Q&A: Medicaid director Jacey Cooper says new Medi-Cal expansions are a “huge win” for California

Jacey Cooper has served as California’s Medicaid director since January 2020. She previously worked as the Department of Health Care Services (DHCS) senior advisor of health care programs and assistant deputy director of health care delivery systems, and has also held leadership positions at Meridian Healthcare Partners, Kern Medical Center, and COPE Health Solutions. Taking the helm of the department just before the onset of the pandemic, Cooper has been at the forefront of California’s fight against COVID-19.

In this Q&A, Cooper discusses the significance of recently passed expansions to Medi-Cal, the state’s commitment to implementing full Medi-Cal expansion, and her thoughts on how the Biden-Harris administration’s financial support has benefited California’s safety net system.

 

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Eli Kirshbaum: How do you think the recently finalized expansion of Medi-Cal coverage for undocumented individuals 50 and older will impact the state?

Jacey Cooper: “I think with [individuals] 50 and older being covered … it really represents the governor’s commitment to kind of closing equity gaps in California, but providing it and kind of making a big step towards universal coverage. And I think you see that reflected clearly in the legislature’s priorities as well, and so I think using the historic surplus that we have identified this year and putting those supports towards closing additional gaps in universal coverage is a huge win for the legislature and for the administration.

California likes to lead naturally, and so we were the first in the nation to cover up to age 26 and the first in the nation to expand to [individuals aged] 50 plus, so we’re very excited about that coverage. Approximately 235,000 Californians would be newly eligible to have full-scope coverage in Medi-Cal, which is big. It’s important to make sure that people have full access to health care services, including a number of things that they don’t if they are only able to receive restricted-scope services, and so we look forward to the expansion, getting it rolled out, and ensuring that we do what we can in the future to get to that future goal of universal coverage in California.”

EK: What about elimination of the Medi-Cal asset test?

JC: “It’s a huge step forward … There are a lot of things in the budget that help close inequities and some gaps, and I think that is significantly one. There are a lot of racial inequities in regards to home ownership between Black and Latinx Californians compared to white Californians. 

So it’s a huge step forward for us to have kind of a two-phased elimination of that asset test. We have the first phase, which greatly increases the cap, and then it’s eventually fully eliminated no sooner than 2024. There’s only a few other states who have radically changed their asset limits before us — Arizona has fully eliminated [it] — but we’re happy to be joining those states to move that needle forward and show commitment to kind of closing those types of equity gaps, but also ensuring that people have access to adequate health care services in California.”

EK: How is DHCS ensuring it includes the voices of underserved communities in its CalAIM goal of advancing health equity?

JC: “When we first built CalAIM … We had gone across the state, of course had conversations with counties and plans and providers and a magnitude of people to say what’s working in Medi-Cal and what’s not [working] to kind of come up with CalAIM.

But one of the other groups that we talked to originally were beneficiaries, and I think it’s really important work. We do know that some of our whole-person care pilots do beneficiary focused groups, and some of our plans do, but our new chief quality officer, who’s been recently talking about the rollout of our comprehensive quality strategies, she has full intentions of engaging — which includes, just to be clear and connect the dots, our equity roadmap, [which] will be a part of that comprehensive quality strategy. It will include CalAIM’s goals as well as our equity goals, and she has full intentions of kind of engaging in a patient-beneficiary feedback loop for that work that’s anticipated between now and the end of the year. 

So we look forward to working with — very much so — the beneficiary side, but also the community level feedback that we can get on that type of work will be really critical, especially if you think about it in order to kind of move equity gaps of any kind, it really is going to end up being various local conversations [with] community-based organizations, faith-based leaders, that can help come to the table and partner with the providers across the state of California — plans, counties, etc. — to kind of move the needle, and so we look forward to that engagement in the future as well.”

EK: How instrumental has federal financial support been during COVID-19? Has the Biden administration’s efforts to help fund health services been enough, or do you believe more is needed?

JC: “The partnership that has availed itself from the Biden-Harris administration has been remarkable, in my opinion. Just broadly, I think the COVID response in regards to financial support has been critical since the beginning, whether it’s infrastructure, testing, vaccines — those are really important. And CMS really partnered with all the states quickly to move out mass flexibilities, and in California we had over 75 flexibilities approved from COVID just to ensure people could access care, and that’s instrumental. 

But I think, really, the Biden-Harris administration getting dollars, whether it’s the ARPA funds and getting those out the door, whether it’s the HCBS spending plan, I think it’s pivotal. I think if COVID has really taught us anything, it’s that we need to invest in HCBS, social determinants of health, and closing equity gaps. Those are three clear things that COVID has highlighted in regards to policy priorities. As you can see, those are very clear policy priorities of the Biden and Harris administration. I think that they are backing that up with funding for states. They are backing it up with flexibility for states. I applaud the work that the administration and CMS did on the HCBS spending plan in giving the flexibility to states to spend that fund in the way that we have been allowed, and I think it will make a real difference in regards to the infrastructure to move those needles.

So I of course look forward to future partnerships with them as we tackle some of the big pieces before us, coming as we unwind, hopefully, in the future, [from] the public health emergency, and then really start closing in on those three areas that I just talked about. So we’ve really appreciated their partnership, and the funds will go to good use in California for sure.”

EK: Looking toward the rest of session (when lawmakers return), what legislation are you and DHCS watching? Any bills on the move that will impact the department and/or the safety net system?  

JC: “Obviously, DHCS is watching a number of bills, but at this time, can’t really opine in regards to positions or priorities for us in regards to the final bills for us to review, but we look forward to partnering with the legislature as they come back and engaging in those final decisions through the rest of the year.”

This interview was edited for clarity and length.