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Predicted Increase in Medi-Cal Enrollment under the Affordable Care Act: Regional and County Estimates

UC Berkeley Center for Labor Research and Education
UCLA Center for Health Policy Research

The Affordable Care Act (ACA) will expand access to health coverage across California. Californians with household incomes up to 138 percent of the Federal Poverty Level ($15,415 for an individual and $31,809 for a family of four in 2012) will be eligible for Medi-Cal starting in January 2014 under the law. Childless adults will be eligible for Medi-Cal for the first time based on income alone, while the income thresholds will be increased for parents and children ages 6-19. The new law will also significantly simplify program enrollment and retention, including eliminating asset tests for those who are eligible solely due to their income.1 As a result, between 1.2 and 1.6 million more Californians are predicted to be enrolled in Medi-Cal in 2019 than otherwise would have been under current law. (See Nine Out of Ten Non-Elderly Californians Will Be Insured When the Affordable Care Act is Fully Implemented).

An estimated 1.4 million Californians under age 65 will be newly eligible for Medi-Cal in 2014 due to the ACA. Of the newly eligible, 730,000 are predicted to take up the program by 2019 under our base scenario, and 900,000 under our enhanced scenario, which involves extensive outreach and multiple consumer-friendly  enrollment pathways. In addition, 1.3 million Californians are currently eligible for Medi-Cal, but not enrolled. About 100,000 of those currently eligible but not enrolled are predicted to take up coverage under our base scenario, while 300,000 will take up under our enhanced scenario.2

Medi-Cal enrollment will expand in every county across the state. Los Angeles and the remaining Southern California counties are predicted to each account for more than 30 percent of the new enrollees. The San Joaquin Valley will have a higher share of new enrollees (14 percent under the base scenario) compared to its population size (10.4 percent of the state’s population), while the Greater Bay Area will have a smaller share of new enrollees (11.4 percent) compared to its size (19.3 percent of the state’s population).

Exhibit 1: Predicted Increase in Medical Enrollment due to the ACA, Californians under Age 65, by REgion and County, 2019

Data Sources and Methodology

We used the California Simulation of Insurance Markets (CalSIM) model, version 1.7, to predict changes in health coverage in California under the ACA. The model is designed to estimate the impacts of various elements of the ACA on employer decisions to offer insurance coverage and individual decisions to obtain coverage in California. For further information on the CalSIM methodology, please visit http://healthpolicy.ucla.edu/publications/Documents/PDF/calsim1.7methods.pdf.

About the Authors

Ken Jacobs is the chair of the University of California, Berkeley, Center for Labor Research and Education. Dave Graham-Squire is a research associate at the University of California, Berkeley, Center for Labor Research and Education. Gerald F. Kominski is the director of the UCLA Center for Health Policy Research and a professor at the UCLA Fielding School of Public Health. Dylan H. Roby is the director of the Health Economics and Evaluation Research Program at the UCLA Center for Health Policy Research and an assistant professor at the UCLA Fielding School of Public Health. Nadereh Pourat is the director of research at the UCLA Center for Health Policy Research and a professor at the UCLA Fielding School of Public Health. Christina M. Kinane is a research associate/project manager at the UCLA Center for Health Policy Research. Greg Watson is a data analyst at the UCLA Center for Health Policy Research. Daphna Gans is a research scientist at the UCLA Center for Health Policy Research. Jack Needleman is a professor at the UCLA Fielding School of Public Health.

Acknowledgements

We would like to thank Peter Lee, Katie Marcellus, Laurel  Lucia, and Len Finocchio for their helpful comments. Funding for this research was provided by the California Health Benefit Exchange. The California Simulation of Insurance Markets (CalSIM) model was developed with the generous support of the California Endowment.

Endnotes

  1. Asset tests remain for individuals applying for other Medicaid eligibility categories, including the elderly and disabled.

  2. For more details see Exhibits 12-17, Kominski et al., Health Insurance Coverage in California under the Affordable Care Act, June 2012.