Medi-Cal Archives - �鶹Ů�� Health News

Medi-Cal Immigrant Enrollment Is Dropping. Researchers Point to Trump’s Policies.

Claudia Boyd-Barrett — Wed, 15 Apr 2026 09:00:00 +0000

For months, a cloud of fear has hovered over the immigrant community in San Bernardino, California, making it hard for María González to do her job as a community health worker in this city where almost a quarter of residents are foreign-born.

It started building over the summer, fed by news of across Southern California, Trump administration plans to with Immigration and Customs Enforcement, and the passage of state and federal restrictions on immigrant Medicaid eligibility. Then in November, the federal government released a new that, if enacted, could block certain immigrants from obtaining permanent legal residency if they or family members have used public benefits, including Medicaid.

Many of González’ clients and their children, often U.S. citizens, still qualify for California’s Medicaid program, known as Medi-Cal, which provides health coverage to over 14 million residents with low incomes or disabilities. But increasingly, they don’t want to enroll or renew their coverage, she said.

“Many people don’t want to apply,” she said. “There are people who say they don’t even want to go outside and water their plants.”

An analysis by �鶹Ů�� Health News found that, from June to December, the latest month for which figures are available, almost 100,000 immigrants without legal status left Medi-Cal, representing about a quarter of all disenrollments in that time frame, even though this group makes up only about 11% of Medi-Cal enrollees.

It marks a reversal in a steady rise in enrollment among immigrants without legal status in California. Until July, sign-ups among this group had risen every month since the state opened Medi-Cal to all low-income residents regardless of immigration status in January 2024.

Tessa Outhyse, a spokesperson for the California Department of Health Care Services, which oversees Medi-Cal, said the enrollment declines can be mostly attributed to the fact that the government restarted eligibility checks that were suspended during the covid-19 pandemic. Indeed, overall Medi-Cal enrollment peaked in May 2023, and has since declined by about 1.6 million.

But two researchers, Leonardo Cuello at Georgetown University’s Center for Children and Families and Susan Babey at the UCLA Center for Health Policy Research, pointed out that California and most other states had fully resumed eligibility checks . In other words, that wouldn’t explain why enrollment has fallen precipitously in the last 12 months or so.

What has changed, Cuello said, is that the federal government passed the One Big Beautiful Bill Act, and executive orders added more changes that are propelling disenrollment.

Surveys Offer Clues

found immigrant adults nationally, especially parents, to be increasingly avoiding government programs that help pay for food, housing, or health care, to avoid drawing attention to their or a family member’s immigration status. That included lawfully present residents and naturalized citizens. Parental avoidance of these programs is particularly concerning, Cuello said, because about 1 in 4 children in the U.S. have an immigrant parent, even though most of those children were born in the U.S.

Cuello suspects that may help explain a nationwide enrollment drop of almost 3% in Medicaid and the Children’s Health Insurance Program during the first 10 months of last year, including a 5.6% drop in enrollment among California children, according to .

During the first Trump administration, the president broadened public charge criteria to allow consideration of Medicaid use and food and housing assistance. That led many citizen children and other household members to they were eligible for. Some the programs even after several courts blocked implementation and Democratic President Joe Biden rescinded the rule.

“It caused a high level of confusion,” said Louise McCarthy, president and CEO of the Community Clinic Association of Los Angeles County, which represents about 70 health centers in the Los Angeles area. “Community health center staff are still working to undo the effects of the first rule.”

Projected Savings

Currently, only people reliant on cash assistance programs or long-term, government-funded institutionalized care may be considered a public charge risk when applying for a visa to enter the country or to become a legal permanent resident. But under the Trump administration’s proposed rule, Medicaid and other noncash programs could be used to determine whether an immigrant is likely to become dependent on the government. Immigration officers would also have more discretion to label people a public charge.

The Department of Homeland Security’s proposal says the changes are needed because the existing rules hamper the agency’s ability to make decisions about an immigrant’s risk of becoming reliant on government resources. A public comment period for the proposal ended in December.

DHS did not respond to a request about when it plans to make a final decision on the rule. The change would “align with long-standing policy that aliens in the United States should be self-reliant and government benefits should not incentivize immigration,” the proposal states.

The agency projected the change could save federal and state governments almost $9 billion annually from people disenrolling from or forgoing enrollment in public benefit programs.

A of the proposed rule estimated it could result in 1.3 to 4 million people disenrolling from Medicaid or CHIP, including as many as 1.8 million citizen children.

“It’s clearly being weaponized to create fear and anxiety,” said Benyamin Chao, supervising health and public benefits policy manager at the California Immigrant Policy Center. He called the proposal part of an “assault on lawfully present immigrants and U.S. citizens who are family members, and just the general community.”

Public charge fears are expected to decrease enrollment also in anti-hunger programs, such as the Supplemental Nutrition Assistance Program, known in California as CalFresh. Mark Lowry, who heads the Orange County Food Bank, said that that — along with disenrollment related to the One Big Beautiful Bill Act — could overwhelm food pantries, since federal nutrition programs account for the vast majority of food aid.

“There’s no way that the emergency food system has the capacity or resources to address those needs,” he said.

Health Care Needs

Fear of Medi-Cal enrollment doesn’t extend to all immigrants. Juana Zaragoza manages a program in Oxnard that helps mostly Indigenous Mexican farmworkers sign up for Medi-Cal. Overall enrollment and reenrollment has remained steady over the past few months, she said. Neither she nor the community members she serves know much about the public charge proposal, she added.

Often, any concerns they have are outweighed by an immediate need for health care.

“We encounter a lot of people who are balancing: what benefits me now and what benefits me later,” she said. “Some just want to cover their needs in the moment.”

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How Medicaid Contractors Stand To Gain From Trump’s Policy

Samantha Liss — Fri, 03 Apr 2026 18:30:00 +0000

States are paying contractors such as Deloitte, Accenture, and Optum millions of dollars to help them comply with the One Big Beautiful Bill Act — a law that will strip safety-net health and food benefits from millions.

State governments rely on such companies to design and operate computer systems that assess whether low-income people qualify for Medicaid or food aid through the Supplemental Nutrition Assistance Program, commonly known as food stamps. Those state systems have a history of errors that can cut off benefits to eligible people, a �鶹Ů�� Health News investigation showed.

States are now racing to update their eligibility systems to adhere to President Donald Trump’s sweeping tax-and-spending law. The changes will add red tape and restrictions. They are coming at a steep price ― both in the cost to taxpayers and coverage losses ― according to state documents obtained by �鶹Ů�� Health News and interviews.

The documents show��government agencies��will spend millions��to save��considerably��more��by��removing��people from��health benefits.��While states��sign��eligibility system contracts with companies��and��work with them to manage��updates, the federal government��foots��most of the bill.

The law’s Medicaid policies will cause��to��become uninsured��by 2034, according to the nonpartisan Congressional Budget Office.��Roughly��will lose��access to��monthly cash��assistance��for��food, including those with children.��

In five states��alone,��for state officials��and reviewed by �鶹Ů�� Health News��show that changes��will cost at least $45.6��million��combined.��

The law��requires most states��to��tie��Medicaid coverage��for some adults��to��having��a��job,��and��imposes other restrictions that will make it harder for��people��with low incomes��to stay enrolled.��SNAP restrictions began to take effect in 2025. Major Medicaid provisions��begin��later this year.��

Documents��prepared by consulting company Deloitte��estimate��that a pair of��computer system��changes��for��Medicaid work requirements��in Wisconsin��will��. Two other changes��related��to the state’s SNAP program will cost an additional $4.2��million, according to the documents, which for the Wisconsin Department of Health Services.

In Iowa, changes to its Medicaid system are expected to cost at least $20 million, , a consulting company that��operates��the state’s��eligibility system.��

Optum��—��which��operates��the platform Vermont residents use��for Medicaid and marketplace��health��plans under the Affordable Care Act��—��to��evaluate and��incorporate��new��health��coverage restrictions.��

Initial changes in Kentucky, which has had a contract with Deloitte since 2012,��. And in Illinois,��will cost at least $12 million.

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Oz Says California’s Not Fighting Health Care Fraud, but Data Shows It’s Part of a Larger Battle

Don Thompson — Thu, 19 Mar 2026 09:00:00 +0000

SACRAMENTO, Calif. — For weeks, Mehmet Oz has been waging a public feud with California leaders over health care fraud, accusing the blue state of failing to adequately combat such abuse.

Oz, who heads the U.S. Centers for Medicare & Medicaid Services, there was approximately $3.5 billion of fraud in the hospice and home health care industry in Los Angeles County alone. “This administration under President [Donald] Trump is not going to tolerate taxpayer dollars being stolen because people aren’t paying attention anymore. We’re focused on this,” . He claimed the fraud was largely orchestrated by the “Russian, Armenian mafia” and said that most of the money spent on home and community-based services across California “might be fraudulent.”

However, CMS clarified that not all billing activities referenced by Oz were presumed to be improper. And a review of the most recent available data shows that there are hotbeds of health care fraud across the country and across practice areas, most of them allegedly perpetrated by health insurers and other domestic actors, and that California outperforms most other states in recovering fraud dollars.

As the temperature heats up in the conflict between the Trump administration and California, a handful of Republican state lawmakers have entered the fray, accusing Gov. Gavin Newsom in of allowing “rampant fraud.” Democratic state officials insist they aggressively combat fraud, and Newsom has filed a against Oz, calling language in the allegations “baseless and racially charged.”

“The Trump Administration is attempting to take the issue of fraud — a very real, and national issue — and weaponize it against Democratic states,” California Attorney General Rob Bonta said in an early February statement.

Oz said that he would halt “hundreds of millions of dollars” in payments to California if he didn’t get satisfactory answers from state officials. He and Vice President JD Vance announced in late February that they would delay about $260 million in Medicaid payments , another Democratic-led state, over fraud allegations there, and the state is now suing.

Oz has also launched social media campaigns alleging high-dollar public benefit fraud in Democratic-led Maine and New York. On March 17, he added a Republican-led state to his target list: Florida.

Georgetown University professor Andy Schneider, who served as a senior adviser primarily on Medicaid integrity issues during the Obama administration, said fraud has always been an issue across states, dating back decades. About $3.4 billion in Medicare and Medicaid fraud across the country was , according to the most recent report available. Insurers have paid the highest settlements in alleged health care fraud schemes.

“Bad actors trying to steal public health care funds have been around for a long time,” Schneider said.

How California Stacks Up

The federal government is responsible for Medicare, which primarily benefits older people, while Medicaid, which primarily serves people with lower incomes, is a joint federal-state program. Melissa Rumley, a spokesperson for the Department of Health and Human Services’ Office of Inspector General, said the office could not make state-by-state data on Medicare fraud available because the federal probes often cross jurisdictions.

States file annual reports on actions by Medicaid anti-fraud units that are jointly funded with the federal government and run by state attorneys general. They investigate fraud as well as abuse and neglect of Medicaid patients.

These reports provide a sense of the scale of Medicaid fraud across states. In fiscal 2024, states recovered , compared with $949 billion in total Medicaid spending, according to from the HHS Office of Inspector General. California recouped an outsize share, recovering more than 50% of all the criminal recoveries made by the anti-fraud units nationwide in fiscal 2024 even though the state made up only about 17% of enrollment.

California ranked fourth in the U.S. in 2024 in dollars recovered per Medicaid enrollee across civil and criminal investigations, behind the District of Columbia, Montana, and Delaware. It led all the most populous states, followed in order by Texas, Florida, and New York. (California and federal officials noted that state recovery data varies significantly year to year, often because of the length of investigations.)

Vulnerability of Hospice Care

One aspect of health care fraud that has been at the center of Oz’s attack on California is hospice fraud, which has plagued Republican and Democratic administrations.

The use of hospice, intended to provide care to patients expected to die within six months, increased by over 8% from fiscal 2020 to 2024, to about 1.84 million Medicare beneficiaries, significantly.

To combat fraud, the Biden administration in 2023 of hospices in California, Arizona, Nevada, and Texas. The Trump administration Ohio and Georgia.

CMS spokesperson Chris Krepich did not say specifically what criteria were used to choose which states to monitor, only that the decision was based on “activity typically indicative of hospice-related fraud.” As of June, the agency had revoked the Medicare enrollment of 122 hospices in the original four states, but Krepich said a breakdown by state was not available.

While Oz stated there was some $3.5 billion of fraud in the hospice and home health care industry in Los Angeles County alone, his agency clarified that the number is for overall Medicare billing related to hospice and home health services. Krepich said that “not all billing activity referenced in the remarks is presumed to be improper” and added that the agency could not identify the amount of fraudulent activity until an “evidence-based” investigation was completed.

That’s not to say there is no truth to allegations of hospice fraud.

A published in 2022 found “numerous indicators” of large-scale fraud in Los Angeles County, and a highlighted nearly 500 hospices within a 3-mile radius, including 89 companies registered to a single building in Van Nuys. that “hospice fraud has become an epidemic in California.” He noted that state officials have been aggressively combating it for years, including with .

In January, the state in Monterey County with hospice fraud. That follows hospice scam cases in and .

However, California public health officials are overdue in adopting that were supposed to be . The state’s Department of Public Health is currently revising the regulations, according to spokesperson Mark Smith.

In the interim, the state has revoked the licenses of more than 280 hospices over the past two years and is evaluating an additional 300 hospices, . California had licensed hospice agencies as of 2022, according to the state audit.

Civil Rights Complaint

Meanwhile, Newsom is pushing back on Oz. The governor filed his discrimination complaint with the at HHS, which oversees CMS. The office said it will first decide whether it has the authority to investigate, then, if so, will gather information through interviews and documents. However, the process seems designed to aid individuals who have lost a job to discrimination, or to correct a specific policy, and it is unclear whether there could be any real-world consequences.

The governor wants the agency to address “systematic bias from their leadership,” said Newsom spokesperson Marissa Saldivar.

Krepich said CMS “does not target communities, ethnic groups, or states” and bases its decisions on “confirmed investigative findings.” The allegations of organized fraud refer to “documented criminal cases,” Krepich said, providing a link to in which California residents were convicted of using the identities of foreign nationals to steal almost $16 million from Medicare.

It’s unclear what cases Oz was referring to when he spoke of the Russian and Armenian mafia.

Ciaran McEvoy, a spokesperson for the U.S. attorney’s office for the Central District of California, which includes Los Angeles County, said it doesn’t track whether hospice fraud defendants are alleged to be foreign nationals, but he pointed to the office’s online prosecution announcements. None alleged involvement by foreign influences or organized crime.

The state audit references by the U.S. Justice Department under President Barack Obama that an “Armenian-American organized crime enterprise” was behind a nationwide health care scam.

Federal officials at the time described an “international organized crime enterprise” based in Los Angeles and New York but with roots in Russia and Armenia. The scheme involved billing for unneeded medical treatments, not hospice fraud.

A revealed fraud schemes in which hospice operators recruited patients who were not actually terminally ill, then paid kickbacks to doctors who falsely certified these patients as dying so the hospices could bill Medicare. There was no mention of foreign involvement.

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Newsom Walks Thin Line on Immigrant Health as He Eyes Presidential Bid

Christine Mai-Duc — Thu, 05 Feb 2026 10:00:00 +0000

California Gov. Gavin Newsom, who is eyeing a presidential bid, has incensed both Democrats and Republicans over immigrant health care in his home state, underscoring the delicate political path ahead.

For a second year, the Democrat has asked state lawmakers to roll back coverage for some immigrants in the face of federal Medicaid spending cuts and a roughly that if the artificial intelligence bubble bursts. Newsom has proposed that the state not step in when, starting in October, the federal government stops providing health coverage to an estimated 200,000 legal residents — comprising .

Progressive legislators and activists said the cost-saving measures are a departure from Newsom’s , while Republicans continue to skewer Newsom for using public funds to cover any noncitizens.

Newsom’s latest move would save an estimated $786 million this fiscal year and $1.1 billion annually in future years in a proposed budget of $349 billion, according to the Department of Finance.

State Sen. Caroline Menjivar, one of two Senate Democrats who voted against Newsom’s immigrant health cuts last year, said she worried the governor’s political ambition could be getting in the way of doing what’s best for Californians.

“You’re clouded by what Arkansas is going to think, or Tennessee is going to think, when what California thinks is something completely different,” said Menjivar, who said previous criticism got her from a key budget subcommittee. “That’s my perspective on what’s happening here.”

Meanwhile, Republican state Sen. Tony Strickland criticized Newsom for glossing over the state’s , which state officials say could balloon to $27 billion the following year. And he slammed Newsom for continuing to cover California residents in the U.S. without authorization. “He just wants to reinvent himself,” Strickland said.

It’s a political tightrope that will continue to grow thinner as federal support shrinks amid ever-rising health care expenses, said Guian McKee, a co-chair of the Health Care Policy Project at the University of Virginia’s Miller Center of Public Affairs.

“It’s not just threading one needle but threading three or four of them right in a row,” McKee said. Should Newsom run, McKee added, the priorities of Democratic primary voters — who largely mirror blue states like California — look very different from those in a far more divided general electorate.

Americans are deeply divided on whether the government should provide health coverage to immigrants without legal status. In a last year, a slim majority — 54% — were against a provision that would have penalized states that use their own funds to pay for immigrant health care, with wide variation by party. The provision was left out of the final version of the bill passed by Congress and signed by President Donald Trump.

Even in California, support for the idea has waned amid ongoing budget problems. In a by the Public Policy Institute of California, 41% of adults in the state said they supported providing health coverage to immigrants who lack legal status, a sharp drop from the 55% .

, Vice President , , and congressional Republicans have repeatedly accused California and other Democratic states of using taxpayer funds on immigrant health care, a red-meat issue for their GOP base. Centers for Medicare & Medicaid Services Administrator Mehmet Oz has of “” to receive more federal funds, freeing up state coffers for its Medicaid program, known as Medi-Cal, which has enrolled roughly 1.6 million immigrants without legal status.

“If you are a taxpayer in Texas or Florida, your tax dollars could’ve been used to fund the care of illegal immigrants in California,” he said in October.

California state officials have denied the charges, noting that only state funds are used to pay for general health services for those without legal status because the law prohibits using federal funds. Instead, Newsom has made it a “” that California has opened up coverage to immigrants, which his administration has noted and helps them avoid costly emergency room care often covered at taxpayer expense.

“No administration has done more to expand full coverage under Medicaid than this administration for our diverse communities, documented and undocumented,” Newsom told reporters in January. “People have built careers out of criticizing my advocacy.”

Newsom warns the federal government’s “carnival of chaos” passed Trump’s One Big Beautiful Bill Act, which he said puts 1.8 million Californians at risk of losing their health coverage with the implementation of work requirements, other eligibility rules, and limits to federal funding to states.

Nationally, 10 million people could lose coverage by 2034, according to the Congressional Budget Office. higher numbers of uninsured patients — particularly those who are relatively healthy — could concentrate coverage among sicker patients, potentially increasing premium costs and hospital prices overall.

Immigrant advocates say it’s especially callous to leave residents who may have fled violence or survived trafficking or abuse without access to health care. Federal rules currently require state Medicaid programs to cover “qualified noncitizens” including asylees and refugees, according to Tanya Broder of the National Immigration Law Center. But the Republican tax-and-spending law ends the coverage, affecting legal immigrants nationwide.

With many state governors yet to release budget proposals, it’s unclear how they might handle the funding gaps, Broder said.

For instance, Colorado state officials estimate roughly 7,000 legal immigrants could lose coverage due to the law’s changes. And Washington state officials refugees, asylees, and other lawfully present immigrants will lose Medicaid.

Both states, like California, expanded full coverage to all income-eligible residents regardless of immigration status. Their elected officials are now in the awkward position of explaining why some legal immigrants may lose their health care coverage while those without legal status could keep theirs.

Last year, spiraling health care costs and state budget constraints prompted the Democratic governors of , potential presidential contenders JB Pritzker and Tim Walz, to pause or end coverage of immigrants without legal status.

California lawmakers last year voted to eliminate dental coverage and freeze new enrollment for immigrants without legal status and, starting next year, will charge monthly premiums to those who remain. Even so, the state is slated to spend $13.8 billion from its general fund on immigrants not covered by the federal government, according to Department of Finance spokesperson H.D. Palmer.

At a press conference in San Francisco in January, Newsom defended those moves, saying they were necessary for “fiscal prudence.” He sidestepped questions about coverage for asylees and refugees and downplayed the significance of his proposal, saying he could revise it when he gets a chance to update his budget in May.

Kiran Savage-Sangwan, executive director of the California Pan-Ethnic Health Network, pointed out that California passed a law in the 1990s requiring the state to cover when federal Medicaid dollars won’t. This includes green-card holders who haven’t yet met the five-year waiting period for enrolling in Medicaid.

Calling the governor’s proposal “arbitrary and cruel,” Savage-Sangwan criticized his choice to prioritize rainy day fund deposits over maintaining coverage and said blaming the federal government was misleading.

It’s also a major departure from what she had hoped California could achieve on Newsom’s first day in office seven years ago, when he declared his support for and proposed extending health insurance .

“I absolutely did have hope, and we celebrated advances that the governor led,” Savage-Sangwan said. “Which makes me all the more disappointed.”

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GOP Cuts Will Cripple Medicaid Enrollment, Warns CEO of Largest Public Health Plan

Bernard J. Wolfson — Thu, 15 Jan 2026 10:00:00 +0000

When the head of the nation’s largest publicly operated health plan worries about the looming federal cuts to Medicaid, it’s not just her job. It’s personal.

Martha Santana-Chin, the daughter of Mexican immigrants, grew up on Medi-Cal, California’s version of Medicaid, the government-run health care program for people with low incomes and disabilities. Today, she is CEO of L.A. Care, which runs by far the biggest Medi-Cal health plan, with more than 2.2 million enrollees, exceeding the Medicaid and Children’s Health Insurance Program enrollments in .

“If it weren’t for safety nets like the Medi-Cal program, I think, many people would be stuck in poverty without an ability to get out,” she said. “For me personally, not having to worry about health care allowed me to really focus on what I needed to focus on, which was my education.”

As she begins her second year steering L.A. Care, Santana-Chin is grappling with federal and state spending cuts that complicate her task of providing health care to the poor and medically vulnerable enrollees in Medicaid. The insurer also provides Affordable Care Act marketplace plans through Covered California.

Santana-Chin warns that the GOP’s One Big Beautiful Bill Act, enacted last year and also known as HR 1, could result in 650,000 enrollees falling off L.A. Care’s Medi-Cal rolls by the end of 2028. This will strain the plan’s finances as revenues decline. The insurer had revenues of $11.7 billion in the last fiscal year.

HR 1 is expected to cut more than $900 billion from Medicaid over the next 10 years — including in California, according to the Department of Health Care Services, which runs Medi-Cal.

Like other states facing big deficits, California has reduced its Medicaid spending through such steps as freezing new enrollments for immigrants without legal status and reintroducing an . And that’s before the state reckons with the spending cuts that likely will be required by the withdrawal of so many federal dollars under HR 1.

Santana-Chin oversaw Medi-Cal and Medicare operations for the for-profit insurer Health Net before taking the helm of L.A. Care in January 2025, nearly three years after state regulators over violations they said compromised the health and safety of its members. L.A. Care paid to the state and agreed to contribute $28 million to community health projects.

In a wide-ranging interview, Santana-Chin talked to �鶹Ů�� Health News senior correspondent Bernard J. Wolfson about the financial headwinds facing L.A. Care and why she believes health care shouldn’t be restricted based on a person’s immigration status. This interview has been edited for length and clarity.

Santana-Chin is the daughter of Mexican immigrants and was a beneficiary of Medi-Cal throughout her childhood. Because of that experience, she says, the concerns of L.A. Care members resonate with her on a personal level. (Bernard J. Wolfson/�鶹Ů�� Health News)

Q: You grew up on Medicaid. How has that shaped your views now that you run one of the largest Medicaid plans in the country?

What really motivates me is knowing that many of the people that we’re serving are just like my family. They’ve struggled and have had to have their own children translate things that were very difficult to translate. I remember doing that for my own mother. You know, basic human dignity requires that you have access to health care.

Q: Has anything you’ve dealt with at Health Net or L.A. Care reminded you of your childhood experiences in Medi-Cal?

Back then they didn’t cover transportation, and we didn’t have a vehicle. Today, one of the issues we’ll hear from our members is the need to make sure we have trustworthy transportation that shows up on time, where the drivers treat them with respect. Had I had that, had my mother had that, life would have been much easier.

Q: What do you think the impact of HR 1 will be?

It’s going to devastate the delivery system. The state obviously isn’t going to be able to make up for the shortfalls in federal funding, and over the course of the next several years, funding is going to be less and less, and the people we cover are going to decrease significantly. We are expecting between now and the end of 2028 that we’re going to see 650,000 people drop off the rolls. That’s just L.A. Care.

Q: That’s over a quarter of your Medi-Cal enrollment.

Yes, it’s very, very significant. The reductions in payment and the rise in uncompensated care are really going to impact our delivery system. As the delivery system gets destabilized and hospitals and other health care providers are forced to close services or reduce the number of sites they have, it’s going to impact access. And it’s not only going to impact those that lose coverage.

Q: How will L.A. Care respond?

Obviously, we’re going to see a significant drop in revenue. We’re very focused on making sure that we are operating as efficiently as we can operate. And we are looking at creative ways to use technology to empower our people to do higher-level work. Mostly supporting our call center agents with smarter technology that helps them answer questions and resolve problems more quickly. Some of it is automating processes on the claims payment side.

Q: What do you have to say to congressional Republicans who passed HR 1?

We are at a point of inflection in the health care delivery system. And we have to recognize that some of the components of HR 1 will have long-term unintended consequences — maybe they were intended; I’ve got to believe that some of these things are not. There’s probably a need to reconsider some of the things that were passed.

Q: Such as?

Work requirements are an example of something that many people did believe was the right thing to do to be good stewards of the health care dollar. It is very complex and is going to cause people to lose coverage that actually do qualify. It’s unfortunate, and that would be something that I would urge folks to reconsider.

Q: What impact do you expect from California’s decision to freeze Medi-Cal enrollment for immigrants without legal status?

It doesn’t matter what immigration status you are. If you are a human being and you need health care, you’re going to try to access health care wherever you can. That’s going to put a strain on the delivery system if you’re uninsured.

Q: What has L.A. Care done to address the state’s concerns in 2022 that it delayed authorizing care and addressing patient grievances?

There has been quite a bit of investment in the L.A. Care infrastructure over the last several years — our IT platforms, our data. There’s also quite a bit of investment in adding new capacity, adding bandwidth to many of the teams, more folks to help support the work.

Q: How have federal immigration raids in L.A. affected L.A. Care members and the broader community?

It absolutely has had a chilling effect. Families are afraid to come in. They’re not taking their children to get vaccinated. I’ve had numerous providers in emergency departments say that they have experienced a drop in the volume of individuals coming in. One of our case managers was really distraught because there was an individual that decided to forgo serious lifesaving treatment because of fear.

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This California Strategy Safeguarded Some Medicaid Social Services Funding From Trump

Mark Kreidler — Tue, 13 Jan 2026 10:00:00 +0000

When Virginia Guevara moved into a studio apartment in California’s Orange County in 2024 after nearly a decade of homelessness, she needed far more than a roof and a bed.

Scattered visits to free clinics notwithstanding, Guevara hadn’t had a full medical checkup in years. She required dental work. She wanted to start looking for a job. And she was overwhelmed by the maze of paperwork needed simply to get her off the street, much less to make any of the other things happen.

But Guevara had help. The Jamboree Housing Corp., an affordable-housing nonprofit that renovated the former Stanton, California, hotel Guevara now calls home, didn’t just move her in — it also provided her a fleet of wraparound services. Jamboree counselors helped Guevara navigate the health care system to see a doctor and a dentist, buy a few things for her apartment, and get training to become a caregiver.

“I was years on the street before I got the kind of help I needed so I could help myself,” said Guevara, 68.

Amid the Trump administration’s apparent opposition to using Medicaid funding for such social services, staffers at Jamboree and similar affordable housing providers in California have been worried about losing federal money, particularly as the experimental waivers that provide the primary funding for the program they rely on expire at the end of 2026. But as it turns out, the state had the foresight several years ago to designate certain nonhousing social services, such as mental health care, drug counseling, and job training, as a form of Medicaid spending that will continue to be reimbursed.

Catherine Howden, a spokesperson for the federal Centers for Medicare & Medicaid Services, confirmed that California’s use of the “in lieu of services” classification for these wraparound programs is allowed under federal regulations.

“It is starting to sound positive that we will, at the very least, be able to continue billing for these services after the waiver period,” said Natalie Reider, a senior vice president at Jamboree Housing.

During President Donald Trump’s first term, states were permitted to use Medicaid money for social support services not typically covered by health insurance. But the second Trump administration is reeling that policy back in, saying that the intervening Biden administration took the supportive services process too far. Howden said in a statement that the policy “distracted the Medicaid program from its core mission: providing excellent health outcomes for vulnerable Americans.”

Through CalAIM, a five-year experimental build-out of the Medicaid system, programs like Jamboree were able to leverage federal funding to offer the kinds of nonhousing social services that experts contend are essential to keeping people permanently housed.

However, these wraparound services are only one component of the CalAIM initiative, which is attempting to take Medicaid, known as Medi-Cal in California, in a more holistic direction across all areas of care. And when CalAIM launched, California officials gave the programs the Medicaid “in lieu of services” designation, known as ILOS, effectively putting them outside the waiver process and ensuring that even when CalAIM sunsets, money for those social initiatives will continue to flow.

“California has tried to future-proof many of the policy changes it has made in Medi-Cal by including them in mechanisms like ILOS that do not require federal waiver approval,” said Larry Levitt, executive vice president for health policy at �鶹Ů��, a health information nonprofit that includes �鶹Ů�� Health News. “That allows these policy changes to continue, even with a politically hostile federal administration.”

The designation allows these social services to be funded through Medicaid managed-care plans under existing federal laws because they are cost-effective substitutes for a Medicaid service or reduce the likelihood of patients needing other Medicaid-covered health care services, said Glenn Tsang, policy adviser for homelessness and housing at the state’s Department of Health Care Services. The state could not provide an estimate of the annual funding for these wraparound services because they are not distinguished from other payments made to Medicaid managed-care plans.

“We are full steam ahead with these services,” Tsang said, “and they are authorized.”

Although California was the first state to incorporate the designation for such housing and other health-related social support, Tsang said, several other states — including Arizona, Arkansas, Florida, New York, and North Carolina — are now using the mechanism in a similar fashion.

Early results suggest such support saves on health care spending. When Jamboree, in Northern California, in the Central Valley, and other permanent supportive housing providers employ a holistic approach that includes social services, they have reported higher rates of formerly homeless people remaining in housing, less frequent use of costly emergency health services, and more residents landing jobs that help them pay rent and stay housed.

At the nonprofit MidPen Housing, which serves 12 counties in and around the San Francisco Bay Area, roughly 40% of the units in the program’s pipeline are earmarked for “extremely low-income” people, a group that includes the homeless, said Danielle McCluskey, senior director of resident services.

CalAIM reimbursements help fund the part of MidPen that focuses on supportive services across a wide range of experiences, from chronic homelessness to mental health issues to those leaving the foster care system. McCluskey described it as one leg of a three-legged stool, the others being real estate development and property management.

“If any of those legs are not getting what they need, if they’re not funded or not staffed or resourced, then that stool is kind of wobbly — off-kilter,” the director said.

A recent found that people who used at least one of the housing support services — including navigation into new housing, health care assistance, and a deposit to secure an apartment — saw a 13% reduction in emergency department visits and a 24% reduction in inpatient admissions in the six months that followed.

Documenting those outcomes is critical because the department needs to show federal officials that the services lessen the need for other, often costlier Medicaid-covered care — the essence of the classification.

Advocates for the inclusion of supportive services argue that the American system ultimately saves money on those investments. As California’s homeless population to more than 187,000 on a given night — nearly a quarter of the U.S. total — Jamboree has been allocating more of its resources to permanent supportive housing.

Founded in 1990 in Orange County, Jamboree builds various types of affordable housing using federal, state, and private funding. Reider said about a fifth of the organization’s portfolio is dedicated to permanent supportive housing.

“They’re not going back out to the streets. They’re not going to jail. They’re not going to the hospitals,” Reider said. “Keeping people housed is the No. 1 outcome, and it is the cost-saver, right? We’re using Medicaid dollars, but we’re saving the system money in the long run.”

Job counselors provided by Jamboree Housing Corp. helped Guevara find work as a caregiver. (Juan Tallo/Jamboree Housing Corporation)

Guevara, who wound up on the streets after a falling-out with family in 2015, spent years living out of her truck before a shelter worker connected her with Jamboree. There, she was paired with a specialist to help her figure out how to get and see a doctor, and to keep up with scheduling the battery of medical tests she needed after years spent living in temporary shelters.

“I also got a job developer, who helped me get this job with the county so I can pay my rent,” Guevara said of her position as a part-time in-home caregiver. “Now I take care of people kind of the same way people have been taking care of me.”

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California Ends Medicaid Coverage of Weight Loss Drugs Despite TrumpRx Plan

Don Thompson — Fri, 09 Jan 2026 10:00:00 +0000

SACRAMENTO, Calif. — Many low-income Californians prescribed wildly popular weight loss drugs lost their coverage for the medications at the start of the new year.

Health officials are recommending diet and exercise as alternatives to heavily advertised weight loss drugs like Wegovy and Zepbound, advice experts say is unrealistic.

“Of course he tried eating well and everything, but now with the medications, it’s better — a 100% change,” said Wilmer Cardenas of Santa Clara, who said his husband lost about 100 pounds over about two years using GLP-1s covered by Medi-Cal, California’s version of Medicaid.

California joined several other states in restricting an option they say is no longer affordable as they confront soaring pharmaceutical costs and steep Medicaid cuts under the Trump administration, among . Despite negotiated price reductions announced in November that would make the drugs available at a “dramatically lower cost to taxpayers” and enable Medicaid to cover them, states are going ahead with the cuts, which providers say may undermine patients’ health.

“It will be quite negative for our patients” because data shows people typically regain weight after stopping the drugs, said , medical director of the University of California-San Francisco Weight Management Program.

While California, , , and stopped covering adult GLP-1 prescriptions for obesity on Jan. 1, they continue to cover the drugs for other health issues, such as Type 2 diabetes, cardiovascular disease, and chronic kidney disease.

, , and Wisconsin are planning or considering restrictions, according to �鶹Ů��’s .

That reverses a trend that saw 16 states covering the medications for obesity as of Oct. 1. Interest in providing the coverage “appears to be waning,” the survey found, likely due to the drugs’ cost and other state budget pressures. North Carolina pulled back GLP-1 coverage in October, but reinstated it in December, bowing to court orders despite a lingering budget shortfall.

Catherine Ferguson, vice president of federal advocacy for the American Diabetes Association and its affiliated Obesity Association, said it’s not clear how states will adjust to the White House plan to lower the cost of several of the most popular GLP-1s through TrumpRx, an online portal for discounted prescription drugs. The price of Wegovy, for example, will be $350 per month for consumers, versus the current list price of nearly $1,350, and Medicare and Medicaid programs will pay $245, according to the plan.

“Many states are facing budgetary challenges, such as deficits, and are working to address the impacts of the changes to Medicaid and SNAP,” Ferguson wrote, referring to the Supplemental Nutrition Assistance Program. “As more details become available for the Administration’s agreements, we will see how state Medicaid responds.”

The Department of Health and Human Services referred questions to the White House, which did not respond to requests for comment on states’ termination of Medicaid coverage for the weight loss drugs.

California projected its costs to cover GLP-1s for weight loss would have more than quadrupled over four years to if it didn’t end Medi-Cal coverage for that use. Medi-Cal has covered weight loss drugs since 2006, but use of GLP-1s soared only in recent years. By 2024, more than 645,000 prescriptions were covered by Medi-Cal across all uses of the medications. The California Department of Health Care Services could not readily provide a breakdown of whether the drugs were for weight loss or other conditions.

When asked whether the state would reconsider its plans in light of the announced price cuts, Department of Finance spokesperson H.D. Palmer said it had no plans to do so. California’s cut is written into .

California officials would not say how much it could save under the TrumpRx plan, citing federal and state restrictions on disclosing rebate information.

Health providers don’t expect the Trump administration’s negotiated price cuts to make much difference to consumers, because pharmaceutical companies already offer some discounts.

“The out-of-pocket costs will still be very cost-prohibitive for most, especially individuals with Medicaid insurance,” Thiara said.

is among the other states that ended their coverage Jan. 1. Officials with the New Hampshire Department of Health and Human Services did not respond to requests for comment.

About 1 in 8 adults are now taking a GLP-1 drug for obesity, disease, or both, up 6 percentage points from May 2024, according to released in November. Over half of users said their GLP-1s were difficult to afford, and many who had stopped the treatment cited the cost.

Public and private payers have been trying to wean patients off to save costs. California health officials said Medi-Cal members and their health care providers “other treatment options that can support weight loss, such as diet changes, increased activity or exercise, and counseling.” That echoes advice from the New Hampshire Medicaid program.

California Department of Health Care Services spokesperson Tessa Outhyse said in an email that the official advice to try those other approaches now “is not meant to dismiss any past efforts, but to encourage Medi-Cal members to take a renewed, proactive, and medically supported approach with their healthcare provider that may appropriately include these additional options.”

But that may be unrealistic, said , founding director of the Center for Clinical Nutrition at Keck School of Medicine of the University of Southern California.

“We definitely want patients to do their part with the diet and exercise, but unfortunately, and from a practical standpoint, that itself frequently is not enough,” Hong said, adding that usually by the time patients see doctors they have already failed at achieving results through those means.

Hong understands why Medicaid programs, as well as private providers, want to cut back on covering the drugs, which can cost per patient per year. However, they can produce twice the weight loss as the medications typically used previously, he said.

A school of medical thought supports patients’ gradually ending their use, but Hong said obesity is generally considered a chronic condition that requires indefinite treatment.

“Once they reach their target weight, a lot of people will try to see whether or not they can wean off,” Hong said. “We do see a lot of patients — when they try to get off, unfortunately, then the weight comes back.”

Medi-Cal members under age 21 for purposes including weight loss, California officials said, citing a federal requirement.

Medi-Cal members are able to keep their GLP-1 coverage if they can demonstrate it is medically necessary for purposes other than weight loss, the department said. Members who are denied coverage can seek a hearing, the department said in to members.

Members will still be able to pay for the prescriptions and may be able to use various discounts to lower costs. Another option is new pills to treat obesity, which will be cheaper than their injectable counterparts. The a pill version of Wegovy on Dec. 22, which will likely run $149 per month for the lowest dosage, and similar weight loss pills are expected to be available in the first half of the year.

While Cardenas said his husband, Jeffer Jimenez, 37, uses GLP-1s primarily for weight loss, Jimenez’s prescription is for his diabetes, so the couple hoped to continue receiving coverage through Medi-Cal.

“He tried a thousand medications, pills, natural teas, exercise program, but it doesn’t work like the injections,” Cardenas said. “You need both.”

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Medicaid Health Plans Step Up Outreach Efforts Ahead of GOP Changes

Claudia Boyd-Barrett — Mon, 22 Dec 2025 10:00:00 +0000

ORANGE, Calif. — Carmen Basu, bundled in a red jacket and woolly scarf, stood outside the headquarters of her local health plan one morning after picking up free groceries. She had brought her husband, teenage son, and 79-year-old mother-in-law to help.

They grabbed canned food, fruit and vegetables, and a grocery store gift card. And then Basu spotted a row of tables in the parking lot staffed by county social service workers helping people apply for food assistance and health coverage. Her mother-in-law, also a Medicaid recipient, might qualify for food assistance, she was told.

“It would be less money for me that I would have to put aside,” said Basu, who has been the sole breadwinner for the family from Anaheim since her husband suffered a stroke. “Maybe I can use that extra money to cover other expenses.”

Basu was among the more than 3,000 people who turned up at a November CalOptima event in one of California’s most affluent counties. It marked the start of a $20 million campaign by the Medicaid health insurer to help low-income residents get and maintain health coverage and food benefits as federal restrictions under President Donald Trump’s One Big Beautiful Bill Act take effect.

Over 3,000 people attended a food distribution and community resource event in November organized by CalOptima in Orange, California. Low-income people are being strained by high living costs, job losses, and worries about changes to food and health assistance programs, local officials say. (Alisha Jucevic for �鶹Ů�� Health News)

The law cuts more than for Medicaid, known in California as Medi-Cal. It also slashes around $187 billion from the Supplemental Nutrition Assistance Program, or SNAP, known as CalFresh in California. That’s about 20% of the program’s budget over the next 10 years. As a result, up to 3.4 million Medi-Cal recipients and almost 400,000 CalFresh beneficiaries could lose benefits. (Most CalFresh beneficiaries .)

Republican representatives say the changes, some of which have already taken effect, will prevent waste, fraud, and abuse through expanded eligibility checks and work requirements. Yet, Medicaid health plans across the nation are bolstering outreach to low-income households in a bid to not lose enrollees, many of whom are already struggling with high grocery and medical costs.

In Los Angeles County, L.A. Care Health Plan launched community information sessions this month to educate the public about upcoming changes to Medi-Cal. Hawaii’s AlohaCare is mobilizing a to help mitigate the impact of Medicaid coverage losses. And Community Behavioral Health, a Medicaid managed-care plan for behavioral health in Philadelphia, plans to host a series of summits starting next year to get the word out about the changes.

“We know that these changes will affect a lot of our members,” said Michael Hunn, CEO of CalOptima, one of about two dozen Medi-Cal managed-care plans paid monthly based on their number of enrollees. “We have a great responsibility to make sure that they understand and can navigate these changes as they are implemented.”

Sam Flores (far left) and his mom, Irene Flores (center left), pick up food from Second Harvest Food Bank team members Clarissa Green and Joey Fonseca-Islas. (Alisha Jucevic for �鶹Ů�� Health News)

CalOptima, a public entity whose board is appointed by county supervisors, has allocated up to $2 million through the end of 2028 to pay for county eligibility workers at events like the food giveaway to provide on-the-spot assistance. It’s funding that An Tran, head of Orange County’s Social Services Agency, said can help pay for critical outreach the county otherwise wouldn’t be able to afford.

Orange County has about 1,500 eligibility workers to handle reenrollments and verification checks for around 850,000 Medi-Cal members and over 300,000 CalFresh recipients.

“We are talking about families who desperately need help especially at a time when food costs and inflation is high and they’re barely able to make it,” Tran said.

In addition to funding county workers, CalOptima intends to provide grants to community organizations to conduct Medi-Cal outreach and run a public awareness campaign in multiple languages to make enrollees aware of new requirements, Hunn said.

U.S. Rep. Young Kim, a Republican who represents part of Orange County, did not respond to a request seeking comment but has said Trump’s signature budget law, which she voted for, “takes important steps to ensure federal dollars are used as effectively as possible and to strengthen Medicaid and SNAP for our most vulnerable citizens who truly need it.” She and other Republicans have said it will provide tax relief for working Americans.

Eligibility technician Maria Elisa Castillo (right) from the County of Orange Social Services Agency helps a Medi-Cal member. (Alisha Jucevic for �鶹Ů�� Health News)

After nearly an hour with an eligibility worker, Basu learned she earned too much for her mother-in-law, who lives with the family, to qualify for CalFresh. Now, Basu said, she’s worried about Medi-Cal eligibility changes for immigrants, which she fears could affect her mother-in-law, who obtained lawful permanent residency about a year and a half ago.

“Before having that, we were paying cash for cardiology, for labs, everything. It was very pricey,” Basu said. “I’m thinking I will have to, in a few months, pay again out-of-pocket. It’s a lot on me. It’s a burden.”

In most of the nation, people who’ve had a green card for less than five years generally for federally funded Medicaid. However, California has provided state-funded Medi-Cal coverage for them and low-income immigrants without legal status.

But even those benefits are being rolled back amid state budget pressures. In July, the state will eliminate full-scope dental benefits for some enrollees who have had a green card for less than five years, as well as certain other immigrant enrollees. A year later, this group will start being charged monthly premiums.

And starting in January, California will freeze enrollment for people 19 or over without legal status, as well as some lawfully present immigrants. It will also reinstate an asset limit for all older enrollees.

Meanwhile, the state is drafting guidance for counties on how to implement the federal Medicaid eligibility changes, said Tony Cava, a spokesperson for California’s Department of Health Care Services. The federal work rules and twice-yearly eligibility checks are slated to take effect by the start of 2027, applying to enrollees under the Affordable Care Act coverage expansion.

The California Department of Social Services, which manages CalFresh, has already changed how home utility costs are calculated and imposed a cap on benefits for very large households. It is still developing guidance for the federal work requirements and changes that disqualify some noncitizens, agency Chief Deputy Director David Swanson Hollinger said at a recent hearing.

The Department of Health Care Services has developed a “” webpage about the state and federal Medicaid changes. It’s also leveraging a network of Medi-Cal “” to provide information and updates in communities across the state in multiple languages. And it’s collaborating with counties and Medi-Cal managed-care plans to support community-based enrollment assistance, including at local events, Cava said.

Aquilino and Fidelia Salazar, a husband and wife getting help with a CalFresh application, said they didn’t expect to be affected by the work requirements and Medi-Cal eligibility changes. That’s because they are both permanent U.S. residents who have chronic health conditions and can’t work, they said. People considered physically or mentally unable to work can be exempted from work requirements. But the couple are concerned other immigrants in their community could lose care.

“It’s not fair because a lot of people really need it,” Fidelia Salazar said in Spanish. “People earn so little and then medicines and going to the doctor is extremely expensive.”

Medi-Cal enrollees Fidelia Salazar and her husband, Aquilino, pick up a box of Thanksgiving groceries. During the event, they were also able to get help signing up for food assistance through CalFresh. (Alisha Jucevic for �鶹Ů�� Health News)

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Health Care Costs Jump to the Fore as Candidates Jockey To Be California Governor

Claudia Boyd-Barrett — Mon, 10 Nov 2025 23:30:00 +0000

RIVERSIDE, Calif. — California’s gubernatorial election is a year away, and the field of primary candidates is still taking shape. But one persistent issue has already emerged as a leading concern: the cost of health care.

At Nov. 7 in the Inland Empire, four Democratic candidates vying to succeed Gov. Gavin Newsom vowed to push back against Republican cuts to health care programs and to improve people’s access to medical care, including mental health services. But while some floated taxes, candidates were light on details about how they would bring down health care costs.

Former U.S. Health and Human Services Secretary Xavier Becerra promised to be California’s next “health care governor,” echoing to lower costs and broaden access when he first got into office. State Superintendent of Public Instruction Tony Thurmond pledged to create a single-payer health care system in which everyone is pooled into one program. Former state Controller Betty Yee said she would “build back better” from federal cuts and create a health care system tailored to California’s diverse communities.

And former Los Angeles Mayor Antonio Villaraigosa vowed to fight to preserve safety net health care pared by the Trump administration and Republicans in Congress, although he acknowledged the challenge given limited state resources.

“I’m not gonna sell you snake oil,” he said. “It is going to be tough to provide that care, but I’m absolutely committed to it.”

The candidates’ assurances come amid recent shifts in state and federal policies that, together with a variety of forces, are driving up the cost of health care and making it harder for people to obtain and maintain coverage. In addition to providers raising prices, other include an aging population, rising chronic conditions, medical advancements, and new technologies, according to analysts. That’s added to a sense of financial precarity for the millions of Californians struggling with the state’s and .

Although the forum was open to up to six candidates, former U.S. Rep. Katie Porter and entrepreneur Stephen Cloobeck declined to participate, citing scheduling or other factors, according to Jon Koriel, an event spokesperson.

Four Democratic candidates vying to be California governor appeared at a forum on health care on Nov. 7 in Riverside: (from left) former U.S. Health and Human Services Secretary Xavier Becerra, California Superintendent of Public Instruction Tony Thurmond, former Los Angeles Mayor Antonio Villaraigosa, and former state Controller Betty Yee. (Leroy Hamilton)

Health Care Top Concern

A commissioned by the California Wellness Foundation ahead of the forum found that nearly 80% of likely voters worry about the cost of health care and that 72% think the next governor should prioritize capping out-of-pocket expenses. Access to affordable mental health care and being able to care for aging family members or friends were also top concerns. Perhaps in an early signal, voters last week in Santa Clara County passed to help backfill federal cuts to food and health care safety net programs.

California mirrors much of the nation. Exit polls from the Nov. 4 election show 81% of those who voted for Democrat Abigail Spanberger, winner of the Virginia governor’s race, as the most important issue facing the state. In a national , health care was cited as the top everyday expense Americans want Congress to prioritize. And 65% of voters said an annual health cost increase of $1,000 would have some impact on their 2026 vote, according to a .

Some Californians interviewed on Nov. 4, the day of the state’s special election, expressed disappointment in Newsom’s unmet promises on health care. Newsom, a Democrat who is mulling as he wraps up his second term in January 2027, had campaigned on .

During his tenure he’s steered billions of dollars and engineered rules to help the neediest Californians afford and access health care. The state also expanded state-funded Medicaid coverage, known as Medi-Cal, to all eligible residents, regardless of immigration status. Medicaid provides free or low-cost health insurance to low-income and disabled people.

But this year, facing rising costs and budget deficits, Newsom and the Democratic-controlled legislature walked back some of that expansion by freezing enrollment for adults without legal status starting in 2026 and implementing premiums. They also resurrected an asset test for older adults and people with disabilities. Meanwhile, health care costs and homelessness remain a huge problem, and many Californians . And there’s no sign of a single-payer health care system, which Sacramento lawmakers have repeatedly amid concerns about cost, including one estimate in 2017 of $400 billion annually.

“I remember him coming and speaking to our members and telling them that he was going to fight with them for single payer,” Michael Cusack, a 30-year-old former health care union worker from Oakland, said as he cast his ballot last week. “And I never saw him deliver on that campaign.”

Michael Cusack, a registered Democrat working at a national research lab in Oakland, California, says health care costs are top of mind for him as he weighs his vote next year, both for Congress and the governor’s race. (Christine Mai-Duc/�鶹Ů�� Health News)

Paying for Health Care

Becerra, Thurmond, and Yee said they would be open to raising taxes to pay for health care programs. Villaraigosa sidestepped the tax question, saying his focus would be to “grow the pie” economically. Yee also suggested offering tax credits to help struggling families pay for health care and caregiving expenses.

During the forum’s lightning round, Becerra, Thurmond, and Yee also raised their hands when asked whether they supported single-payer care. Becerra said after the event that he doesn’t believe the state would receive support from the Trump administration for a single-payer system, but he said he would push for universal access to health care.

Indeed, all the candidates appeared mindful of Washington’s power over health care resources, even as they vowed to stand up to President Donald Trump, who has an especially adversarial relationship with Newsom.

“Let’s recognize that the federal government is our largest partner,” Becerra said. “We must work with them. We will not take a knee, but we must work with them.”

Currently, the biggest threats to health care costs and accessibility come from the federal government. Republicans in Congress have refused to give in to Democrats’ demand to extend premium tax subsidies for health insurance plans purchased on Affordable Care Act exchanges, the main issue that drove the government shutdown. Enrollees in Covered California, the state’s health insurance exchange, have received notices that their premiums will increase next year. On average, monthly premium payments��for people receiving ACA subsidies��are across the nation.

Laura Jones, a small-business owner in Oakland, currently pays the minimum possible for her Covered California plan, but she worries she wouldn’t be able to afford a major medical emergency. She thinks about one of her friends who recently suffered a stroke.

“The hospital bills were just so egregious,” Jones said. “How would I pay for that?”

Meanwhile, an impending in federal Medicaid spending reductions under the One Big Beautiful Bill Act and tighter eligibility restrictions are expected to push as many as out of the program. More than a third of Californians are currently enrolled in Medi-Cal.

Oseoba Airewele, 29, of Ventura, a registered Democrat who previously worked as a software engineer, said Medi-Cal became a lifeline after he lost insurance through his job and needed mental health and dental care.

“If I were to lose it, I would be very concerned,” he said. “I’d be in a bad place.”

Oseoba Airewele stands next to a ballot box in Ventura, California, where he cast his vote in the Nov. 4 special election. Airewele enrolled in Medi-Cal after being laid off from his job as a software engineer. He says that coverage has been critical. (Claudia Boyd-Barrett/�鶹Ů�� Health News)

People with employer-based health coverage also face steep price hikes. Family premiums for employer-based plans averaged almost $27,000 this year, up 6% from 2024, a . Workers typically pay almost $7,000 of that, the report found. That doesn’t include other out-of-pocket expenses.

“Even though I have a job, it’s still really expensive to pay for the copays,” said Rheema Calloway, 35, a San Francisco independent.

Primary in June

Among the other Democratic candidates vying for governor in 2026, Porter has said she to Medicaid and Medicare a top priority, along with expanding and improving health care for all residents. Porter’s campaign suffered a blow after viral videos surfaced of her threatening to walk out of a CBS interview and berating a staff member. Former Assemblyman Ian Calderon has said he would protect . And Cloobeck wants to fast-track .

Republican candidates include Riverside County Sheriff and , a former Fox News contributor and policy adviser to David Cameron when he was Britain’s prime minister. Both have pledged to tackle affordability issues, especially housing costs.

Two other high-profile Democrats — former Vice President Kamala Harris and U.S. Sen. Alex Padilla — have said they won’t run. Rick Caruso, a Republican-turned-Democrat and wealthy Los Angeles businessman, has yet to decide whether to run.

The California primary will be held June 2 and the general election on Nov. 3.

�鶹Ů�� Health News correspondent Christine Mai-Duc and ethnic media editor Ngoc Nguyen contributed to this report.

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Health Care Cuts Threaten Homegrown Solutions to Rural Doctor Shortages

Bernard J. Wolfson — Thu, 18 Sep 2025 09:00:00 +0000

CHICO, Calif. — Olivia Owlett chose to do her primary care residency in this Northern California college town largely because it faces many of the same health care challenges she grew up with.

Owlett is one of four residents in the inaugural class of a three-year family medicine residency program run by the local nonprofit . She is the kind of doctor the organization seeks to draw to the far north of California, a region with .

That’s because Owlett knows in her gut what a lack of health care means, having seen family members drive hours to see a specialist or simply forgo care in her hometown of Wellsboro, a hamlet in Pennsylvania. She did rural training at medical school in Colorado. And because her husband attended Chico State, the couple has a strong social network here, making them likely to remain.

“With the growing family medicine residency program here, it’s a great opportunity to bring more doctors into the area, and I’d love to be a part of that,” Owlett said.

Owlett exemplifies what leaders in rural Northern California want more of: doctors trained locally who stay to work in the area. They have ambitious plans to attract more Owletts and expand the medical workforce, but recent state and federal spending cuts will pull dollars out of an already frayed health system, exacerbating the shortage of care and making their efforts more challenging.

“We need help up here, and cutting funding is not going to help us,” said Debra Lupeika, associate dean for rural and community-based education at the University of California-Davis School of Medicine and a family physician at the tribal Rolling Hills Clinic in Red Bluff, about 40 miles northwest of Chico. “We are in dire straits. We need doctors.”

California’s far northern region is a collection of sparsely populated counties stretching from just north of Sacramento all the way up to Oregon and from the Pacific coast to the Nevada border. The shortages are so pervasive that support for one of the costliest solutions — a proposed $200 million health care training campus — transcends partisanship.

“It’s about what are the priorities, right? And health care certainly is a priority — should be a priority,” said California Assembly Republican Leader James Gallagher, who represents Chico and the surrounding area. “I think it’s been pretty bipartisan, this kind of stuff.”

Republicans in Congress, including the nine GOP lawmakers in California’s delegation, voted in July to cut nearly a trillion dollars from Medicaid. Area Rep. Doug LaMalfa said the “those eligible for benefits continue to receive them.” Meanwhile, the Democratic-controlled California legislature has its health care coverage for immigrants who lack legal status.

California’s health care shortage is driven by the struggles of rural hospitals; an aging physician workforce; the inherent appeal to up-and-coming doctors of more urban areas; and the financial pressures of doing business in a region with a high proportion of , especially Medi-Cal, the state’s version of the Medicaid program, for people with low incomes and disabilities.

Almost everyone who lives up here is affected by the shortages, ranging from people with complex medical needs to those with simple, straightforward ones.

When Lupeika’s 24-year-old daughter, Ashley, injured her shoulder this summer, she couldn’t get an MRI for nearly a month, despite her severe pain.

Ginger Alonso, an assistant professor of political science and public administration at Chico State, said she drives 70 miles to Redding for OB-GYN care.

Ginger Alonso is an assistant professor of political science and public administration at Chico State. She is conducting interviews of health care providers about their decision of whether to relocate following natural disasters. (Bernard Wolfson/�鶹Ů�� Health News)

Enloe Medical Center is the only acute care hospital in Chico, California. Enloe Health’s CEO, Mike Wiltermood, said the closure of Glenn Medical Center, about 30 miles to the southwest, could bring a few hundred additional patients to Enloe’s emergency room every month. Enloe won’t have trouble absorbing them, but he worries about what Glenn’s closure portends for other small, financially precarious hospitals in the region. (Bernard Wolfson/�鶹Ů�� Health News)

The long waits or distances people must travel often lead them to delay or forgo care. As a result, they show up at emergency rooms, urgent care, or community clinics with illnesses that are more severe than they would have been had they received medical attention sooner.

“We see sicker patients, bottom line,” said Tanya Layne, a primary care physician in Chico who recently closed her private practice for financial reasons and works at an urgent care clinic in town, owned by Enloe Health, which also runs the sole hospital in town.

Patients walk through the door with undiagnosed cancers, uncontrolled asthma, raging diabetes, and severely high blood pressure, Layne said.

In many northern counties, specialists in acutely short supply include neurologists, gastroenterologists, rheumatologists, endocrinologists, OB-GYNs, oncologists, and urologists.

“We have whole areas with no specialists at all, or where specialists are so overworked that the waits are really long, and people are forgoing care,” said Doug Matthews, a Chico-based colorectal surgeon and regional medical director of Partnership HealthPlan, which provides Medi-Cal coverage in 24 northern counties.

The health care shortage in the region grew more acute after the catastrophic 2018 Camp Fire devastated the town of Paradise, 15 miles east of Chico, shuttering and sending dozens of doctors out of the region.

In response, local leaders created , which launched a four-year residency in psychiatry last year followed by the family medicine program this year. The group also runs a program to expose high school students to potential careers in health care, and it is behind early plans for the $200 million “interprofessional” health care campus that would train future doctors, nurses, physician assistants, and others.

James Schlund is a radiologist and board member of Healthy Rural California, a Chico-based nonprofit dedicated to improving public health and addressing the acute shortage of health care workers in California’s northern counties. Schlund is pushing for the creation of a $200 million health care campus to train a wide range of medical professionals in the region. (Bernard Wolfson/�鶹Ů�� Health News)

The startup cost would likely need to come from California’s state legislature, but lawmakers are limited by severe budget pressures. Nevertheless, James Schlund, a radiologist and board member of the organization, is discussing it with officials from UC Davis and Touro University.

“We are building the coalition,” Schlund said, “to go to the legislature with an empty bucket and ask them to fill it with money at the hardest of possible times.”

Meanwhile, medical and political leaders in Chico and Redding, the two largest cities in California’s far north, are each exploring building a medical school, possibly in collaboration and under the auspices of UC Davis, which considers rural medicine integral to its mission.

A medical school, paired with more residency slots, would keep graduating students in the area long enough for them to establish roots, buy homes, and start families, boosting the supply of local physicians, said Paul Dhanuka, a gastroenterologist and member of the Redding City Council.

But some say the region’s small population makes it a challenge to train more residents.

“The number of residents you can accommodate is limited by the ability to get the right kinds of patients with the right kind of cases that give the residents the training they need,” said Duane Bland, a physician who runs the family practice residency program at Mercy Medical Center in Redding.

Dhanuka said that in sparsely populated areas, a low number of childbirths limits how many residents can be trained in family medicine. But that is not the case with other specialties such as surgery, psychiatry, cardiology, and gastroenterology. And, he said, across the whole northern region, “there are multiple hospitals as well as clinics which absolutely are looking for more residency participation.”

Residency programs are largely funded with federal dollars through Medicare, and that funding is not at imminent risk — though the number of residency slots paid for by Washington has not significantly increased in about 30 years.

Duane Bland runs the family practice residency program at Mercy Medical Center in Redding, California. The region’s small population makes it a challenge to expand the size of residency programs, he says, because they are “limited by the ability to get the right kinds of patients with the right kind of cases.” (Bernard Wolfson/�鶹Ů�� Health News)

However, some graduate medical education is state-funded, and in California many of those slots rely on revenue generated from a tax on Medi-Cal health plans, which California voters earmarked for that and other purposes last fall by passing . That revenue is projected to under changes in the budget law and a similar rule proposed by the Centers for Medicare & Medicaid Services.

“We could lose that Prop. 35 funding,” said Mark Servis, vice dean for medical education at the UC Davis School of Medicine. “And we have been planning on it for over a year as a way to build out graduate medical education.”

Servis and other medical educators also worry about new caps on federal student loans, which could deter lower-income students, including those in rural areas, from medical school.

Altogether, the financial constraints will only make the health care shortage worse — in large part because of its impact on the region’s smaller, weaker hospitals and the burden on those that remain.

It’s already begun: Glenn Medical Center in Willows, about 30 miles from Chico, announced last month it its ER and hospital services in October after losing its federal designation as a “critical access” hospital, which afforded it higher payments and more regulatory flexibility.

A $50 billion rural health care fund in the budget law will offset a little more than a third of the money that rural areas are expected to lose because of the Medicaid cuts, from �鶹Ů��. And it’s not clear how, or to which states, that money will be distributed.

Civic and medical industry leaders in Chico and Redding say the message needs to get out that a robust health care system will serve the interests of everyone, across political lines.

“Health care is such a human need, because we all hurt the same, regardless of race, color,” Dhanuka said. “We can address this. And we don’t need to take sides on this.”

This article was produced by �鶹Ů�� Health News, which publishes , an editorially independent service of the .��

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