Proposition 52: Medi-Cal Hospital Fee Program.
Should (a) a fee charged on private hospitals to facilitate Medi-Cal funding be made permanent; (b) the Legislature’s ability to change it be limited; and (c) the State Constitution be amended to exclude this revenue from California’s education funding calculations?
The Medi-Cal program provides basic health care benefits to eligible low-income Californians (currently 13 million people). Generally, the state and federal governments share the costs of the program equally, but for some costs the federal government pays more than the state.
Since 2009, the state has charged most private hospitals a fee (currently $4.6 billion) which funds the state’s share of increased Medi-Cal benefits and generates state General Fund savings. Between state and federal funds, hospitals realize a $3.5 billion net benefit in payment for services rendered.
Since it began, the Legislature has extended the fee four times, and could potentially extend it again beyond its current ending date of January 1, 2018. Any extension of the fee by the Legislature or by Prop. 52 must also be approved by the federal government.
Prop. 52 would make the fee permanent. The Legislature could end the fee by a two-thirds vote in each house, an increase from the current majority requirement. Changes to the fee generally would require future voter approval in a statewide election. However, the Legislature—with a two-thirds vote—could make certain specific changes without voter approval, such as to obtain federal approval of the fee.
The State Constitution requires an annual minimum funding level for K-12 education and community colleges, based on state General Fund revenue. As under current practice, Prop. 52 would exclude the fee from these calculations (requiring an amendment to the State Constitution).
The fiscal effect of this measure is uncertain primarily because it is not known whether the Legislature would have again extended the fee.
- The fiscal effect of this measure is uncertain primarily because it is not known whether the Legislature would have again extended the fee.
- If the fee would have been extended, Prop. 52 would likely have minor fiscal effect on the state and local governments.Without Legislative extension of the fee, Prop. 52 would have a major fiscal effect on state and local governments. The fiscal effects under this scenario would likely be similar to the Medi-Cal revenue and state benefit experienced through the fee in past years.
These impacts, however, could be affected by new federal requirements impacting the fee, which are not known at this time.