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Senate committee questions Medi‑Cal expansion freeze and $30 premium plan; enrollment projections disputed
Summary
Department of Finance presented proposed changes to the Medi‑Cal expansion population that include an enrollment freeze, monthly premiums for some adults and elimination of certain benefits. Senators asked for better enrollment and cost estimates and warned savings rely on behavioral changes that are uncertain.
Department of Finance staff told the committee that the budget agreement contains policy changes to the Medi‑Cal program for the undocumented expansion population (often referenced in the hearing as the UIS or "undocumented expansion" population), including an enrollment freeze and modest premiums.
Jacob Ward of the Department of Finance summarized the administration’s projections: "The total case load for, the UIS population is expected to be about 1,600,000. That is expected to increase slightly, by about 800,000 in the next year." Ward also said the department expects case loads to decline beginning in 2026–27 under the package’s assumptions.
Finance staff described three principal elements that are driving projected savings in the package: a freeze on new enrollments effective Jan. 1, 2026; a $30 monthly premium for adults ages 19–59 with unsatisfactory immigration status slated to take effect July 1, 2027; and limits on certain benefits and provider reimbursements for state‑only services. The health omnibus trailer bill language summarized by Finance includes a mix of revenue and assumed behavioral changes. Officials said that some of the projected savings are generated by reduced enrollment through disenrollment and by premium revenue.
Senators pressed officials on the underlying assumptions and timeline. Senator Sciarto expressed concern that the state may be relying on one‑time solutions, borrowing, and optimistic enrollment assumptions. Senator Durazo and others asked whether the administration’s enrollment projections accounted for recent changes in migration patterns and enforcement, and whether a pre‑January surge of enrollments could undercut the savings.
Jacob Ward and other Finance staff said their estimates were based on observed take‑up rates — which they reported as roughly 15,000–18,000 enrollments per month prior to the proposed freeze — and that those trends informed the fiscal modeling. Officials and the Legislative Analyst’s Office warned the committee that behavioral responses are uncertain and that the estimates carry considerable risk.
The Department of Finance and LAO representatives told the committee they would provide updated case‑load and fiscal information as new data arrive in future budget revisions.
Ending: Committee members asked for more detailed enrollment and cost projections, and for updated fiscal estimates in subsequent budget materials; no votes were taken at the hearing.
