Last November, the director of the state Department of Health Care Services was “pleased to announce” that the federal government had approved a new five-year Medicaid Section 1115 waiver for California. In his announcement letter, he summarized the $10 billion plan, referred to as the “California Bridge to Reform,” and proclaimed that health care coverage would be expanded ” to as many as 500,000 low-income uninsured residents” under the new program. The other provisions are designed to help counties prepare for the changes in 2014 brought about by the federal health care reform laws enacted last year and to move the high-cost, high-service-consuming seniors and persons with disabilities from the state’s fee-for-service program to the more cost-efficient regional managed care programs.

Getting this waiver and the largess that comes with it is welcome relief for our deficit-plagued state and cash strapped counties. But a “bridge to reform” …well…that may be hard to demonstrate?

County budgets have been stressed for several years now, and many support the medical care needs of our poor and vulnerable residents with overpromised and underfunded programs. These counties will be hard-pressed not to use their portions of the Waiver funds to simply maintain their existing (over) commitments.

The “as many as 500,000 low-income uninsured residents” who will gain access to coverage falls woefully short of the 3,061,000 residents who are eligible for one of the two programs created by the Waiver, as estimated by the Insure the Uninsured Project. Additionally, with some exceptions, California’s counties are shying away from extending coverage to the uninsured with individual annual incomes between 134 and 200 percent of the federal poverty level (or $14,400 and $21,600). Most are focusing this new funding source on those uninsured individuals with incomes between 100 and 133 percent of the federal poverty level who will become eligible for Medi-Cal in 2014 under provisions of the Affordable Care Act. Moreover, those to be covered by this new funding source by many of the counties closely approximate the number of uninsured currently supported by them.

This all leads me to conclude that most of our poor and uninsured residents won’t be allowed onto California’s “bridge to reform.”

Your thoughts?