Dr. Richard Pan, a pediatrician and former state senator known for authoring some of California’s toughest childhood vaccination laws, is challenging Rep. Kevin Kiley, a two-term Republican-turned-independent, for the newly reconfigured 6th Congressional District, which now stretches across parts of Yolo, Sacramento and Placer counties. Their contest is emerging as one of the more closely watched matchups in the state, with control of a narrowly split House potentially hanging in the balance.

The two men could hardly be more different on healthcare policy. Pan has spent much of his career pushing for expanded vaccination requirements and broader coverage, including his vote to extend Medi-Cal to immigrants without legal status. Kiley, a Placer County native who ran unsuccessfully in the 2021 recall effort against Gov. Gavin Newsom, has built his political identity in part on opposition to pandemic-era mandates and government-run healthcare expansions.

The debate arrives as affordability concerns are surging among California voters. Health insurance premiums are set to climb more than 10% in many parts of the state next year, and the ranks of the uninsured are expected to grow as well. A recent survey from the Public Policy Institute of California found that seven in ten residents are unhappy with the cost of healthcare, while two-thirds of likely voters believe the federal government should ensure all Americans have access to care.

“We often talk about gas prices and grocery prices, but Californians right now are just as worried about the cost of healthcare,” said Mark Baldassare, the survey director at PPIC.

Much of that anxiety traces back to the sweeping federal law passed under President Donald Trump last year, which enacted the largest changes to Medicaid since the Affordable Care Act took effect. Only about a quarter of California adults approved of the measure in an earlier PPIC poll. The law is projected to cut federal Medicaid spending by nearly $1 trillion over the next decade, largely through new work requirements and shorter eligibility windows — changes expected to push millions of people off the rolls nationally and cost California billions of dollars a year.

“There’s a lot of this that ends up becoming part of the Trump agenda, and it’s hard to untangle,” said Sacramento-based Democratic strategist Andrew Acosta, noting that many House races this cycle are essentially referendums on policies enacted during the first two years of Trump’s second term.

Community health advocates say the stakes are high. Anna Marshall, deputy director of federal policy for the California Primary Care Association, said Medicaid expansion under the Affordable Care Act transformed rural and underserved communities by allowing clinics to grow and add services like behavioral health. California now has more than double the number of community clinics it had before the ACA took effect. Her organization opposed the recent federal law but has not weighed in on the Pan-Kiley race.

State officials estimate roughly 2.2 million Californians will lose health coverage in the coming years — most falling off Medi-Cal, with hundreds of thousands more priced out of the Covered California exchange as premiums rise.

Given California’s new congressional map, which gives registered Democrats a nine-point registration advantage in the district, some might assume the race is a foregone conclusion. But Acosta said he still views it as competitive, given both candidates’ long track records in public life.

“Candidates have to defend their record, and these are two candidates with a lengthy record,” he said.

Pan has become something of a lightning rod over the years for his advocacy on vaccines. He authored California’s stringent school vaccination requirements following a 2010 whooping cough outbreak that killed nine infants and a 2014 measles outbreak — traced to Disneyland — that spread across several states and into Canada and Mexico. His stance has drawn intense backlash from anti-vaccine activists, including one incident in which he was physically shoved on a downtown Sacramento street and another in which protesters threw menstrual blood onto lawmakers from the Capitol gallery.

Kiley, by contrast, has staked out a reputation as a fierce critic of pandemic-era restrictions, arguing that California’s COVID-19 vaccine mandates and prolonged school closures damaged public trust in vaccines and inadvertently drove down childhood immunization rates by keeping kids away from in-person medical visits tied to school enrollment.

Matt Fleming, a conservative columnist and district resident who once served as a legislative staffer alongside Kiley in the Assembly, said he expects a genuinely competitive race, pointing to Kiley’s strong name recognition and independent streak.

“I don’t really see Richard Pan as someone who is going to blaze a trail and be an independent voice, even as a Democrat,” Fleming said. “Kevin Kiley is not a rubber stamp for Trump or Mike Johnson.”

In fact, Kiley told the news outlet Semafor this week that he intends to stop caucusing with Republicans altogether if reelected — a move that would require House rules changes to preserve committee assignments for lawmakers who caucus with neither party.

On the substance of federal health policy, Kiley — who voted for the Trump-backed law — disputes the characterization that Medicaid was cut, arguing that overall spending continues to rise due to increasing healthcare costs even as enrollment drops. Critics, including Pan, argue that pushing people off the program functionally amounts to a cut regardless of overall spending totals.

Kiley does say Congress erred in allowing enhanced ACA subsidies to expire, which contributed to sharp premium increases this year — California’s typical Covered California plan now runs about $570 a month, with statewide rates rising another 9.9% on average in 2027. He co-authored a bipartisan bill with Democratic Rep. Sam Liccardo of San Jose seeking a two-year extension of the subsidies, though the effort stalled in Congress. He faults leadership in both parties for the impasse.

“It’s a very clear case study in how the brokenness of Congress is directly costing Americans in many ways,” Kiley said.

On that point, the two candidates find rare agreement — both support restoring the subsidies, with Pan arguing that California’s middle class is especially exposed to rising costs since many residents earn too much to qualify for assistance but still feel squeezed by higher premiums.

Where they diverge is on who bears responsibility. Pan, who serves on the state’s healthcare affordability oversight board, points to federal policy shifts under Trump as the primary driver of rising costs. Kiley instead blames state lawmakers in Sacramento, singling out a newly passed tax on health insurers — meant to help offset federal Medicaid cuts — that is projected to add roughly $100 a year to premiums per person. Kiley and fellow Republicans have asked federal regulators to block the tax from taking effect.

Pan counters that without the new revenue, “costs will start to show up in premiums anyway,” arguing that hospitals and clinics will pass along the expense of treating a growing uninsured population to commercial insurers. Economists are divided on how much of that cost actually gets shifted, though some estimates put the added burden at around $100 per person annually — with most agreeing hospitals absorb the majority of unpaid care costs.

Pan also defended his vote to extend Medi-Cal eligibility to immigrants without legal status, acknowledging the state has struggled with the program’s price tag — now exceeding $10 billion a year — but arguing government assistance shouldn’t be denied to those who qualify because of budget concerns.

“We have to ultimately recognize that we’re trying to respond to what the Trump administration, the Republican Congress, including Kevin Kiley, voted for,” Pan said.

Locally, Democrats say last year’s redistricting — which split Placer County into three Democratic-leaning districts — has energized the party in a region long dominated by Republicans.

“Now we have three winnable Democratic seats,” said Julann Brown, chair of the Placer County Democratic Party. “We’ve become relevant in a way that we didn’t expect.”

Brown said her party has endorsed Pan and is focused on defeating Kiley, whom she describes as a reliable vote for the Trump-aligned wing of the GOP despite his shift away from the Republican Party label. The Placer County Republican Party, which has endorsed Kiley, did not respond to requests for comment.

Brown said healthcare resonates strongly with rural voters in the district, many of whom already travel long distances for basic medical care and fear further service cuts if clinics and hospitals lose funding. She recalled her own family’s experience during the 2008 recession, when her husband lost his job and, with it, their health coverage — two years before the Affordable Care Act expanded options for families like hers. At the time, their children qualified for a special assistance program while she and her husband went without insurance.

“My family had a choice between making our house payment and having health coverage,” Brown said. “That’s where we’re headed again.”

Original source: CalMatters

The post Vaccine Mandate Advocate Challenges Party-Switching Conservative in Bid to Flip Seat appeared first on The Hemet & San Jacinto Chronicle.

But newly released federal poverty data offers a more complicated picture, one that Newsom’s talking points tend to leave out.

The U.S. Census Bureau this week published updated poverty figures showing that California’s official poverty rate stands at 10.7%, matching the national average. That’s the standard measure used for decades to determine eligibility for various federal aid programs.

A more telling number, though, is the bureau’s “supplemental poverty measure,” which factors in regional living costs, housing expenses and other financial pressures often left out of the traditional formula. By that measure, California’s poverty rate jumps to 17.8% — well above the national rate of 13%, and slightly higher than the 17.7% recorded in the previous report.

Still, there’s a silver lining buried in the numbers: for the first time in years, California is no longer at the very bottom. Louisiana has now surpassed the Golden State, posting a supplemental poverty rate of 19.8%, after the two states were previously tied.

The reasons behind high poverty rates, however, differ sharply between the two states. In Louisiana and much of the South, the driving force is low wages. In California, it’s the opposite problem — incomes may be higher, but the state’s sky-high cost of living, particularly housing, along with steep utility and transportation costs, erodes much of that advantage.

Separate research from the Public Policy Institute of California and Stanford University’s Center on Poverty and Inequality backs up the Census Bureau’s findings. Using a similar cost-adjusted approach known as the California Poverty Measure, the groups calculated the state’s 2024 poverty rate at 17.4%, closely mirroring the federal figures.

Their analysis went a step further, breaking down poverty rates by county and identifying Californians who fall into a “near poor” category — those earning up to 150% of the federal poverty threshold, or roughly $42,600 a year for a family. When combined with the state’s poor population, the research found that 35% of Californians were either poor or near poor in 2024, struggling to afford housing, food and other basic needs.

That figure lines up closely with enrollment in Medi-Cal, California’s health insurance program for low-income residents. Roughly 13.9 million Californians — also about 35% of the state’s population — currently rely on Medi-Cal, a program whose price tag has ballooned to $222 billion and now represents one of the largest components of the state budget.

Medi-Cal illustrates both the reach of California’s safety net and its limitations. The state can cushion the effects of poverty through public spending, but it cannot spend its way out of the underlying problem. Meaningful, lasting reductions in poverty will require either a drop in housing and living costs or a resurgence of the kind of middle-class job growth that once defined California’s economy. Right now, neither trend is moving in a favorable direction, leaving more than a third of Californians caught in a persistent lower economic tier.

If Newsom does launch a bid for the White House, it’s a near certainty that his political opponents will seize on these poverty figures to challenge the rosy portrait he often paints of the state he leads.

Original source: CalMatters

The post California Ranks Among Nation’s Poorest States as Living Costs Take Toll, New Data Shows appeared first on The Hemet & San Jacinto Chronicle.

Under a corrective action plan issued by the California Department of Health Care Services, Health Net must now continue covering assisted living and home care services for all affected members through the end of the year, rather than cutting off some as early as October as originally planned.

Health Net, one of the nation’s largest Medicaid insurers, informed providers months ago that it intended to drop its assisted living and home care contracts. Because those services are optional benefits under Medi-Cal, California’s Medicaid program, insurers can choose annually whether to keep offering them. But providers and families say they received little advance notice, leaving many uncertain about how to secure alternative housing or care for loved ones.

In an August letter to Health Net, state regulators outlined eight separate violations in how the company managed the transition, including failing to submit individual transition plans for members, neglecting to move patients into appropriate alternative care, and denying services outright to some enrollees. The department warned that these lapses “jeopardize member safety, disrupt continuity of care, and endanger medically vulnerable members.”

The state has threatened fines of up to $25,000 per member, per day of violation, if Health Net fails to extend coverage and develop transition plans tailored to each patient’s needs.

Advocacy groups and care providers estimate roughly 3,500 Medi-Cal enrollees depend on Health Net to help cover the cost of assisted living. Most are elderly, and a significant number live with cognitive conditions such as dementia. Health Net administers Medi-Cal coverage across 10 counties, including Los Angeles, Fresno, Sacramento, San Joaquin, Stanislaus and Tulare, among others.

Health Net spokesperson Beatriz Lopez confirmed the company will maintain coverage for all affected members through December but still intends to eliminate the benefit altogether starting next year. “Health Net and DHCS share a commitment to advancing the health and well-being of Medi-Cal members,” Lopez said in a statement.

The insurer has previously argued that the assisted living benefit hasn’t demonstrably reduced emergency room visits or hospital stays among enrollees. The program falls under CalAIM, a sweeping state effort to modernize Medi-Cal and curb costs by better managing care for patients who frequently rely on emergency services. Lopez said the company will continue reviewing outcome data to determine which services provide the most value to members.

Providers reached by CalMatters confirmed their contracts with Health Net have now been extended through the close of the year.

Despite the reprieve, advocates warn the underlying problem remains unresolved. Hagar Dickman, director of long-term services and supports at Justice in Aging, said the state’s intervention only delays a looming crisis. “Thousands of older Californians are still set to lose their housing on January 1st,” she said.

Dickman noted that allowing insurers to eliminate housing-related benefits creates a particularly dangerous situation, since most assisted living residents have no other place to live. She also pointed out that state continuity-of-care protections may not apply if a member switches to a different insurer that still covers assisted living — meaning the new plan could simply refuse to pay for that member’s care.

“It’s disingenuous to say there are protections and then say the protections don’t apply,” Dickman said. “So the option is skilled nursing or homelessness.”

Pauline Shatara, deputy director of California Advocates for Nursing Home Reform, echoed those concerns, saying the state’s corrective measures fall short of a real fix. “It doesn’t sound like we found a solution to help pay for these people to remain where they are,” she said.

Original source: CalMatters

The post State Regulators Penalize Insurer Over Coverage Cuts to Assisted Living Facility Residents appeared first on The Hemet & San Jacinto Chronicle.

A recent report examining how Medi-Cal cuts could ripple outward and raise costs for privately insured Californians made a compelling case. But it left out the more uncomfortable question underlying the whole debate: Can the program keep growing at its current pace without consequences?

The federal government is roughly $40 trillion in debt, adding more than $1.8 trillion to that total every year. Medicaid, the program that funds Medi-Cal in California, has been among the fastest-growing federal expenses over the past decade. It now covers far more people than it was originally designed to serve. That expansion deserves examination alongside any discussion of cuts — yet it rarely gets one.

Part of the problem is who gets asked for comment. Coverage of Medi-Cal funding tends to rely heavily on hospital associations, academic researchers and advocacy groups — voices that, understandably, have a financial or institutional interest in seeing the program grow. Missing from the conversation are the taxpayers footing the bill and the policymakers wrestling with long-term fiscal reality.

That imbalance shows up in how work requirements get discussed. Critics frame them as inherently punitive, since verifying whether someone still qualifies for benefits creates administrative friction and can knock eligible people off the rolls by mistake. That’s a legitimate concern — government paperwork is rarely efficient. But any program that means-tests eligibility has to periodically confirm recipients still meet the criteria. Without that check, a safety net doesn’t stay targeted at the people who need it most. It simply expands indefinitely.

The same dynamic is playing out right here in California. Economists have warned that federal Medicaid cuts could push private insurance premiums up by 1% to 2%, adding roughly $500 a year to the average family’s costs. That’s real money. But it pales next to a bigger, more immediate hit: the new state tax on health plans that Sacramento approved this year, which is expected to add closer to $100 per person almost immediately. Lawmakers passed that increase quietly while public attention was fixed on Washington’s budget fights.

There’s also the matter of history getting stretched to fit a narrative. The 2007 closure of Martin Luther King Jr.-Harbor Hospital in Los Angeles is sometimes invoked as an example of what happens when health funding dries up. In reality, that hospital closed because of well-documented patient-safety failures, not a lack of money.

None of this is to suggest uninsured and underinsured Californians don’t deserve attention and support — they do. But an honest conversation about Medi-Cal has to include its price tag and its trajectory, not just the harm that might come from trimming it. With the national debt approaching $40 trillion, asking whether the program’s growth is sustainable isn’t a distraction from the issue. It is the issue — for California, and for the country as a whole.

Original source: CalMatters

The post Medicaid’s Growth Beyond Its Original Purpose Demands Closer Look at Costs appeared first on The Hemet & San Jacinto Chronicle.

What followed was a nine-month struggle that exposed a stark gap in how the state’s Medi-Cal program treats older adults depending on where they live — a gap that ultimately led to a new pilot program aimed at giving rural Californians more say in how and where they age.

John had moved back to the ranch to help his sister with daily tasks like bathing and dressing, but caring for her while also managing the property and his own work as a writer became unsustainable. The siblings agreed that Roselie, who qualifies for Medicaid, should transition into assisted living.

That’s when John discovered a frustrating reality: Medi-Cal does not fund assisted living care in Siskiyou County — or in 42 other counties across California. Only 15, mostly in urban areas, offer that option through what’s known as an assisted living waiver.

The disparity leaves many rural seniors with only one real alternative: a nursing home, even when their needs don’t require that level of institutional care, simply because they cannot afford to pay for assisted living privately.

“You’re wasting money by dumping somebody like my sister in a skilled nursing facility and lessening her quality of life and her chance at doing better,” John said. “By doing this, it makes no fundamental sense.”

**A statewide problem coming into focus**

California is bracing for a dramatic shift in its population — within a decade, one in four residents will be over 60. State officials have said they want to help older adults age in their own communities rather than in institutions. But whether that promise is fulfilled often depends on which managed care organization administers Medi-Cal benefits in a given county, and what services that plan chooses to offer.

Roselie is covered by Partnership HealthPlan, the dominant Medi-Cal managed care provider across a swath of Northern California, serving nearly a million residents. In 15 counties, it’s the only option available to Medi-Cal enrollees.

According to the California Department of Health Care Services, managed care organizations are “encouraged” — but not obligated — to offer optional benefits known as community supports, which can include help with the cost of assisted living, temporary rental assistance, respite care and in-home personal care. These fall under CalAIM, the state’s sweeping effort to modernize Medi-Cal. Even after related waivers expire at year’s end, these community support benefits are expected to continue.

Dustin Lyda, a spokesperson for Partnership, said the plan opted not to include an assisted living benefit due to cost concerns and a shortage of qualified facilities in the rural communities it serves. Any change, he said, would require evidence that assisted living leads to better outcomes than nursing homes. Still, he acknowledged the shortcomings.

“There’s definitely a lot more work that we need to do on our end to navigate the more rural areas,” Lyda said.

Maura Gibney, executive director of California Advocates for Nursing Home Reform, said the lack of options compounds an existing shortage in rural regions.

“There’s not a lot of options to begin with in rural counties,” Gibney said. “You take (the assisted living waiver) off a table, which already has a history of a long waiting list, and the options are pretty bleak.”

**Fighting for a place close to home**

John initially assumed his sister would have to leave Siskiyou County altogether, since it offers just one Medi-Cal-approved facility — a nursing home. Roselie had previously stayed at an assisted living facility in neighboring Shasta County and felt at home there, but Partnership doesn’t cover assisted living costs in that county either.

The plan instead offered to place Roselie in Sonoma County — roughly five hours from the family ranch. The Aiellos refused, worried the distance would cut Roselie off from the relatives she relied on for emotional support.

“If you remove her totally from a family contact, she would not be thriving right now. She needs to see family,” John said. “When there were resources available that fit her needs in Redding — that’s the closest point to her home county — why do I need to move her to Oakland, to Los Angeles, to San Diego?”

For nine months, John pushed back — sending emails, making calls, and enlisting Roselie’s doctor to advocate on her behalf, all while trying to secure her a spot at the Shasta County facility. The process took a toll on both of them.

“He was doing all of this to help me,” Roselie said. “Where was it going to end?”

**A system with built-in gaps**

Advocates say most people would rather remain in community settings than move into nursing homes, which tend to be significantly more expensive to operate. But nursing home capacity is limited and should be preserved for people who genuinely need round-the-clock medical supervision, Gibney said.

“We really try to help people look at the other options that exist for remaining in the community,” she said. “You’re going to have better health outcomes, better quality of care, if you can stay in the community and out of an institutional setting.”

Still, the picture isn’t entirely one-sided. Dr. Kenneth Lam, a geriatrician and assistant professor at the University of Colorado Anschutz Medical Campus, noted that people in assisted living are sometimes hospitalized more often than nursing home residents, which can offset some of the anticipated savings.

“The evidence suggests that it’s a trade-off,” he said.

State officials confirmed that managed care contracts aren’t competitively bid, and plans aren’t required to offer specific community supports like assisted living assistance as a condition of their contracts.

“Whether a plan chooses to provide specific community supports is not a factor in contract renewal, which focuses instead on overall compliance with state and federal performance standards,” said Tessa Outhyse, a spokesperson for the Department of Health Care Services.

Partnership’s state contract, originally set to expire in December, has been extended to 2029 after California delayed its broader process for awarding managed care contracts. Lyda said demand for community supports, including requests for assisted living help, has been rising steadily. But even in counties where such benefits exist, waitlists can stretch on for months.

Statewide, the number of new enrollees approved for an assisted living waiver actually declined at the start of 2025, even as the waitlist kept growing. By September, more people were waiting for a waiver than were actually receiving one.

Gibney said the sequence itself can be part of the problem — many Medi-Cal recipients are advised to join the waitlist before they’ve even applied for the funding, adding to the delays. Some spend months waiting only to learn they don’t qualify.

“It’s a lot of shifting sand, that’s what people are finding themselves in the middle of,” Lam said. “They’re being told that they get to choose, but it’s a complex choice.”

**A new chapter for Roselie**

In March, Roselie finally moved into Sundial Assisted Living in Shasta County — the very facility she and John had hoped for from the start. Two months earlier, Partnership had agreed to cover her care, offering her a spot in a new pilot program launched July 1 that expands assisted living access to select members of its network. There’s no formal application process; eligible members are referred through healthcare providers or can request consideration directly.

The pilot is designed to test whether expanding assisted living coverage leads to better health outcomes and lower costs overall.

“Success would also be having these individuals being able to continue to receive care within their community setting, being in their home,” Lyda said. “We know that that is more impactful to health than being completely taken out of a familiar area.”

The transition hasn’t been simple for Roselie, who has been hospitalized twice since moving to Sundial and spent a brief stint back in a nursing home. But socially, she has flourished — making new friends, teaching card games to fellow residents, and receiving visits from caretakers and neighbors during her hospital stays.

“I’m looking at it like this: It’s a new adventure,” she said.

John remains uneasy about his sister’s health and whether Sundial will be a lasting solution. He’s relieved the fight paid off, but still troubled that it took so much effort to get there.

“I don’t understand why I was the guy fighting for everybody,” he said. “I’m just one person trying to support myself, trying to take care of a family member.”

Original source: CalMatters

The post Medi-Cal Rarely Covers Assisted Living in California — This Brother Refused to Accept That appeared first on The Hemet & San Jacinto Chronicle.

“If something is available to help you to be more healthy, to avoid comorbidities … why would we want to wait till a person became diabetic to help them?” Richardson asked fellow lawmakers during a June legislative hearing.

Her frustration reflects a problem playing out across California, where medications like Ozempic and Wegovy have shown remarkable promise for treating obesity and related conditions but remain financially out of reach for many residents. Prices have edged downward in recent years, but most insurance plans still won’t cover the drugs, and state health programs — worried about ballooning costs — have in some cases pulled back coverage rather than expand it.

Now Richardson is pushing legislation aimed at closing that gap. Senate Bill 1089, which is nearing final approval in Sacramento, would direct the state to pursue a partnership with a drug manufacturer to boost competition and drive down GLP-1 prices through CalRx, California’s program for producing and distributing costly medications at reduced rates.

Any such deal would likely take years to materialize. It took the state three years to bring its $55 insulin product to market through CalRx, which currently also distributes albuterol inhalers and naloxone.

The version of SB 1089 now moving through the Legislature is considerably scaled back from its original form. Earlier drafts would have required CalPERS, which provides health coverage to 1.3 million public employees and retirees, to cover GLP-1 medications outright. CalPERS pushed back hard against that provision, warning it could raise premiums by roughly $28 per member each month.

Richardson said she has since discussed adding GLP-1s to the CalRx program directly with Gov. Gavin Newsom, describing him as “very positively open” to the idea. State health officials have confirmed that GLP-1s are among the medications under consideration for the program.

Spending on the drugs has climbed dramatically in recent years. According to state data, the number of GLP-1 prescriptions issued specifically for weight loss — across both Medi-Cal and private insurance — surged from about 20,000 in 2018 to 700,000 in 2023. That year alone, California spent nearly $417 million on weight-loss GLP-1 prescriptions through Medi-Cal, while commercial insurers spent over $405 million.

A report from the Legislative Analyst’s Office found that overall pharmacy spending in California nearly doubled during that period, driven largely by medications treating diabetes, obesity and inflammatory conditions.

Facing similar cost pressures, California recently eliminated Medi-Cal coverage of GLP-1s when prescribed solely for weight loss, though the drugs remain covered when prescribed for diabetes. The state isn’t alone — New Hampshire, Pennsylvania, Massachusetts and South Carolina have made comparable cuts to their Medicaid programs. Currently, only a dozen states cover GLP-1s for obesity under Medicaid, and Rhode Island is set to end its coverage this October. Coverage under private insurance is similarly inconsistent, with health plans citing GLP-1 costs as a major factor pushing up premiums.

Alison Sexton Ward, an economist and research scientist at the University of Southern California, said the medical benefits of these drugs are well documented, with modeling suggesting long-term savings in health care spending and a reduction in health disparities. But she said insurers face a difficult calculus: the upfront costs are steep, and the savings from preventing obesity-related illness may not materialize until years later — often after a patient has switched insurance providers.

“The thing about treating obesity is just because you lose weight today doesn’t mean that your health care costs go down tomorrow,” Ward said. “There’s been this unique pressure on these drugs that they pay for themselves.”

One model drawing attention from researchers is the federal Medicare GLP-1 Bridge Program, a temporary initiative designed to bring the price of drugs such as Zepbound, Wegovy and Foundayo down to roughly $50 a month.

Dr. Wayne Ho, an obesity specialist and researcher based in Los Angeles, said he sees firsthand how uneven access shapes patient outcomes. Those who can afford the drugs out of pocket, or whose insurance covers them, are often able to manage their conditions far more effectively than patients forced to rely on less effective alternatives.

“It’s really disheartening to see because we have these wonderful innovative treatments that really are life altering,” Ho said.

The high price tag has pushed some patients toward cheaper, compounded versions of the medications — a trend that worries many physicians because those products lack FDA approval. Compounding is typically used to modify a drug for a specific medical need, such as removing an allergen, but a growing number of compounding pharmacies and telehealth platforms are now offering altered versions of GLP-1s that swap out ingredients. Ho warns that these products carry greater risk because they skip the FDA’s standard review process.

Nationally, calls to poison control centers related to weight-loss medications spiked by 1,500% between 2019 and 2025, according to America’s Poison Centers. Research has linked compounded GLP-1s to higher rates of adverse reactions and dosing errors, including a Binghamton University study that found compounded versions were associated with higher hospitalization rates. The FDA has also cautioned about counterfeit products entering the market.

Despite the challenges, Ho remains optimistic that broader, affordable access to FDA-approved GLP-1 medications is within reach, and he credits ongoing legislative efforts with helping move the needle.

“I think there’s more and more pressure to cover these medications as more and more scientific data come out to show how it affects the body in a very positive manner,” he said.

Original source: CalMatters

The post California Lawmakers Push Plan to Cut Costs of GLP-1 Weight-Loss Drugs appeared first on The Hemet & San Jacinto Chronicle.

The Centers for Medicare and Medicaid Services finalized a rule this month barring federal reimbursement for gender-affirming medical care provided to minors. The change takes effect Oct. 13, and could immediately affect roughly 1,500 transgender and gender-nonconforming children across California who rely on Medi-Cal for puberty blockers, hormone therapy and related treatment.

In response, state legislators are pushing for $10 million in emergency funding before the legislative session ends, intended to bridge the gap while the Department of Health Care Services builds a new, state-only funding system that doesn’t rely on federal dollars. But the department itself has said that process could take up to a year — far longer than the six weeks lawmakers have to act.

Assemblymember Chris Ward, a San Diego Democrat who chairs the Legislature’s LGBTQ caucus, said the stakes are high for a population that depends heavily on public assistance.

“They’re low-income Californians who need support arguably the most, and Medi-Cal is their lifeline to access that care,” Ward said. “We need to stand up for them.”

Still, many parents and advocacy organizations say they doubt the state can create a new program in time — and feel blindsided after months of budget talks that they believed had already addressed the issue.

For nearly eight months, LGBTQ advocates and medical groups warned California officials that federal cuts were coming and pressed for the state to set aside funding to protect transgender youth on Medi-Cal. Many believed lawmakers had done just that in June, when the state budget included $56 million earmarked for gender-affirming and reproductive health services.

But after the budget passed, advocates discovered that language guaranteeing a portion of that money would fund a separate, state-run Medi-Cal pathway for transgender children had quietly been removed by the Newsom administration.

One mother, identified by CalMatters only by her initials, A.W., to protect her children’s privacy, said she felt misled.

“I thought that when we took our kids to Sacramento to meet with members of the Assembly and Senate that we were advocating for a backfill that would cover kids on Medi-Cal who would lose those federal dollars,” she said. “I’m really disappointed that our coalition spent so much time and effort on something that I’m not sure we’ll reap the benefits of, and that sucks.”

The Department of Health Care Services, which oversees Medi-Cal, declined to explain why the funding wasn’t specifically directed toward the program, referring questions instead to the Department of Finance. A finance department spokesperson said officials were “aware of this particular issue” but offered no further details.

Ward said the state budget — which grappled with California’s fourth consecutive deficit — left little room for new commitments, and noted that the federal rule hadn’t been finalized when budget negotiations concluded in June.

The California Health and Human Services Agency has pointed to the $56 million already allocated, stating on social media that the state remains “committed to ensuring all people have access to the medically necessary, evidence-based care that will allow them not only to survive, but thrive.”

But advocates argue that statement obscures the reality of how the money will actually be spent. Arne Johnson, an organizer with Rainbow Families Action, called the framing misleading.

“In the end, not a penny of it is going to backfill Medi-Cal at all,” Johnson said.

According to two people familiar with the budget negotiations, the funds will instead go toward building up infrastructure at transgender health clinics — a response to more care shifting from hospitals to outpatient settings amid federal pressure — as well as supporting other groups affected by federal funding cuts, including military families and veterans.

While many advocates welcome that long-term investment, they say it does little to address the immediate risk facing children who could lose care within weeks.

“It’s been very frustrating to see California say in many words that it’s supportive of trans people, and be so unprepared for something we all knew was about to happen,” Johnson said.

Laura Sheckler, budget and policy director for the California Primary Care Association, which represents community health clinics, said time is running out for the state to act.

“The bigger question is how is California going to ensure that whatever they set up is going to be available on Oct. 13 when these rules go into effect?” she said.

For A.W.’s family, the stakes are deeply personal. Her eldest son, now 15, has received care through Stanford’s specialty gender clinic since he was 8, when he began seeing a therapist after showing signs of gender dysphoria from an early age — pulling bows from his hair, resisting dresses and asking why he couldn’t use the bathroom standing up.

“We had zero education or inkling that he might be trans, but as we started educating ourselves and learning more, we realized that he at a very, very young age was verbally communicating with us who he is,” A.W. said.

The family relocated from Virginia to the Bay Area, and her son later began puberty blockers before transitioning to weekly testosterone injections, which he now administers himself. When her husband lost his job two years ago, Medi-Cal allowed her son to continue seeing the same medical team without interruption — something A.W. said was critical to his wellbeing.

Her younger child came out as transgender last year as well, adding another layer of urgency to the family’s concerns about the looming funding cliff.

For her eldest son, she said, any disruption in access to testosterone wouldn’t just be an inconvenience — it could force an unwanted medical detransition.

“A gap in care for my son is a terrible thing,” A.W. said. “He doesn’t take testosterone and what happens? He would be forced to medically detransition. It’s unacceptable that the state wasn’t prepared.”

Original source: CalMatters

The post Parents of Transgender Youth Say California Isn’t Ready as Federal Cuts Threaten Their Kids’ Healthcare appeared first on The Hemet & San Jacinto Chronicle.

Counties from the Bay Area to the Central Valley are reporting fewer people living on the streets or in shelters compared with last year, based on preliminary tallies from January’s count. Some of the declines were dramatic. San Joaquin County, for instance, saw its overall homeless population fall by nearly a third since 2024, with unsheltered homelessness cut nearly in half. Other regions saw smaller improvements — San Francisco’s count dipped about 4 percent.

Of the 28 California counties and regional homeless service areas that have released 2026 figures so far, more than half showed a decrease. Eight did not conduct a count this year, and seven have yet to make their results public.

Local officials crediting the drop point to new shelter beds and affordable housing units funded by a wave of state homelessness spending in recent years. But not everyone is convinced the numbers tell the full story. Homeless advocates note that cities have intensified encampment sweeps and citations for illegal camping, which can scatter unhoused residents and make them harder to locate — and count — even if they haven’t actually found housing.

And even where officials are touting real progress, there’s growing worry about whether those gains can hold up. Federal cuts to Medi-Cal and other social services threaten to undo recent momentum, several county leaders said.

“We’ve made progress,” said Jonathan Russell, director of Alameda County Health Housing and Homelessness Services, which reported a 13 percent decline compared with 2024. “And there are real threats, real peril.”

Point-in-time counts are federally mandated tallies that most counties conduct every one to two years, typically on a single night in January, when volunteers and outreach workers fan out to count every person sleeping outside, in shelters or in vehicles. The method is widely acknowledged to undercount the true homeless population — people hidden in cars, tucked behind buildings or otherwise out of sight are easy to miss — but it remains the primary tool used nationwide to track trends over time.

Last year’s statewide count found 181,934 homeless Californians, a nearly 3 percent decline from 2024. The U.S. Department of Housing and Urban Development, which compiles the official statewide and national figures, won’t release final 2026 numbers for months, but many counties have already published their own preliminary data.

Not every region saw improvement. Los Angeles County, after two consecutive years of decline, reported a 1 percent increase in homelessness this year. Sacramento County’s overall count rose 13 percent from 2024, even as the number within Sacramento city limits fell. Contra Costa County, which had posted a significant drop between 2024 and 2025, saw a 7 percent increase this year.

The count’s limitations were also on display. A Los Angeles Times investigation found that an accounting error had inflated the city’s homeless total by more than 600 people. And in Fresno and Madera counties, which reported what appeared to be the state’s steepest decline — 34 percent — officials acknowledged the drop may be misleading. This year, volunteers counted only people who confirmed they were homeless and agreed to be surveyed, a change from the broader method used in 2025 that counted anyone visibly living on the street. Officials told the Fresno Bee that the shift makes year-over-year comparisons unreliable.

Some counties are highlighting a different kind of progress: moving people from the streets into shelters, even if they remain technically homeless. In Alameda County, the share of unhoused residents living in shelters rose from 21 percent in 2019 to 37 percent this year. The county also reached a milestone last year — for the first time since it began tracking the data in 2021, slightly more people exited homelessness into housing than fell into it.

Russell attributes much of that shift to a surge of state funding that arrived roughly four years ago, including money from the Homekey program, which helps local governments convert hotels into homeless housing, and the state’s Homeless Housing, Assistance and Prevention fund. Additional state dollars targeted at homeless residents with mental illness or substance use disorders followed in 2023 and 2024.

San Joaquin County, meanwhile, added 304 shelter beds and 1,078 permanent housing units between 2024 and 2026, boosting the number of people in permanent housing by 86 percent.

“There just wasn’t money available 10 years ago like there is now,” said Dawn McLeish, deputy director of the county’s human services department. “It just took a couple years for those investments to get all the way off the ground.”

Not everyone is buying the good news. Niki Jones, executive director of the Sacramento Regional Coalition to End Homelessness, is skeptical of the downward trend.

“They can call it progress if they want to,” Jones said. “I call baloney.”

Since the U.S. Supreme Court’s 2024 ruling giving cities broader authority to clear homeless encampments, many municipalities have adopted new camping bans, increased citations and stepped up encampment clearings. Advocates say that has pushed unhoused residents into hiding, making them harder to find during the count.

“It’s a lot harder to find one person with a blanket somewhere than it is to see a camp,” Jones said.

A recent RAND Corporation study of Los Angeles’ Skid Row, Hollywood and Venice neighborhoods found that overall unsheltered homelessness stayed roughly flat between December 2024 and January 2026 — but the composition changed. The number of people living in tents fell 23 percent, while the number sleeping without any shelter at all rose 20 percent. That shift could complicate efforts to house people, since Mayor Karen Bass’ signature Inside Safe program focuses on clearing tent encampments and moving residents into hotels. People sleeping rough, the study noted, often struggle to keep hold of identification and phones, making the path into housing more difficult.

In Monterey County, homeless services director Roxanne Wilson said it’s hard to know exactly how much enforcement is skewing count results, but she has seen tangible movement of people into housing. The county reported a 15 percent drop in overall homelessness compared with 2024, with unsheltered homelessness down nearly a quarter. Wilson credits three state Encampment Resolution Grants that helped relocate more than 150 people from encampments along the Pajaro River levee and in Soledad and King City. The funding paid for a new shelter in Santa Cruz County for former Pajaro River residents, tiny homes in Soledad and hotel rooms in King City — stepping stones toward permanent housing.

Wilson called it “a huge accomplishment,” but cautioned that state homelessness funding typically arrives as one-time grants, leaving counties uncertain from year to year about what support they’ll receive. That unpredictability makes long-term planning difficult.

“The reality is that it’s going to be hard to hold this line,” Wilson said, “if we don’t start having more stable funding sources.”

Original source: CalMatters

The post California Counties Report Decline in Homeless Populations This Year appeared first on The Hemet & San Jacinto Chronicle.

Family physicians like myself work inside California’s community health clinics every day, delivering care to patients who often have nowhere else to turn. Prop. 44 puts that work — and the clinics themselves — in serious jeopardy.

The problem lies in how the measure is written. Its spending rules are so rigid that, by some estimates, roughly 91 percent of the state’s health centers would fail to meet them. An independent analysis commissioned by the California Primary Care Association found that clinics could collectively face as much as $1.7 billion in penalties in just the first year, with continuing costs in the years after. That’s money that currently keeps clinic doors open and supports the kind of comprehensive, community-based care that has made these centers a trusted resource for millions of Californians.

The financial fallout could be severe. Recent data suggests that the vast majority of clinics statewide are already operating on thin margins. A sudden wave of penalties tied to Prop. 44 could push most of them into the red, forcing painful decisions about which services to cut just to stay afloat.

If that happens, some clinics may be forced to shut down entirely — eliminating safety-net care for the very communities that depend on it most. Each year, California’s community clinics serve more than 7 million patients, including children, working families, uninsured residents, seniors, veterans, and roughly one in three Medi-Cal enrollees. Prop. 44 threatens the funding base that keeps this system functioning.

Beyond the financial risk, the measure is poorly constructed and legally murky. Clinics could be penalized simply for spending money on the things that keep them running — new medical equipment, technology upgrades, disaster preparedness, or reserve funds set aside for emergencies. Under the initiative’s language, even responsible financial planning could trigger steep penalties.

Anyone who has spent time inside a community clinic understands that health care extends well beyond the exam room. Programs that provide patients with transportation to appointments, telehealth options for those who can’t make it in person, and enrollment assistance to help people access insurance they qualify for are not extras — they are essential parts of keeping people healthy and connected to care. Prop. 44 puts all of that at risk.

Perhaps the most troubling piece of this measure is what it does to the relationship between doctors and patients. Prop. 44 would give the state Attorney General — an elected official without medical training — significant influence over which services clinics are able to offer. If recent years have taught us anything, it’s that political figures should not be inserting themselves into decisions about a patient’s care.

Our health care system is already stretched thin. Costs continue to climb, wait times for primary care and specialist appointments keep growing, and emergency rooms are routinely overwhelmed. If Prop. 44 leads to clinic closures or reduced services, patients won’t simply stop needing care — they’ll delay treatment until conditions worsen, often ending up in emergency rooms for issues that should have been handled through routine, preventive visits. That shift would only add more strain to hospitals, lengthen wait times, and drive health care costs even higher.

Opposition to Prop. 44 spans a wide and politically diverse coalition — not just physicians, but many others who understand what’s at stake for the patients who rely on these clinics every day. Millions of Californians are counting on voters to get this one right.

Original source: CalMatters

The post Proposition 44 Would Inject Politics Into California Patient Care appeared first on The Hemet & San Jacinto Chronicle.

For Matt Johnstone, the news arrived a month ago in a phone call from the North Hollywood board-and-care facility where his 89-year-old father has lived. Health Net, which has been covering the cost of his father’s care, told the facility it was dropping the benefit — meaning residents like Johnstone’s father would soon need to find somewhere else to go.

His father has dementia and requires constant supervision. Johnstone and his brother can’t afford the roughly $6,000 a month the facility charges, nor can they safely care for their father themselves. Without the Medi-Cal benefit, Johnstone fears his father could wind up homeless.

“He’s declining, and I just don’t know what’s going to happen if the program ends,” said Johnstone, whose father’s name is being withheld at his request out of concern that speaking publicly could affect his care.

According to documents reviewed by CalMatters and interviews with care providers, Health Net plans to eliminate assisted living coverage for an estimated 3,500 Medi-Cal members by year’s end. Most affected residents are elderly, and many suffer from dementia or other cognitive conditions, according to senior advocacy organizations. Two smaller plans that contract with Health Net — CalViva Health and the Community Health Plan of Imperial Valley — have also told the state they intend to end the benefit.

The decision has left families and providers scrambling for information, with many describing a chaotic rollout marked by conflicting messages and a lack of formal notice. Advocates worry that without a clear transition plan, some residents could end up bouncing between hospitals, skilled nursing facilities or, in the worst cases, onto the street.

Fears of a “disaster”

Pauline Shatara, deputy director of California Advocates for Nursing Home Reform, said her organization has already heard from assisted living operators who say residents have been dropped off at hospital emergency rooms with nowhere else to go.

“This is going to be a disaster,” Shatara said.

The assisted living benefit is optional under Medi-Cal, giving health plans the choice each year whether to keep offering it. It’s part of CalAIM, the state’s initiative to modernize Medi-Cal and reduce costs by better serving high-need patients who often cycle through emergency rooms. The benefit covers most of the round-the-clock care costs at memory care homes, board-and-care facilities and similar settings, while residents pay for room and board out of pocket.

By comparison, a nursing home — which provides a higher level of medical care — can cost more than $10,000 a month, while assisted living generally runs between $5,000 and $7,000. The Medi-Cal benefit was created partly to ease pressure on a separate, state-run assisted living program that has an 18,000-person cap and a waitlist stretching three to four years.

Health Net operates Medi-Cal managed care plans across 10 counties, including Los Angeles, Fresno, Sacramento and Tulare. In a written statement, a company spokesperson pushed back on the idea that members would be left without care or become homeless, saying affected patients will continue receiving services through their current authorization period and will be evaluated for alternatives such as nursing home placement, in-home supportive services, or other available programs.

“We are working closely with members, providers and care management teams to develop individualized transition plans based on each member’s clinical needs and eligibility for other available programs and services,” the statement read.

The company also said its internal data shows the assisted living benefit hasn’t reduced emergency room visits or hospital stays among members who use it.

In a termination notice filed with the state Department of Health Care Services, Health Net said the decision was driven partly by a rise in patients moving into assisted living directly from their homes, rather than from nursing facilities — a trend the company says increases costs rather than generating savings. The insurer also faulted state regulators for revising program rules in a way that limited the company’s ability to restrict such transitions.

“The guidance raises concerns regarding program integrity and long-term viability,” the notice states.

The Department of Health Care Services declined an interview request. In an email, the agency said it would work with Health Net “to ensure member protections and continuity of care.”

This isn’t the first time Health Net has scaled back a CalAIM-related benefit. Last year, the insurer ended a similar arrangement with a Los Angeles County provider of temporary medical housing, displacing hundreds of patients.

“Their position is it’s less costly to offer no services than some services,” said Hagar Dickman, director of long-term services and supports for Justice in Aging.

Confusion reigns among families

When Johnstone first learned of the change, he checked Health Net’s website for details. He found nothing. Calling customer service didn’t help either.

“When I called into Health Net customer service, they didn’t even know what the program is,” Johnstone said. He said he has yet to receive any official notice about the termination.

Jennifer Horcasitas-Glenn had a similar experience. Her mother-in-law, 75-year-old Jacqueline Glenn, has dementia and Alzheimer’s disease. Horcasitas-Glenn and her husband cared for her at home for nine years before a series of hospitalizations made that impossible. Glenn has lived in a memory care facility since May.

Horcasitas-Glenn said she also learned about the benefit’s termination from a third-party provider rather than from Health Net directly. She said she spent days being transferred between representatives who had never heard of the program, eventually reaching a Health Net social worker who confirmed the change but had no further details.

“I told her I have a plethora of questions I need answered. She said, ‘I think you should forward all of your questions to this email,'” Horcasitas-Glenn recalled. She says she still hasn’t gotten a response.

Providers told CalMatters that Health Net notified some major contractors that services would end Oct. 7. But according to families and advocates, individual Medi-Cal enrollees have not received formal notice from the insurer.

Much of the confusion centers on timing. While many provider contracts expire in October, Health Net is required to continue services through the end of the year, Dickman said.

“The question is, what’s Health Net going to do after October 7? They don’t have contracts with these facilities, so how are they going to provide?” said Jonathan Istrin, chairman of Libertana, a company whose contract with Health Net was terminated. Libertana subcontracts with hundreds of assisted living facilities statewide, and Istrin said Health Net lacks the systems needed to pay those facilities directly.

Under state rules, Health Net must give members 30 days’ notice before ending services. But providers say it remains unclear whether those notices will go out in late September or early December — and Shatara warned that for some residents, the notice could arrive only after they’ve already been forced out.

“Right now it can feel like a rumor mill, and nobody knows what they should do because Health Net has not been giving anyone any information,” she said.

On Aug. 10, Horcasitas-Glenn received a letter from Health Net stating that her mother-in-law’s approval for memory care would be revoked a month early “at the request of the provider.” But the facility told her it had made no such request — instead, it had asked Health Net how to ensure patients received the care they were entitled to through year’s end. CalMatters independently verified this account.

“This is baloney. They’re not being transparent about anything, and they’re lying on documents,” Horcasitas-Glenn said. She added that Health Net customer service representatives still don’t recognize the program when she calls.

State officials say Medi-Cal members are entitled to continued assisted living services through Dec. 31, as long as the care remains “clinically appropriate,” and that members whose authorizations expire sooner should request an extension.

Few safeguards in place

Beyond the 30-day notice requirement, advocates say the state has done little to ensure members aren’t left without care once the benefit ends.

Health Net has not provided individualized transition plans for most patients, Shatara said, and the state cannot guarantee that displaced residents will find comparable care elsewhere. Advocates and providers say both Health Net and the Department of Health Care Services have repeatedly pointed to each other when asked for specifics.

In its statement, the department said existing consumer protections — including the right to appeal, file grievances, and access continuity-of-care provisions — are sufficient, adding that “Medi-Cal members have strong protections.” The agency maintains that responsibility for managing the transition ultimately rests with Health Net.

The insurer’s termination notice states that affected members “will be transitioned to alternative care settings, including home, as appropriate.”

But Shatara said returning home isn’t realistic for most patients. Many live on fixed Social Security incomes and gave up their previous residences to afford assisted living costs that Medi-Cal doesn’t otherwise cover. Their care needs are often too complex for family members to manage. That leaves nursing homes and hospitals as the only other options — facilities that may not have room to absorb a sudden influx of new patients.

“It’s inevitable that people will end up in ERs and on the streets,” Shatara said.

Some families are exploring whether switching to a different Medi-Cal plan might preserve access to the benefit, but Horcasitas-Glenn said she’s been told other insurers are reluctant to approve costly long-term placements for new members. Others, like Johnstone, say they simply don’t know where to turn.

Johnstone’s father spent much of his life restoring motorcycles and racecars, eventually building a successful autobody shop in Southern California. As undiagnosed dementia set in during his later years, Johnstone said, his father’s mind began slipping into decades-old memories, leading him to make costly business mistakes and take on debts he could no longer manage. A terminal cancer diagnosis for Johnstone’s mother further drained what savings the family had left.

“There is nothing else,” Johnstone said.

Original source: CalMatters

The post Insurance Cancellation Leaves California Seniors Facing Eviction from Assisted Living Homes appeared first on The Hemet & San Jacinto Chronicle.