Gov. Gavin Newsom stated last month that California was Done doing business with Walgreens after the pharmacy chain said it would not distribute an abortion pill in 21 states where Republicans threatened legal action. Since,

KHN Kaiser health news

has learned that the Democratic governor has to compromise on his harsh tweet.

California is required by law to continue doing business with Walgreens through the state’s massive Medicaid program, health law experts said. And according to a public records request, the state paid Walgreens $1.5 billion last year.

The Newsom administration has confirmed that it will continue to comply with federal law by paying Walgreens through Medi-Cal, which provides health coverage to approximately 15 million low-income residents with disabilities. If California stopped providing Medi-Cal prescriptions to be filled at Walgreens stores, lawyers warned, the state would be in violation of federal law, which allows patients to get their medications at any licensed pharmacy.

California does not intend to take any action that would violate federal Medicaid requirements, or that could undermine access for low-income people,

said

Tony Cava, a spokesman for the California Department of Health Care Services,

said

in a statement.

Newsom spokesperson Anthony York said: Tweeting is not policy. He added that the governor will not take any action that harms people who need access to care. Walgreens has even been invited back to apply for a specialty drug contract, which Newsom declined to renew last month, York said. Walgreens received approximately $54 million from the state under the contract.

The dust

–

The partnership with the Illinois-based pharmacy chain illustrates Newsom’s panache for sweeping social media announcements, where he makes national headlines but offers few details and few follow-ups, political strategists said. Newsom has increased his national profile and speculation about a presidential bid by traveling to red states and creating a new political action committee.

It’s much more about the look, style and approach than the substance, says David McCuan, chairman of Sonoma State’s political science department.

University

. Newsom and his administration oversell their pronouncements and don’t really live up to them.

On March 6, the governor tweeted

That

California will not do business with @walgreens or any company that cringes at the extremists and endangers women’s lives after the second-largest US pharmacy chain said it would not provide mifepristone in states where it is illegal to pill or where the company could face potential lawsuits if it did.

Democratic strategist Steve Maviglio said continuing to pay Walgreens through Medi-Cal does not diminish Newsom’s support for abortion rights.

He’s going to make headlines for protecting abortion rights, and he can attribute this to a technicality, Maviglio said. He will be rewarded for standing up for a company.

Federal law is designed to ensure that Medicaid patients have choices in where they get health care

care, including prescriptions. Authorized Providers

like like like

Walgreens are protected by the Medicaid statute, which states that no health plan or entity can limit the choice of the qualified person from whom the individual may receive services. Legal and Medicaid experts said it is extremely difficult for the Newsom administration to disqualify Walgreens.

As long as Walgreens performs for Medicaid beneficiaries as it should, dispensing all legal drugs in a manner consistent with permitted pharmacy practice, then I see no reason to exclude them, said Sara Rosenbaum, a professor of health law and policy at the George Washington University.

The federal regulations protecting Walgreens are the same ones that enabled Planned Parenthood to provide health care

healthcare services to Medicaid enrollees in conservative states where leaders have unsuccessfully tried to exclude the network of clinics from receiving tax dollars.

A licensed pharmacy company can be banned from state networks only if it committed fraud or other contract violations, added Edwin Park, a research professor at Georgetown University with expertise in Medicaid law.

That certainly wouldn’t be the case for Walgreens, Park said.

It’s unclear whether Newsom knew how difficult it would be for California to terminate its Medi-Cal supply agreement with Walgreens, said Daniel Schnur, a Republican-turned-independent strategist who also teaches political science at

USC the University of Southern California

.

The original announcement sounded like a groundbreaking move for the state of California to take on principle, even at a great financial cost, Schnur said. They quietly withdrew.

By means of an archive request,

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learned that the state paid Walgreens $1.5 billion last year to buy and distribute prescriptions to Medi-Cal enrollees. The bulk of the payment, $1.4 billion, reimbursed Walgreens for the prescriptions it distributed. And the remaining $123 million went to pharmacy fees, a payment to pharmacists for every prescription they fill. The federal government covers at least half of state payments, which are also offset by rebates from drug manufacturers.

A Walgreens spokesperson declined to comment on its business with California, citing the same statement it made in March: Providing legally approved drugs to patients is what pharmacies do and is rooted in our commitment to the communities in which we operate.

Walgreens said it plans to distribute mifepristone in any jurisdiction where it is legally allowed to do so. The company responded to a

nFDA Food and Drug Administration

finalized in January that would allow certified pharmacies to dispense the abortion pill, which is the most common way people end a pregnancy. Walgreens is not proposing to restrict the sale of abortion pills in California or other states where abortion is legal and allowed to provide abortion.

Democrats have been urging pharmacy chains to sell the abortion pill, even as GOP attorneys general threaten legal action. But many, including Walmart, Costco, Albertsons and Health Mart, have not joined the fray. Only Rite Aid and CVS have said they plan to begin certification to distribute the pills.

If Newsom could have broken Medi-Cal’s relationship with Walgreens, he would have contradicted one of its signature health initiatives. When he took office in 2019, Newsom proposed that the state take over prescription drug coverage for Medi-Cal patients, many of whom were covered through managed care plans.

Part of Newsom’s pitch: Patients can go to almost any pharmacy in California.

This story was produced by

Kaiser health news

an editorially independent news agency of the Kaiser Family Foundation that provides in-depth coverage of health issues.