Publication LHPC WorksOctober 2019 Issue

Federal Regulatory Actions Threaten the Health of Low-Income Californians

Federal regulatory activity over the past year has continued to target immigrants and low-income households. These proposed or final policies — including public charge, changing the poverty measure inflation factor, and requiring immigration status verification for households receiving housing assistance — fundamentally erode and disincentivize receipt of public services that are critical for the health and well-being of the nation’s most vulnerable populations. California’s local plans are concerned about the harmful impacts these three sweeping policies will have on their beneficiaries and the communities in which they live.

See below for summaries of these proposed or final rules and LHPC’s comment letters on each.

Public Charge Final Rule Dissuades Immigrants from Seeking Necessary Care

Under the public charge rule, the federal government may deny legal permanent resident status or deny entry into the U.S. based on a determination of whether the individual is likely to become a public charge. While this has been a longstanding policy, the Department of Homeland Security’s Final Rule — effective Oct. 15, 2019 — drastically expands what is considered in public charge determinations.

  • Definition. Public charge means an immigrant who receives one or more public benefits for more than 12 months in the aggregate within any 36-month period.
  • Medicaid considered a public benefit. Therefore, receipt of the benefit will be considered a negative factor during public charge determinations.
  • Exceptions. The Final Rule includes exceptions to considering Medicaid in public charge determinations. Notable exceptions include:
    • Receipt of emergency Medicaid
    • Medicaid benefits received by individuals under the age of 21
    • Medicaid benefits received by a woman during pregnancy and during the 60-day period postpartum
    • Services or benefits funded by Medicaid but provided under the Individuals with Disabilities Education Act
  • Other benefits to be considered. Other federally funded benefits that will be considered in public charge determinations include Supplemental Security Income, cash assistance, food stamps and housing assistance.
  • Resources

 Read LHPC’s comment letter on the public charge proposed rule.

Proposed Rule Regarding Changes to Poverty Measure Inflation Factor Would Shrink Eligibility for Public Programs

In May, the President’s Office of Management and Budget released a request for comment regarding potential changes to the methodology for calculating inflation that is applied annually to the poverty threshold, or the Official Poverty Measure (OPM). Namely, the federal Administration is considering changing from its longstanding use of the Consumer Price Index (CPI) for all Urban Consumers to chained CPI.

  • Summary of chained CPI. Unlike the CPI for all Urban Consumers, chained CPI assumes that consumers generally change their purchasing behaviors to switch to lower cost goods when the cost of comparable goods rise at different rates. Experts have longstanding concerns about the accuracy of chained CPI for low-income and elderly households.
  • Impact of Chained CPI on the OPM. It is anticipated that the OPM will grow at a slower rate if chained CPI is adopted. In 2013, when the federal Administration last contemplated changing the OPM inflation factor, the Congressional Budget Office estimated that the chained CPI would result in an average of 0.25 percentage points less than annual adjustments to the OPM using the CPI.
  • Use of the OPM by the U.S. Department of Health and Human Services (HHS). Changing the inflation measure applied to the OPM could have significant impacts on eligibility for public programs. Each year, HHS publishes poverty guidelines that dictate eligibility for dozens of federal programs using the inflation-adjusted poverty threshold.
  • Federal programs that use the HHS poverty guidelines. Medicaid, the Children’s Health Insurance Program (CHIP), Head Start, the Supplemental Nutrition Assistance Program (SNAP), the National School Lunch Program, and many state and local programs use the HHS poverty guidelines to determine eligibility guidelines.
  • Request for comment on the Federal Register

Read LHPC’s comment letter on the poverty measure inflation factor proposed rule.

Proposed Rule Requiring Verification of Eligible Status for Households Receiving Housing Assistance Could Spur Increase in Homelessness

The U.S. Department of Housing and Urban Development (HUD) proposed rule requires every member of a household that receives federal housing assistance to verify his or her legal immigration status for the household to receive any subsidy or assistance.

  • Existing process. Current rules require that financial assistance to mixed households be prorated based on the number of eligible individuals in the family. Therefore, total household assistance is calculated by the number of confirmed eligible individuals in the household.
  • Change to affirmative verification. All members of a household will be required to provide verification of eligible immigration status. Households that currently receive prorated assistance based on the number of verified citizens or eligible non-citizens (“mixed households”) in a household would no longer receive this assistance if even one member of their household does not affirmatively verify eligibility.
  • Impact on children. Nationally, over 55,000 citizen children living in mixed households may face eviction as a result of the proposed rule. California families and children would be disproportionately impacted, as the HUD analysis estimates that 37 percent of mixed families receiving housing assistance live in our state.
  • Impact on homelessness. The HUD analysis acknowledges that homelessness could be an impact of the rule, particularly in tight housing markets. This would be particularly problematic for California households, where vacancy rates are at a 30-year low.
  • Proposed Rule on the Federal Register

Read LHPC’s comment letter on the verification of eligible status proposed rule.

Publication LHPC WorksOctober 2019 Issue

Legislative Wrap-Up

Taxes. Sanctions. Oversight. Data sharing. We covered it all in the first half of the 2019-20 legislative session.

Publication LHPC WorksOctober 2019 Issue

Spotlight On …
Jarrod McNaughton

Jarrod McNaughton, CEO of Inland Empire Health Plan, brings a person-focused philosophy to leadership and life. Learn more about his personal and professional goals, leadership approach and what makes him tick.

Publication LHPC WorksOctober 2019 Issue

Message from the CEO

LHPCWorks was launched as an extension of our member health plans’ commitment to being accountable partners and leaders among California’s Medi-Cal stakeholder community. With the flurry of activity both federally and in California, LHPC has been hard at work advocating for policies and legislation that would enhance access and quality of care for Medi-Cal beneficiaries. All in all, 2019 has been a remarkable year.

Publication LHPC WorksOctober 2019 Issue

“Carving Out” Medi-Cal’s Pharmacy Benefit: What California Can Learn from 13 Other States

The proposed Medi-Cal pharmacy carve-out —“Medi-Cal Rx” — will transfer the pharmacy benefit offered by health plans back to the fee-for-service program, where it would be administered by a pharmacy benefit manager. The carve-out concept is not untested. Are there lessons learned for California to do it differently?