{"edition":"california","organization":"National Health Law Program","organizationId":"org:national-health-law-program","boundaryVersion":"US-CA-state-v1","updated":"2026-09-13","model":{"version":"ca-nhelp-rule-implementation-v2","costScope":"Three years of all recipient programs/support at FY2025 audited resource cost including donated legal labor. One national implementation pathway quantified; other portfolio net health set zero, not a proven lower bound. Public treatment and wider social costs excluded.","geographicAttribution":"Specific Medicaid-rule pathway only, not whole-recipient share. Manatt Table2's 2028 CA difference=(2147−1673)*1000=474000; national=(8606−6706)*1000=1900000. g=474/1900=.2494736842. Applying this share to 2029 and other scenario years, and assuming equal conditional remedy, replacement coverage, utility and advocacy yield across states, are explicit judgments. Table1's 2027–34 average451/1808=.2494469 is a consistency check, not the chosen temporal denominator.","formula":"A=sum(t=start..start+T-1)(1+discount)^(-t); V=N*r*u*A; H=V*q; Q_all=b*(p*a*H-h); Q_CA=g*Q_all; Cost=C*Y; Price10=10*Cost/Q_CA when positive. Central g=(2147-1673)/(8606-6706)=474/1900. National enrollment snapshots are assumed sustained over each credited year; q is a sustained annual utility judgment. All-population outcomes match the national view; California and USA are not additive donations.","counterfactual":"Existing state litigation, other amici, public administrators, grants and clinical care continue. Only further work's change in strict versus less restrictive administration counts, not repeal or all losses. r removes forecast/remedy overreach, u removes replacement coverage, b removes financial substitution.","attribution":"p=.1 incremental coalition contribution, a=.1 NHeLP share and b=.25 funding additionality are separate subjective factors. Current amicus and strategy show a live role but identify none of them. Existing work receives no automatic future-donation credit.","uncertainty":"Weak-confidence, explicitly subjective policy-pathway best estimate. Finite central is useful conditional on the shared USA judgments; it is not a measured portfolio return or rigorous lower bound. Clinical, policy and financial priors dominate the source-observed geographic ratio. Root may reject numerical acceptance. Other California and national portfolio health is set net zero, not proven absent.","nativeOutcomes":"Additional Medicaid enrollment, then genuinely additional insured person-years with effective access; finite QALY utility differences. Filings, fiscal transfers and legal wins are not health units.","inputs":[{"name":"C","value":13035827,"unit":"USD annual recipient resources","basis":"observed","rationale":"Full audited expense, all functions and recognized donated professional services; original review reused from CA worker.","sourceIds":["audit25"]},{"name":"Y","value":3,"unit":"funding years","basis":"judgment","rationale":"Three-year capacity cohort, not a priced brief; constant latest expense.","sourceIds":[]},{"name":"N","value":1900000,"unit":"annual Medicaid enrollment difference","basis":"observed","rationale":"Published forecast, not realized outcome: Figure 1 2028 8.6m−6.7m and 2029 8.8m−6.9m; visually verified rounded values. Point-in-year forecast treated as sustained for a full year; this is a temporal approximation, not an observed person-year integral.","sourceIds":["nhelp-manatt"]},{"name":"r","value":0.5,"unit":"realized/remediable share of forecast","basis":"judgment","rationale":"Half allows forecast error, narrower remedy and incomplete state implementation.","sourceIds":["nhelp-manatt","nhelp-amicus"]},{"name":"u","value":0.5,"unit":"share genuinely preventing uninsurance","basis":"judgment","rationale":"Half allows other public/private insurance and enrollment-accounting differences. Effective health among newly insured is separately q.","sourceIds":["oregon"]},{"name":"q","value":0.02,"unit":"QALYs per additional insured year","basis":"judgment","rationale":".02 transfer below Oregon's .05 self-rated mapping. No separate mortality, depression or financial benefit added. Assumes the utility improvement persists throughout each credited insured year.","sourceIds":["oregon"]},{"name":"p","value":0.1,"unit":"incremental coalition probability/intensity improvement","basis":"judgment","rationale":"Ten percentage points from further coalition work over three years beyond baseline public action; not overall litigation success probability.","sourceIds":["nhelp-prepare","nhelp-cms"]},{"name":"a","value":0.1,"unit":"NHeLP share of coalition effect","basis":"judgment","rationale":"Ten percent recognizes co-authorship and national expertise; 90% remains with states, other counsel and organizations. Not 1/71 arithmetic or filing credit.","sourceIds":["nhelp-amicus","cases"]},{"name":"b","value":0.25,"unit":"marginal capacity additionality","basis":"judgment","rationale":"Quarter allows grants, reserves and other donors; local linearity could fail and zero is possible.","sourceIds":["audit25","careers"]},{"name":"start","value":2,"unit":"first benefit year","basis":"judgment","rationale":"Year two approximately 2028, allowing preparation lag; no first-year credit.","sourceIds":[]},{"name":"T","value":2,"unit":"benefit years","basis":"judgment","rationale":"Two years approximately 2028–29 then paths reconverge; no perpetual entitlement credit.","sourceIds":[]},{"name":"discount","value":0.03,"unit":"annual discount fraction","basis":"judgment","rationale":"3% applied by health event year; no remaining-life multiplication.","sourceIds":[]},{"name":"h","value":0,"unit":"other net health harm before b","basis":"judgment","rationale":"Net zero for unpriced portfolio and public-resource displacement, not established zero; adverse sensitivities independent of p*a.","sourceIds":[]},{"name":"CA2028 rule-related enrollment difference","value":474000,"unit":"forecast Medicaid enrollees","basis":"observed","rationale":"Published rounded Table2 forecasts2147k−1673k, visually checked; not realized enrollment.","sourceIds":["nhelp-manatt"]},{"name":"g","value":0.24947368421052632,"unit":"California share of pathway health","basis":"judgment","rationale":"2028 forecast share474k/1900k applied to2029 and conditional health/influence yields; not an observed health share or organization geography.","sourceIds":["nhelp-manatt"]}],"scenarios":[{"id":"central","label":"Weak-confidence California rule-implementation estimate","costUSD":39107481,"allPopulationQalys":44.12126725156421,"editionQalys":11.007095093284967,"assumptions":"{\"C\":13035827,\"Y\":3,\"N\":1900000,\"r\":0.5,\"u\":0.5,\"q\":0.02,\"p\":0.1,\"a\":0.1,\"b\":0.25,\"start\":2,\"T\":2,\"discount\":0.03,\"g\":0.24947368421052632,\"h\":0}; A=1.857737568486914; conditional discounted insured person-years=882425.3450312841; conditional QALYs=17648.50690062568.; California g=474/1900, temporal and relative-health-yield transfer judgment."},{"id":"favorable","label":"Broader sustained effect","costUSD":39107481,"allPopulationQalys":7405.326138414443,"editionQalys":1847.433994530761,"assumptions":"{\"C\":13035827,\"Y\":3,\"N\":1900000,\"r\":1,\"u\":0.8,\"q\":0.05,\"p\":0.3,\"a\":0.15,\"b\":0.6,\"start\":2,\"T\":4,\"discount\":0.03,\"g\":0.24947368421052632,\"h\":0}; A=3.608833400786766; conditional discounted insured person-years=5485426.7691958845; conditional QALYs=274271.33845979423.; California g=474/1900, temporal and relative-health-yield transfer judgment."},{"id":"poor","label":"Very weak influence and access","costUSD":39107481,"allPopulationQalys":0.0017909322273541334,"editionQalys":0.0004467904609293996,"assumptions":"{\"C\":13035827,\"Y\":3,\"N\":1900000,\"r\":0.1,\"u\":0.2,\"q\":0.005,\"p\":0.02,\"a\":0.01,\"b\":0.05,\"start\":2,\"T\":1,\"discount\":0.03,\"g\":0.24947368421052632,\"h\":0}; A=0.9425959091337544; conditional discounted insured person-years=35818.644547082666; conditional QALYs=179.09322273541332.; California g=474/1900, temporal and relative-health-yield transfer judgment."},{"id":"health-mapping-high","label":"Use .05 health mapping","costUSD":39107481,"allPopulationQalys":110.30316812891056,"editionQalys":27.517737733212424,"assumptions":"{\"C\":13035827,\"Y\":3,\"N\":1900000,\"r\":0.5,\"u\":0.5,\"q\":0.05,\"p\":0.1,\"a\":0.1,\"b\":0.25,\"start\":2,\"T\":2,\"discount\":0.03,\"g\":0.24947368421052632,\"h\":0}; A=1.857737568486914; conditional discounted insured person-years=882425.3450312841; conditional QALYs=44121.26725156421.; California g=474/1900, temporal and relative-health-yield transfer judgment."},{"id":"low-funding-additionality","label":"Only 5% additional capacity","costUSD":39107481,"allPopulationQalys":8.824253450312844,"editionQalys":2.2014190186569937,"assumptions":"{\"C\":13035827,\"Y\":3,\"N\":1900000,\"r\":0.5,\"u\":0.5,\"q\":0.02,\"p\":0.1,\"a\":0.1,\"b\":0.05,\"start\":2,\"T\":2,\"discount\":0.03,\"g\":0.24947368421052632,\"h\":0}; A=1.857737568486914; conditional discounted insured person-years=882425.3450312841; conditional QALYs=17648.50690062568.; California g=474/1900, temporal and relative-health-yield transfer judgment."},{"id":"no-policy-change","label":"No implementation change","costUSD":39107481,"allPopulationQalys":0,"editionQalys":0,"assumptions":"{\"C\":13035827,\"Y\":3,\"N\":1900000,\"r\":0.5,\"u\":0.5,\"q\":0.02,\"p\":0,\"a\":0.1,\"b\":0.25,\"start\":2,\"T\":2,\"discount\":0.03,\"g\":0.24947368421052632,\"h\":0}; A=1.857737568486914; conditional discounted insured person-years=882425.3450312841; conditional QALYs=17648.50690062568.; California g=474/1900, temporal and relative-health-yield transfer judgment."},{"id":"no-health-change","label":"No additional health from coverage","costUSD":39107481,"allPopulationQalys":0,"editionQalys":0,"assumptions":"{\"C\":13035827,\"Y\":3,\"N\":1900000,\"r\":0.5,\"u\":0.5,\"q\":0,\"p\":0.1,\"a\":0.1,\"b\":0.25,\"start\":2,\"T\":2,\"discount\":0.03,\"g\":0.24947368421052632,\"h\":0}; A=1.857737568486914; conditional discounted insured person-years=882425.3450312841; conditional QALYs=0.; California g=474/1900, temporal and relative-health-yield transfer judgment."},{"id":"no-capacity-change","label":"Only substitute existing financing","costUSD":39107481,"allPopulationQalys":0,"editionQalys":0,"assumptions":"{\"C\":13035827,\"Y\":3,\"N\":1900000,\"r\":0.5,\"u\":0.5,\"q\":0.02,\"p\":0.1,\"a\":0.1,\"b\":0,\"start\":2,\"T\":2,\"discount\":0.03,\"g\":0.24947368421052632,\"h\":0}; A=1.857737568486914; conditional discounted insured person-years=882425.3450312841; conditional QALYs=17648.50690062568.; California g=474/1900, temporal and relative-health-yield transfer judgment."},{"id":"adverse","label":"No policy benefit plus 50 QALYs harm","costUSD":39107481,"allPopulationQalys":-12.5,"editionQalys":-3.118421052631579,"assumptions":"{\"C\":13035827,\"Y\":3,\"N\":1900000,\"r\":0.5,\"u\":0.5,\"q\":0.02,\"p\":0,\"a\":0.1,\"b\":0.25,\"start\":2,\"T\":2,\"discount\":0.03,\"g\":0.24947368421052632,\"h\":50}; A=1.857737568486914; conditional discounted insured person-years=882425.3450312841; conditional QALYs=17648.50690062568.; California g=474/1900, temporal and relative-health-yield transfer judgment."},{"id":"other-harm","label":"200 QALYs other net harm","costUSD":39107481,"allPopulationQalys":-5.878732748435787,"editionQalys":-1.466589117241349,"assumptions":"{\"C\":13035827,\"Y\":3,\"N\":1900000,\"r\":0.5,\"u\":0.5,\"q\":0.02,\"p\":0.1,\"a\":0.1,\"b\":0.25,\"start\":2,\"T\":2,\"discount\":0.03,\"g\":0.24947368421052632,\"h\":200}; A=1.857737568486914; conditional discounted insured person-years=882425.3450312841; conditional QALYs=17648.50690062568.; California g=474/1900, temporal and relative-health-yield transfer judgment."},{"id":"double-cost","label":"Twofold future cost","costUSD":78214962,"allPopulationQalys":44.12126725156421,"editionQalys":11.007095093284967,"assumptions":"{\"C\":26071654,\"Y\":3,\"N\":1900000,\"r\":0.5,\"u\":0.5,\"q\":0.02,\"p\":0.1,\"a\":0.1,\"b\":0.25,\"start\":2,\"T\":2,\"discount\":0.03,\"g\":0.24947368421052632,\"h\":0}; A=1.857737568486914; conditional discounted insured person-years=882425.3450312841; conditional QALYs=17648.50690062568.; California g=474/1900, temporal and relative-health-yield transfer judgment."},{"id":"ca-share-low","label":"Lower California relative implementation/health exposure","costUSD":39107481,"allPopulationQalys":44.12126725156421,"editionQalys":4.412126725156422,"assumptions":"g=.1 subjective stress case; national model unchanged."},{"id":"ca-share-high","label":"Higher California relative implementation/health exposure","costUSD":39107481,"allPopulationQalys":44.12126725156421,"editionQalys":17.648506900625687,"assumptions":"g=.4 subjective stress case; national model unchanged."}],"sensitivity":["Central California Q=11.007095093284967; price10=35529338.729759924. This is the national implementation scenario's CA share, with entire recipient three-year cost retained.","At the same national health total, g=.1 yields price10=88636350.30476949 and g=.4 yields 22159087.57619237. These are stress tests, not confidence bounds.","A 2028-only California benefit omits2029 entirely and roughly doubles the price; permanent credit is not allowed.","Shared national policy influence p=.1, NHeLP attribution a=.1 and financing b=.25 are judgments; changing the geographic denominator does not validate them.","If California-specific other net harm exceeds44.02838 QALYs before financial additionality, it erases the central CA gain. The source does not measure public resource displacement or other portfolio health.","If the point-in-year enrollment difference persists for only half of each modeled benefit year, health is halved and cost per 10 QALYs doubles. This temporal assumption is distinct from replacement coverage."],"missingInputs":["Costed unfunded implementation plan and staffing/output response given current grants and reserves.","Case/administrative outcomes with and without incremental NHeLP capacity, separate from states and other counsel.","Actual state implementation, remedy scope, duration, uptake and alternative coverage.","Current beneficiary utility, public treatment/opportunity costs and other portfolio health/harms.","State-year California forecast and remediable medically-frail subgroup, actual California implementation, alternate coverage and utility; current share is an explicit transfer assumption."]},"sources":[{"id":"audit25","title":"2025 audited financial statements","publisher":"National Health Law Program","url":"https://healthlaw.org/wp-content/uploads/2026/03/20251231-National-Health-Law-Program-Inc.pdf","published":null,"retrieved":"2026-09-13"},{"id":"audit24","title":"2024 audited financial statements with 2023 comparative","publisher":"National Health Law Program","url":"https://healthlaw.org/wp-content/uploads/2025/03/National-Health-Law-Program-2024-Audit-Final.pdf","published":null,"retrieved":"2026-09-13"},{"id":"finance","title":"Current original financial-document index","publisher":"National Health Law Program","url":"https://healthlaw.org/financial-documents/","published":null,"retrieved":"2026-09-13"},{"id":"california","title":"California advocacy and support-center role","publisher":"National Health Law Program","url":"https://healthlaw.org/california-advocacy/","published":null,"retrieved":"2026-09-13"},{"id":"strategy","title":"Strategic framework 2023–2027","publisher":"National Health Law Program","url":"https://healthlaw.org/strategic-framework/","published":null,"retrieved":"2026-09-13"},{"id":"cases","title":"Current litigation portfolio","publisher":"National Health Law Program","url":"https://healthlaw.org/our-cases/","published":null,"retrieved":"2026-09-13"},{"id":"behavioral","title":"California commercial-plan behavioral-health investigation analysis","publisher":"National Health Law Program","url":"https://healthlaw.org/regulatory-investigations-reveal-systemic-failures-among-commercial-california-health-plans-in-delivering-timely-behavioral-health-care/","published":"2026-06-18","retrieved":"2026-09-13"},{"id":"dmhc","title":"Behavioral health investigation phases and plan changes","publisher":"California Department of Managed Health Care","url":"https://www.dmhc.ca.gov/Portals/0/Docs/OPM/HealthPlanChanges.pdf","published":null,"retrieved":"2026-09-13"},{"id":"hca","title":"Health Consumer Alliance services and client accounts","publisher":"Health Consumer Alliance","url":"https://healthconsumer.org/","published":null,"retrieved":"2026-09-13"},{"id":"oregon","title":"The Value of Medicaid: Interpreting Results from the Oregon Health Insurance Experiment","publisher":"Finkelstein, Hendren and Luttmer, Journal of Political Economy","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC8081392/","published":null,"retrieved":"2026-09-13"},{"id":"careers","title":"Current job opportunities","publisher":"National Health Law Program","url":"https://healthlaw.org/careers/","published":null,"retrieved":"2026-09-13"},{"id":"donate","title":"Official donation route","publisher":"National Health Law Program","url":"https://healthlaw.org/?form=together","published":null,"retrieved":"2026-09-13"},{"id":"nhelp-prepare","title":"National Medicaid implementation strategy","publisher":"National Health Law Program","url":"https://healthlaw.org/prepare/","published":null,"retrieved":"2026-09-14"},{"id":"nhelp-amicus","title":"Medically-frail exemption amicus","publisher":"NHeLP and co-amici","url":"https://healthlaw.org/wp-content/uploads/2026/09/Mass.-v.-Oz.Amici-Brief-1.pdf","published":"2026-09-10","retrieved":"2026-09-14"},{"id":"nhelp-ifr-comments","title":"Work requirement IFR comments","publisher":"National Health Law Program","url":"https://healthlaw.org/wp-content/uploads/2026/08/7-31-26_NHeLP-Comments_FINAL.pdf","published":"2026-07-31","retrieved":"2026-09-14"},{"id":"nhelp-cms","title":"Nationwide Medicaid work requirement framework","publisher":"CMS","url":"https://www.cms.gov/newsroom/press-releases/cms-launches-nationwide-framework-implement-medicaid-work-requirements","published":"2026-06-01","retrieved":"2026-09-14"},{"id":"nhelp-manatt","title":"50-state additional coverage-loss model, Figure 1 and methodology","publisher":"Manatt Health / Boozang and colleagues","url":"https://assets-us-01.kc-usercontent.com/9fd8e81d-74db-00ef-d0b1-5d17c12fdda9/23b961e2-a654-4fd1-9358-1e3d42205358/Vital%20Signs%2050-State%20Tracking_CMS%20Medicaid%20Work%20Requirements%20Rule.pdf","published":"2026-07-16","retrieved":"2026-09-14"}]}