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45-476: Medi-Cal provides health coverage for people with low income and limited ability to pay for health coverage, including the aged, blind, disabled, young adults and children, pregnant women, persons in a skilled nursing or intermediate care home, and persons in the Breast and Cervical Cancer Treatment Program (BCCTP). People receiving federally funded cash assistance programs, such as CalWORKs (a state implementation of

90-550: A 15% reduction in maximum benefits (as well as other reductions) of the AFDC program beginning in 1991 that illustrates some of these impacts. After 7 years, the employment rates and average wages were somewhat higher for AFDC recipients who had been placed in the reduced-benefit program than in the control group. This could be explained by participants having a greater need for employment income when their benefits are smaller. The average disposable incomes (including wages and benefits) for

135-428: A cause for concern the decreased time CalWORKs participants are able to spend parenting their children due to increased time working in the formal sector instead. Despite these hardships associated with welfare-to-work programs, CalWORKs is generally viewed favorably by participants. In particular, the job search components are viewed as helpful in obtaining a job for unemployed participants. Indeed, 91% of those leaving

180-557: A child under 6) of work, or work-related activities such as job training, job search assistance, or community service. In 2017, California had a WPR of 61%, thanks mainly to the 52% of recipients of federal money who had un-subsidized employment. The State has responded to accountability to Federal work participation requirements in several ways. Governor Jerry Brown proposed reforms—enacted in 2012—to require recipients to be engaged in Federally-approved work activities after

225-420: A form of workfare . There is also a lifetime cap of 48 months of benefits received, with some benefits restricted to 24 months. Only 50% of CalWORKs recipients are still enrolled one year after they first entered the program, and only 33% remain past two years. Two years after they first enrolled, the average recipient has used only 9 months of benefits. While the long-term effects of CalWORKs on California as

270-948: A home mortgage, paying home loans, and paying off other debts. Beginning in 2014 under the Patient Protection and Affordable Care Act (PPACA), those with family incomes up to 138% of the federal poverty level became eligible for Medi-Cal (pursuant to 42 U.S.C.   § 1396a (a)(10)(A)(i)(VIII)), and individuals with higher incomes and some small businesses may choose a plan in Covered California , California's health insurance marketplace , with potential government subsidies. Medi-Cal has open enrollment year-round. Lawful permanent residents (green card holders) are eligible for full-scope Medi-Cal in California regardless of their date of entry if they meet all other eligibility requirements, even if they have been in

315-536: A parent who is choosing not to work) or unintentionally (e.g. for a parent that is unable to meet the requirements). Workfare policies also add burdens to those who do receive aid, which again are unintentional in some cases, such as parents left unemployed by a contraction in the labor market being required to apply for weekly quotas of (scarcely available) jobs or attend job-readiness classes. These differences between welfare programs without work requirements and workfare programs like CalWORKs that are inter-connected with

360-558: A poverty rate for the state. Several such measures are calculated, including the Census Bureau ’s Supplemental Poverty Measure (SPM) and the Public Policy Institute of California’s California Poverty Measure (CPM). The current CPM poverty rate in is 20%, but it is estimated it would be 21% without CalWORKs benefits. That 1 percentage point reduction corresponds to about 380,000 Californians kept "out" of poverty by

405-536: A set payment – "capitation" – for these services. As of 2014, 26 states have contracts with MCOs to deliver long-term care for the elderly and individuals with disabilities. There are two main forms of Medicaid managed care, "risk-based MCOs" and "primary care case management (PCCM)." Managed care delivery systems grew rapidly in the Medicaid program during the 1990s. In 1991, 2.7 million beneficiaries were enrolled in some form of managed care. Currently, managed care

450-496: A variety of services intended to help them find and prepare for employment. The most current requirements, and application instructions, can be found on the CDSS CalWORKs website ; the main requirements are: To receive benefits, parents must fulfill requirements such as working 30 hours per week and/or applying for a specified number of jobs per week and/or participating in training and readiness programs. This makes CalWORKs

495-467: A whole are complex and multi-faceted, some immediate effects on those receiving aid are easier to quantify. The resources available to each Californian (i.e. their income, accounting for taxes and benefits such as medical care) can be compared to an estimate of the resources required to meet their basic needs (a poverty threshold varying based on factors such as family size and local cost-of-living) to label them as “in” or “out” of poverty, and thus determine

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540-632: Is important for understanding how it affects Californians participating in it. Conditioning the provision of welfare benefits on work requirements increases the burdens on families trying not to 'fall through the cracks' between safety net programs. Even without work requirements, families face application processes for the various separate welfare programs in California that require considerable time, effort, and diligence—and often yield one or more rejections. Work requirements are an additional burden in that process as well as barrier rejecting more families from receiving CalWORKs aid, whether intentionally (e.g. for

585-709: Is managed by the California Department of Social Services (CDSS), but is operated and administered locally by the 58 counties of California . In Los Angeles County , the county Department of Public Social Services (DPSS) administers CalWORKs. It has a caseload larger than any other jurisdiction except the States of California and New York and an annual budget of over $ 3 billion. Federally recognized native tribes are also eligible to receive federal TANF funding to administer TANF programs ("Tribal TANF"). The State of California also provides funding to supplement

630-532: Is one of a few US states that provide Medicaid dental benefits to adults. A patchwork of supplemental programs has grown up to fill in some of the gaps, including Federally Qualified Health Centers (FQHC), a designation that refers to hundreds of health clinics and systems that operate in underserved, low-income and uninsured communities. As of December 2022, 2.2 million people were enrolled in Medi-Cal fee-for-service, representing about 14.5% of all enrollees. In

675-662: Is the health insurance marketplace in California, the state's implementation of the American Health Benefit Exchange provisions of the Patient Protection and Affordable Care Act . Since 1933, California law has required counties to provide relief to the poor, including health care services and general assistance. County indigent medical programs can be categorized as California Medical Service Program ( CMSP ) and Medically Indigent Service Program (MISP) counties. There are 34 CMSP counties and 24 MISP counties. The CMSP county programs are largely managed by

720-622: Is the most common health care delivery system in Medicaid. In 2007, nearly two-thirds of all Medicaid beneficiaries are enrolled in some form of managed care – mostly, traditional health maintenance organizations (HMO) and primary care case management (PCCM) arrangements. This amounted to 29 million beneficiaries, of which 19 million individuals were covered by fully capitated arrangements and 5.8 million were enrolled in Primary Care Case Management. During this time, states increasingly turned to health plans already serving

765-562: The website . However, individuals in need of Medi-Cal often need help with their use of the online application process and face barriers, including Online applications seem to pose difficulty for those who aren’t tech-savvy. However, people can apply in-person or over the phone to avoid such confusion. Medi-Cal health benefits include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder treatment, dental (Denti-Cal), vision, and long-term care and supports. California

810-699: The CMS Medicaid/CHIP Child Core Set and 15 of 19 frequently reported from the CMS Medicaid Adult Core Set. CalWORKs The California Work Opportunities and Responsibility to Kids ( CalWORKs ) program is the California welfare implementation of the federal welfare-to-work Temporary Assistance for Needy Families (TANF) program that provides cash aid and services to eligible needy California families. CalWORKs provides cash aid to parents, as well as

855-643: The Low Income Health Program (LIHP), and incentive pay-for-performance to hospitals via the Delivery System Reform Incentive Pool (DSRIP). It also made enrollment in managed care plans (as opposed to fee-for-service programs) mandatory for people with disabilities with the intention of improving care coordination and reducing costs. The DSRIP program showed improvements in quality of care and population health, with less improvement in cost of care. Renewal of

900-535: The TANF grants received by tribes located within the State. This is allotted based on the number of families receiving benefits from each Tribal TANF program. For Federally recognized tribes that do not implement TANF programs, county CalWORKs administrators are required to make CalWORKs benefits available. Members of unrecognized tribes are treated by the counties as residents, and so can receive CalWORKs as well. CalWORKs

945-629: The United States for less than 5 years. Beginning in 2024, people without a lawful immigration status who meet the requirements for Medi-Cal are eligible for full-scope Medi-Cal. Previously, meeting eligibility requirements other than immigration status qualified them restricted-scope Medi-Cal limited to emergency and pregnancy-related services only unless they qualified for the Young Adult Expansion (YAE) or Older Adult Expansion (OAE), which allowed individuals ages 19–26 or those over

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990-405: The age of 50 full-scope benefits regardless of immigration status. There are multiple ways to apply for Medi-Cal: one can apply at a Social Services office or over the phone by calling your nearest social service office, or one can apply online (the most common). Most websites make the application process clear and cohesive. They also allow for the user to select different languages to best navigate

1035-889: The county level: In Denti-Cal, the majority of beneficiaries are covered through fee-for-service arrangements, where the state pays dentists directly for services, instead of the managed care model. However, more than 879,000 Denti-Cal enrollees do receive dental care through managed care plans started as experimental alternatives in the 1990s: in Los Angeles County where managed care plans are optional for beneficiaries, and in Sacramento County where they are mandatory. Eleven counties had no Denti-Cal providers or no providers willing to accept new child patients covered by Denti-Cal: Del Norte , Tehama , Yuba , Sierra , Nevada , Amador , Calaveras , Alpine , Mariposa , Mono and Inyo counties. Delta Dental , operating in

1080-1197: The county welfare department in each of the 58 counties is responsible for local administration of the Medi-Cal program. C4Yourself and CalWIN are statewide online application systems that allows you to apply for benefits. Federal law mostly consists of the Social Security Amendments of 1965 which added Title XIX to the Social Security Act ( 42 U.S.C.   § 1396 et seq. ), and related California law mostly consists of California Welfare and Institutions Code (WIC) Division 9, Part 3, Chapter 7 ( WIC § 14000 et seq. ). Federal regulations are mostly found in Code of Federal Regulations (CFR) Title 42, Chapter IV, Subchapter C ( 42 CFR 430 et seq. ); while California's regulations are contained in California Code of Regulations (CCR) Title 22, Division 3 (22 CCR § 50005). Medi-Cal costs are estimated at $ 73.9 billion ($ 16.9 billion in state funds) in 2014–15. For comparison,

1125-414: The design and implementation of their TANF programs, they must meet certain requirements to receive Federal funds. This puts the generosity or austerity of CalWORKs to some degree under the control of Federal legislation, and it has lately been growing more austere, as described above. The effects of such reductions in benefits are of course varied and complex. California conducted a controlled experiment of

1170-450: The entire California state budget in 2014-2015 is $ 156 billion, of which about $ 108 billion was general funds (not allocated for special expenditures, such as bonds). The Long-Term Care Partnership Program is a public-private partnership between states and private insurance companies, designed to reduce Medicaid expenditures by delaying or eliminating the need for some people to rely on Medicaid to pay for long-term care services. To encourage

1215-489: The event that the State as a whole receives a penalty. The State further requires CalWORKs recipients, along with their caseworker, to construct plans for beginning work-activities as soon as possible. Medicaid managed care Medicaid managed care Medicaid and additional services in the United States through an arrangement between a state Medicaid agency and managed care organizations (MCOs) that accept

1260-665: The federal Temporary Assistance for Needy Families (TANF) program), the State Supplementation Program (SSP) (a state supplement to the federal Supplemental Security Income (SSI) program), foster care, adoption assistance, certain refugee assistance programs, or In-Home Supportive Services (IHSS) are also eligible. As a means-tested program, Medi-Cal imposes asset limits on certain prospective enrollees. Medi-Cal individuals who receive long-term supportive services or who enroll in Medi-Cal through certain disabilities are subject to asset tests. This limit depends on

1305-424: The fee-for-service arrangement, health care providers submit claims to the Medi-Cal program for services rendered. Most beneficiaries receive Medi-Cal benefits from contracted Medicaid managed care organizations (MCOs). As of January 2018, 10.8 million people were enrolled in a Medi-Cal managed care plan, representing about 81% of all enrollees. California has several models of managed care which are designated at

1350-473: The first 24 months of aid (during which time a more flexible set of work activities is available). This change was also intended to decrease the time recipients spend in the program, hence cutting costs at the same time as guarding against a reduction in Federal funding. The State also extends this accountability to the counties through a policy of decreasing funding to counties that don't meet the Federal rate in

1395-428: The labor market make workfare programs less able to aid parents that are already doing as much as they can to secure jobs that would provide sufficient income. This creates what Eva Bertram describes as "a three-sided trap, defined by a lack of assistance for the nonworking poor, inadequate support for those in low-wage jobs, and few exits from the low-wage sector to middle-class jobs." Other researchers have identified as

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1440-516: The number of individuals being considered for coverage; for one enrollee, this limit is $ 2,000, while for two enrollees, the limit is $ 3,000. Each additional individual being considered results in an additional $ 150 of permitted assets, up to a total of ten individuals covered. If applicants possess property whose total value exceeds the allowed amount, they are required to reduce ("sell down") their assets through activities such as purchasing clothes, purchasing home furnishings, paying medical bills, paying

1485-548: The primary way that the state affects the operations, quality, and coverage of managed care plans. In 2005, the California Health Care Foundation recommend various steps to improve the plans, which resulted in some changes to the contracts. Medi-Cal is jointly administered by the Centers for Medicare and Medicaid Services (CMS) and the California Department of Health Care Services (DHCS), while

1530-448: The program in 2001 were currently employed, and 97% had been employed at some point while enrolled. The majority of those staying in the program or returning after a brief period not enrolled had been employed while in the program as well. While CalWORKs seems to be effective at getting participants some employment, the quality of that employment is a bigger challenge. The large number of participants who are employed and receiving benefits at

1575-438: The program than they had with the AFDC. The California Legislature initially created CalWORKs to be more generous than many other states' TANF implementations, but has since reformed it to be generally more austere. The lifetime benefit cap, for example, was initially set at 60 months but was reduced in 2011 to 48 months, and split in 2012 so that partial restrictions applied after 24 months. Although states have broad freedom in

1620-806: The program. Of all welfare programs in the state, only CalFresh and earned income tax credits (the federal EITC and the new CalEITC) are responsible for larger reductions (2 percentage points each). This is a larger reduction than the nation-wide average for TANF programs, but by other metrics CalWORKs performs on-par with other states. As far as can be determined from Census (CPS) data, CalWORKs achieves similar effects for low-income families as programs in comparable states. Specifically, no significant differences were found in poverty rates, unemployment rates, TANF (CalWORKs) enrollment rates, or education/training enrollment rates when comparing likely CalWORKs-eligible families. Looking beyond this binary in-or-out of poverty type of effect, CalWORKs' welfare-to-work nature

1665-693: The public coverage programs such as Medicaid and SCHIP to operationalize expansions of coverage to uninsured populations. States used health plans as a platform for expansions and reforms because of their track record of controlling costs in public coverage programs while improving the quality of and access to care. A variety of different types of health plans serve Medicaid managed care programs, including for-profit and not-for-profit , Medicaid-focused and commercial, independent and owned by health care providers such as community health centers. In 2007, 350 health plans offered Medicaid coverage. Of those, 147 were Medicaid-focused health plans that specialize in serving

1710-624: The purchase of private partnership policies, long-term care insurance policyholders are allowed to protect some or all of their assets from Medicaid spend-down requirements during the eligibility determination process, but they still must meet income requirements. The California Partnership for Long-Term Care Program links Medi-Cal and the In-Home Supportive Services program, i.e., private long-term care insurance and health care service plan contracts that cover long-term care for aged, blind, or disabled persons. Covered California

1755-562: The reduced-benefit group stayed approximately equal to that of the control group, however, as increases in wages made up for decreases in benefits. This disposable income (for both groups) remained well below the poverty line. A key way the Federal government exerts its influence is by threatening a reduction in funding unless at least 50% of families receiving monthly payments meet work or job training requirements. Specifically, to be counted toward this Work Participation Rate (WPR), parents must perform 30 hours per week (20 for single parents with

1800-420: The same building as DHCS ' Denti-Cal division, enrolls dentists into DentiCal, processes claims by dentists, pays dentists and authorizes treatments, and also handles customer service operations and outreach. In 2011, CMS approved a Section 1115 Medicaid waiver called Bridge to Reform. The program included an expansion of the patient-centered medical home primary care approach, an expansion of coverage with

1845-604: The same time illustrate that neither CalWORKs' benefits nor their wages are alone sufficient to meet their family's needs. Indeed, most of those with jobs have extremely low wages (well below their poverty thresholds on average) and little opportunity for advancement. Participants identified a lack of support from CalWORKs for improving inadequate employment or for maintaining employment once hired. In short, unemployed parents in search of jobs are often able to gain employment through CalWORKs, but that does not translate directly to earning sufficient income to meet their family's needs. It

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1890-562: The state, whereas MISP counties manage their own programs with their own rules and regulations. Many patients from both the CMSP and MISP county programs transitioned to Medi-Cal when the Patient Protection and Affordable Care Act took effect in 2014. Medi-Cal reports quality metrics, broadly similar to the HEDIS metrics from the NCQA . In 2017, it reported on 13 of the 20 frequently reported from

1935-402: The unique needs of Medicaid and other public program beneficiaries. Over 11 million are enrolled in Medicaid focused health plans [1] . All states except Alaska , and Wyoming have all, or a portion of, their Medicaid population enrolled in an MCO. States can make managed care enrollment voluntary, or seek a waiver from CMS to require certain populations to enroll in an MCO. If states provide

1980-613: The waiver in 2015 extended the program to 2020 in an initiative called Medi-Cal 2020, with additional programs including additional alternative payment systems, the Dental Transformation Initiative, and the Whole Person Care program focused on high-risk, high-utilizing recipients. In the negotiation with CMS, several proposals were dropped. Medi-Cal enforces requirements on MCOs with contracts, with boilerplate versions posted online; these contracts

2025-609: Was created by the Welfare-to-Work Act of 1997. It replaced the former Greater Avenues to Independence (GAIN) program, the California implementation of the federal Aid to Families with Dependent Children (AFDC) program. At the Federal level, AFDC was replaced with TANF in 1996, bringing work requirements that were stricter than those of the AFDC program, and a new cap on individuals' lifetime benefits. While these requirements for participants were stricter, TANF did give more freedom to states to design their implementations of

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