vania-janet/multiturn-rag-retrieval-data huggingface dataset:
The 2024-25 Budget: Medi-Cal Analysis
Depending upon future federal and state actions, the state’s recent success in minimizing the impact of continuous coverage unwinding on enrollees may only be temporary. The extent to which the state’s efforts continue to be successful or, alternatively, caseload begins to return to more normal levels over the next few years, will be an important issue to watch. 
MCO Tax Budget Solution
In this section, we analyze the Governor’s proposed MCO tax budget solution. We first provide background on the MCO tax and last year’s MCO tax package. Next, we describe the Governor’s proposed budget solution. We then conclude with our assessment and recommendations. 
Background
MCO Tax Provides Net Fiscal Benefit to State, While Imposing Minimal Cost to Health Insurance Plans. The MCO tax is a tax on health insurance enrollment in the Medi‑Cal program and in the commercial sector. Though MCOs (organizations that offer health insurance plans to consumers) pay the tax, they bear very little of the tax’s cost. Instead, most of the cost of the tax is covered by the Medi‑Cal program, using a portion of MCO tax proceeds and federal funds. Because federal funds help cover the cost of the tax, the tax still provides the state a net fiscal benefit. The state must receive approval from the federal government to use the tax to draw down federal funds.
Last Year’s Budget Package Enacted New, Much Larger MCO Tax. The Legislature has not permanently authorized the MCO tax. Instead, it has authorized and renewed it for limited periods of time. Most recently, the Legislature enacted Chapter 13 of 2023 (AB 119, Committee on Budget), establishing a new version of the MCO tax from April 2023 through December 2026. The tax is structured similarly to the version preceding it, with one key difference—the tax rate on Medi‑Cal enrollment is more than triple that of the previous version. As a result, the new tax is expected to generate $19.4 billion in net fiscal benefit over its term, which is several billion dollars more than past versions. (Our past post, The 2023‑24 California Spending Plan: Health, provides more detail on the enacted MCO tax package.)
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General Qualifications: Applicants must possess essential personal qualifications including integrity, initiative, dependability, good judgment, the ability to work cooperatively with others, and a state of health consistent with the ability to perform the assigned duties of the class. A medical examination may be required. In open examinations, investigation may be made of employment records and personal history and fingerprinting may be required. Eligible Lists: Eligible lists established by competitive examination, regardless of date, must be used in the following order: 1) sub-divisional promotional, 2) departmental promotional, 3) multi-departmental promotional, 4) service-wide promotional, 5) departmental open, 6) open. When there are two lists of the same kind, the older must be used first. Eligible lists will expire in one to four years unless otherwise stated on the bulletin.High School Equivalence: Equivalence to completion of the 12th grade may be demonstrated in any one of the following ways: 1) passing the General Education Development (GED) Test; 2) completion of 12 semester units of college-level work; 3) certification from the State Department of Education, a local school board, or high school authorities that the competitor is considered to have education equivalent to graduation from high school; or 4) for clerical and accounting classes, substitution of business college work in place of high school on a year-for-year basis. Accepted applicants must provide proof of identification at each in-person test session. Acceptable identification consists of a photo identification card or two forms of signed identification.

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The 2024-25 Budget: Medi-Cal Analysis
The deferral, which was initially enacted to help address a budget problem in the 2006‑07 budget, was originally scheduled to end in 2022‑23. The 2023‑24 budget delayed its end to 2024‑25. The Governor’s budget assumes that withdrawing the scheduled end of the deferral in 2024‑25, thereby allowing it to continue, provides $533 million one‑time General Fund savings.
Delays Funding Rounds of Behavioral Health Grant Initiatives. The Governor proposes to further delay $140 million of the final round of BH‑CIP grant funding to 2025‑26, with the remaining $100 million to still be provided in 2024‑25. In addition, the Governor proposes to delay $235 million for BHBH from 2024‑25 to 2025‑26. (Separately, and not as a budget solution, the Governor proposes to transfer $265 million for the third round of BHBH funding back to the General Fund from the MHSF. The administration states this action is needed because of declining MHSF revenues, resulting in insufficient funding to support the initiative.)
Sweeps Medi‑Cal Drug Rebate Fund. The Governor proposes to further sweep the Medi‑Cal drug rebate reserve to offset General Fund spending. The reserve account was established in the 2019‑20 budget package to help offset unexpected cost increases in Medi‑Cal. The 2023‑24 budget swept the reserve account as a budget solution. According to the administration, however, the state is expected to receive more drug rebate funds than anticipated in last year’s budget, providing more funds to sweep from the reserve account. The proposal provides $163 million in General Fund savings, with most of the impact in 2023‑24.
Reduces Physician Supplemental Payments. The Governor proposes to reduce General Fund spending on an existing supplemental payment program for physician services. The program was established in the 2017‑18 Budget Act and originally supported entirely by Proposition 56 (2016) revenues. Since then, Proposition 56 revenues have declined, resulting in the General Fund backfilling a portion of the program’s costs. The administration states that the reduction in General Fund spending would be more than offset by increased funding for physician payments in the proposed MCO tax package.
The 2024-25 Budget: Medi-Cal Analysis
The Governor’s budget includes $35.9 billion General Fund spending in 2024‑25 on Medi‑Cal, the state’s Medicaid program. This amount reflects a $1.4 billion (3.8 percent) reduction from the previous‑year level. The net decline in General Fund spending primarily is driven by a series of proposed fund shifts, delays, and reductions to help address the state’s budget problem. Absent these proposals, spending in Medi‑Cal would grow by $1.3 billion in 2024‑25 under the Governor’s budget.
State’s Efforts to Limit Impacts of Continuous Coverage Unwinding Appear to Be Working. The Governor’s budget estimates that Medi‑Cal caseload will decline by about 1 million enrollees in 2024‑25 over the previous year—to 13.7 million. This decline reflects that the state and counties currently are redetermining eligibility for a historic high number of Medi‑Cal enrollees, as a result of the unwinding of a federal policy that resulted in rapid caseload growth since the start of the pandemic. The state has in place several federally approved flexibilities meant to maximize continuity of coverage for enrollees during this time. Based on our review of recently released data, the state’s efforts appear to be working. Specifically, caseload is coming in much higher than was previously assumed to be the case—both by the administration and our office. The Governor’s budget caseload estimates are broadly reflective of the recent data on continuous coverage unwinding and therefore are reasonable.
Proposed Managed Care Organization (MCO) Tax Budget Solution Is Worth Considering. As a budget solution, the Governor proposes to modify last year’s MCO tax package by (1) increasing the tax rate on Medi‑Cal enrollment and (2) shifting funds out of a reserve for planned augmentations in Medi‑Cal and other health programs. The administration states that the proposal, which would provide an additional $4.6 billion in General Fund savings through 2026‑27, would advance the timing of when the reserve is expected to be depleted.
The 2024-25 Budget: Medi-Cal Analysis
Outside of the MCO tax package, the Governor proposes $1.2 billion in budget solutions across 2023‑24 and 2024‑25. Given the substantial budget problem facing the state, these proposed solutions are warranted. Moreover, considering additional options now would be wise in light of the state’s deteriorating budget condition. For example, if voters approve Proposition 1 in March, we recommend the Legislature consider shifting the remaining $481 million General Fund for the Behavioral Health Continuum Infrastructure Program to bond funds.
Introduction
This brief analyzes the Governor’s proposals in the 2024‑25 budget for Medi‑Cal, California’s Medicaid program. It first provides an overview of Medi‑Cal and its proposed budget. It then provides our analyses of the administration’s (1) caseload estimates and projections, (2) other major current law adjustments, (3) proposed managed care organization (MCO) tax budget solution, (4) proposed MCO tax‑funded provider payment increases, and (5) other proposed budget solutions.
Overview
In this section, we provide key background on the Medi‑Cal program, describe Medi‑Cal’s overall budget picture, and summarize the key changes in General Fund spending in the current year (2023‑24) and budget year (2024‑25).
Background
Medi‑Cal Provides Health Coverage for Low‑Income Californians. Medi‑Cal, the state’s Medicaid program, provides health care coverage for low‑income Californians. Health care services covered by Medi‑Cal include visits to the doctor’s office, stays at the hospital, prescription drugs, behavioral health services, long‑term care, and dental services, among many other areas. The Governor’s budget assumes an average monthly Medi‑Cal caseload level of 14.8 million in 2023‑24, over one‑third of Californians.
Medi‑Cal Is a Sizable Portion of California’s Budget. More than half of Medi‑Cal’s budget is supported by federal funds, with the remainder supported by the General Fund and other state and local government sources.
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Health Plan Changes Are Effective January 1
Did you make any of the following changes during Open Enrollment?

Changed your health plan
Changed your dental and/or vision benefits
Enrolled for the first time
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If so, make sure to carefully review your January paycheck or pay warrant to verify that the premiums are accurate and being paid to the proper plan.
What if your January pay warrant does not reflect your new health, dental, or vision plan’s premium payment?
The payment will be adjusted during the next pay period. If your changes are still not reflected on your next pay warrant, contact your employer’s health benefits officer or personnel office. Retirees in CalPERS Health Benefits Program should contact CalPERS directly.
What if you changed health plans during Open Enrollment and have not received an identification card from your new health plan?
Contact your new health plan. And, if your new health plan changes your prescription drug benefit services, you may need a separate pharmacy benefit manager identification card. If you didn’t receive one, contact your plan.
You should also contact your new health plan for assistance if you need care or prescription medication before your new identification card arrives. Do not use your previous health plan services.
For more information about your CalPERS health benefits coverage, contact your plan, visit the Plans & Rates page on the CalPERS website, or log in to your myCalPERS account.

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The 2024-25 Budget: Medi-Cal Analysis
These initiatives have been implemented over multiple rounds of grant funding. There are other, smaller one‑time initiatives covering other areas of Medi‑Cal as well.
Last Year’s Budget Included Medi‑Cal Budget Solutions. As part of a package of budget solutions across state programs, the 2023‑24 budget included $5 billion in reductions, delays, funding shifts, and new revenue in Medi‑Cal in 2022‑23 and 2023‑24. More than half of this amount was from enacting a new MCO tax, of which some of the revenues are used to offset General Fund spending in Medi‑Cal. Other notable actions were one time. For example, the state delayed $716 million in planned spending for BH‑CIP and BHBH to 2024‑25 and 2025‑26. Another $265 million for BHBH was shifted to the Mental Health Services Fund (MHSF). Other one‑time actions included deferring the planned end to a two‑week deferral of Medi‑Cal provider payments to 2024‑25 and sweeping a Medi‑Cal drug rebate reserve account.
Proposals
Proposes Additional Medi‑Cal Budget Solutions. Outside of the MCO tax package, the Governor proposes an additional $1.2 billion in budget solutions in Medi‑Cal across 2023‑24 and 2024‑25. Many of the budget solutions are similar to those taken last year and mostly are one time. Below, we describe each proposal.
Continues Provider Payment Deferral. The Governor proposes to withdraw the scheduled end of a two‑week deferral in fee‑for‑service payments. The deferral, which was initially enacted to help address a budget problem in the 2006‑07 budget, was originally scheduled to end in 2022‑23. The 2023‑24 budget delayed its end to 2024‑25. The Governor’s budget assumes that withdrawing the scheduled end of the deferral in 2024‑25, thereby allowing it to continue, provides $533 million one‑time General Fund savings.
Delays Funding Rounds of Behavioral Health Grant Initiatives.
Did You Know Your Medicare Health Plan Includes These Perks? - CalPERS PERSpective
While each app has a different focus and format, they’re designed to help you improve sleep, develop self-care skills, and guide you through meditations provided by world-renowned teachers and thought leaders.
Sharp Health Plan
Wellness Incentive — You can earn a $150 reward by participating in a six-week program that includes completion of online learning activities or telephonic personal health coaching program that focuses on a health issue of your choice.
Discount to Fitness Centers — Access an easy-to-use fitness center network for a low monthly fee through Your Best Health. Benefits also include activity tracking and unlimited digital video workouts.
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Free Gym Membership — You can take advantage of an easy-to-use fitness center network including YMCA, LA Fitness, 24 Hour Fitness, Anytime Fitness, Snap Fitness for free through Renew Active.
Let’s Move Wellness Program — Learn more about the importance of nutrition, physical activity, mental health, social and caregiver well-being, and financial fitness. Take advantage of virtual cooking demonstrations, recipes, wellness challenges, strategies for financial well-being, and volunteer opportunities at no additional cost at Let’s Move by UHC.
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Free Fitness Memberships — You have access to local and national fitness clubs, home fitness kits, digital workout gear, and more at no additional cost through Western Health Advantage’s MyCareFitness.
Healthy Recipes — The benefits of eating healthy, coupled with physical activity, include improved emotional well-being and healthy weight management. Other benefits of eating whole, homemade foods include decreased risk for and treatment of infections and disease, and lengthened longevity.

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Open Enrollment Takes Place each Fall
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