CSAC Bulletin Article

Health and Human Services 04/05/2013

Health Care Special Legislative Session

SBX1 3 (Hernandez) – Support
As Amended on March 6, 2013

SBX1 3, by Senator Ed Hernandez, would create a health care “Bridge Plan” to create a low-cost health plan through Covered California that would help ensure provider continuity for low-income individuals as they move between eligibility for public and private health coverage. 

The CSAC Executive Committee supported as similar measure by Senator Hernandez last year (SB 703) that would have created a Basic Health Plan. 
The current Bridge Plan will allow low-income individuals to affordably purchase health insurance while maintaining provider continuity and a medical home. The Bridge targets individuals with incomes approximately between $15,000 and $22,000 – those most at risk of being unable to afford coverage. Even with federal subsidies, these individuals will still have monthly premiums and co-pays. Developing affordable coverage options is crucial to ensure individuals and families enroll in coverage, particularly since we know that under best case scenarios 3 to 4 million Californians will remain uninsured five years after health reform implementation.

Additionally, the Bridge Plan would allow low-income individuals to retain their existing health care providers. Many individuals with incomes between 138% and 200% of the federal poverty level are currently enrolled in Low Income Health Programs. The Bridge can help ensure continuity of care for these patients and a seamless transition into managed care.
Twelve counties own and operate county hospitals and health systems. Additionally, a number of other counties own and operate primary care and specialty care clinics. The Bridge Plan would help ensure that county safety net providers maintain a diverse payer mix with Covered California enrollees. Counties believe the Bridge will help counties continue to serve the remaining uninsured.

For these reasons, CSAC supports SBX1 3. The Senate Health Committee passed the bill on March 20 and the Senate Appropriations Committee will hear it on April 8.

Regular Legislative Session 

Mental Health

AB 1054 (Chesbro) – Support
As Amended on April 2, 2013

AB 1054, by Assembly Member Wesley Chesbro, would reduce the annual rate increase that counties pay to Institutions for Mental Disease (IMD) for inpatient psychiatric treatment from 4.7 percent to 3.5 percent. 

The measure, sponsored by CSAC affiliate California Mental Health Directors Association (CMHDA), originally removed the automatic rate increase altogether and would have allowed counties to negotiate rates with IMDs within their borders. For counties, the 4.7 percent annual increase was a significant fiscal concern, as county mental health departments are responsible for the full cost of IMD rates. 

AB 1054 was amended in the Assembly Health Committee on Tuesday to instead reduce the automatic rate increase down to 3.5 percent annually, which is consistent with a reasonable cost of living adjustment. The measure as amended was passed by the committee and now goes to the Assembly Appropriations Committee.

Human Services

AB 197 (Stone) – Support
As Introduced on January 29, 2013

AB 197, by Assembly Member Mark Stone, would allow California Work Opportunities and Responsibility to Kids (CalWORKs) program applicants and recipients to own reliable cars. 

AB 197 would specifically delete the requirement that counties assess the value of a motor vehicle when determining or redetermining CalWORKs eligibility. AB 197 will decrease the administrative workload required of counties to verify the value of applicants’ vehicles. Counties also believe that the success of CalWORKs participants is often dependent on reliable transportation, along with key employment supports and services.

AB 197 Was passed by the Assembly Human Services Committee on April 2 and it now goes to the Assembly Appropriations Committee. 

SB 283 (Hancock) – Support
As Introduced on February 14, 2013

SB 283, by Senator Loni Hancock, would allow those who have been convicted of a felony after 1996 and who meet all current eligibility requirements to receive California Work Opportunity and Responsibility to Kids (CalWORKs) and CalFresh services, employment training, and nutrition assistance. 

Senator Hancock’s SB 283 will allow California to join with 38 other states in altering or opting out of a federal lifetime ban on receiving Temporary Assistance to Needy Families (TANF grants – called CalWORKs here in California) funding for those with past drug felonies. California already allows some people with certain drug-related felonies to receive Supplementary Nutrition Assistance Program (SNAP or food stamps, called CalFresh in California) benefits, but the exceptions are narrow. 
Counties support SB 283 because we believe it provides an important tool for counties in the service continuum post-2011 realignment. By removing the lifetime ban on receiving CalWORKs and CalFresh benefits, counties will be able to provide employment activities, services, and nutritional support to those who are released from incarceration. Evidence suggests that social service components play a key role in safely reintegrating those convicted of a felony back into our communities, and California’s counties must have the ability to provide intensive services to an often difficult-to-serve population. 

It is for these reasons that CSAC support SB 283, which will be heard by the Senate Human Services Committee on April 9. 

SB 346 (Beall) – Support
As Amended on April 2, 2013

SB 346, by Assembly Member Jim Beall, would allow county social services and health departments within a county to share limited eligibility information. 

Senator Beall’s SB 346 will streamline the eligibility and enrollment process for public social services and health programs at the county level. By allowing county social services and health departments to share eligibility information, SB 346 will break down the eligibility siloes that may exist between health departments and social services departments in counties and encourage a “client centered” model of integrated services. Further, this measure will result in easier access to health care and social services for the most needy and vulnerable eligible residents in our communities. 

On the eve of the implementation of the Affordable Care Act, counties are seeking innovative processes and solutions to comply with the Act’s “no wrong door” approach for health care enrollment. We believe that SB 346 is a simple solution that will enable counties to improve service and access to health care services and other public social service programs. The measure is sponsored by Santa Clara County. 

The Senate Human Services Committee will hear SB 346 on April 9. 
Emergency Medical Services

SB 191 (Padilla) – Support
As Introduced on February 7, 2013

SB 191, by Senator Alex Padilla, would emove the sunset date for local Maddy Emergency Medical Services Funds (Maddy Funds) to allow counties to continue to assist hospitals and emergency physicians with the costs of treating uninsured patients, local emergency services, and pediatric trauma care. 

Senate Bill 191 simply removes the January 1, 2014 sunset date for local Maddy Funds. Counties supported measures creating and sustaining Maddy Funds, and nearly all counties currently operate a Maddy Fund by collecting an additional $2 for every $10 penalty for all criminal offenses and moving violations. This funding is allocated to hospitals and emergency physicians to reimburse them for care given to uninsured patients and allows counties to supplement local emergency services. Fifteen percent of the funds collected are also directed to pediatric trauma care (Richie’s Fund), representing the only statewide funding source for these critical services for kids. 

California’s counties continue to grapple with a reduction of resources for the health care safety net. These changes are also felt by hospitals and emergency physicians, as well as by Californians who need emergency medical services. In rural areas, access to emergency department services is increasingly difficult, and urban areas are experiencing the same problem as fewer hospitals are able to finance emergency departments. Maddy funding statewide is small – about $50 million in non-state General Funds – but it is an important element in the local emergency services safety net and availability of pediatric trauma care.

For these reasons, CSAC supports SB 191. The Senate Health Committee will hear the measure on April 10. 

AB 1225 (Maienschein) – Concerns
As Introduced on February 22, 2013

AB 1225, by Assembly Member Brian Maienschein, would allow for an additional 10 percent fund transfer from other subaccounts to the mental health subaccount within the 1991 Realignment financing structure. We incorrectly reported on March 15 that AB 1225 pertained to the 2011 Realignment superstructure. 

CSAC is working with the County Welfare Directors Association (CWDA), the California Mental Health Directors Association (CMHDA) and the County Health Executives Association of California (CHEAC) to communicate our concerns with the measure to Assembly Member Maienschein. AB 1225 has been double-referred to the Assembly Local Government Committee and Assembly Health Committee, but has not yet been set for hearing. 

Medical Care

AB 361 (Mitchell) – Support
As Introduced on February 14, 2013

AB 361, by Assembly Member Holly Mitchell, would allow the state and counties to work together to leverage significant federal funding and create a patient-centered “health home” program for Medi-Cal beneficiaries who are frequent hospital users. 

Specifically, the measure would allow California to utilize a 90 percent federal funding match for two years under the Affordable Care Act to create a comprehensive program for frequent hospital users. The funding can be used to implement comprehensive engagement and case management services to high-risk populations and will help promote an integrated approach (“health home”) to health care and wellbeing for the most chronically ill people in our communities. The program goal is to stabilize – and even increase – the health of frequent hospital users while reducing their utilization of costly medical care. 

Currently, a dozen counties fund or manage health home integrated programs for frequent hospital users, and have realized medical cost savings as a result. Further, Assembly Member Mitchell has secured private funding from the California Endowment for the non-federal costs associated with the first two years of the program. Counties, many of which are working to implement the integrated health model, welcome an opportunity to opt into the health home services funding offered through the Affordable Care Act. We believe counties and the state can achieve significant cost savings for the sickest and most expensive users of hospital care – all without incurring state costs for erecting a health home program.

For these reasons, CSAC supports AB 361. The Assembly Health Committee passed the measure on April 2, and it now goes to the Assembly Appropriations Committee. 

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