Leaders at CalOptima – the county-run Medi-Cal program for OC’s neediest residents – are bracing for drastic cuts and eligibility changes to the public health insurance program that almost a third of Orange County residents rely on to cover doctor visits and hospital stays.
Last year, CalOptima and county Social Service Agency leaders warned of the expected impacts of President Donald Trump’s “Big Beautiful Bill” that includes a trillion dollars worth of cuts to Medicaid – a public health insurance program – over about a decade’s time.
[Read: OC’s Poorest Brace For Cuts to Food Stamps and Health Insurance This Thanksgiving]
CalOptima Chief Operating Officer Yunkyung Kim said the changes will likely mean a decrease in members as they faced a steady decline in the past couple of months.
“It’s going to be kind of harder for folks to apply for Medi-Cal, and then also to keep their Medi-Cal,” said Kim in a Friday interview.
“We do expect that there will be individuals in Orange County who have had Medi-Cal who either will no longer receive their Medi-Cal benefits, or at least will not receive the full scope of their medical benefits. That’s the piece that we worry about, of course, the most.”
The bill signed into law last year will also mean eligibility changes for recipients of Medi-Cal – California’s Medicaid program – this year and in the coming years including enrollment freeze for undocumented adults, work requirements and more frequent application renewals.
Those changes also include reinstated asset limits for older adults and people with disabilities as well as copayments for certain health care services.
Orange County Supervisor Vicente Sarmiento, the new chair of CalOptima, said the changes will hurt people’s access to health coverage as the agency is already experiencing a decrease in members.
“We are preparing for these changes by prioritizing clear communication and outreach, so residents are aware of what is changing and can plan accordingly, while continuing to support our providers and community partners who will be on the front lines of these impacts,” he said in an emailed statement last week.
“The anticipated federal Medicaid reductions and policy changes have already caused a drastic decline in our membership – now below 800,000 (from nearly a million in 2024) – undoing years of progress made in expanding access to care for our most vulnerable residents.”
As of Nov. 30, CalOptima had 877,271 members– about 28% of the county’s population, according to CalOptima and U.S. census data.
In 2023, nearly a million OC residents were CalOptima members.
Kim said enrollment numbers dropped less than they expected when the redetermination process started after the COVID-19 pandemic and that numbers have been on a study decline since last August.
The changes are coming as CalOptima sits on over $1.8 billion in reserves they’ve been stockpiling partly in case of cuts to Medicaid despite state auditors raising concerns in 2023 that the agency should be spending more on service improvements and expanding access.
[Read: Orange County’s Medi-Cal Program Stockpiles $1.8 Billion Despite CA Auditor Concerns]
In November, CalOptima CEO Michael Hunn defended the reserves at a virtual convening about the “big beautiful act’s” impacts.
“We have to be very prudent in having sufficient reserves that if there is a real hiccup in the funding or the financial flow for whatever reason, we’ve got enough reserves to pay medical claims and make sure our members have access to all levels of care,” he said.
Kim said CalOptima’s board will soon discuss using the reserves in response to the changes and cuts and how sustainable that will be.
“It’s going to be a discussion with our board, with management, as well as with our stakeholders in terms of how we use those reserves to support these programs,” she said.
“Our members are going to be impacted. Our providers are going to be impacted so again, how do we do this so that we can support the entire delivery system?”
Eligibility Changes to Medi-Cal
This month’s changes include reinstated asset limits for adults age 65 and older and individuals with disabilities as well as enrollment freezes on undocumented adults.
Later this year, dental coverage will stop for undocumented adults.
In 2027, able bodied recipients will have to meet work requirements to be eligible for Medi-Cal and recipients 19-64 will have to renew their Medi-Cal application every six months.
By 2028, Medi-Cal recipients will have co-payments for certain health care services.
Kim said those enrolled in Medi-Cal today won’t be subject to some of those changes as long they maintain their enrollment.
“If you are enrolled today, then you can maintain that, as long as you maintain your enrollment, go through the process, do not let that eligibility lapse,” she said.
CalOptima’s Response
In response to the expected changes, Hunn announced last fall that the agency would be launching a nearly $20 million outreach and education campaign to warn residents of the eligibility shifts and help them keep their coverage.
“We will be launching a $19.8 million multiyear effort to educate our members on how to keep their health care benefits and navigate the new rules ahead, including work requirements and more frequent eligibility renewals,” he later wrote in a December Op-Ed published in the Voice of OC.
“We will do all we can to support eligible members in receiving their benefits.”
Kim said about $5 million from the outreach campaign will go towards navigation grants with community partners to help keep members enrolled in their health benefits.
Beyond that, she said they’re focusing on advocacy at the state and federal levels so policy makers understand the impacts on the ground and keeping members informed about the changes.
Public Food Assistance Program Simultaneously Faces Drastic Cuts & Changes
The public health insurance program isn’t the only welfare program that many families rely on that is facing cuts and eligibility changes.
Last year, Social Service Agency and food bank leaders also warned of impacts of the “Big Beautiful Bill” on CalFresh food stamps, including $4.5 billion worth of cuts annually to the food assistance program.
[Read: Orange County Families Confront Hunger & Financial Woes This Holiday Season]
About 200,000 CalOptima members are also enrolled in the CalFresh program, according to OC Hunger Alliance.
The warning came on the heels of a prolonged federal government shutdown that temporarily disrupted the CalFresh program.
In response to the disruption, CalOptima board members allocated $5 million to provide $25 flex cards to their members also enrolled in CalFresh ahead of Thanksgiving.
They also provided $1.5 million to Second Harvest Food Bank and $1.5 million to Community Action Partnership of Orange County – which runs the OC Food Bank.
Kim said the agency is concerned about its members who will navigate the changes to both CalFresh and Medi-Cal and they will continue to communicate with food bank leaders on how they can support.
“We are continuing to talk to them about whether there are other ways that CalOptima Health can support those programs. We have been big supporters of nutrition programs over the past several years,”
“Food is health, and we intend to continue to be supportive of those programs.”
Hosam Elattar is a Voice of OC reporter and corps member with Report for America, a GroundTruth initiative. Contact him at helattar@voiceofoc.org or on Twitter @ElattarHosam.