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key takeaway

Federal government shutdowns can significantly disrupt California’s essential safety net programs, potentially affecting millions of residents and underscoring the importance of ongoing support for these vital services.

Access to health care, affordable food, safe housing, and a safety net to turn to during unexpected challenges is essential for everyone. Safety net programs provide critical support to more than 1 in 3 Californians every year. Without these important public supports, California’s poverty rate would be much higher.

During a federal government shutdown, safety net programs that receive federal funding can be affected, potentially causing disruptions to the lives of millions of Californians. This Q&A provides an overview of California’s safety net programs and how they can be impacted during a federal government shutdown.

What Are Safety Net Programs and How Many Californians Do They Support?


Safety net programs provide financial assistance, health care, and other essential services to millions of Californians. These programs help people with low-incomes or people experiencing unexpected challenges — such as losing a job — receive the care and support they need to get by. California safety net programs are supported by state and federal funding.

Why Does a Federal Government Shutdown Happen?

A federal government shutdown occurs when the United States Congress fails to pass annual or temporary spending bills before the start of the new federal fiscal year, which begins on October 1st. Federal policymakers can enact temporary spending bills, or continuing resolutions, that allow the government to continue operating while policymakers reach an agreement on the federal budget. Shutdowns typically happen due to political disputes, disagreements over spending priorities, and legislative gridlock.

How Can a Federal Government Shutdown Impact Safety Net Programs?

The duration of a federal government shutdown would determine the impact on safety net programs. Prolonged shutdowns can have devastating consequences for Californians who receive health, food, and housing assistance. If a shutdown persists, California policymakers should allocate additional state funds to sustain critical programs and services.

In contrast, shorter federal government shutdowns, lasting only a few days, generally cause less disruptions. Californians can still access various health and safety net supports during these brief closures. For instance, Californians who rely on Medi-Cal can maintain access to health care services, as Medi-Cal providers could continue to receive reimbursement in the short term. This is partly due to advance funding provisions within the Medicaid program, which can be secured in prior federal budgets.

What Are the Potential Impacts of a Brief Government Shutdown?

Community health centers, including Federally Qualified Health Centers, are more susceptible to adverse impacts. Even a brief shutdown would affect community health centers’ ability to provide services and meet operating expenses because they rely on funding from federal grants.

Short shutdowns can also have repercussions for other safety net programs. Some government employees would be furloughed during shutdowns, which means programs could experience staffing shortages. Staffing shortages could negatively impact Californians. For example, even though Californians could continue to receive rental assistance through HUD (Housing and Urban Development), nearly all of HUD’s fair housing activities would cease due to a reduced staffing.

What’s At Stake?

A prolonged federal shutdown could have disastrous effects on our state and disrupt the lives of millions of Californians, especially communities of color. Past and current racist wage and employment policies concentrate people of color into under-valued occupations with lower wages and minimal benefits. As a result, Black, Latinx, and other Californians of color are more likely to have trouble affording basic needs — like housing, groceries, and diapers — and are also more likely to qualify for safety net programs. If a prolonged shutdown leads to a suspension or reduction of critical programs and services, it would disrupt the lives of millions of Californians and exacerbate economic inequality. This underscores the need to ensure that every Californian, regardless of their race, age, zip code, or gender, can thrive and share in the state's prosperity.

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key takeaway

California’s uninsured rate reached an all-time low in 2022, but the state must now work to maintain this progress. State leaders must ensure equitable access to health coverage as they process Medi-Cal renewals, which were temporarily suspended during the COVID-19 pandemic.

Consistent access to health care is necessary for everyone to be healthy and thrive. During the pandemic, millions of Californians with low incomes were able to stay continuously enrolled in Medi-Cal (California’s state Medicaid program) due to a federal pandemic-era policy.1A provision in the federal Families First Coronavirus Response Act passed in March 2020 required states to provide continuous coverage for Medicaid beneficiaries in exchange for enhanced federal funding during the federally declared Public Health Emergency (PHE). The Consolidated Appropriations Act of 2023, which federal policymakers passed in December 2022, delinked the continuous coverage provision from the PHE, thereby ending this provision on March 31, 2023. Partly as a result of this federal policy, Medi-Cal enrollment in California reached an all-time high — with over 15 million people enrolled — while the uninsured rate dropped to a historic low (6.5%).

Earlier this year, California began processing Medi-Cal renewals for the first time since the start of the pandemic. Recent data reveal an alarming trend: More than 500,000 Californians have lost Medi-Cal coverage during recent months. Although not everyone who loses Medi-Cal coverage becomes uninsured, the majority of people who lost coverage did so because of paperwork challenges. Certain groups, including immigrants, older adults, and people with disabilities, are at greater risk of losing Medi-Cal coverage during this continuous coverage “unwinding” period.

State leaders have implemented measures to reduce barriers to accessing and maintaining Medi-Cal coverage. Still, policymakers can take additional steps to prevent Californians who remain eligible for Medi-Cal from losing coverage. This includes pausing procedural terminations and investing in health navigators. By taking additional action, state leaders can strive to ensure that all Californians, regardless of race, age, disability, or immigration status, can access and maintain the critical health coverage they need to be healthy and thrive.

What is health equity?

When everyone has the opportunity to be as healthy as possible and no one is disadvantaged from achieving this because of their race, gender identity, sexual orientation, the neighborhood they live in, or any other socially defined circumstance.

California’s Health Coverage Landscape: Progress, Disparities, and the Path to Equitable Coverage

California has made significant strides in expanding access to health coverage. This progress is primarily due to the federal Affordable Care Act (ACA) and, more recently, the state’s efforts to expand comprehensive Medi-Cal coverage to income-eligible undocumented Californians. The percentage of Californians without health coverage decreased to 6.5% in 2022, down from the previous record low of 7% in 2021. These recent improvements in health coverage highlight the significant progress that California has made over the last decade when the uninsured rate was over 17%.

While access to health coverage has improved for all racial/ethnic groups in California over the last decade, racial disparities in coverage persist. Notably, gains in health coverage were significantly lower for Californians who identified as American Indian or Alaska Native (AI/AN), who had the highest uninsured rate. The uninsured rate of AI/AN Californians was nearly double that of the overall Californian population. Racial disparities were also evident for Latinx Californians, who had the second-highest uninsured rate. This is particularly concerning given that people identifying as Latinx account for over 40% of the state’s population.

The racial disparities in health coverage highlight the profound and enduring impact of racism, which blocks Californians of color from equal access to health care. For example, some people of color may hesitate to seek coverage because they distrust the government and health care systems that are responsible for past and ongoing mistreatment against them, their families, and their communities. Another instance of a racist policy is the exclusion of undocumented immigrants, driven by racial and xenophobic biases, from enrolling in federally funded Medicaid coverage or purchasing coverage through the ACA marketplaces.2Undocumented immigrants are not eligible to enroll in federally funded Medicaid coverage or purchase coverage through the ACA Marketplaces. In recent years, California has allocated state funding to expand eligibility for full-scope Medi-Cal to undocumented immigrants.

While California has made significant progress in increasing health coverage, there is much more work to be done to ensure equitable access to health coverage for all Californians. Addressing the racial disparities in health coverage requires targeted outreach and education efforts along with other antiracist policy actions to improve health and well-being for Californians of color.

Many Californians Are Losing Medi-Cal Coverage Due to Paperwork Challenges

On April 1, 2023, California began the process of redetermining eligibility for Medi-Cal enrollees for the first time since the onset of the COVID-19 pandemic. The California Department of Health Care Services (DHCS) publishes data showing the number of Californians who become disenrolled as a result of the redetermination process (i.e., undergo a procedural termination).3The California Department of Health Care Services (DHCS) publishes interactive Medi-Cal dashboards detailing statewide and county-level demographic data on Medi-Cal application processing, enrollments, redeterminations, and renewal outcomes. DHCS also provides valuable insight into the circumstances leading to the disenrollment of Medi-Cal beneficiaries, which are categorized as follows:

  • Procedural: an individual loses coverage due to issues with their renewal paperwork.4In this issue brief, the term "paperwork" is used in place of the term "procedural." This may be a result of a Medi-Cal enrollee not receiving or returning requested forms on time, or other issues with the application system.
  • Over Income: an individual's income exceeds the Medi-Cal eligibility threshold, potentially making them eligible for coverage through Covered California — the state’s health insurance marketplace. 
  • Other Reasons: an individual moves out of the state, voluntarily disenrolls, or passes away.

Nearly 9 in 10 Californians (89.2%) who lost Medi-Cal coverage in August 2023 did so because they did not complete the renewal paperwork or had incorrect or missing information in their forms. Although not everyone who loses Medi-Cal coverage becomes uninsured, the data reveal a troubling trend.5Medi-Cal members have 90 days after their disenrollment to provide the necessary outstanding information to their local Medi-Cal office to restore their coverage. After the 90 days, people can submit a new application. Historically, California has seen a reinstatement rate of about 4% over the 90-day period.

Completing the renewal process often involves complex paperwork and documentation requirements, which can be difficult to navigate. Additionally, some Californians have experienced extended call wait times when attempting to contact county Medi-Cal workers regarding their application.

Certain groups, including older adults and people with disabilities, are at greater risk of losing Medi-Cal coverage during the unwinding period.6Jennifer Tolbert and Meghana Ammula, 10 Things to Know About the Unwinding of the Medicaid Continuous Enrollment Provision (Kaiser Family Foundation, June 2023). Immigrants and their family members face unique obstacles to remaining covered, such as language barriers, privacy concerns, and fear of immigration consequences. As such, many Californians who are losing Medi-Cal coverage due to paperwork challenges may still meet the eligibility criteria.7Of the redeterminations that were received and processed in August 2023, about 20% were ineligible. See California Department of Health Care Services, Medi-Cal Continuous Coverage Unwinding Dashboard (August 2023), 14.

The high disenrollment rate due to paperwork challenges underscores the need to further streamline the renewal process and alleviate the paperwork burden on beneficiaries during the unwinding period and beyond. Addressing these challenges is essential to ensure that those who are eligible for Medi-Cal continue to receive vital health coverage.

Policy Recommendations to Support Equitable Access to Health Coverage Amidst the Unwinding Period

State leaders have taken steps to mitigate the impact of the continuous coverage unwinding period and better support access to health coverage. Earlier this year, the California Department of Health Care Services (DHCS) set forth a detailed plan with a guiding principle to maximize the continuity of coverage for Medi-Cal beneficiaries. These actions include: 

  • Providing one-time funding support to local county offices, which are responsible for determining the initial and continuing Medi-Cal eligibility for an individual or a family.
  • Authorizing Covered California to enroll individuals in a qualified health plan when they lose Medi-Cal coverage.
  • Engaging community partners to serve as “Coverage Ambassadors” to share information with Medi-Cal beneficiaries about how to maintain Medi-Cal coverage.

State leaders can build on previous policy changes by taking action on the following recommendations:

By taking these steps, state leaders can work towards ensuring that all eligible individuals, regardless of age, disability, or immigration status, can access and maintain the critical health coverage they need in order to be healthy and thrive.

  • 1
    A provision in the federal Families First Coronavirus Response Act passed in March 2020 required states to provide continuous coverage for Medicaid beneficiaries in exchange for enhanced federal funding during the federally declared Public Health Emergency (PHE). The Consolidated Appropriations Act of 2023, which federal policymakers passed in December 2022, delinked the continuous coverage provision from the PHE, thereby ending this provision on March 31, 2023.
  • 2
    Undocumented immigrants are not eligible to enroll in federally funded Medicaid coverage or purchase coverage through the ACA Marketplaces. In recent years, California has allocated state funding to expand eligibility for full-scope Medi-Cal to undocumented immigrants.
  • 3
    The California Department of Health Care Services (DHCS) publishes interactive Medi-Cal dashboards detailing statewide and county-level demographic data on Medi-Cal application processing, enrollments, redeterminations, and renewal outcomes.
  • 4
    In this issue brief, the term "paperwork" is used in place of the term "procedural."
  • 5
    Medi-Cal members have 90 days after their disenrollment to provide the necessary outstanding information to their local Medi-Cal office to restore their coverage. After the 90 days, people can submit a new application. Historically, California has seen a reinstatement rate of about 4% over the 90-day period.
  • 6
    Jennifer Tolbert and Meghana Ammula, 10 Things to Know About the Unwinding of the Medicaid Continuous Enrollment Provision (Kaiser Family Foundation, June 2023).
  • 7
    Of the redeterminations that were received and processed in August 2023, about 20% were ineligible. See California Department of Health Care Services, Medi-Cal Continuous Coverage Unwinding Dashboard (August 2023), 14.

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About this event

Making sure every Californian has access to quality health care should be a top priority for policymakers. Despite significant progress toward universal coverage over the last decade, we know that racial disparities in coverage persist. In addition, many Californians are losing access to health care, including our state’s Medi-Cal system. 

We’ll explore the recent downward trend in Medi-Cal coverage and learn what state leaders can do to ensure that all Californians can access and maintain the health coverage they need in order to be healthy and thrive.

You’ll hear from a panel featuring a researcher, an advocate, a community health worker, and a state official, each offering their unique perspective on efforts to expand health care coverage and build a robust health workforce that reflects communities throughout California.

Speakers

  • Adriana Ramos-Yamamoto, Senior Policy Analyst (moderator)
  • Maria Lemus, Executive Director, Vision y Compromiso
  • Celia Valdez, Director of Health Coverage, Maternal and Child Health Access
  • Elizabeth Landsberg, Director, California Department of Healthcare Access and Information

Thank you to our event sponsors

Blue Shield of California Foundation, Heising Simons Foundation, James Irvine Foundation, Hilton Foundation

About the California Budget & Policy Center

The California Budget & Policy Center is a research and analysis nonprofit advancing public policies that expand opportunities and promote well-being for all Californians.

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Key Takeaway

Over 50% of eligible students do not participate in SNAP, and the complexity of the rules is a major contributor.

All Californians should have the opportunity to pursue higher education without sacrificing their basic needs. However, food insecurity among college students is an ongoing problem. For example, a 2019 survey of California community college students revealed that over half had trouble paying for their meals.

Over 50% of Eligible College Students Don’t Participate in SNAP

While there are safety net programs in place, such as the Supplemental Nutrition Assistance Program (SNAP) — or CalFresh, as it is known in California — to help people put food on the table, people who are enrolled in college at least half-time face significantly more complex rules to qualify.

A recent government report estimated that over 50% of eligible students did not participate in SNAP. The report pointed to the complexity of student-specific eligibility rules as a likely contributor to low enrollment rates. To qualify, students enrolled at least half-time must meet the regular income eligibility criteria and also meet one of eight additional requirements.1Under SNAP/CalFresh, people are considered students if they are enrolled in an institution of higher education at least half-time, are between the ages of 18 and 49, and are deemed mentally and physically fit. Students who are enrolled less than half-time are not classified as “students” under CalFresh. These students only have to meet the regular income eligibility criteria to receive benefits. Four of these requirements are geared toward parents or caretakers. The other four require that students:

  • Be in their final semester.
  • Work at least 20 hours a week.
  • Participate in work study, or enroll in an employment training program.

If they do not meet these requirements, they cannot receive CalFresh regardless of their income or needs.

A stacked bar chart showing the community college enrollment by age in the fall of 2022 where nearly three-quarters of students enrolled at least half-time are under the age of 25.

CalFresh Requirements Need to Be Simplified for College Students

Given the increasingly high costs of attending college, students with low incomes face a significant disadvantage and a higher likelihood of experiencing food insecurity. In fact, within the California Community Colleges (CCC) system, which serves high percentages of people of color and people with low incomes, over half of all students are enrolled at least half-time. Therefore, these students would need to meet the burdensome requirements to access CalFresh. Nearly three-quarters of these students are under the age of 25, which makes them less likely to meet requirements geared toward parents and families. This suggests that most students in need of food assistance would have to take on jobs on top of their heavy course loads. This could significantly impact their ability to meet their educational goals.

Under federal COVID-19 relief policies, additional exemption criteria were granted to allow more students to receive CalFresh. The expansion allowed students eligible for federal or state work study, regardless of whether they participated, or those with $0 in expected family contributions to qualify for CalFresh if they met the regular income requirements. As a result, student applications for CalFresh more than quadrupled in 2021.2Aaron Kunst, Andrew Cheyne, Becky Silva, and Ruben E. Canedo, CalFresh for College Students: Equitable and Just Access (California Association of Food Banks, March 2022), 4, https://www.cafoodbanks.org/wp-content/uploads/2022/03/College-CalFresh-WhitePaper-final-March2022.pdf. However, these federal exemptions ended in June 2023. Students who qualified for CalFresh via these exemptions will no longer be eligible at their renewal date.

Policymakers Can Ensure College Students Have Better Access to Food Assistance

College students should have the same opportunity as any other Californian to access CalFresh. Policymakers have a responsibility to support college students in meeting their educational goals to ensure a skilled workforce in California.

Federal policymakers can help reduce student hunger by:

  • Reinstating COVID-19 expansions to SNAP.
  • Completely removing the additional red tape that students face to put students on equal footing with everyone else.

In the meantime, state policymakers can continue to support students by investing in administrative support and ensuring that the program is accessible to all eligible students.


Support for this report was provided by the Hilton Foundation.

  • 1
    Under SNAP/CalFresh, people are considered students if they are enrolled in an institution of higher education at least half-time, are between the ages of 18 and 49, and are deemed mentally and physically fit. Students who are enrolled less than half-time are not classified as “students” under CalFresh. These students only have to meet the regular income eligibility criteria to receive benefits.
  • 2
    Aaron Kunst, Andrew Cheyne, Becky Silva, and Ruben E. Canedo, CalFresh for College Students: Equitable and Just Access (California Association of Food Banks, March 2022), 4, https://www.cafoodbanks.org/wp-content/uploads/2022/03/College-CalFresh-WhitePaper-final-March2022.pdf.

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key takeaway

State policymakers must continue to invest in the health workforce in order to meet the needs of Californians. This includes investments in community-led efforts to promote health, such as community health workers and promotores de salud.

Access to health care services is important for everyone’s health and well-being. The state’s workforce must meet the needs of Californians to achieve equitable access to timely and culturally competent health services. While state policymakers have made considerable investments in recent years to bolster the health workforce, investments in various health workforce areas still fall short.

Investments to Increase Provider Participation in Medi-Cal Are Critical

More than 15 million Californians with modest incomes — nearly half of whom are Latinx — receive free or low-cost health care through Medi-Cal (California’s Medicaid program). In order to better support the millions of Californians who rely on the state’s health safety net, policymakers have taken steps to increase provider participation in Medi-Cal.

Specifically, this year’s 2023-24 budget includes $237.4 million to increase Medi-Cal provider rates effective January 1, 2024. Rate increases are targeted to:

  • primary care, which includes nurse practitioners and physical assistants,
  • maternity care (i.e., obstetrics/gynecology physicians and doulas),
  • and non-specialty mental health services, such as for mental health evaluation and treatment.

The governor’s administration also plans for additional Medi-Cal provider rate increases in future years for hospital outpatient procedures and services, family planning services, emergency physician services, and more.

related resource

See our Report: Californians Need State Leaders to Make Health Care More Affordable to learn how state leaders can use revenues to make progress on health care affordability.

Policymakers Should Also Invest in Community-Led Efforts to Promote Health 

California is home to people with diverse cultural and ethnic backgrounds. Therefore, policymakers should invest in workforce strategies that leverage community-led efforts to improve health. This includes investing in community health workers and promotores de salud, frontline public health workers who are trusted members of their communities. They serve as liaisons between the community and health and social service providers in order to facilitate access to services and improve service delivery. Community health workers and promotores provide services in a way that is linguistically and culturally responsive to the needs of the communities they serve.

State leaders have taken initial steps to integrate community health workers and promotores into the Medi-Cal workforce. For instance, state leaders established a community health worker benefit within the Medi-Cal program in July 2022. This allows these workers to be paid for providing services to Medi-Cal enrollees. These services include:

  • health education to help patients manage chronic health conditions,
  • and health navigation to assist people access health care services.

Additional ongoing investments are needed to develop a strong pipeline of community health workers and also to ensure that workers are paid fair wages.

State Policymakers Should Increase Health Workforce Opportunities for Youth

Youth and young adults have tremendous power to improve health outcomes within their communities — both in the immediate and long term. Examples of youth supporting youth are peer-to-peer programs in school settings and peer support specialists. Research shows that peer-to-peer supports help improve mental health outcomes, decrease substance use, and reduce hospital admission rates. Policymakers should invest in peer support programs that lead to meaningful career pathways for youth and young adults. Particularly, for individuals disconnected from school or employment.

Meeting the health needs of Californians will require significant long-term investment in youth workforce development programs. In 2019, the California Future Health Workforce Commission developed a strategic plan for addressing health workforce gaps. According to a recent progress report, policymakers have made progress on many of the priority recommendations. However, state leaders can do more to recruit and train students from rural areas and other historically underserved communities to practice in community health centers.

Bottom line: State policymakers must continue to build a health workforce that meets the needs of Californians. Policymakers should also invest in efforts to make sure that the health workforce better reflects the diversity of all Californians. This includes their race/ethnicity, disability status, gender identity, and sexual orientation. Doing so will require sustained, ongoing investment.

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All Californians deserve to be able to care for themselves or their loved ones when they are ill. While California is set to become the world’s fourth-largest economy, the state lags behind when comparing paid sick leave laws across the US (see Table). As a result, many California workers face the impossible decision of going to work while sick or losing their paycheck.

In California, state law mandates that eligible workers can earn up to 24 hours of paid sick leave, depending on how many hours they work. Employers may provide workers with more paid sick time. However, workers with low wages — who are disproportionately women and people of color — are far less likely to have additional employer-provided time off. This means many workers have just three days of paid sick leave for an entire year.

How are workers left behind in California?

Left behind: A father works as a janitor and has a daughter who gets the flu. He needs to stay home and care for her. He has earned the maximum amount of paid sick leave mandated by his state, but his employer doesn’t provide any further leave.

  • In California, he uses up his 24 hours to care for his daughter because she needs to stay home from school for three days. He is now left with zero paid sick leave for the remainder of the year.
  • In Colorado, he has 48 hours of paid sick leave. He uses 24 of those hours to care for his daughter, and has 24 hours left for other illnesses that arise.

Left behind: A grocery store cashier tests positive for COVID-19. She needs to stay home for at least five days. While she worked enough hours to accumulate the maximum amount of leave provided by her state, her employer does not provide additional leave.

  • In California, she uses up her 24 hours in the first three days — leaving her with no sick leave for the rest of the year — and must stay home for two more days, unpaid. She wants to stay home for more than five days to fully recover, but that would mean going even longer without pay or working while sick.
  • In New Mexico, she has 64 hours of paid sick leave. She uses 40 hours for her isolation period, and still has 24 hours remaining to further recover.

COVID-19 demonstrated the critical importance of paid sick leave. Unfortunately, the supplemental paid sick leave put in place during the early days of the pandemic has expired. Workers need more paid time off when they or their family members are sick. It’s time for California to catch up to the states that are leading on this issue.

Paid Sick Leave Policies in Effect in the US, 2023

StateHow Many Hours Employees Must Be Allowed to Earn*Applies to Which Employers?
WashingtonNo cap: 1 hour earned for every 40 hours workedAll employers
New Mexico 64 hoursAll employers
Colorado48 hoursAll employers
Minnesota**48 hoursAll employers
Vermont40 hoursAll employers
New Jersey40 hoursAll employers
New York40 or 56 hoursEmployers with < 100 workers (40 hours)***

Employers with 100+ workers (56 hours)
Oregon40 hoursEmployers with 10+ workers
Massachusetts40 hoursEmployers with 11+ workers
Arizona24 or 40 hoursEmployers with < 15 workers (24 hours)

Employers with 15+ workers (40 hours)
Maryland40 hoursEmployers with 15+ workers
Rhode Island40 hoursEmployers with 18+ workers
Connecticut40 hoursEmployers with 50+ workers
Michigan40 hoursEmployers with 50+ workers
Washington DC3, 5, or 7 daysEmployers with < 25 workers (3 days)

Employers with 25-99 workers (5 days)

Employers with 100+ workers (7 days)
California24 hoursAll employers

* Employers may choose to provide more paid sick leave than required by state law, but these laws establish a minimum requirement that workers can earn.

** This will go into effect on January 1, 2024.

*** For employers with 4 or fewer workers, the requirement to provide at least 40 hours of paid sick leave applies only if the employer’s annual net income exceeded $1 million in the previous tax year.

Source: Data from A Better Balance and Budget Center analysis of state paid sick leave laws

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All Californians should be able to afford food, yet many struggle to meet this basic need. CalFresh, or SNAP as it’s known federally, provides around 5 million Californians with low incomes monthly benefits to purchase food. Since the beginning of the COVID-19 pandemic, CalFresh benefits were increased with emergency allotments (EA) of federal funds. In January alone, over $521 million additional dollars went out across California to CalFresh recipients. For reference, the total CalFresh issuance was about $1.36 billion in the same month. Emergency allotments accounted for nearly 40% of that amount.

Increased safety net supports, in particular EA, played an important role in reducing child poverty across California in recent years. However, this additional funding came to an end in March, which reduced families’ monthly CalFresh assistance by at least $95, and up to $258 in some cases, amid rising food prices. Already, 1 in 4 families nationwide are reporting increased levels of food insufficiency, according to recent Census data. This figure is on par with states that ended their participation in the EA program before the benefits expired federally. The loss of these additional food benefits is expected to undermine the recent decline in child poverty. With the federal Farm Bill up for reauthorization this year, federal policymakers should  improve benefit adequacy in order to keep up the progress made in recent years. In addition, state leaders should take steps to raise the CalFresh monthly benefits and broaden eligibility to currently excluded Californians to avoid pushing millions of families over the hunger cliff.

Millions of Californians Receiving CalFresh Benefited from Emergency Allotments, January 2023

Congressional DistrictRepresentativePartyEstimated Average Number of Participants, 2022*CalFresh Participants as a Share of the District  PopulationEstimated EA CalFresh Benefits in January 2023**Rank (Highest to Lowest EA Benefit)
CaliforniaN/AN/A4,896,00012.5%$521,115,000N/A
1Doug LaMalfaRepublican119,00015.5%$13,865,0005
2Jared HuffmanDemocratic76,0009.9%$8,949,00034
3Kevin KileyRepublican49,0006.3%$6,716,00048
4Mike ThompsonDemocratic66,0008.7%$8,074,00037
5Tom McClintockRepublican82,00010.6%$11,274,00025
6Ami BeraDemocratic116,00015.4%$11,492,00022
7Doris MatsuiDemocratic117,00015.4%$11,276,00024
8John GaramendiDemocratic89,00011.9%$7,090,00045
9Josh HarderDemocratic107,00013.9%$11,352,00023
10Mark DeSaulnierDemocratic37,0004.9%$6,234,00049
11Nancy PelosiDemocratic80,00011.3%$10,288,00027
12Barbara LeeDemocratic92,00012.5%$7,499,00041
13John DuarteRepublican146,00018.7%$14,458,0004
14Eric SwalwellDemocratic50,0006.7%$7,507,00040
15Kevin MullinDemocratic42,0005.7%$4,404,00052
16Anna EshooDemocratic33,0004.5%$4,755,00051
17Ro KhannaDemocratic35,0004.7%$5,374,00050
18Zoe LofgrenDemocratic89,00012.2%$6,794,00047
19Jimmy PanettaDemocratic50,0006.5%$7,012,00046
20Kevin McCarthyRepublican116,00015.1%$16,011,0003
21Jim CostaDemocratic199,00026.3%$16,958,0001
22David G. ValadaoRepublican188,00023.6%$16,318,0002
23Jay ObernolteRepublican150,00019.7%$11,905,0007
24Salud CarbajalDemocratic69,0009.1%$8,378,00036
25Raul RuizDemocratic149,00019.4%$12,351,0006
26Julia BrownleyDemocratic61,0008.1%$7,273,00042
27Mike GarciaRepublican117,00015.6%$11,639,0009
28Judy ChuDemocratic66,0008.9%$11,613,00011
29Tony CárdenasDemocratic121,00016.4%$11,593,00017
30Adam SchiffDemocratic101,00013.9%$11,608,00012
31Grace NapolitanoDemocratic100,00013.6%$11,593,00017
32Brad ShermanDemocratic69,0009.1%$11,595,00016
33Pete AguilarDemocratic126,00016.5%$11,724,0008
34Jimmy GomezDemocratic137,00018.2%$11,608,00012
35Norma TorresDemocratic95,00012.3%$11,635,00010
36Ted LieuDemocratic44,0006.0%$11,608,00012
37Sydney KamlagerDemocratic165,00021.9%$11,562,00020
38Linda SánchezDemocratic81,00010.9%$11,239,00026
39Mark TakanoDemocratic99,00013.0%$9,561,00029
40Young KimRepublican37,0004.9%$7,562,00039
41Ken CalvertRepublican71,0009.0%$9,629,00028
42Robert GarciaDemocratic121,00016.3%$11,593,00017
43Maxine WatersDemocratic166,00022.5%$11,562,00020
44Nanette BarragánDemocratic116,00015.4%$11,608,00012
45Michelle SteelRepublican84,00011.2%$7,665,00038
46Lou CorreaDemocratic103,00013.6%$7,171,00044
47Katie PorterDemocratic40,0005.3%$7,186,00043
48Darrell IssaRepublican68,0009.1%$9,244,00030
49Mike LevinDemocratic40,0005.3%$8,469,00035
50Scott PetersDemocratic51,0006.8%$9,077,00032
51Sara JacobsDemocratic87,00011.4%$9,065,00033
52Juan VargasDemocratic125,00016.5%$9,101,00031

* Figures are rounded to the nearest 100. Estimates do not sum to total due to rounding and excluded zip code data.

** Figures are rounded to the nearest 1,000. Estimates do not sum to total due to rounding and excluded zip code data.

Note: Values for California reflect the actual number of CalFresh participants from January to December 2022 and the total value of SNAP Emergency Allotment spent in January 2023. District-level estimates are based on zip code-level data for CalFresh recipients in December 2022. About 1% of zip code-level data are excluded due to hidden totals for de-identification purposes and special classifications of zip codes. Therefore, participation for some congressional districts may be underestimated. Data are for individuals receiving federal SNAP benefits and do not reflect individuals receiving state-funded assistance through the California Food Assistance Program.

Source: California Budget & Policy Center analysis of data from the Department of Social Services and US Census Bureau, American Community Survey

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Health care should be accessible and affordable to all Californians. No one should ever have to skip or delay health care due to the cost. Forgoing preventive care or treatment for health conditions is harmful to health and well-being.

Unfortunately, many Californians lack access to affordable health care. For some, monthly health insurance premiums are too high, and so they go without coverage. But even when people have health insurance, steep out-of-pocket costs — such as copays and deductibles — often deter individuals from obtaining the care they need. The impact of unaffordable care falls disproportionately on Californians of color due to a legacy of racist policies and practices:

  • Latinx Californians are most likely to experience problems paying medical bills, followed by Black, white, and Asian Californians.
  • Latinx and Black Californians are more likely to report having medical debt.
  • Black and Latinx Californians are most likely to skip health care services due to the cost.

Ensuring that all Californians have access to affordable health coverage and that they can access care when they need it will require additional state investments. In fact, funds are already available to make coverage more affordable for hundreds of thousands of Californians. Yet, Governor Newsom has blocked efforts to use these funds to boost affordability assistance.

California’s Individual Mandate Penalty: A Funding Source to Help Make Health Coverage More Affordable

In 2019, state policymakers created a penalty that applies, with certain exceptions, to people who lack minimum essential health coverage. This penalty is formally called the “Individual Shared Responsibility Penalty,” but is more commonly known as the “individual mandate penalty.”

The individual mandate penalty has two primary purposes:

  • Encourage young and healthy people — who might be inclined to go without health insurance — to enroll in coverage in order to ensure a more balanced “risk pool” and prevent premiums from spiraling upward.
  • Provide a funding source to reduce the cost of health insurance for people who buy coverage through Covered California, our state’s health insurance marketplace.

The individual mandate penalty can be costly. An adult who lacks coverage for an entire year and doesn’t qualify for an exemption must pay at least $850 plus $425 per dependent child under 18 in the household. This means that a family with two adults and two children could face a penalty of at least $2,550.

Many Californians with low-to-moderate incomes are penalized for lacking health coverage. Specifically, nearly 2 in 5 households who reported that they owed the penalty for tax year 2020 had incomes at or below 266% of the federal poverty level (FPL). In 2020, 266% FPL reflected an annual income of around $34,000; for a family of four, it was about $69,700.

A bar chart showing the individual shared responsibility penalty by federal poverty level during the tax year 2020, where about 2 in 5 households penalized for not having minimum essential health care coverage had low-to-moderate incomes.

Individual Mandate Penalty Revenue Has Not Been Used for Its Intended Purpose

California is expected to raise a total of $1.4 billion in individual mandate penalty revenue across four state fiscal years: 2020-21 through 2023-24, which begins on July 1, 2023. (The penalty revenue is deposited into the state’s General Fund.) However, none of these dollars have been specifically budgeted to reduce the cost of insurance purchased through Covered California. Instead, some penalty revenue appears to have been absorbed by the state’s General Fund and used to support other public systems and services.

Notably, state leaders did agree in 2021 to deposit $334 million in penalty revenue into a new Health Care Affordability Reserve Fund. These dollars were explicitly set aside to fund affordability assistance for Covered California enrollees.

However, last year the governor halted implementation of an affordability assistance program that would have been supported with the penalty reserve funds. This program would have eliminated deductibles and reduced copays for hundreds of thousands of Californians who purchase health insurance through Covered California — including people with low-to-moderate incomes.

Moreover, the governor now proposes to transfer all $334 million in penalty revenue from the Health Care Affordability Reserve Fund to the state’s General Fund in order to help address the projected budget shortfall. With this proposal, the governor makes clear that he does not prioritize using the penalty revenue for its intended purpose: further reducing the cost of health coverage for Californians who are struggling to afford the cost of care.

The governor also has failed to outline a plan for how to use the hundreds of millions of dollars in penalty revenue that the state will continue to receive each year from Californians who lack minimum essential health coverage. Without a plan, penalty dollars will end up supporting general state budget costs rather than being targeted to assist Californians struggling with the high cost of health care.

Penalizing Californians with Low-to-Moderate Incomes Without Addressing Health Care Affordability Is an Injustice

Penalizing Californians with low-to-moderate incomes for not obtaining health coverage and then failing to use the penalty revenue to address the high cost of coverage and care is an injustice. Additional financial assistance is critical for Californians who are uninsured and struggling to purchase coverage as well as for those who are insured but can’t afford to access the care they need. Governor Newsom should ensure that dollars raised from the state’s individual mandate penalty help people afford health insurance through Covered California, as was intended when the penalty was established.

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