Image: California counties

As reported by Governing, the Governor of California has proposed an option for implementing the Affordable Care Act’s Medicaid expansion by expanding the low-income insurance program on a county-by-county basis.

Under Brown’s plan, outlined in his FY 2013-2014 budget, counties — rather than the state — would be the entities responsible for the fiscal and operational aspects of the expansion. They would have to meet some state minimums for eligibility (138 percent of the federal poverty level, the ACA’s new threshold) and the range of health benefits that would be covered (also tied to the ACA). But expansion funding would run through the counties, counties would enroll newly eligible beneficiaries, etc. They would be responsible for setting payment rates, processing claims and developing provider networks. The county-by-county plan builds on a partial Medicaid expansion that California undertook in 2010. Under that program, called the Low Income Health Program, counties could choose to adopt the Medicaid expansion early, increasing eligibility to the 138 percent threshold, in exchange for a 50 percent federal match on the cost. According to Brown’s budget, Low Income Health Programs are already serving 500,000 people in 51 counties.

The Governor’s proposal may require a waiver from the federal Centers for Medicare and Medicaid Services, if it is approved.  A similar idea was set forth by several counties in Texas last year, according to Governing‘s coverage. In Maryland, the Maryland Health Benefits Exchange (MHBE) Board of Directors decided on a regional distribution of navigator entities in the Individual Exchange, with one navigator entity appointed in each of 6 regions in the State. Navigators must “have expertise in working with vulnerable and hard-to-reach populations; and conduct outreach and provide enrollment support for these populations.” For more information, see our related post, County Health Departments – Possible “Navigators” in Health Care?