By Tim Clark
In the last several years, California has proposed or implemented three major changes to Medi-Cal that could add half a million Californians to its safety net health coverage program. Those changes—in one case updating financial rules that had been unchanged since 1989—resulted after steady advocacy from various advocacy programs including the Health Consumer Center of the Legal Aid Society of San Mateo County.
“These very welcome changes will make free or low-cost health care available through Medi-Cal to many deserving individuals, including seniors, persons with disabilities, and undocumented immigrants,” said Amira Elbeshbeshy, directing attorney and director of Legal Aid’s Health Consumer Center.
One change, which went into effect July 1, increased the amount of assets a Medi-Cal recipient may have and remain eligible from $2,000 to $130,000 per person or family member. Under the legislation, the asset limitation will be removed entirely in January 2024. Eligibility limits based on income, as opposed to assets, were increased in 2020.
The second reform, “share of cost” reform, is “the most exciting for us,” Elbeshbeshy said.
Here is how it worked before this reform: Medi-Cal recipients were required to pay their “share of cost” if their income exceeded $1,564 per month or $18,768 annually. If their income was even $1 over that level, their “share of cost” or monthly deductible was approximately $940, about two-thirds of their income. Those limits had not been adjusted since 1989.
After years of lobbying, Medi-Cal advocates won $31 million in California’s 2022-23 state budget to address the problematic share of cost. The change is scheduled to go into effect in January 2025. Under the current Covid public health emergency, still in effect, the state is not taking any taking any actions that would downgrade coverage for current Medi-Cal recipients.
To illustrate the “share of cost” issue, staff attorney Camille Nguyen cited a recent client whose income is only $71 over the current limit. This woman was recently diagnosed with cancer and is about to start chemotherapy. Under the proposed Medi-Cal reform she would have a share cost of $71 rather than the $1,015 cost that she is currently responsible for.
Finally, as of May 1, Medi-Cal has added coverage for undocumented immigrants aged 50 and older. Previous changes covered children and young adults through age 25. The latest action leaves a coverage gap for undocumented individuals between ages 26 to 49. That last gap for undocumented immigrants is slated to be closed in 2024, but other coverage gaps remain in the complex Medi-Cal program.
To inform San Mateo County residents of these changes, the Health Consumer Center collaborates with other health law programs through the statewide Health Consumer Alliance as well as the Health Plan of San Mateo, the managed care plan for Medi-Cal recipients in the county, to outreach to the community.
Ironically, California’s worst public health emergency in decades indirectly boosted Legal Aid’s ability to work on legislative changes: Because of the pause on Medi-Cal negative actions for current recipients, the Health Consumer Center was seeing fewer Medi-Cal clients, freeing more of the staff’s time for legislative work and for other practice areas. The practice is now focusing more on medical debt, improper billing, and charity care under the federal Hospital Fair Pricing Act, working with San Mateo Medical Center, the county’s public hospital.
If the unit’s work sounds like a cross between legal work and social policy, it reflects the background of director Elbeshbeshy. After earning her law degree from Fordham and working for several years in New York City, she got a master's degree in Social Work from University of Southern California (USC).
“This is the perfect job to apply my education as a lawyer and a social worker,” she says. In her social work internship, Elbeshbeshy was told not to address certain legal issues—just leave that to the lawyers. Nowadays, she doesn’t hear that anymore.