Two Medi-Cal bills, both sponsored by Asm. Joaquin Arambula (D–Fresno), recently passed a hearing in the Assembly Committee on Health. The bills address deductibles for “medically needy” people with higher incomes that qualify for Medi-Cal through cost-sharing, as well as premiums and copayments for pregnant and postpartum individuals, children, and employed people with disabilities.
Currently, “medically needy” individuals—defined as disabled individuals or those over 65 with serious medical needs—who are over 138% of the FPL, and thus don’t qualify for free Medi-Cal, can receive Medi-Cal coverage by sharing a portion of the cost. A patient’s share of the cost is calculated monthly based on their income level, with a requirement that the patient is guaranteed a minimum “maintenance need income level (MNIL)” after paying their share of cost. The MNIL is what’s considered to be sufficient for the individual to pay for essentials like food. The MNIL has been $600 per month, or 55% of the FPL, since 1989.
This means that some individuals who just barely don’t qualify for full Medi-Cal coverage are left with only $600 a month to pay for all of their expenses.
Assembly Bill 1900 would lower the monthly cost sharing responsibility for these individuals by increasing the MNIL from 55% to 138% of the FPL, or from $600 to $1,482 per month.
Arambula said the low current income limit is resulting in older adults and people with disabilities whose income is even slightly over the free Medi-Cal income limit (138% FPL) to have little left to pay for other expenses such as rent, food, and utilities after they pay their share of their health care bill. He also mentioned that, despite the high cost of living in the state, California trails behind several states in how much people in certain Medicaid programs must pay for their own health care before Medicaid kicks in.
“This program has not been updated since 1989, and older adults and people with disabilities are paying the price,” he said. “By making this much-needed adjustment, we can help to ease the financial burdens so that people are not choosing between the need for medical attention and the need to pay for rent and to buy food.”
Sawait Seyoum, representing Disability Rights California, testified in favor of the bill. She said the outdated MNIL for Medi-Cal cost-sharing participants are in some cases incentivizing patients to refuse to seek care.
“The share of cost program acts as a critical pathway to health coverage for low income older adults and people with disabilities who have significant health care needs but are just above the free Medi-Cal income limit,” she said. “The outdated income limits have forced people to spend more than half of their income on health care needs every month. The result: older adults and people with disabilities are pushed into extreme poverty, and some just forgo care entirely because it’s just too expensive.”
She added that low-income adults and people with disabilities who are only $1 over the limit for free Medi-Cal, and live on fixed incomes, are currently expected to pay 60% of their monthly income on health care expenses.
“It’s not fair that older adults and people with disabilities are the only population forced to pay so much to obtain essential health care,” she said.
The bill unanimously passed and moved on to the Assembly Appropriations Committee.
Arambula’s second bill discussed at the hearing, AB 1995, would eliminate Medi-Cal premiums and subscriber contributions for pregnant and postpartum individuals, children under 2 years old, and people with disabilities.
Arambula said this bill would help ensure that low-income Californians can access the health care services they need, and that they don’t have to delay their medical care due to losing their health insurance.
“We need to change the system so that pregnant women, children, and people with disabilities can be assured that their Medi-Cal coverage continues, and that they won’t have to choose between paying for their health care or paying for household bills,” he said.
He added that Medi-Cal premiums and copayments are no longer consistent with the more inclusive direction that health care coverage is going in the state.
Katie Andrew, associate director of health at Children Now, said these premiums and copayments created additional economic burdens for struggling families without yielding significant cost savings for the state.
She said eliminating monthly premiums and copayments would not only alleviate the economic burden on low-income families, but also promote health coverage for California families and promote equity between public and private coverage.
“Last year, lawmakers allocated funding to provide $0 coverage for [certain] Covered California members, noting that even nominal costs deter enrollment in and utilization of health coverage,” she said. “Medi-Cal kids and families deserve the same relief and protection.”
She emphasized her belief that the language contained in Gov. Gavin Newsom’s budget proposal to reduce Medi-Cal premiums to zero does not go far enough, and leaves the door open for a future administration to reinstate Medi-Cal premium and copayment requirements.
“This is extremely problematic, given that the families and the individuals that are required to pay Medi-Cal premiums and copayments are likely to be hit the hardest by an economic downturn.”
Though a few comments were made about how the state would be able to pay for the eliminated premiums and copayments in the committee discussion, the bill passed in a 12-0 vote and moved onto the Assembly Appropriations Committee, where more detailed budgetary conversations concerning the bill will take place.