The , had already cleared the state Senate, but faced opposition in the Assembly Health Committee.

Among those expected to vote against the bill were , almost all of whom are Latino, after the Archdiocese of Los Angeles increased its lobbying  efforts. Church officials argued that some poor residents could feel pressured into ending their lives prematurely if they couldn’t afford expensive medical treatment. have also fought against the legislation.

“We continue to work with Assembly members to ensure they are comfortable with the bill,” said a joint statement from Sens. Lois Wolk, D-Davis, and Bill Monning, D-Monterey, and Assemblywoman Susan Eggman, D-Stockton. “For dying Californians like , who was scheduled to testify today, this issue is urgent. We remain committed to passing the End of Life Option Act for all Californians who want and need the option of medical aid in dying.”

Under the bill, mentally competent adults who are terminally ill with less than six months to live could request lethal medication from a physician.

“We’re going to review our options,” Monning said in an interview later. “We walk away from the decision today knowing that we’re going to have to spend more time cultivating our colleagues in the Assembly.”

The aid-in-dying issue was brought home to Californians last year after 29-year-old resident moved to Oregon so she could get a lethal prescription under that state’s death with dignity law. Maynard was terminally ill with brain cancer and died last November. A she recorded 19 days before she took life-ending drugs was shown at a Senate hearing in March.

Last month, a found that 69 percent of Californians and 70 percent of Latinos supported the bill. The poll was conducted by the advocacy group Compassion and Choices.

The bill also got a boost after the California Medical Association changed its stance from opposed to neutral.

It was modeled after a 1994 Oregon law that permits aid in dying. Four other states — Washington, Montana, Vermont and New Mexico — have similar laws.

This story is part of a reporting partnership with NPR, KQED and Kaiser Health News.

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After Jarett filed the form with Medi-Cal — a death notice as required — the state sent a bill for a hefty $76,349. Jarett was stunned. It was for the cost of health, vision and dental insurance, she said.

The bill was part of Medi-Cal’s “estate recovery program.” Under a federal law not widely known to consumers, states can seize assets of Medicaid beneficiaries after they die. “I was never aware of this wrinkle that they could recover for health insurance,” Jarett said.

Jarett’s clients did not want to speak to reporters, but Jarett said they insisted their mother had not been to the doctor in years and had even died at home. But Jarett said the charges included a breakdown by month of the state’s payments to a managed care plan as part of Medi-Cal.

While a 1993 federal law mandates that states recover assets for nursing home care, the law makes it optional that states recover for medical services — doctor visits, hospital stays and the like — for people 55 and over. Advocates say , but it isn’t clear that the other states pursue the assets as aggressively as California.

“It’s an awful system, and it needs to be changed. It absolutely needs to be changed,” said Pat McGinnis, executive director of California Advocates for Nursing Home Reform. Her group is sponsoring a bill, , introduced by state Sen. Ed Hernandez (D-West Covina), that would abolish this optional recovery. The bill was heard by the Senate Health Committee on Wednesday and passed out of committee by a vote of 8-0. It will go before the Senate Appropriations committee next.

Last year, a similar bill , but was ultimately vetoed by Gov. Jerry Brown. Still, in a statement last September when he vetoed the bill, Brown left an opening. He said estate protection might be a “reasonable policy goal,” but that the cost “needs to be considered alongside other worthwhile policy changes.”

Figuring out that cost is a challenge. In 2013 and 2014, the state recovered $61 million in 3,900 cases, said Carol Sloan with the Department of Health Care Services. But the state does not break down how much of that $61 million is for nursing home care and how much of it is for medical services.

For perspective, $17.8 billion in state general fund dollars went to Medi-Cal last year. The total budget for Medi-Cal is significantly more than that after adding in federal dollars and various taxes— $85.7 billion.

‘Leery’ of Medi-Cal

Like the attorney Jarett, Anne-Louise Vernon, 60, of Campbell, had never heard of estate recovery. She had been “so looking forward,” she says, to signing up for insurance under the Affordable Care Act. Her income was too low for her to qualify for subsidies to purchase insurance on the Covered California marketplace. Instead, she qualified for Medi-Cal.

Vernon said she was “leery,” and asked if there were strings attached. “I was told, ‘No, no, it’s completely free.’” She said it was some time later, when she was looking around online, that she found a reference on an FAQ page about assets being seized. She was furious.

“So you’re breaking the law if you don’t have health insurance,” Vernon said, referring to Obamacare’s “individual mandate” that everyone have health insurance. She said she felt forced into Medi-Cal: “They don’t tell people it’s a loan.”

Vernon held onto her home years ago after a divorce, but said she was “involuntarily retired” and has been living on savings. She knows she could shelter her home but doesn’t want to take that step. “I’m 60! I’m not going to sign my house over to my kids at this age.”

For other people, attorneys’ fees to take the legal steps to shelter a property are a big issue. “People who end up on Medi-Cal are poor people,” said McGinnis. “They’re the ones that usually cannot afford to pay an attorney $300 to $400 an hour.”

‘Collection Agency for the Feds’

Estate recovery has become a much bigger issue since the rollout of Obamacare started more than a year ago. Under the expansion of Medicaid, people earning up to 138 percent of the federal poverty level are eligible (in states like California that are participating in the expansion). But for those people, 100 percent of the cost of their health coverage is borne by the federal government for the first three years, drifting down to 90 percent after that, and any recovered money would be returned to the federal government.

“What are we? A collection agency for the feds?” asked McGinnis, who also says CANHR is hearing from consumers who will disenroll from Medi-Cal if the policy has not changed. Other advocates believe the policy is a barrier to enrollment for some people.

For now, Vernon is staying on Medi-Cal. Like 80 percent of Medi-Cal beneficiaries in California, she is enrolled in a managed care plan. When she wanted to know what her Medi-Cal coverage cost, she spent “hours and hours on the phone” calling both her managed care plan and the state, she says, and got the runaround from both of them. No one could tell her what her coverage cost.

Finally, an advocate sent her a link to the exact page on a state website where she could find out how to file a request for information — with a $25 fee. She finally got an answer: $578.71 a month. If she stays on Medi-Cal for another five years until she’s 65, when she becomes eligible for Medicare, the state will have paid almost $35,000 for her managed care premium. After she dies, the state could bill her estate for that amount — or more, if she continues on Medi-Cal.

Ironically, if Vernon, and others like her, earned just a bit more money, they would qualify for heavily subsidized private insurance through the Covered California exchange. The state estimates that the “per member per month” premium for those newly eligible for Medi-Cal is $620.98, or nearly $75,000 over 10 years.

Vernon plugged her age and ZIP code into the Covered California insurance calculator, but increased her income to $17,000 to see what would happen.

She found she could get a plan for as little as $31 a month, “estate recovery free,” she noted. These plans come with a $2,250 out-of-pocket limit, but even if a 55-year-old maxed that out every year, the 10-year total of deductible plus premium is $26,220 — about $50,000 less than what would be accrued on Medi-Cal, with no estate recovery.

This story is part of a reporting partnership that includes , and Kaiser Health News.

This <a target="_blank" href="/medicaid/some-face-a-big-bill-from-medi-cal-after-they-die/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

from on .

Carl Krawitt has watched his son, Rhett, now 6, fight leukemia for the past 4 and a half years. For more than three of those years, Rhett has undergone round after round of chemotherapy. Last year he finished chemotherapy, and doctors say he is in remission.

Now, there’s a new threat: measles.

Rhett cannot be vaccinated, because his immune system is still rebuilding. It may be months more before his body is healthy enough to get all his immunizations. Until then, he depends on everyone around him for protection — what’s known as .

But Rhett lives in Marin County, Calif., a county with the  in the Bay Area and among the highest in the state. This school year, 6.45 percent of children in Marin have a personal belief exemption, which allows parents to lawfully send their children to school unvaccinated against communicable diseases like measles, polio, whooping cough and more.

“It’s very emotional for me,” Carl Krawitt said. “If you choose not to immunize your own child and your own child dies because they get measles, OK, that’s your responsibility, that’s your choice. But if your child gets sick and gets my child sick and my child dies, then your action has harmed my child.”

Krawitt is taking action of his own. His son attends Reed Elementary in Tiburon, a school with a 7 percent personal belief exemption rate. (The statewide average in California is 2.5 percent). Krawitt had previously worked with the school nurse to make sure that all the children in his son’s class were fully vaccinated. He said the school was very helpful and accommodating.

Now Krawitt and his wife, Jodi, have emailed the district’s superintendent, requesting that the district “require immunization as a condition of attendance, with the only exception being those who cannot medically be vaccinated.”

Carl Krawitt provided me with Superintendent Steven Herzog’s response. Herzog didn’t directly address their query, instead saying: “We are monitoring the situation closely and will take whatever actions necessary to ensure the safety of our students.”

Typically, a response to health emergencies rests with county health officers. During the current measles outbreak, unvaccinated students at Huntington Beach High School in Orange County out of school for three weeks after a student there contracted measles. It’s one way to contain an outbreak.

But those steps were taken in the face of a confirmed case at the school.

Marin County health officer Matt Willis said he was going to check with the state to see what precedent there was to keep unvaccinated kids out of school even if there were no confirmed cases. “This is partly a legal question,” he said.

Right now, there are no cases of measles anywhere in Marin and no suspected cases either. Still, “if the outbreak progresses and we start seeing more and more cases,” Willis said, “then this is a step we might want to consider” — requiring unvaccinated children to stay home, even without confirmed cases at a specific school.

Rhett has been treated at the University of California, San Francisco, and his oncologist there, Dr. Robert Goldsby, said that he is likely at higher risk of complications if he were to get measles.

“When your immune system isn’t working as well, it allows many different infections to be worse,” Goldsby said. “It’s not just Rhett. There are hundreds of other kids in the Bay Area that are going through cancer therapy, and it’s not fair to them. They can’t get immunized; they have to rely on their friends and colleagues and community to help protect them.”

Goldsby pointed to the number of people who, when facing a friend or family member who receives a challenging diagnosis, will immediately ask how they can help. “Many families will say, ‘What can I do to help? What can I do to help?’ ” he said, repeating it for emphasis. “One of the main things they can do is make sure their [own] kids are vaccinated to protect others.”

Krawitt has been speaking up about vaccination for a long time now. He told me about going to a parent meeting at his daughter’s school just before the start of the school year, where a staff member reminded parents not to send peanut products to school, since a child or children had an allergy. “It’s really important your kids don’t bring peanuts, because kids can die,” Krawitt recalls the group being told.

The irony was not lost on him. He told me he immediately responded, “In the interest of the health and safety of our children, can we have the assurance that all the kids at our school are immunized?”

He found out later from a friend that other parents who were present were “mad that you asked the question, because they don’t immunize their kids.”

This story is part of reporting partnership that includes , and Kaiser Health News.

This <a target="_blank" href="/public-health/to-protect-his-son-a-father-asks-school-to-bar-unvaccinated-children/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">