Medi-Cal
and Who’s at Risk from the House GOP Plans to Slash the Medicaid program
According to the California Department of Health Services, there are 14.8 million Californians enrolled at a given moment in time. https://www.dhcs.ca.gov/dataandstats/statistics/Documents/FastFacts-December2024.pdf That is well over 1/3rd of our state’s population that is enrolled in a health program that is being targeted for $880 billion in spending cuts by the House GOP and Project 2025, a roadmap for program cutting in the new Trump Administration.
If you add in Covered California, the other component of the Affordable Care Act, 42% of Californians are enrolled in programs being targeted by the Trump Administration. https://www.chcf.org/publication/how-many-congressional-district-get-medi-cal-premium-subsidy-through-covered-california/#related-links-and-downloads The Trump Administration and the GOP are planning to let the Biden era enhanced tax credits that pay for better and broader premium assistance and reduced cost sharing in the Exchanges (like Covered California) expire at the end of the year. Quite a contrast to their plans to preserve and expand the Trumpian tax cuts targeted mostly for the nation’s billionaires.
Roughly 5 million Californians are eligible for MediCal due to the Affordable Care Act. They are vulnerable due to the House GOP’s plans to cut the enhanced matching rates for the Medicaid expansion eligibles. This is part of the game plans laid out by Project 2025 for the new Trump Administration to slash government spending.
About 1.8 million are seniors and persons with disabilities dually eligible for both Medicare and Medicaid while over 728 thousand are seniors and persons with disabilities with no Medicare coverage. 1.2 million are children in families with moderate incomes and pregnant women in families with moderate incomes. https://www.dhcs.ca.gov/dataandstats/statistics/Documents/FastFacts-December2024.pdf They have higher federal matching rates due to their eligibility under the CHIP program. Their higher matching rates are not for now endangered by the plans of the House GOP and Project 2025. In total, 5.5 million of MediCal eligibles are children, and for now they are likely not the target of the House GOP and Project 2025. However the 7.8 million MediCal adults between the ages of 20 and 64 are the low income Californians at highest risk. They are targeted in two ways: potential reduction in the federal matching rates and imposition of work requirements.
14 million MediCal eligibles are enrolled in managed care plans while 800 thousand are in fee for service. This means their health plans are at risk if the GOP simply caps the program’s per capita growth rates. This is one of the many recommendations proposed by the Project 2025 authors. https://static.project2025.org/2025_MandateForLeadership_CHAPTER-14.pdf
Medi-Cal is budgeted for $175 billion in the current fiscal year. https://www.chcf.org/publication/medi-cal-federal-government/#related-links-and-downloads Of that, 62% is federal funding, these are the funds at immediate risk from the $880 billion in Medicaid spending cuts being developed by the House GOP. We should begin to see the details emerge this coming week.
Program enrollment in MediCal and Covered California varies by the percentages of low and moderate income Californians in a given Congressional District. https://www.chcf.org/publication/how-many-congressional-district-get-medi-cal-premium-subsidy-through-covered-california/#related-links-and-downloads Representative David Valdao (GOP) from the Central Valley is the elected California Congressperson with the highest percent of his district’s population enrolled in the two programs – 70%. He is followed closely by Democratic Representative Jim Costa – 67%.
You can see by the maps developed by the California Health Care Foundation that percentages of enrollment in MediCal and Covered California are highest in the agricultural and rural regions of our state with high percentages of low wage workers. https://www.chcf.org/publication/how-many-congressional-district-get-medi-cal-premium-subsidy-through-covered-california/#related-links-and-downloads They are lowest (about 20% of residents) in the state’s most affluent communities in Silicon Valley, the South Bay of Los Angeles, and the coastal districts in Orange and San Diego Counties. https://www.chcf.org/publication/how-many-congressional-district-get-medi-cal-premium-subsidy-through-covered-california/#related-links-and-downloads
GOP Representative David Valdao is cautiously warning his colleagues about the perils of their massive proposed cuts to Medicaid. https://www.politico.com/live-updates/2025/04/29/congress/its-a-dangerous-situation-gop-rep-with-most-medicaid-constituents-sends-a-warning-00316761 He says he is open to reducing the federal match for expansion eligibles to some degree. GOP Orange County Representative Young Kim is also warning the House GOP of the political perils of cutting Medicaid. https://www.facebook.com/RepYoungKim/posts/a-budget-that-does-not-protect-vital-medicaid-services-for-the-most-vulnerable-c/1255003143300942/ California’s GOP representatives are hearing loud, consistent and clear local voices from their constituents opposing the cuts to their health coverage. https://calmatters.org/health/2025/03/medicaid-cuts-republican-districts / They need to hear more and more, louder and louder calls, letters and e-mails from their constituents, their local providers and the health plans.