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of San Francisco

Medi-Cal and Medicaid Issues


What are Medi-Cal and Medicaid?

Medicaid (Medi-Cal in California) is nation's largest single insurance plan, covering 47 million. It is primarily a program for the poor, covering 12 million poor elderly and disabled adults, one in five children, poor pregnant women, 60% of the elderly in nursing homes, and disabled adults. It provides basic hospitalization, doctor's visits, prescriptions, long-term care, tests, and many other services. Because of funding cuts, Medicaid services have been compromised for years, but the intent of the program has continued.

Currently, Medicaid is run by states in accordance with federal guidelines, and is financed by Federal-State cost-sharing, where each state dollar is matched by one to three federal dollars, without limit.

As healthcare provider for the poor, Medicaid is the second most costly item in states' budgets, and costs are increasing because of growing unemployment, loss of job-based health insurance, the high-cost of job-based to workers, low wages, and 43 million uninsured. At the same time, state budgets are still suffering their worst deficits in 50 years, because of collapse of the dot-com bubble, tax cuts to the rich, and decreasing federal revenue because of the expenses of war and homeland security. Because of these factors, the federal government and virtually all states and federal governments are agressively cutting Medicaid/Medi-Cal expenses and services.

Many of the states' strategies to cut Medicaid expenses involve getting waivers, permissions from the federal government allowing states to operate their Medicaid programs free from various federal regulations.

Medicaid waivers are generally gotten to save states money, though some waivers allow states the flexibility to have more state services qualify for federal assistance. However, waivers must be "revenue neutral" (not cost the federal government more than without the waiver), so that added services often come at the expense of other services.

Summary of States' Cuts in Medicaid Programs (Microsoft Word Program)

State and Federal Moves to Cut Costs and Services
by Restructuring Medi-Cal and Medicaid

California's plan to introduced Tiered Medi-Cal

The Federal plan to introduce Block Grants into Medicaid

Protest Schwarzenegger's Dirty Deal to Cut Federal Medi-Cal Funding for the Next Five Years! The Deal: the State gives the Feds permission to cut funding & The Feds give the State permission to cut Medi-Cal services. Learn the impact on San Francisco Public Health, which is already struggling. See Factsheet.  


Useful Links

Resources for people on Medi-Cal or who want Medi-Cal

Medi-Cal 101, Comprehensive Facts and Figures on Medi-Cal from the California HealthCare Foundation (53 pages, slow download)



Read articles about Medi-Cal and Medicaid.