On Monday, House Republicans introduced legislation to gut mental health care for millions of Americans.
For individuals enrolled in Medi-Cal, the legislation will enact a per-capita cap, or a limit on federal spending for each Medicaid enrollee. For enrollees with significant health costs, including prescription drugs, on-going treatments, and hospitalizations, this will mean that costs above the cap must be covered by the state or by the enrollee. California stands to lose at least $20 billion, or one fifth of our Medi-Cal program, which will force the state to make dramatic cuts to eligibility and benefits.
The legislation also dismantles the Medi-Cal Expansion. Thirty percent of those newly eligible for coverage are living with mental illness and/or substance use disorders, the majority previously uninsured. While people who are currently enrolled in Medi-Cal will be able to remain covered, new enrollment will be frozen in 2020. Additionally, anyone with a coverage gap of more than one month will lose his/her coverage.
Additionally, beginning in 2020, the Essential Health Benefits requirement in Medicaid would be eliminated, including mental health and substance use treatment. California will have the option of whether or not to require Medi-Cal Managed Care plans to provide these benefits in light of decreased federal funding for the program.
For individuals enrolled through Covered California, income-based tax subsidies will be eliminated and replaced with an unspecified and discretionary fund for states. Additionally, for commercially insured individuals, the prohibition on discriminating on the basis of pre-existing conditions, including mental health conditions, will be eliminated. Individuals who have not maintained continuous coverage will be required to pay a 30% penalty beginning in 2019.