some of the ways this health care budget proposal differs from the earlier one. The Legislature has until June 15 to approve a budget. 

CalAIM

California Advancing and Innovating Medi-Cal launched in 2019 with several goals, including improving Medi-Cal managed care, modernizing payments to community clinics, and integrating behavioral and physical health care.

Under the revision, the program’s implementation would be delayed, and some of the funding for it would be pulled back. 

Erica Murray with the California Association of Public Hospitals and Health Systems says this project was supposed to carry forward some initiatives currently being supported by a federal 1115 waiver.

“We had been working with the state on a set of proposals that would help build a bridge between the expiration of the waiver and what would come next, especially for high-risk, low-income populations,” Murray said. 

She pointed to Whole Person Care pilots, which help to provide coordinated care for homeless, chronically ill individuals. 

Medi-Cal Eligibility

Newsom’s earlier proposal to expand eligibility to undocumented seniors has been withdrawn, despite pleas from advocates that this population needs coverage during COVID-19.

Undocumented people up to age 26 who meet the income guidelines were added to the program for 2020, and children were already covered. In his January proposal, Newsom proposed covering income-eligible undocumented seniors over age 65.

The revision withdraws that expansion, resulting in roughly $113 million in savings. 

“We’re putting dollars on people’s lives here,” said Orville Thomas, director of government relations for the California Immigrant Policy Center. “These are the people that are taking care of grandchildren while their children are at work. These are vital members of the community.”

He says universal health care advocates will now take their concerns to the legislature.

A proposed expansion to make people who are blind, disabled, or over age 65 and meet certain income guidelines eligible for Medi-Cal would not be implemented under the revision.

Medi-Cal Cuts

For adults who are already enrolled in Medi-Cal, services such as adult dental procedures, audiology, physical therapy and incontinence creams would be removed from the benefits list. Referral to treatments for opioids and other drugs is also on the list of benefits that could be cut. These changes generate roughly $55 million in savings. 

The revision also proposes taking away $1.2 billion in revenue from Proposition 56, the 2016 voter-approved cigarette tax, which usually supports payments for family services, developmental screenings for children and loan repayments for doctors and dentists in the Medi-Cal program. 

“In recent years, the allocations of Proposition 56 funds to sexual and reproductive health care has been the primary reason Planned Parenthood’s health centers have been able to remain open after years of compounding budgetary challenges," said Jodi Hicks, CEO of Planned Parenthood Affiliates of California, in a statement. “Continued Proposition 56 funding is critical for Planned Parenthood’s doors to remain open.”

Maternal and Infant Health

A 2019 Budget Act expansion that provides additional Medi-Cal benefits to postpartum mothers diagnosed with a maternal mental health condition would not be implemented under the proposed May budget revision. The move saves the state just over $34 million.

Maternal mental health conditions often go untreated, and the issue has been gaining traction in California for the past several years. 

The governor also suggests withdrawing a $4.5 million allocation to the state’s Black Infant Health program, which gives African American moms access to case management and support groups. Nationally, African American infants are two to three times more likely to die than white infants, namely from low birth weights and sudden infant death syndrome.

In-Home Support

Under the May budget revision, people who receive in-home supportive services from the state would see a 7% reduction in hours. This change would save the state $205 million. 

United Domestic Workers of America, a union representing in-home caregivers in California, said fewer hours would be challenging for those who rely on the program for housework, transportation and other assistance. 

“It’s clear that the governor is forced to make distressing decisions, and that we must employ creative solutions, but we must not do so at the expense of seniors, people with disabilities, and those who care for them,” said union director Doug Moore. “Now is not the time to drain resources from a critical program that is already struggling to meet the growing need for care in a state with a rapidly aging population.”

By 2030, more than one-fifth of California residents will be seniors, according to state projections.