San Diego County would lose significant momentum in its multi-year quest to transform substance use treatment if Congress goes through with Medicaid cuts of the magnitude that some speculate may soon occur.
That was the message conveyed Tuesday during a special Board of Supervisors meeting in San Diego that highlighted ongoing plans to shift the region to a more-preventive mode of care that has already increased the availability of treatment programs and care for those in crisis.
Convened by board acting chair Terra Lawson-Remer, the meeting sought to draw attention to existing plans that would add an estimated 16,000 “treatment slots” for those struggling with addiction by 2030. Already, officials said, work on what the county has called its “Optimal Care Pathways” plan has resulted in about 5,100 additional slots, and also investing in countywide resources such as mobile crisis response teams and crisis stabilization units.
These investments, the executive said, have already helped reduce the burden on local emergency departments and can do more if they continue.
“Over the last five years, we have built a crisis and diversionary service network that didn’t exist before,” said Luke Bergmann, director of behavioral health for the county.
But, due to restrictions in the range of funding sources that the county receives, Medicaid — called Medi-Cal in California — provides an outsize share of the revenue that can be spent on programs that address substance use disorders.
“Last year, Medi-Cal funding covered 70 percent of costs within our substance use system and while the details of future directions for the Medicaid program remain unclear, congressional proposals are already on the table that would have a huge financial impact on the State of California,” Bergmann said.
“If they were adopted, the loss of Medi-Cal funding would have ripple effects across all behavioral health programs in San Diego County.”
Lawson-Remer, in comments made after the meeting’s conclusion, said she thought it was important to make the public aware of substance use programs and plans for the future as cuts loom.
“If we have significant shifts in the federal funding environment, in Medicaid, we will not be able to move forward with these goals,” Lawson-Remer said.
It remains unclear exactly how large such cuts might be.
There has been talk in Washington that a recent budget resolution which requests that the House Energy and Commerce Committee cut $880 billion in spending through 2034 will include significant reductions to Medicaid, as it is a very large part of the body’s overall appropriations program.
Laswon-Remer said that she believes that the reduction in Medi-Cal funding coming to San Diego County specifically is likely to “slash Medicaid funding to San Diego County by 33%.”
Asked afterward where she got that figure, the supervisor cited a recent analysis by the public policy research organization, Center for American Progress, which posted an estimate of possible losses by congressional district “based on previous proposals from House Budget Committee Republican leadership.”
Several modes of cutting have been proposed, with an internal memo obtained and published by the political news website politico.com indicating that $2.3 trillion could be pared from the nationwide program by instituting “per capita” caps on benefits and “equalizing Medicaid payments for “able-bodied adults.” Lowering the “matching” rates that the federal government uses with states is also on the list.
States generally must provide their own cash in order to “draw down” payments from the federal Medicaid program, which covers nearly 80 million Americans, about 950,000 of them in San Diego County. Kaiser Family Foundation, an independent health care research organization, also recently explored another proposed method for reducing Medicaid spending: eliminating the match rate for states that expanded the program’s eligibility under the Affordable Care Act. The federal government covers 90 percent of the cost of covering Americans who gained coverage through the ACA, an initiative that, according to KFF, brought in about 20 million people nationwide. California would lose about $129 billion over the next decade in Medi-Cal revenue if this change were made, according to the analysis.
The county would be far from the only local entity affected. Local medical providers at all levels treat patients with Medi-Cal coverage, and federally qualified health centers would likely be among the hardest hit as a significant percentage of their overall treatment volume is for patients with Medi-Cal coverage.
