California Medi-Cal Commission Prepares for Federal Medicaid Cuts

from Ana B. IbarraCalMatters

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As states figure out how to adjust to federal funding cuts, policy changes and major changes to Medicaid, 2026 will be a pivotal year for California health officials and lawmakers.

Many Californians are already on Medicaid, better known here as Medi-Cal struggle for access timely and quality care. now experts warn that millions more could lose coverage HR1making radical changes to the country’s safety net programs.

Anticipating the consequences, a group of health foundations formed The Future of the Medi-Cal Commission. Her task: create a 10-year plan for a program that covers more than 14 million low-income residents and pays for key services from childbirth to nursing home care.

The commission is co-chaired by Governor Gavin Newsom former chief of staff Ann O’Leary and his former Secretary of Health and Human Services Dr. Mark Galliwho is leading the state’s response to the COVID-19 pandemic.

The 29-member committee will begin meetings in January and provide recommendations in early 2027.

Ghaly spoke with CalMatters about the commission and the challenges ahead. “Nothing makes you think about these things more than the threat to your current existence,” Galli said.

This conversation has been edited for length and clarity.

What is the origin story of this order? Who decided it should exist and why?

The health foundations collectively that focus on programs like Medicaid and think about equity issues … came together and said, “We need to be responsive and prepared for the immediate changes.” It’s a compelling functional moment—and a state like California because of its millions of people who benefit from Medi-Cal, but also the nation needs to set some process in motion to consider: What does this all mean for the mission of supporting low-income people to be healthy and well?

Obviously, the HR 1 makes a lot of changes. What do you see as the biggest challenge for Medi-Cal right now?

There is this great concern that many people who have become confident and comfortable in their care may lose it either because of eligibility or if there are—God forbid—cuts to services. These are the things that I think are the concerns of “now”. Future care is a little different. They include some of the things I just mentioned, but it’s also about program sustainability and growth and cost, and how we make sure we’re doing the right things that actually make health outcomes better.

Speaking of costs, the Medi-Cal program has grown significantly over the past few years — some people say it grew too much and earlier this year, the program went over budget. At what point does the program become too big?

See, Medi-Cal has become a real health care program, not just a health care program. (It means that) it really thinks about all the things that go into creating healthy individuals, healthy families, healthy communities and, by extension, a healthier state.

Has it grown too much? I think the part of this that I appreciate and think is very important to dig into is, are we doing all the important things? It’s great that we do things to support health in general, but are all the things we pay for and create a workforce for the things that make sense to do? I think that will be a very interesting piece (for) this committee to delve into.

The state is already freezing enrollment and cutting aid because of budget pressures. Are more service cuts and people kicked out of the program inevitable to meet the federal shifts?

It is difficult to answer this question without knowing what other pressures the state will face. Never say never, but I know that governor, I know the team there. They will not want to make such cuts and decisions. But at the end of the day, the state is responsible for its budget to make sure it is good and balanced.

What do you expect to happen with the committee’s recommendations?

I would like to think that what the committee writes and ends up with is something that can be used by politicians.

Part of what I like about the composition of the commission is that there are a lot of operators. Many people can understand how a high-level idea can actually be implemented on the ground and through the different channels and levels of bureaucracy, which is a very big plus.

By the time the commission submits its report, California will have a new governor. What should the next governor think and say about these issues?

I would like our candidates to be really hungry to understand what they could come up with and what they expect to do to support improving, modernizing and ensuring that California’s flagship Medi-Cal program is sustained and maintained.

If you find a somewhat sophisticated candidate and then elected health care governor, they will see how not all roads lead to Medi-Cal, but Medi-Cal is a major highway in the health care environment and she or he has the choice to really influence and control.

I’ll just add one more thing. Health care is a huge part of California’s economy. And I don’t just mean Medicaid; I mean in general terms. Almost every person in California is thinking, “How do I secure and maintain access to health care and live in a healthy community?” I think these are important priorities.

This article was originally published on CalMatters and is republished under Creative Commons Attribution-NonCommercial-No Derivatives license.