Bolstered by millions of dollars of aid from Washington, California managed to hold its healthcare safety nets together last year despite the fallout from the recession. Now, however, with emergency federal aid schedule to end this year, it is unclear how much longer California's financially strained government will be able to head off cutbacks. Driven by poverty and expanded eligibility, enrollment in Med-Cal. The Medi-Cal programs is jointly funded by federal and state governments using a complex formula that varies from state to state.

The Medi-Cal expansion - coupled with growth in the Healthy Families program for children in low to moderate-income families provided much-needed coverage and peace of mind to families while they looked for jobs and struggled to pay the bills. Without Medi-Cal and Healthy Families, the uninsured rate most certainly would have been higher.

Maintaining those two programs was possible in large part because of the special assistance that Congress has made available to California starting with the economic stimulus bill passed in early 2009. More recently (Nov 2 2010), California sought and won a Medicare waiver from the federal government. The plan, which the state calls a "bridge to reform," is also designed to bolster the state's safety-net hospitals, as well as lower overall health care costs. Under the agreement (a waiver of standard Medicaid rules aimed at allowing states to test innovative new programs) California promised to shave $2 billion per year from its existing Medi-Cal bill by streamlining care for its highest-cost recipients: seniors, adults with disabilities and children with severe illnesses. The federal government agreed to give California $2 billion per year in return.

The plan, which the state calls a "bridge to reform," is also designed to bolster the state's safety-net hospitals, as well as lower overall health care costs. Under the Nov. 2 agreement _ a waiver of standard Medicaid rules aimed at allowing states to test innovative new programs _ California promised to shave $2 billion per year from its existing Medicaid bill by streamlining care for its highest-cost recipients: seniors, adults with disabilities and children with severe illnesses. The federal government agreed to give California $2 billion per year in return.

The California safety net weathered the recession to date because the enhanced federal aid required the state not to narrow eligibility for Medi-Cal, even though it was allowed to pare back some benefits.

The Affordable Care Act (ACA) continues that requirement until 2014, but the extra money from Washington is set to run out in June. That is forcing California leaders to contemplate a new round of cuts. This week, newly elected Gov. Jerry Brown proposed $1.7 billion in cuts to the Medi-Cal program, including new limits on prescription drugs and doctor visits.