State 2021-22 Budget Benefits Health of Low-Income Californians

*This blog was compiled by NHeLP Fellow T. Nancy Lam in collaboration with the staff in our Los Angeles office

On Thursday, July 15, 2021, the California Legislature passed its new budget that expands and improves health coverage for millions of low-income Californians. And just Tuesday, July 27, 2021, a key budget health trailer bill, AB133, was signed. The state’s historic $262.6 billion spending plan aims to expand health care for undocumented immigrants, alleviate homelessness, dramatically expand behavioral health services for youth, and help Californians still struggling through the pandemic. With a total funding of $209.9 billion for all programs overseen by the Department of Health Care Services, the budget will transform California’s health care system into a more accessible, affordable, and equitable health system.

Some of the key benefits in the budget are:

Medi-Cal Eligibility

• Health4AllElders. The budget expands full scope Medi-Cal to all elders 50 and up regardless of immigration status no sooner than May 1, 2022. This historic victory builds on the success of existing Medi-Cal coverage expansion for children and young adults to age 26 regardless of immigration status, and illustrates California’s commitment to equal access to health care for all.
• Eliminates Assets Test. After a multi-year effort, the budget increases the Medi-Cal asset test to $130,000 for an individual no sooner than July 1, 2022 and fully eliminates the asset limit for Medi-Cal programs serving seniors and persons with disabilities no sooner than January 1, 2024. This ends the disproportionate harm against people of color who are more likely to have cash savings and live in rental housing instead of owning an exempt property like a home.
• Post-pregnancy eligibility extension. The budget extends Medi-Cal coverage to 12 months post pregnancy. This extension is effective April 1, 2022 and will continue for up to five years. California is seeking federal funding through a Medicaid State Plan Amendment, as permitted under the American Rescue Plan Act of 2021.
• Medi-Medi Navigator Funds. The budget approved Navigator Funds of $12 million per year for 2 years to support older adults with Medicare and Medi-Cal, who need guidance when transitioning between or enrolling onto both programs.
• Provides accelerated enrollment to adults. Effective July 1, 2021, adult applicants aged 19 through 64 who apply through the Single Streamlined Application, California’s California Healthcare Eligibility, Enrollment and Retention System (CalHEERS), will be eligible for immediate and temporary Medi-Cal while income verifications are pending. This expedited enrollment process builds on the existing practice of granting accelerated enrollment to children, and ensures more adults have expedient access to Medi-Cal coverage.

Medi-Cal Benefit

• Doula Benefit. For the first time, Medi-Cal will cover full spectrum doula care, which includes prenatal and postpartum care, presence at labor and delivery, and doula care for miscarriage, stillbirth, and abortion care. This benefit will be effective January 1, 2022, and is available regardless of immigration status.
• Children and youth behavioral health investments. The budget includes a $4 billion investment in behavioral health services for Californians aged 0-25 over the next five years. The goal of the initiative is to transform California’s behavioral health system into a prevention-focused system where our children and youth receive routinely screening, support, and services they need. The initiative applies to both Medi-Cal as well as commercial plans and will build on existing infrastructure to provide youth and young adults services and support 24/7 through a virtual platform. It will also enhance Medi-Cal benefits and expand the availability of school-based behavioral health services.
• Covering Dyadic Services Benefit in Medi-Cal. The budget includes an important new statewide benefit that provides integrated physical and behavioral health screening and services to families. This model of care has been proven to improve access to preventive care for children, rates of immunization completion, coordination of care, child social-emotional health and safety, developmentally appropriate parenting, and maternal mental health. The budget includes $200 million total funds ($100 million General Fund) ongoing.
• Permanently ends the suspension of Medi-Cal benefits and provider rate. The budget will permanently remove the expiration dates of certain “optional” Medi-Cal benefits such as speech therapy, eyeglasses and podiatry services that states are not required to cover. These benefits were eliminated and later restored in 2019, but had expiration dates. It also funds supplemental provider payments and eliminates specific rate freezes. These changes ensure all benefits are available under Medi-Cal and provides the state with more flexibility to set reasonable payment rates for Medi-Cal services.

Other Medi-Cal Actions

• Field testing. The final budget approved a one-time allocation of $1 million in 2021-2022 with $30,000 ongoing funding for field testing translated Medi-Cal documents. These funds are important to ensure that translated materials are understandable and culturally responsive to their intended audience, specifically recipients of Medi-Cal benefits.
• Telehealth. Following some compromises with the state legislature, the Governor’s final budget includes $151.1 million in 2021-22 for the extension of telehealth flexibilities allowed during the federal public health emergency—including payment parity for audio-only modalities—through December 2022 and coverage of remote patient monitoring. The budget also allocates $6 billion to expand broadband infrastructure and improve access, particularly for underserved households.

Other Health Care Proposals

• Zero out $1 premium. In accordance with the Affordable Care Act (ACA), qualified health plans must segregate two premium payments per enrollee: one for abortion services and another one for other health care services (and abortions in cases of rape, incest, and life endangerment). In determining the premium allocated to abortion services, the ACA requires plans to charge at least one dollar per month per enrollee. This extra charge prevents thousands from enrolling in Covered California. To alleviate this burden to Californians who are low-income and encourage more Covered California enrollment, the final budget dedicates $20 million to subsidize this ongoing cost.
• Health Care Affordability Reserve Fund. The Health Care Affordability Reserve Fund sets aside individual mandate penalty revenue in the event that federal subsidies are not continued. This ensures the continued investment in Covered California subsidies, and the commitment to provide affordable coverage to low and middle income Californians.
• Transgender Equity Fund. The final budget includes a one-time allocation of $13M to the Transgender Wellness and Equity Fund. The allocation is part of a larger investment of $100 million for community based organizations (CBOs) to address health disparities and $200 million to public health entities. This historic funding is dedicated to transgender-led CBOs for addressing health disparities and reducing health barriers for transgender, gender non-conforming, and intersex populations.
• Compensation for Californians who were forcibly sterilized. The final budget allocates $7.5M to compensate survivors of state-sponsored forced sterilizations. Between 1909 and 1979, California sterilized at least 20,000 people with disabilities, Latinas, women, and low-income people were disproportionately targeted for sterilization. The State’s reproductive violence continued in state prisons as late as 2010. While no amount of money can adequately redress the harms experienced by sterilization survivors, it is imperative that California’s leadership confront the State’s long history of reproductive violence against Black, Indigenous, Latinx and other people of color, people with disabilities, LGBTQI+ people, people in carceral settings, and/or people living in poverty.
• Language access services. The budget includes $10 million ongoing to support and promote language access and cultural competency across the Regional Center system, specifically funding multi-language orientations, culturally sensitive outreach efforts, and translation services for persons served and their families who are non-English speaking. The budget also includes a $20.3 million one-time investment to improve and deliver language access services across the spectrum of Health and Human Services (HHS) programs by developing and implementing a HHS-wide policy framework to improve language access standards across programs and services.
• Guaranteed Income Pilot for pregnant people. A guaranteed income pilot program that prioritizes pregnant Californians. The budget includes $35 million General Fund over five years for Guaranteed Income Pilot Program, including one that prioritizes pregnant or parenting foster you and low-income Californians.
• CalWORKs for pregnant people. Earlier access to CalWORKs for pregnant people and an increase in the CalWORKs pregnancy supplement. The budget includes $10 million General Fund for CalWORKs Aid to Pregnant Parents.

This overall investment in programs and policies that benefit low-income Californians once again demonstrates the leadership of California in this country to focus on equity and its commitment to improve the lives of all people in this state, in particular those individuals who are the most underserved.