Reforms to ease federal Medi-Cal changes in San Diego passed

The San Diego County Board of Supervisors voted 4-1 Tuesday in favor of reforms aimed at making health care more accessible and helping residents maintain coverage as federal Medi-Cal requirements change.

The reforms proposal by board Chair Terra Lawson-Remer and Vice Chair Monica Montgomery Steppe are intended to modernize County Medical Services by removing barriers including property liens, credit checks, reimbursement agreements, some in-person appointments and red tape.

“County Medical Services is supposed to help people who have nowhere else to turn, but some of its requirements have made getting care unnecessarily difficult,” Montgomery Steppe said. “These reforms are an important step toward making health care more accessible, and we know there is more work ahead as federal changes threaten coverage for thousands of San Diegans.”

Changes under the Trump administration are projected to cause 68,761 San Diegans to lose Medi-Cal coverage because of new federal work requirements. Another 67,630 people currently receiving full-scope Medi-Cal are projected to lose that coverage because of immigration eligibility changes, according to a statement from the supervisors.

“San Diego County must be prepared now to protect our health care system from the severe federal funding cuts and rising costs coming at us. People don’t stop getting sick when they lose their health coverage,” Lawson-Remer said. “When Washington creates holes in the health care safety net, the consequences eventually show up in our clinics, in our hospitals and in our emergency rooms.”

Medi-Cal is California’s Medicaid program, providing free or low-cost health coverage to people who qualify.

Before Tuesday’s vote, Lawson-Remer said the measure would not fix House Resolution 1, passed by the Republican-controlled Congress last year, as the money is not there to cover gaps in federal funding cuts.

“We have to build a better county safety net for people who lose their coverage because they’re not eligible for Medi-Cal,” she added.

Supervisor Jim Desmond was the lone no vote Tuesday. He said that while he agreed with many of the recommended updates for the application process, he didn’t agree with the overall direction of the program.

He said the county shouldn’t expand medical services to able-bodied adults who won’t volunteer or work 20 hours a week, or those living in the United States who are not documented.

“We cannot afford to do that,” he said.

The board voted 4-1 in March to study the reforms, forming an ad hoc subcommittee composed of Lawson-Remer and Montgomery Steppe.

One of the major changes involves property liens that applicants may be required to sign, allowing the county to secure repayment of county-paid medical expenses against real property.

“For a program intended to serve people with nowhere else to turn, that creates a basic contradiction: accessing last-resort health care can also mean accepting a long-term financial claim against one of the most important assets a family can build,” according to a statement from the supervisors’ offices.

Their plan eliminates the lien requirement, releases existing liens and ends lien-based repayment for services.