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California Medi-Cal Hospital Reimbursement Initiative (2014)

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A California Medi-Cal Hospital Reimbursement Initiative (#13-0022) has been approved for circulation in California as a contender for the November 4, 2014 ballot as an initiated constitutional amendment.

The federal government's Medicaid program helps pay for health care services provided to low-income patients. In California, this program is called Medi-Cal. For a state to receive federal Medicaid funds, the state has to contribute a matching amount of its own money. In 2009, a new program was created such that California hospitals were required to pay a fee to help California obtain the available federal Medicaid funds. This program has resulted in the receipt of roughly $2 billion a year in additional federal money to Medi-Cal.

If the initiative qualifies for the ballot and is approved by the state's voters, it will add language to the California Constitution to require voter approval of changes to the hospital fee program to ensure that California uses these funds for the intended purpose of supporting hospital care to Medi-Cal patients and to help pay for health care for low-income children.

Supporters of Initiative #13-0022 reported submitting an estimated 1.3 million signatures on April 21, 2014, versus a requirement of 807,615 valid signatures.[1]

Text of measure

Ballot title:

State Fees on Hospitals. Federal Medi-Cal Matching Funds. Initiative Statutory and Constitutional Amendment.

Official summary:

"Increases required vote to two-thirds for the Legislature to amend a certain existing law that imposes fees on hospitals (for purpose of obtaining federal Medi-Cal matching funds) and that directs those fees and federal matching funds to hospital-provided Medi-Cal health care services, to uncompensated care provided by hospitals to uninsured patients, and to children's health coverage. Eliminates law's ending date. Declares that law's fee proceeds shall not be considered revenues for purposes of applying state spending limit or determining required education funding."

Fiscal impact statement:

(Note: The fiscal impact statement for a California ballot initiative authorized for circulation is jointly prepared by the state's Legislative Analyst and its Director of Finance.)

"State savings from increased revenues that offset state costs for children's health coverage of around $500 million beginning in 2016-17 (half-year savings) to over $1 billion annually by 2019-20, likely growing between 5 percent to 10 percent annually thereafter. Increased revenues to support state and local public hospitals of around $90 million beginning in 2016-17 (half-year) to $250 million annually by 2019-20, likely growing between 5 percent to 10 percent annually thereafter."

Path to the ballot

See also: Signature requirements for ballot measures in California
  • Thomas W. Hiltachk submitted a letter requesting a title and summary on October 9, 2013.
  • A title and summary were issued by the Attorney General of California's office on December 2, 2013.
  • 807,615 valid signatures are required for qualification purposes.
  • The 150-day circulation deadline for #13-0016 was May 1, 2014. Filing sufficient signatures by that date would not allowed the initiative to compete on the November 4, 2014 ballot.
  • The Secretary of State’s suggested signature filing deadline for the November 4, 2014 ballot was April 18, 2014.
  • About 1.2 million signatures were filed with election officials on April 21, 2014.[1] This was three days after the suggested deadline.

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