Settled in for his second and last term in Sacramento, not needing to worry about re-election and possibly looking to establish himself as America’s leading progressive long before a potential future run for president — that’s Gov. Gavin Newsom, who lately does not hesitate to push on many fronts for the priorities he vocally espoused back in 2018 during his first run for governor.
There was his call for reviving much of the state mental health program and infrastructure that was dismantled for financial reasons in the 1960s and ’70s by Govs. Ronald Reagan and Jerry Brown.
There’s his sometimes heavy-handed push to force every city in California to add large numbers of new housing units in an effort to solve the state’s affordable housing shortage, which may not be as extensive as he says, but nevertheless remains very real for millions. There’s his push to electrify new cars and trucks and railroad engines. And more.
The most revolutionary of Newsom’s causes, though, may be his push to have Medi-Cal (California’s version of Medicaid) not merely ensure health care for every person in this state, regardless of their immigration status, but now to use Medicaid money toward solving the seemingly intractable problem of homelessness.
Newsom says he’s discussed this with President Biden, who would have to approve it for this to happen. He wants to classify homelessness as a cause of illness and treat it with preventive care, much as most preventive care is covered for pregnant women.
Low-income women getting this coverage may not be ill when they receive services, but Medi-Cal nevertheless gives them prenatal care, labor and delivery coverage, post-partum care for a year after pregnancy plus all other medically necessary dental and mental health treatments during that time. The principle is that such wide care prevents all manner of illnesses for mothers and their newborns, thus saving many millions of dollars in the long term.
Newsom can’t do this on his own, needing legislative and federal government approval, but he seeks a new program called “transitional rent” to provide six months of rent or temporary housing for low-income people already enrolled in Medi-Cal who are either unhoused or in danger of losing their housing.
There are doubts even among liberal Democrats about whether this goes too far. After all, Medi-Cal already covers almost all of California’s poor, including every person older than 50 in the state who qualifies financially and some who are younger if they’re pregnant or have certain other medical conditions.
Immigration or citizenship status doesn’t matter here. If Medi-Cal began covering all or part of the rent for unhoused individuals, it presumably also would cover many of the undocumented to the same degree. That’s a novel concept, but this has rarely bothered liberal California politicians who have already granted things like drivers licenses to the undocumented, along with the right to vote in some local elections.
For sure, living in homeless encampments, whether in tents, cardboard boxes or with no shelter at all, can lead to illness and death. The Kaiser Permanente health plan’s news service the other day cited a 60-year-old man who needed open heart surgery and repeated emergency room visits for ailments such as diabetes and asthma while homeless. He was able to give up some diabetes medications and became significantly healthier after receiving a federal housing voucher that gave him permanent indoor quarters.
Medi-Cal also reports that 5% of its patients account for 44% of the program’s spending, a high portion of them with unstable housing or none at all. Does the idea of calling homelessness a threat to health and then acting to mitigate it stand a chance of approval? Pilot programs like this already exist in Oregon and Arizona, so why not approve something similar in California?
“Why do we have to wait (until) people become sick?” asks Dr. Mark Ghaly, California’s health secretary. “What we have today doesn’t work.”
He’s right about that, but no one yet knows whether such reasoning will convince Medicaid’s top officials, who would need to approve the plan and will take their cues from Biden.
Thomas Elias can be reached at [email protected]. To read more of his columns, visit californiafocus.net online.
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