Health and Human Services Legislative Update
October 19, 2017
The Governor’s deadline to sign or veto the nearly 1,000 measures sent to his desk during this legislative session was October 15. The below update describes significant measures of interest that the CSAC Health and Human Services team worked on throughout the 2017 legislative session.
Due to work earlier in the session by the HHS team, several problematic measures were shelved in policy committee or by the authors well before the end of the legislative session. In addition to working as part of the Stop AB 1250 team, the HHS team was also able to shepherd an In-Home Supportive Services (IHSS) budget trailer bill and a few other measures through the process during the last week of session. For the measures that landed on the Governor’s desk, all of the bills supported by the CSAC HHS team received his signature.
The major HHS legislative accomplishment of the session was negotiating an IHSS agreement with the Administration that will result in significantly reduced county contributions for IHSS costs compared to the January budget. The IHSS agreement was passed in a budget trailer bill (SB 90) in June and included the establishment of a new County IHSS Maintenance of Effort (MOE), State General Fund contributions to partially offset increased IHSS costs, and many other provisions. CSAC continues to work on implementation and the MOE methodology was approved by the CSAC Board of Directors on September 7.
During the last week of session, CSAC also supported AB 130, another trailer bill that included technical clean-up provisions to ensure proper implementation of SB 90. This bill would clarify language around the parties involved with the Public Employment Relations Board process, make technical corrections to ensure caseload growth is calculated correctly, clarify that 2016-17 sales tax growth will be used to offset IHSS costs, and spell out how the wage supplement provision will work. AB 130 was passed by the Legislature on September 15 and signed by the Governor almost immediately on September 16.
CSAC successfully defeated a bill that would have imposed a significant infringement on counties’ statutory authority to set General Relief/General Assistance (GA or GR) funding levels. AB 85 would have required counties to alter their locally-established GA or GR eligibility levels to provide additional county-funded assistance to veterans. This would have imposed a statewide mandate for a specific population without identifying a source of funding. Through our work in partnership with CSAC Affiliates, the bill was held in the Senate Veterans Affairs Committee on July 14.
CSAC was also successful in working with a raft of CSAC Affiliates to stall AB 1603, a measure that would have allowed doctors, psychiatrists, and possibly other licensed medical professionals who contract with counties to join in the collective bargaining process with county union employees.
The measure was opposed by CSAC, CHEAC, CAPH, and CBHDA, as well as psychiatrists and others. AB 1603 is now a two-year bill, which means that the bill did not move forward this session, but could be revived in January. And while AB 1603 was not related to AB 1250 (Jones-Sawyer), it did raise many of the same issues, as county public hospitals, health clinics, and the behavioral health system in each county must retain the authority to contract with clinicians to provide critical safety-net services.
Senator Jim Beall introduced SB 192, a framework to ensure that unspent Mental Health Services Act (MHSA) funding would revert back to the state as outlined in Proposition 63 passed by voters in 2004. After many discussions, a slightly different framework was included in the Health budget trailer bill in June (SB 97). The measure provides a prospective solution for the reversion of unused MHSA funding that forgives past unused funding and gives small counties up to five years to use MHSA funds. CSAC supported SB 97, which was signed by the Governor on July 10.
The Chairs of both the Senate and Assembly Health Committees introduced a pair of bills to implement critical provisions of the federal Medicaid Managed Care rule related to supplemental Medi-Cal funding for California’s public health systems. CSAC supported both SB 171 and AB 205.
In spring 2016, the federal Centers for Medicare and Medicaid Services (CMS) released a final regulation of Medicaid managed care. The regulation included provisions directly related to public health care systems’ supplemental payments and placed new restrictions on how these supplemental payments must be directed from the state to Medicaid managed care plans and to providers.
SB 171 outlines important provisions related to the public hospitals, mental health parity, and the Medical Loss Ratio (MLR). It is critical for California to implement the new federal regulations in a way that meets both the needs of all residents and the local county partners who provide the services on the ground, and SB 171 will assure continued federal funding for county public hospitals and health systems.
AB 205 outlines important provisions on the time, distance and access to care, the quality of care, managed care plan grievance provisions, and provisions related to fair hearings. The measure includes language requiring county specialty mental health plans to conform to state Knox-Keene timeliness and access requirements, which could potentially increase state costs. Overall, however, CSAC supported the implementation of theMedicaid managed care regulations through both bills which were signed by the Governor on October 13.