1. What’s at stake for California under proposals to unwind federal health reform
March 10, 2017
Shannon McConville

2. California fully embraced ACA, now faces uncertainty under federal reform efforts
California experienced dramatic declines in its uninsured rate under the Affordable Care Act
Medi-Cal expansion responsible for most gains in coverage
The federal government provided the bulk of funds for coverage expansions
Federal proposals – in particular funding reductions – will have major implications for state, counties, and individuals
Still considerable uncertainty as to the scope and timing of proposed federal reforms

3. California’s uninsured rate declined substantially under ACA; particularly among people of color
SOURCE: American Community Survey, 2014, 2015, 2016, 1-year Public Use Microdata Sample (PUMS).

4. Largest gains from Medi-Cal expansion; now covers 1/3 of state population
SOURCE: California Department of Health Care Services, Research and Analytic Studies Division, Medi-Cal Summary Pivot Tables; California Department of Finance, County population estimates.

5. Nearly 4 million adults gained Medi-Cal under ACA; make-up nearly 30% of enrollees
Total Enrollees: 13.3 million
SOURCE: California Department of Health Care Services, Research and Analytic Studies Division, Medi-Cal Monthly Enrollment Fast Facts, September 2016

6. Federal government provides about 2/3 of total program funding in recent years
SOURCE: California Department of Health Care Services, Medi-Cal Local Assistance Estimates

7. Opportunities (and now concerns) for enrolling correctional populations
Jail inmates have more physical and behavioral health needs than the general population and most are uninsured
National estimates suggest more than one-third of newly eligible for under ACA may have criminal justice contact
Health coverage could be part of a comprehensive reentry strategy, improve public safety and public health outcomes
State continues to move forward with expanded Medi-Cal program despite federal uncertainty
Coverage options for correctional populations could change, but incentives for providing care and coverage are still present.
First a brief introduction to what motivates our focus on the intersection between jails and health.
The recent implementation of the Affordable Care Act – and in particular the expansion of California’s Medicaid program – Medi-Cal – to low-income single adults presents new opportunities for insurance coverage for much of California’s jail population. In addition, a new state law passed last year to complement the coverage expansions – has the potential to allow jail sites to become places where people moving through the jail systems can get connected/enrolled in available coverage options. This may be particularly beneficial for this group because available evidence indicates they have high health needs and insurance coverage post-release could facilitate better access to needed medical care – for both physical and behavioral health services. At the same time, health coverage and access to care for this population could help reduce county costs related to health care provision within jail systems as well as improvements in public health outcomes and reductions in recidivism.

8. Despite large reductions in uninsured, disadvantaged young men more likely to be uninsured post ACA
SOURCE: Authors calculations from the American Community Survey, 1-year PUMS 2015; PPIC report “Expanding Health Coverage in California: County Jails as Sites of Enrollment” 2016.

9. Medi-Cal could be even more salutary to the correctional population than in the past
Managed care plans are focused on better integrating physical and behavioral health
Re-designed Drug Medi-Cal program provides substance use disorder services
Other programs provide case management, social services to beneficiaries with high needs
Whole Person Care pilot programs
Health Homes for Patients with Complex Needs
PRIME projects at public hospitals to target high-risk populations; incorporate alternative payment models

10. Looking forward
With major federal changes on the horizon, policymakers likely to face difficult choices related to:
Need for increased state funding support
Size and scope of the program
Repercussions of many more uninsured Californians, especially for counties and safety net providers
Important to consider impacts on particularly vulnerable groups who gained coverage under ACA
Correctional populations
People with behavioral health issues, homeless

11. Notes on the use of these slides
These slides were created to accompany a presentation. They do not include full documentation of sources, data samples, methods, and interpretations. To avoid misinterpretations, please contact: Your name (Shannon ) Thank you for your interest in this work.