Yasmin Peled: Hey everybody, and welcome to as we speak’s webinar presentation, Medicaid Cuts in H.R. 1, Updates for Ageing Advocates in California.
I am Yasmin Peled, director of California Authorities Affairs right here at Justice in Ageing, and as we speak I am joined by my colleagues Tiffany Huyenh-Cho, director of California Medicare and Medicaid Integration, and Hagar Dickman, director of California LTSS Advocacy.
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Thanks for sticking with us by means of that background data. For as we speak’s webinar, here is our agenda. In a second, I’ll flip it over to my colleagues to offer an summary of the adjustments to Medicaid and Medicare in H.R. 1 and the potential affect right here in California. We’ll then talk about advocacy ideas for mitigating hurt. We’ll present a quick overview of coverage adjustments within the California state price range. We’ll share a few of Justice in Ageing’s sources after which we can have time for questions. And once more, please use the Q&A operate in Zoom to ask any questions.
Earlier than we dive into the H.R. 1 overview, I am simply going to take a minute to assessment how vital Medi-Cal is right here in California. There are greater than 2.4 million older adults and other people with disabilities who depend on Medi-Cal right here in California, and we obtain $112 billion in federal Medicaid funding for the Medi-Cal program.
There are additionally thousands and thousands extra older adults and other people with disabilities who’re insured by means of the ACA’s Medicaid growth. So these are individuals between the ages of 19 and 64 that gained entry to Medicaid by means of the ACA growth, and there are over 5 million adults on this inhabitants.
And eventually, Medicaid is a really broad program. It covers extra than simply conventional Medicaid’s medical providers. Notably, dwelling and community-based providers are virtually completely funded by means of Medicaid. Additionally, nursing facility care is funded by means of Medicaid, in addition to non-emergency medical transportation and the monetary help that Medicare beneficiaries want who’re duly enrolled in Medicaid.
So now I will flip it over to my colleague Hagar Dickman to stroll us by means of an summary of H.R. 1.
Hagar Dickman: Thanks, Yasmin. Good morning. My identify is Hagar Dickman. I am director of California LTSS Advocacy at Justice in Ageing, and I exploit she/her pronouns. I will begin us off speaking about some background on H.R. 1 and its affect on California’s Medi-Cal program.
H.R. 1 is a price range reconciliation invoice that handed Congress on July third with solely Republican votes, and it was signed by the president into regulation on July 4th. The invoice was beforehand named the One Huge Stunning Invoice Act, however the identify was truly eliminated simply earlier than it was handed. And so we will probably be referring to it because the Funds Reconciliation Act of 2025 or H.R. 1 for brief.
H.R. 1 makes the biggest cuts to Medicaid in this system’s 60-year historical past, about $990 billion. In order that’s virtually a trillion {dollars} in cuts in accordance with the official rating from the Congressional Funds Workplace. It is almost 4 instances as giant as any earlier Medicaid minimize in this system’s historical past. And while you add to it the Medicare cuts and cuts to Inexpensive Care Act and H.R. 1, the entire is properly over a trillion {dollars} in cuts to healthcare.
The affect of H.R. 1 can be measured based mostly on how many individuals will lose entry to well being care. H.R. 1 is anticipated to terminate protection for at the very least 10 million individuals nationwide, and most of these are people who find themselves Medicaid enrollees. And in California, the Division of Healthcare Providers estimated that H.R. 1 will trigger roughly 4 million individuals to lose their medical health insurance within the state. 3.4 million of these people are from Medi-Cal alone.
Congress additionally made extra adjustments to the Inexpensive Care Act together with failing to increase enhanced premium tax credit on this invoice, which signifies that in 2026, at first of the 12 months and truly even this fall, as individuals want to enroll within the Inexpensive Care Act market plans, these premiums are going to essentially be spiking if Congress doesn’t lengthen the improved premium tax credit and makes these plans too costly and unaffordable for a lot of Californians. Cuts and adjustments to the Inexpensive Care Act are estimated to end in a further 660,000 individuals shedding their healthcare. Subsequent slide.
By way of the massive image of how these cuts will end in protection termination, H.R. 1 cuts federal Medicaid funding and shifts prices to states. As a result of Medi-Cal is a price sharing program between the federal and the state authorities, any lack of funding from the federal authorities will drive California to chop spending, which the state can do by means of chopping Medi-Cal providers, lowering eligibility to this system, or chopping supplier reimbursement charges. And almost certainly the state might want to resort to a mixture of those cuts.
H.R. 1 additionally will increase limitations to accessing Medi-Cal, for instance, by means of imposing work necessities and extra frequent redeterminations, which we’ll speak extra about in higher element in a while. And it additionally immediately terminates eligibility for Medi-Cal, Medi-Care, and the Inexpensive Care Act tax credit for a lot of lawfully current immigrants. In October of 2026, many immigrants can have Medi-Cal terminated and they’ll not be eligible for the Inexpensive Care Act premium tax credit score at that time.
Now that I’ve given a basic overview of H.R. 1 impacts, we’ll go into some particular adjustments within the regulation and the way they affect older Medi-Cal members. As I simply talked about, Medicaid is a price sharing program. So California pays for Medi-Cal providers it delivers, after which it requests reimbursement from the federal authorities for the federal share.
H.R. 1 restricts California’s potential to fund its share of Medi-Cal prices by freezing and lowering supplier and insurer taxes. These taxes are one thing that each state, apart from Alaska, makes use of to assist fund their share of Medicaid. And so they’re actually essential as a result of states must spend their very own cash first earlier than they will obtain reimbursement from the federal authorities.
So the federal match, often known as the FMAP, kicks in after states spends its personal cash. If California has much less of our personal cash to spend, we’ll even be getting much less in federal reimbursement. And eventually, H.R. 1 additionally reduces the federal match for emergency Medi-Cal providers supplied to adults who’re ineligible for Medicaid attributable to immigration standing.
I need to simply present somewhat bit extra element on these restrictions on supplier and insurer taxes which affect state revenues in a few methods. First, the regulation is prohibiting all states from establishing new supplier taxes or growing current taxes. For Medicaid growth states like California, the regulation lowers the bounds for these taxes from 6% to %3.5 of supplier revenues by 2032, which successfully acts as a cap on how a lot income the state can elevate by means of these taxes.
In a state like California that is an growth state, utilizing the 6% tax, this cuts the income in almost one-half. To make issues extra marquee, California’s managed care tax can be out of compliance and the state might want to work on coming into compliance, which will probably be troublesome to do whereas sustaining the identical income degree. As well as, taxes on nursing amenities are topic to a freeze, so states can’t implement new taxes on nursing amenities. However for states which have taxes as much as the 6% threshold, they will hold these taxes.
There’s one other part of the regulation that additionally restricts state-directed funds. Directed funds are instruments that states use to extend Medi-Cal suppliers in sure specialties as an incentive and particularly to handle shortages of these suppliers. Limiting California’s potential to make use of directed funds can even limit the power of the state to handle supplier shortages in areas of the state. Subsequent slide please.
H.R. 1 undermines the Medicaid program in a number of methods, particularly by placing important monetary pressures on the state. For instance, forcing the state to place in place work necessities will add important value to California all through the implementation and in addition in truly enforcement of labor necessities. Cal-Recent prices can even improve for the state, and on the similar time, American Rescue Plan Act funds are wrapping up.
So the discount in federal matching along with elevated prices imposed by H.R. 1 administrative necessities and with lowered income streams which might be additionally imposed by H.R. 1 will all drive California to make some very troublesome selections about easy methods to fill the ensuing huge holes within the price range. States must stability their budgets and Medicaid is likely one of the greatest line gadgets in most state budgets. So meaning they’re actually pressured to chop advantages enrollment or supplier funds, and we’ll doubtless minimize a mixture of these. And California could look to save lots of Medi-Cal prices typically by means of chopping both enrollment or chopping providers.
The best factor for the state to do is definitely to chop optionally available providers and optionally available eligibility classes to cut back the variety of individuals receiving providers and by lowering supplier charges. Quite a lot of packages that older adults and other people with disabilities depend on every single day are literally optionally available underneath federal regulation. They don’t seem to be obligatory for states to offer. And these optionally available providers embrace dwelling and community-based providers, issues like dental, imaginative and prescient, and listening to that Medicare would not cowl. And it additionally contains optionally available eligibility pathways that profit older adults, such because the Working Disabled Program or Share of Value to Medi-Cal eligibility.
Protecting immigrants with state solely funding can be optionally available. California has already frozen new enrollment for undocumented immigrants due to final 12 months’s tight price range 12 months, and we’ll talk about that in a bit. After which when it comes to different cuts to enrollment, states which have expanded their age and disabled eligibility or eligibility for his or her Medicare financial savings program may select to additionally roll that eligibility to the federal minimal.
For instance, California expanded eligibility to individuals with earnings as much as 138% of the federal poverty charge, however could select to cut back that earnings degree with a view to serve much less individuals and save on cash. With much less cash coming in, California can also look to chopping Medi-Cal supplier charges. This may actually worsen what’s already in current direct care workforce scarcity and make it more durable for older adults to entry long-term care. Subsequent slide.
Throughout robust price range years, dwelling and community-based providers are significantly in danger as a result of they account for over half of all optionally available spending and virtually a 3rd of all Medicaid spending. And we all know from historical past that HCBS or dwelling and community-based providers are minimize when Medicaid funding is minimize or when state budgets are tight. We have now some examples right here of instances when California older adults and other people with disabilities have confronted threats to HCBS cuts, together with in the newest governor’s proposed price range in Might, which steered placing caps on time beyond regulation pay for IHSS suppliers, which is a kind of a supplier charge minimize on 2024, when the proposed price range included chopping IHSS entry for undocumented Medi-Cal members.
And I do need to take a small pause right here, and we’ll speak extra about alternatives for advocacy and mitigation in a while, however I do need to encourage us all to not let historical past repeat itself. We actually should be making noise and inspiring policymakers at each degree to do every little thing they will to cease HCBS from being scaled again. The regulation doesn’t prescribe these cuts, however it’s going to be a really onerous battle to maintain HCBS from cuts. For 2 years now, advocates, lots of whom are on this webinar as we speak, confirmed up and fought in opposition to these cuts to California’s HCBS packages, particularly the IHSS program, and that advocacy has been largely profitable.
So I need to simply remind us all right here that whereas the threats are grave, we will be taught from our earlier successes how impactful advocacy will be in saving these important packages. We will speak extra about mitigation methods in a while, however for now I will flip it over to Tiffany to speak about extra dangerous adjustments in H.R. 1 together with work necessities.
Tiffany Huyenh-Cho: Nice. Thanks, Hagar. So I will probably be masking a number of the different provisions that affect eligibility for Medi-Cal in California. One of many greatest items of H.R. 1 will probably be work necessities for adults age 19 by means of 64 as a situation of Medi-Cal eligibility. So an individual might want to show they’ve 80 hours of sure qualifying actions, and these actions will be paid employment or volunteer neighborhood service, job coaching or education to qualify for Medi-Cal protection, or a mixture of those actions.
You may also be deemed to have met work necessities in case your earnings is greater than $580 a month. These qualifying actions or work necessities solely apply to the grownup growth group age 19 to 64 that had been created underneath the Inexpensive Care Act. So individuals on this grownup growth group qualify based mostly on their earnings solely, not their age or different standing like incapacity or being pregnant. And the work necessities for this group will begin January 1st, 2027.
This additionally signifies that work necessities don’t apply to all Medi-Cal enrollees. So there are teams which might be excluded utterly. For instance, older adults age 65 and older are excluded. Twin eligible who’ve Medicare and Medi-Cal or individuals in pregnancy-based Medi-Cal are additionally not topic to those work necessities. The work necessities would should be happy at preliminary Medi-Cal functions, so earlier than you apply, and in addition at renewal. California should confirm compliance with these work necessities for at the very least one month earlier than utility and after enrollment, and at the very least one month each six months after you are enrolled in Medi-Cal.
So this will probably be an enormous change for California and for a lot of different states. States should not have the choice to choose out and should implement these work necessities. We have by no means had work necessities in California, so it is going to be a major endeavor. California is estimating that as much as 3 million persons are estimated to lose Medi-Cal protection due to work necessities, and these numbers make up the majority of the protection loss that is estimated underneath H.R. 1. Subsequent slide, please.
There are some obligatory exemptions to work necessities that I will spotlight. So people who find themselves thought of medically frail or in any other case have particular medical wants will probably be exempt. The regulation lists out a number of examples of people that meet this exemption, equivalent to individuals with disabilities and a listing of medical situations. Nonetheless, incapacity just isn’t well-defined within the textual content. And one other group of exempt people are dad and mom of kids underneath age 14, or people who find themselves caregivers for a member of the family with a incapacity because it’s outlined in one other statute, the Elevate Household Caregiver Act.
And whereas there are restricted exemptions, we don’t but understand how individuals can apply for these exemptions and what data is required to show they meet the exemption. So the federal authorities will probably be releasing extra steering as time goes on and is required to launch remaining steering by June 2026, detailing how states should implement work necessities. And whereas work necessities won’t immediately affect individuals age 65 and older, there are older adults age 50 to 64 within the Inexpensive Care Act growth group, and these older adults will probably be impacted.
Folks with disabilities are additionally on this group too, as it may be simpler to qualify for Medi-Cal underneath the Inexpensive Care Act growth classes than the disability-based packages that are extra strict and based mostly on federal requirements. And regardless that twin eligible or different teams are usually not particularly focused, they may nonetheless really feel the affect. Counties will probably be going through an elevated workload and can have much less capability to reply routine and different normal procedures like processing functions or answering phone calls. The counties will probably be going through a very elevated workload.
After which people who find themselves not in compliance with work necessities or in any other case show they meet an exemption will lose their Medi-Cal protection. And on high of all of it, H.R. 1 additionally prohibits individuals who don’t meet these work necessities or who cannot show they meet considered one of these exemptions from receiving {the marketplace} subsidies on the Lined California trade. These are the subsidies that assist scale back the price of the month-to-month premiums and make healthcare extra reasonably priced. So that is terribly limiting and can general improve our uninsured charge in California. Subsequent slide, please.
So whereas H.R. 1 does exempt people who find themselves medically frail, quote, “medically frail” because it’s used within the textual content of H.R. 1 from work necessities, there may be an inherent contradiction between work necessities and proving you meet this medically frail exemption. In case you are within the aged 19 to 64 growth group topic to those work necessities, you will want to show you’ve got a incapacity or in any other case meet this medically frail time period to qualify for the exemption. However it’s a catch-22 as a result of usually you want medical data, you want physician’s notes, supporting medical documentation to show a incapacity or medical situation within the first place.
However with a view to get that documentation, you want well being protection to see a physician who can substantiate your incapacity or medical situation. And if you do not have Medi-Cal since you aren’t working and might’t show your incapacity, you’re being put in a horrible place. We already know it is difficult for individuals to show they meet incapacity requirements for the disability-based Medi-Cal packages just like the Aged and Disabled or by means of supplemental safety earnings. So we’re afraid of the affect that work necessities can have on individuals who qualify for an exemption however cannot show it. Subsequent slide, please.
So earlier than we transfer on, I simply need to acknowledge that H.R. 1 considerably overhauls Medi-Cal as we all know it. And it may take time to soak up all the items and timelines. So we will probably be placing out extra supplies as time goes on. And there may be additionally simply fairly a bit that we do not know as a result of the textual content of H.R. 1 is the one steering that is been put out by CMS thus far that is obtainable to the general public.
So state businesses and us as advocates are awaiting additional steering on how this textual content is interpreted, extra readability on definitions, and what states can and might’t do when implementing these provisions. However states can take some steps now, like deciding whether or not to take up a number of the extra permissible items, like including in short-term hardship exemptions, or analyzing what methods we at present have in place for folk to make use of to show they meet work necessities, or analyzing what different system adjustments is perhaps wanted. So with that, let’s get again to a number of the different adjustments.
H.R. 1 additionally narrows the size of the Medi-Cal retroactive interval, which as we speak is three months. So retroactive Medi-Cal permits individuals, in the event that they meet all different eligibility necessities, to get Medi-Cal protection for the three months previous to the preliminary utility. And retroactive protection is admittedly beneficial as a result of it gives medical health insurance for providers acquired previous to making use of for Medi-Cal. And it is helpful for individuals who expertise sudden well being crises or want long-term care.
These are individuals not on Medi-Cal initially, however after their well being disaster want to use for Medi-Cal protection. In order that they want Medi-Cal to start sooner than their date of utility. And retroactive Medi-Cal provides you that cushion to assist pay for sudden medical care. However underneath H.R. 1, retroactive protection will probably be narrowed to 2 months for those that are over 65. For youthful adults, retroactive protection is proscribed to at least one month solely. So by limiting that retroactive interval, it is making it a lot more durable for individuals to obtain care and use the additional time to collect the documentation they want for his or her Medi-Cal utility.
One other provision takes place in January 2028 and there will probably be a restrict on how a lot an individual can have in dwelling fairness and qualify for Medi-Cal funded long-term care providers. Folks with dwelling fairness value greater than 1 million won’t qualify for Medi-Cal coated nursing facility care or different long-term providers and helps. And this significantly impacts California because the typical dwelling prices two instances extra right here than in different elements of the nation, particularly in our excessive value areas like Los Angeles or the Bay Space. And so somebody might need purchased their dwelling a long time in the past, when home costs had been cheaper, however now the worth of their house is value greater than one million. And usually, dwelling fairness is the distinction between the property worth and any excellent debt or mortgage.
There are some exceptions to the house fairness limits, equivalent to having a dependent partner or baby that lives within the dwelling, and land that’s zoned for agriculture can be exempt. However by and huge, we are going to see that the house fairness restrict will make many individuals ineligible for Medi-Cal long-term care providers or they could be pressured to promote their dwelling to qualify. So this provision is particularly dangerous for older adults since Medi-Cal is the first payer of long-term care in California and for a lot of home is your most vital asset.
Right this moment, California doesn’t have a house fairness restrict as we speak in 2025, and that is as a result of we don’t contemplate belongings for functions of qualifying for Medi-Cal. Nonetheless, the asset restrict is returning, and in 2028, the house fairness restrict will apply in California. And later, in as we speak’s webinar, we’ll be going over a number of the state price range adjustments just like the return of the asset restrict. Subsequent slide, please.
There are two different provisions I will cowl rapidly. So first, in December 2026, California should conduct extra frequent Me-Ca renewals for the grownup growth group age 19 by means of 64. Right this moment, renewals are set directly yearly or each 12 months for all enrollees, however that can change in December 2026 to each six months for the 19 to 64 new growth or new grownup group. In order that signifies that older adults age 50, 64 which might be on this group can even be impacted.
One other provision begins in October 2028, and it’ll require states to impose cost-sharing for this 19 to 64 new grownup growth group who’ve incomes over one hundred percent of the federal poverty degree. So states can have the choice to decide on the cost-sharing quantity between $1 to $35. Value-sharing will apply to pick out medical providers solely. It doesn’t apply to each factor within the each medical service. And folks which might be over age 65 or who’re a twin eligible won’t be topic to this cost-sharing.
As we all know, individuals on Medi-Cal have restricted incomes, so requiring folks that have restricted incomes to pay cost-sharing will merely result in lowered healthcare utilization. Folks will go with out care, and that can result in a sicker, extra susceptible California. So within the lead-up to the implementation of this provision, one factor that advocates can do is to push their state to set the cost-sharing quantity to the bottom quantity potential to mitigate the hurt that it will trigger. Subsequent slide, please.
So the previous few slides we coated, restrictions are going to make it more durable to qualify. However H.R. 1 additionally stops laws that had been created to enhance entry and high quality of care. So one such affect is pausing implementation of some provisions of the streamlining Medicaid eligibility and enrollment rule. This streamlining rule eliminated limitations that folks usually encounter after they apply for Medi-Cal or doing throughout the renewal course of.
It additionally had particular provisions for those that had been duly eligible in Medicare and Medi-Cal. And since dual-eligibles obtain healthcare from two totally different sources of protection, the streamlining position tried to make enrolling within the Medicare financial savings packages more easy. And once more, the Medicaid packages that make Medicare extra reasonably priced by serving to pay Medicare value sharing. So by pausing provisions of the streamlining rule, states should not have to implement them as initially required.
In California, nonetheless, I will say that the state already carried out one of many massive provisions of the streamlining rule, which was the requirement to robotically enroll individuals on supplemental safety earnings. Folks on SSI robotically get Medi-Cal by advantage of getting SSI. So SSI-linked people had been robotically enrolled within the certified Medicare Beneficiary program, which is simply one of many Medicare financial savings packages. The certified Medicare Beneficiary program is admittedly beneficial. It gives value sharing help for the bottom of Medi-Cal enrollees as a result of the earnings limits are set at one hundred percent of the federal poverty degree.
California already carried out the availability to robotically enroll SSI-linked people into the certified Medicare Beneficiary program and it’ll not be rolled again. Half A buy-in can even proceed as is as properly. There was a provision to vary the family dimension definition within the Medicare financial savings Program to match the low earnings subsidy, however that provision is paused due to H.R. 1 and California doesn’t must comply as initially required.
H.R. 1 additionally blocks implementation of a nursing dwelling minimal staffing rule, which ensured {that a} minimal variety of nurse aides and registered nurses had been on workers at nursing amenities throughout the nation. And this rule was estimated to save lots of 13,000 lives per 12 months. So that is significantly dangerous for older adults resigning in nursing houses as a result of as we all know, well being outcomes and high quality of long-term care is predicated closely on the variety of nurse aides and nurse workers that amenities have. Subsequent slide, please.
After which there are additionally cuts to Medicare. So we mentioned adjustments to Medicaid, however Medicare can be impacted. There are thousands and thousands of individuals duly enrolled in Medicaid and Medicare and virtually one-third of all nationwide Medicaid funding is spent on people who find themselves additionally enrolled in Medicare. So any of those cuts to Medicaid will have an effect on Medicare enrollees as hundreds of individuals depend on Medicaid for long-term care as a result of Medicare’s protection of nursing facility and home-based care is simply very restricted.
After which moreover, H.R. 1 makes direct cuts to Medicare eligibility for immigrants. So previous to H.R. 1, lawfully current immigrants certified for Medicare in the event that they in any other case met different program necessities, like age and work historical past within the US, similar to some other US citizen. However now with the passage of H.R. 1, immigrant eligibility for Medicare is proscribed to a few particular teams which might be listed on the slide. And these are lawful everlasting residents, also referred to as inexperienced card holders, Cubans and Haitians who entered underneath a household reunification program, and other people residing underneath the Compacts of Free Affiliation or COFA. COFA are people who find themselves from choose international locations within the Pacific Ocean like Palau or Micronesia.
In order that signifies that outdoors of those three classes, all different lawfully current immigrants will lose Medicare eligibility. Present enrollees who’re immigrants however not considered one of these three classes will see their Medicare terminated in January 2027. After which extra instantly, new enrollment into Medicare is prohibited for all different lawfully current immigrants aside from these three teams listed. So new immigrants outdoors of those three teams can not newly enroll into Medicare after which we can even see present Medicare enrollees lose their protection in January 2027 due to these immigration adjustments.
Immigrants who’re shedding eligibility embrace people who find themselves granted refugee standing and other people with short-term protected standing. These are individuals who have paid Medicare taxes for years, who’ve labored and paid into the system underneath the promise of future protection. After which by statute, there’s additionally a sequestration problem that would take impact until congress acts. So by regulation, any laws that considerably will increase the deficit additionally triggers $500 billion in cuts and scale back Medicare supplier charges. These cuts could result in fewer Medicare suppliers if suppliers resolve to go away the Medicare program due to these cuts and Congress would wish to cross laws to exempt Medicare from these cuts. Subsequent slide, please.
The affect of chopping Medicare eligibility for immigrants is that H.R. 1 basically decoupled social safety eligibility and Medicare. Earlier than, lawfully current immigrants that certified for social safety additionally met the necessities for Medicare, however now limiting Medicare for immigrants breaks Medicare’s promise. These are individuals who have paid into Medicare by means of payroll taxes anticipating to turn out to be eligible, and now they’re shedding a profit they paid into which is intentionally unfair and punishing. And on high of that, H.R. 1 additionally excludes the identical newly ineligible immigrants from Medicaid and {the marketplace} subsidies by means of Lined California.
The end result of all these adjustments signifies that many older immigrants will probably be left uninsured as soon as Medicare is stripped away. There will probably be few choices for protection in case you can’t afford the complete value of personal medical health insurance or should not have protection by means of an employer. So this coverage can even hurt US residents as properly. Immigrants play a significant position in healthcare and long-term care as one in 4 direct care staff are immigrants they usually present each day caregiving assist in home-based settings. Immigrant caregivers both paid or unpaid who lose well being protection may have to go away their jobs and discover different employment that can present medical health insurance, which can affect and jeopardize our already giant workforce scarcity. Subsequent slide, please.
And as talked about within the final slide, Medicaid eligibility can be being restricted for a lot of lawfully current immigrants. Similar to with Medicare, solely these three immigrant classes which might be listed on this slide stay eligible for federally funded Medicaid after October 2026. After which eligibility for premium tax credit by means of the Lined California well being trade can even be restricted to the identical teams on the slide. Different lawfully current immigrants could join protection on Lined California, however they need to pay the complete month-to-month premium which might run a number of hundred {dollars}.
And fortunately, in California, there could also be different choices for people who find themselves low-income. First, our Medi-Cal program has expanded to incorporate all immigrants no matter immigration standing. And California does this utilizing state funds solely. So immigrants shedding eligibility underneath H.R. 1 can proceed on Medi-Cal as soon as these adjustments go into impact. And a number of other counties additionally provide discounted healthcare for low-income individuals who don’t qualify for Medi-Cal or Medicare. And though it will not be complete insurance coverage, these packages are various sources of care. Advocates ought to examine whether or not their counties provide these kind of well being packages. Subsequent slide, please.
And this slide simply gives a timeline for every of the provisions that we coated stretching from now to 2028. And with that I’ll cross it again to Hagar.
Hagar Dickman: Thanks, Tiffany. So I will speak somewhat bit about some mitigation methods and advocacy alternatives in response to H.R. 1. Go to the subsequent slide.
Our first mitigation technique, and presently I feel it is a very powerful, particularly as a result of we have not actually began on implementation. We’re type of all ready to see what the implementation efforts are going to seem like. A very powerful mitigation technique proper now could be training, each about what’s and isn’t within the regulation. For instance, the regulation would not make a whole lot of direct adjustments to Medi-Cal. There are not any direct adjustments, for instance, to earnings eligibility guidelines at this level.
The largest affect of H.R. 1 is on California’s future price range. As a result of many cuts are usually not but in impact, individuals ought to proceed enrolling and receiving Medi-Cal providers. So advocates ought to actually be encouraging continued enrollment in this system. We additionally do not have a whole lot of element at this level about how these cuts and what particular are going to seem like, and what particular measures like work necessities will seem like or what documentation goes to be wanted, if in any respect, what kind of verification individuals will want if in any respect. And so we’ll know extra about these in months to come back and we’ll educate our community as properly. However at this level, a very powerful factor is to stay educated and engaged about what we do know.
And eventually, customers nonetheless have their due course of rights. There haven’t been any adjustments about notices of termination or attraction rights from hostile selections. So individuals ought to actually be getting assist advocating for themselves and implementing their rights. If a Medi-Cal member, for instance, experiences some unfavourable motion on Medi-Cal eligibility or service, they need to not assume it is from H.R. 1 impacts and may pursue their attraction rights and battle to maintain their entry to providers. Subsequent slide, please.
Because the federal authorities begins issuing steering to states, California goes to start out additionally engaged on implementing H.R. 1, and most of that process will fall to the Division of Healthcare Providers. We urge advocates to work with the state to attenuate hurt wherever there may be state discretion. Whether or not it is asking customers to pay essentially the most minimal Medi-Cal copay allowable, requiring the least frequent eligibility checks, or utilizing as many automated exemptions allowable for work necessities, these are all issues that we as advocates ought to be encouraging the state to take up.
We do not need California to hurry to implementation earlier than steering is supplied. Advocates ought to be speaking with DHCS as an alternative about issues and the affect of any proposed coverage earlier than implementation. So stakeholder engagement goes to be key in ensuring that implementation efforts decrease hurt. And very similar to we have been doing in California, advocates ought to proceed advocating for strengthening dwelling and community-based providers, strengthening Medi-Cal eligibility limits, and implementing streamlined provisions that assist older adults and other people with disabilities get them to maintain their Medi-Cal protection.
So at the same time as we’re engaged on potential dangerous insurance policies, we should always actually hold these three rules in thoughts and actually push for expanded providers, strengthened Medi-Cal, and streamlined provisions that key individuals coated. Subsequent slide, please.
Advocates also needs to proceed to attach with neighborhood advocates to watch implementation. So direct service advocates and supplier teams in addition to ageing and incapacity advocates are all uniquely positioned and might present totally different lenses and the way implementation is impacting members. And so speaking amongst one another and actually educating yourselves and the neighborhood about what you are seeing and experiencing goes to be essential to tell our advocacy.
And eventually, I actually urge you to proceed sharing and accumulating tales about how implementation is impacting Medi-Cal entry, and sharing these tales with the media, with policymakers, social media and different platforms as a result of individuals ought to actually know and are additionally extra conscious of the real-life affect of those dangerous insurance policies. We will, in case you do not thoughts, go to the subsequent slide. We will now flip to the California price range. Do you thoughts going to the subsequent slide please?
We will flip now to the California price range. You possibly can go to the subsequent slide as properly. Governor Newsom signed a state price range on June twenty seventh that responded to a $12 billion price range deficit within the state, and that is unrelated to H.R. 1 or any federal motion. That is earlier than any of these dangerous federal actions have been carried out or taken place. That is simply the character of the California price range at this level.
The ultimate price range impacted Medi-Cal in two distinct methods, the reinstatement of the Medi-Cal asset check and adjustments to immigrant eligibility and protection of sure teams. So I will flip it Tiffany now to undergo these adjustments and impacts.
Tiffany Huyenh-Cho: So like Hagar mentioned, the state price range imposes important adjustments to Medi-Cal. These adjustments had been handed in California earlier than H.R. 1 was signed. As you all know as we speak, asset limits had been utterly eradicated from Medi-Cal in 2024, however these asset limits will probably be reinstated beginning this January 2026. And older adults and other people with disabilities are impacted as a result of they’re the principle group to which asset limits apply. Youthful adults and youngsters on Medi-Cal by means of our Inexpensive Care Act based mostly packages should not have asset limits.
The widespread eligibility pathways for older adults and other people with disabilities are the Aged and Disabled program. The 250% Working Disabled program, Share of Value, Lengthy-Time period Care, and the Medicare Financial savings Applications. These packages will see asset limits return. So starting in January 2026, older adults and other people with disabilities should meet each earnings and asset limits to qualify for Medi-Cal.
The asset restrict will probably be going again to what we had previous to elimination. So it is going to be set at 130,000 per particular person with a further 65,000 per family member. Property embrace issues like financial institution accounts, vehicles, or homes. With belongings coming again, the previous asset counting guidelines are additionally restored. So issues that had been exempt previous to elimination can even be exempt. The house an individual lives in and the primary car are usually not counted, all different countable belongings have to be beneath 130,000 for a single particular person.
After which after January 2026, individuals who newly apply should certify that they meet the Medi-Cal asset restrict, after which present enrollees on Medi-Cal now won’t must certify their belongings till their first renewal in 2026. DHCS can even be accumulating knowledge on those that lose eligibility throughout the first 12 months after belongings return. So we need to know if persons are shedding Medi-Cal as a result of they’re ineligible and over-asset, or if the method approving belongings at renewal is inflicting individuals to lose protection. Subsequent slide, please. Subsequent slide, please. Thanks.
So simply as some background earlier than we get into the subsequent slides, Medi-Cal is a collectively funded state and federal insurance coverage program. After which federal authorities gives funding to assist run every state’s Medicaid. However the federal authorities may also set guidelines on Medicaid eligibility, together with which immigrants qualify for federally funded Medicaid. In California, individuals who have what is known as passable immigration standing, the federal authorities gives federal funding to assist cowl their care. These embrace refugees, asylees, and inexperienced card holders who’ve been right here for 5 years.
For all different immigrants which might be thought of to have unsatisfactory immigration standing, California’s Medi-Cal program does cowl these immigrants in our full Medi-Cal, however California makes use of state funds solely to cowl the price of this care. So these embrace people who find themselves undocumented in addition to inexperienced card holders underneath the five-year bar, or individuals granted short-term protected standing within the US. And by increasing our Medi-Cal program over the previous few years, California has tremendously lowered our state uninsured charge and elevated our general public well being and wellbeing. Subsequent slide, please.
So as we speak, like we simply coated, full scope Medi-Cal has no immigration exclusions. In the event you in any other case meet Medi-Cal’s earnings and state residency necessities, you may qualify for Medi-Cal. Older adults over age 50 no matter their immigration standing, had been eligible to enroll in Medi-Cal as of Might 2022. However beginning this January 2026, California is stopping new enrollment into Medi-Cal for undocumented adults age 19 and older. Undocumented adults age 19 and older who are usually not pregnant and who apply after January 2026 will probably be restricted to restricted or additionally known as Emergency Scope Medi-Cal. These new candidates that apply after January 2026 won’t have entry to full Medi-Cal advantages, like main, specialty care, or in-home supportive providers. Restricted Scope Medi-Cal is proscribed to emergency care solely.
For present enrollees, they may stay on Medi-Cal. It is going to be essential for this group to retain their Medi-Cal eligibility and full annual renewals. And that is as a result of shedding Medi-Cal for a time period could imply they must reapply for Medi-Cal, after which they are going to be restricted to this emergency Medi-Cal due to this new cap on enrollment. And DHCS is referring to this cover on enrollment because the growth freeze.
Advocates with undocumented shoppers ought to present training on the significance of Medi-Cal renewals, which is now much more essential due to the enrollment cap. And I do know that there’s comprehensible worry about enrolling in or utilizing Medi-Cal as a result of immigrants are being focused by immigration authorities and immigrant knowledge has been shared with immigration officers. It’s a deeply private resolution whether or not to enroll in Medi-Cal or not, however the window is open to enroll proper now and it’s closing after December thirty first for immigrants that will probably be topic to this cover on enrollment. So subsequent slide, please.
And on high of all of that, California is introducing two different adjustments that affect immigrants. Dental protection will probably be eradicated for immigrants on Medi-Cal who’re age 19 and older. This may apply to all immigrants on Medi-Cal who’re thought of to have unsatisfactory immigration standing for Medi-Cal functions. So that features inexperienced card holders underneath the five-year bar, in addition to undocumented adults or individuals on humanitarian visas.
These immigrants will nonetheless have entry to all different full-scope Medi-Cal protection, your main specialty care prescriptions, every little thing minus dental. And this elimination of dental protection begins July 2026. After which beginning July 2027, these similar teams of immigrants will probably be topic to a month-to-month $30 premium. So to stay in Medi-Cal, you’ll have to pay this month-to-month premium for these group of immigrants. The premiums apply to these age 19 to 59 solely, individuals which might be age 60 and older won’t must pay the premiums, however the failure to pay may result in Medi-Cal termination.
And as talked about earlier than, the federal H.R. 1 does restrict the lawfully current immigrants which might be eligible for federally funded Medicaid in October 2026. However these immigrants ought to nonetheless qualify underneath state-funded Medi-Cal guidelines, however they are going to be topic to the premiums and lack of dental. So other than H.R. 1, California is in a troublesome spot they usually’re having to chop providers attributable to price range constraints, which solely exasperates the challenges that advocates and enrollees are going through as we speak.
So with that, I do know we coated loads as we speak. We will probably be placing out extra sources on the adjustments. So please join our listserv if you have not already. On this slide, there is a record of sources that cowl the federal adjustments underneath H.R. 1 that we mentioned. Subsequent slide. After which this slide has extra sources as properly. I will spotlight the final two hyperlinks. This slide are particularly from California’s Division of Healthcare Providers and it covers each adjustments from the federal H.R. 1 in addition to the California state price range. And with that, I will flip it again to Yasmin.
Yasmin Peled: Okay, so we at the moment are going to maneuver into questions. Once more, in case you have extra questions, please use the Q&A operate. I feel let’s begin with some clarification round work necessities and who falls into having to satisfy these work necessities and who doesn’t? There have been various questions on in case you’re on SSI or in a regional middle or within the aged and disabled pathway. So Tiffany, may you make clear which Medicaid group has to observe work necessities?
Tiffany Huyenh-Cho: Yeah. Work necessities solely apply to individuals which might be enrolled in our new grownup growth Medi-Cal class, which is about at 138% of the federal poverty degree as we speak. That is the class that was created underneath the Inexpensive Care Act over 10 years in the past. So solely adults on this group will probably be topic to the work necessities. Aged and disabled is a very totally different Medi-Cal pathway. That group won’t be topic to work necessities. Folks which might be duly eligible and have Medicare are usually not within the Inexpensive Care Act 19 to 64 group.
SSI people won’t be impacted by work necessities. SSI of us solely get Medi-Cal due to the receipt of SSI. In order that they have to satisfy SSI guidelines, and so long as they meet and obtain SSI guidelines, they get SSI linked Medi-Cal. They do not do Medi-Cal renewals and they won’t be topic to work necessities. It is actually solely the individuals on the Inexpensive Care Act 138% grownup growth class. So somebody in a regional middle that’s in that class could also be topic to work necessities, however provided that they’re in that pathway. When you have a incapacity and are on the aged and disabled program, you’ll not be topic to the work necessities. I do not know if you wish to add something.
Yasmin Peled: There are additionally various questions clarifying in regards to the immigration restrictions. Are you able to make clear the teams of immigrants that aren’t impacted by H.R. 1 that will not have their eligibility modified to the immigration standing? Are you able to simply repeat that?
Tiffany Huyenh-Cho: Yeah. So immigrants who haven’t been impacted by these H.R. 1 adjustments are lawful everlasting residents or also referred to as inexperienced card holders. Sorry, authorized, everlasting residents, also referred to as inexperienced card holders or LPRs, sure Cuban and Haitian entrants who entered the US by means of a household reunification program. After which individuals which might be residing within the US underneath the Compact of Free Affiliation. So these are individuals from sure international locations within the Pacific Ocean who’ve been granted residency and authorization to work within the US. Solely these three teams will retain eligibility for Medicare and federally funded Medicaid.
Different immigrants, equivalent to individuals granted refugee standing or asylum standing, though they’re thought of lawfully current, they’re shedding eligibility for Medicare and can lose eligibility for Medicaid as soon as these immigrant adjustments in H.R. 1 take impact. And there are different lawfully current immigrants which might be additionally impacted. There’s fairly a number of. I do not know all of them off the highest of my head so I do not need to get it incorrect, however refugees and asylees are one instance. Folks granted short-term protected standing are one other group of immigrants which might be going to be negatively impacted.
Yasmin Peled: After which on the adjustments to undocumented particular person’s entry to Medi-Cal right here in California, are you able to once more simply reiterate when the freeze goes into impact and when the premiums go into impact?
Tiffany Huyenh-Cho: Sure. The freeze goes into impact this January 2026, so we’re virtually three months away, the place California is capping the variety of new undocumented immigrants that may get onto our full scope Medi-Cal program. So enrollment is open proper now, however in January 2026, the undocumented immigrants can apply for Medi-Cal however will solely be eligible for our emergency or restricted scope Medi-Cal.
Folks which might be at present on Medi-Cal now and are undocumented can stay after January 2026. It is the brand new enrollment that’s being capped or frozen because the division is utilizing. After which premiums will begin in July 2027. Premiums will apply to all immigrants which might be on our state-funded program. So anybody that’s thought of to have unsatisfactory immigration standing. It is extra broad than individuals which might be undocumented. It contains individuals on short-term protected standing. It contains inexperienced card holders who’re underneath the five-year bar are thought of to be unsatisfactory immigration standing. In order that they can even be topic to these premiums in July 2027.
Yasmin Peled: There’s one follow-up right here on the premium. Is that this just for full-scope Medi-Cal recipients or additionally emergency scope Med-Cal?
Tiffany Huyenh-Cho: It is just for what we all know as full-scope now. I do not need to complicate it, however there’s one other time period that’s being added as a result of dental is being taken from the Medi-Cal protection for our state-funded immigrant program. It will be full-scope minus dental. So individuals on this scenario who’re shedding their dental, these are those that will probably be topic to the $30 premiums. In the event you’re on emergency or restricted scope Medi-Cal, that premium doesn’t apply.
Yasmin Peled: On the asset restrict and the return of the asset restrict, there is a query about retirement accounts and if these are counted in the direction of belongings.
Tiffany Huyenh-Cho: In case you are on the aged and disabled program or non-Inexpensive Care Act classes the place belongings are counted, your retirement account like a 401(okay) just isn’t counted so long as you are getting common distribution. So in case you’re getting month-to-month or common distributions out of your retirement account, that cash is counted as an earnings. So it does depend in the direction of an earnings restrict, however the remaining stability in your account just isn’t counted in the direction of the asset restrict, however provided that you are getting common distributions out of your retirement account. And that was what the previous guidelines had been. Once more, the previous asset counting guidelines are coming again. We’re basically going again to how we had been in January 2022 when our asset limits had been elevated to 130,000.
Yasmin Peled: After which I feel perhaps a remaining query is that if there are particular points for twin eligibles which might be distinctive to the twin eligible inhabitants within the adjustments to H.R. 1 that you just need to spotlight and uplift for our contributors as we speak?
Tiffany Huyenh-Cho: Nice query. So there are totally different ways in which dual-eligibles will probably be impacted. I feel one of many extra rapid ones are in case you are dual-eligible who’s an immigrant and you are not a authorized everlasting resident, you are not right here underneath COFA, and also you did not enter as a Cuban or Haitian entrant, you might lose Medicare and you might lose Medi-Cal as properly. So there are immigrants who’re dual-eligible who could also be shedding Medicare in January 2027.
I feel a number of the adjustments to our Medicare financial savings program enrollment, like we talked about, California may have aligned the family dimension for the Medicare financial savings program with the low-income subsidy definition. And the low-income subsidy makes use of a extra beneficiant definition of a family, whereas Medicare financial savings program appears to be like at your partner or registered home associate or in case you have a minor baby. However the low-income subsidy program has a extra expansive view and it might’ve included grandparents who deal with their grandchildren.
So that might’ve made making use of for a Medicare financial savings program simpler as a result of your family dimension could be greater and also you may’ve been capable of qualify underneath a much bigger family dimension due to your earnings. So that could be a change that California is not required to implement. It was going to be a requirement in April 2026, however with the pause, California doesn’t have to do that anymore. It is optionally available, nevertheless it’s not a requirement.
In order that’s one other affect that might’ve helped dual-eligibles extra simply qualify for the Medicare financial savings program. After which once more, I feel simply with the affect of the elevated workload that counties will probably be going through, not with simply with work necessities, but in addition with the extra frequent renewals for the ACA class, there simply going to be much less bandwidth on county workers. So dual-eligibles can also simply face longer processing instances attempting to get in contact with a caseworker or submit paperwork. All of that might be impacted due to the sheer quantity of change that’s being wrought by means of H.R. 1.
Yasmin Peled: After which this would be the remaining query, yet another on the immigration adjustments. I will learn this verbatim. To make clear, all immigrants who are usually not assembly the H.R. 1 passable immigration standing, in the event that they apply now for Medi-Cal and are enrolled previous to Jan. 1 of 26, won’t lose their Medi-Cal in 2027? Query.
Tiffany Huyenh-Cho: The January 1, quantity 2026 is critical for immigrants which might be undocumented. They’re those which might be topic to this cover. There are different immigrants who perhaps do not meet the passable immigrant standing, that is underneath federal definition, they will nonetheless enroll after January 2026. It is the individuals which might be undocumented who should not have a documented standing are those that will probably be topic to this cover.
So in case you’re an immigrant that’s thought of lawfully current, perhaps you’ve got that refugee standing, however you are shedding your federally funded Medicaid due to H.R. 1, it is best to be capable of apply after these adjustments take impact and get coated underneath our state funded Medi-Cal program as a result of we’re nonetheless masking individuals with, quote, unquote, “unsatisfactory immigration standing on state-funded Medi-Cal topic to premiums and dentals”. It is the group of immigrants which might be undocumented which might be topic to the freeze or cap on enrollment that begins in January 2026. So I hope I answered that query.
Yasmin Peled: Nicely, I would prefer to thanks all once more for becoming a member of us as we speak and thanks to my colleagues, Hagar and Tiffany. As a reminder, any questions that went unanswered as we speak will probably be adopted up on through electronic mail. And please be at liberty to succeed in out to our audio system with extra questions in case you give you them in a while. Please do not forget to finish the webinar survey. Your suggestions on these packages is essential to us. Thanks and have an important remainder of your day.
