The report developed by the Health Economics and Evaluation Research (HEER) Program through a contract with the California Health and Human Services Agency (CalHHS) examines various aspects of health care financing, such as the role of health plans, provider payments, and benefits; their respective impact on access, quality, and equity; and key considerations if California opted to implement a unified health care financing system. 

The key design considerations for unified financing in California discussed in the report include: 

• Models of unified financing 
• Eligibility and enrollment rules 
• Benefits options 
• Approaches to premiums and cost sharing 
• Provider payment methods 
• Approaches to promoting effectiveness, efficiency, and equity

Authors provide county-level projections of how many fewer Californians will be enrolled in full-scope Medi-Cal by 2028 as a result of policy changes in federal H.R.1 and the enacted 2025–26 state budget. These projections assume the state implements H.R.1 as proposed in the 2026–27 January state budget.

Findings: There is considerable uncertainty about the enrollment impact of these policy changes. Estimates represent the high end of potential Medi-Cal coverage losses. Authors project that 2.98 million fewer Californians will be enrolled in Medi-Cal by 2028 based on and as a result of the following policy changes:

• H.R.1 work requirements, applied to both federally-funded and state-funded ACA expansion adults (1.87 million)
• H.R.1 six-month eligibility redeterminations, applied to both federally-funded and state-funded ACA expansion adults (270,000)
• Asylees, refugees, and other humanitarian immigrants who lose eligibility for federally-funded full-scope Medi-Cal because of H.R.1 and are subsequently moved to partial-scope Medi-Cal (200,000)
• Enacted 2025–26 State Budget enrollment freeze for undocumented adults (550,000)
• Enacted 2025–26 State Budget $30 monthly premiums for state-funded adult enrollees with “unsatisfactory immigration status” (95,000)

This analysis uses administrative data, not survey data, as its basis. Authors estimate the number losing full-scope Medi-Cal coverage, not the number projected to become uninsured. Individuals who lose Medi-Cal may choose to enroll in job-based health insurance coverage (if they have that option) or obtain unsubsidized coverage in the individual market. 

The author discusses how state and federal governments have for decades shared responsibility for funding public health care through programs such as Medicaid and the Children's Health Insurance Program (CHIP), as well as through federal grants. However, recent cuts to federal health and safety net programs mandated in legislation, such as H.R. 1, will weaken the country's future response to crises such as pandemics and natural disasters, and leave states to bear a bigger share of the cost. As a result fewer people will have access to health care or nutrition benefits. The author says that the short-term funding that immediately addressed the COVID-19 pandemic stabilized family incomes, insurance coverage, food availability, and nonprofit support organizations. Long-term interventions by governments could have replicated those short-term efforts, and supported broad health and economic improvements, Instead, under legislation such as H.R. 1, program funding has been cut, and the opportunity has been lost. 

This article introduces a special section in the American Journal of Public Health about health and social policy changes driven by the urgency of the pandemic.

Many Latino immigrants avoid public benefits because of fears about their immigration status or that of family members, which is heightened by anti-immigration rhetoric. This study used data from the Latino Youth Health Study and the 2021–2022 California Health Interview Survey (CHIS) to examine decisions not to apply for noncash public benefits, such as Medicaid, food assistance, and housing subsidies, as well as safety perceptions among income-eligible Latino families in California. Authors also analyzed differences by parental citizenship and household language. 

Findings: Compared to families with two U.S. citizen parents, families with one or both noncitizen parents were more likely (by 38.4 and 46.7 percentage points, respectively) to avoid applying for benefits because of immigration-related concerns, and such families were also more likely to fear deportation for themselves or a family member or close friend. Spanish-only and bilingual households showed similar patterns. These findings underscore the need for accurate information on public benefit eligibility and immigration policies to ensure that immigrant families can access health care and resources to which they are legally entitled.