Gov. Arnold Schwarzenegger's plan to restructure California's mammoth healthcare program for the poor has finally been completed and is expected to be released next month as part of his proposed budget.
But, because the plans have yet to be submitted for federal approval, final action is months away, casting doubt not only on how much the effort might save taxpayers but when the savings will begin.
Medi-Cal, the state's version of the federal Medicaid safety net for the elderly, disabled and low-income children, serves nearly 7 million residents and costs about $30 billion annually in state and federal dollars.
Since he took office last year, Schwarzenegger has said he wanted to restructure the program to control costs. Since 1999, Medi-Cal costs have jumped 45% largely due to an enrollment expansion that added 2 million patients.
Schwarzenegger's proposals have included such ideas as limiting who can qualify for services, requiring patients to contribute a co-payment toward their care as well as trimming the kinds of services that might be made be available.
Last year, administration officials estimated that such changes could save the state as much as $400 million annually. Because the federal government is a partner in the program, the U.S. Department of Health and Human Services must approve the proposed changes.
Twice before, the governor has pulled back his restructuring program from federal review -- once last May and again in August. Both times, the administration said the program was not ready.
Although officials at the California Health and Human Services said their plan is now finished, it has not been submitted to federal officials, according to Mary Kahn, spokeswoman for the CMS.
Indeed, because of the uncertainty over the status of the restructured program, Schwarzenegger's finance director, Tom Campbell, said last week that he is not recommending the governor count on significant savings from the effort as part of next year's budget plan.
Donna Kingwell, spokeswoman for California Health and Human Services Secretary Kim Belshe, said details of the proposed revisions will be released as part of the governor's 2005-2006 budget, which is expected to be made public Jan. 10.
Hospital administrators, physician groups and health care advocates said they are uneasy about the governor's plan because the administration hasn't shared any information about the latest proposal with them.
"We haven't talked to them in months," said Darryl Nixon, spokesman for the California Association of Health Facilities. "Like everyone else, we expected to see the new program with the new budget in January. That's what they said they were going to do when they pulled the plan in August. If it's not coming forward, that's news to us."