Medicaid cuts could hit Contra Costa County hard: ‘People will get sicker’

“I’m scared as hell,” said Kaya Owens. 

A single mom and hairdresser who works in Contra Costa and Alameda counties, Owens relies on Medi-Cal for herself and her young daughter. 

“I don’t have savings,” she said. “I’m pretty screwed.” 

Contra Costa County has the highest percentage of Medi-Cal enrollment in the state, with approximately 250,000 people receiving the benefit. Medi-Cal is California’s version of Medicaid, which provides health care for low-income residents, pregnant people, children and those with disabilities, among others. The federal spending bill has sharply cut Medicaid funding, which will put the onus on states and likely lead to a loss of benefits for many recipients.

Disagreements over the various federal funding streams for health care caused the impasse between Democrats and Republicans, which led to the government shut down Oct. 1.  U.S. Rep. John Garamendi, who represents Contra Costa and Solano counties, is one of hundreds of Democrats refusing to sign off on a resolution to fund the government until health care funding is restored in the budget.

California “simply doesn’t have the funding to offset these drastic cuts,” said Cameron Niven, a spokesperson for Garamendi.

The Medicaid lifeline

Lisa Fishman, a Richmond resident who lives in public housing, is on Supplemental Security Income, relies on CalFresh, is on Medi-Cal and walks with a cane on good days. On bad days she’s in a wheelchair. She says she feels terrible anxiety and a sense of hopelessness these days relating to the federal budget cuts.

“I have blood cancer, I have an autoimmune disease, I have bipolar disorder, a degenerative disc disease. I can’t work,” she said.

“I can’t survive without any of the services I receive.”

Among the changes Congress recently enacted is the requirement for Medicaid recipients to reenroll every six months instead of the current 12. Most recipients would also be required to prove they are working, which the county must verify. 

“It’s almost like they’re saying that financially disadvantaged people just don’t deserve care,” said Doug Amarelo, a health care finance professional in the Bay Area.

Contra Costa County Supervisor John Gioia said the county’s workload will increase, “without the county having the money to do the work.” 

California steps in

House Speaker Mike Johnson told “Meet the Press” in May, “4.8 million people will not lose their Medicaid unless they choose to do so.” 

Johnson said “I’m not buying it. The American people are not buying it,” referring to the notion that new enrollment requirements for “able-bodied young men” to work would be too cumbersome.

Congress in July approved cutting Medicaid by 15% over 10 years, beginning next year.

As a result, Contra Costa residents who rely on Covered California, the state’s Affordable Care Act marketplace for subsidized health insurance, could face dramatic rate hikes that double premiums, a KFF report found. 

The Covered California website echoes those estimates, saying for almost 2 million people, premiums are projected to increase by 10.3% on average. California’s most vulnerable enrollees, with incomes of $31,300 for an individual or $64,300 for a family of four, could see a much larger increase of up to 97% due to the expiration of tax credits. 

In response to the lost federal funding, Gov. Gavin Newsom and the Legislature have increased state funds available for cost-sharing programs by appropriating $165 million to expand access for this group. But the appropriation doesn’t cover the $2.1 billion gap from the federal cuts, according to Covered California.

To help bridge that gap, California has frozen enrollment for undocumented people and added a $30 monthly premium for Covered California enrollees, among other measures, according to the Legislative Analyst’s Office report. 

Contra Costa County Health Director Dr. Grant Colfax estimates that if the federal provisions do not change, 70,000 people will lose health care in Gioia’s district, which includes Richmond, San Pablo, El Cerrito, and Pinole.

Gioia worries about the effects on Contra Costa’s public hospital, the Contra Costa Regional Medical Center. Cuts will hit its vital emergency room and all of the ancillary services the county provides, including mental health care and dentistry. 

“People will get sicker,” Gioia said.

No other option

Niven said Garamendi’s office has fielded weeks of calls and emails from fearful constituents.

Among those who reached out to Garamendi’s office was Rebecca Martinez, a Richmond nurse practitioner, who wrote in an email, “The majority of my patients rely on Medi-Cal for their life-saving HIV treatment and substance use disorder care.”

She added, “There is no other option for them to get better without Medi-Cal.”

Owens, the hairdresser, sees paying more for health care as disastrous to her family’s ability to make ends meet. They are also reliant on CalFresh, the states’ food assistance program funded mostly by the federal Supplemental Nutrition Assistance Program, which is also facing severe cuts.

Owens wonders how she will be able to manage her constellation of health challenges: diabetes, hormonal issues, anxiety and depression.

Medication and help from her providers are critical, she said, to “just to function, to be a mom, to work, to drive.”

A diabetic, Owns gets a GLP-1 injection to manage the condition. The drug is on the chopping block for weight loss, but it also may become more difficult to get for diabetes patients, which makes Owens “terrified.”

“I have lost family members to diabetes.” she said. “This is going to destroy so many people’s lives, including mine.”

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