CSAC Bulletin Article

Health and Human Services 04/15/2011

First 5 Commissions Sue State

Several county First 5 Commissions have filed suit against the Brown Administration over the state’s redirection of $1 billion in First 5 (Proposition 10, Children and Families Act of 1998) funds to Medi-Cal.

The Governor recently signed budget-related legislation (AB 99, Statutes of 2011) that will shift $950 million from county First 5 Commissions and $50 million from the state commission by June 30, 2012. Fifty percent of each county First 5 commission’s fund balance as of June 30, 2010 is included in the redirection, and small counties that receive less than $600,000 in annual Proposition 10 revenue are exempted. The state plans to use the money to provide Medi-Cal services to children under age 5. 

The county First 5 commissions in Los Angeles, Orange, Fresno, Madera, Marin and Merced have joined in two lawsuits alleging that the state’s one-time take of money from the local commissions is illegal. Riverside and Kern County First 5 Commissions are considering joining in the legal action as well. 

The local First 5 commissions contend that Proposition 10, which was approved by the voters and levies a 50-cent tobacco tax to fund early childhood development programs, requires a vote of the people to modify. However, the state took a different route, instead enacting AB 99 by a two-thirds majority vote in both houses, insisting that using the funding for early childhood health care is in keeping with the intent of the proposition. 

Local First 5 commissions point out that the proposition prohibits using the tobacco tax revenue to supplant state or local general funds or pay for existing levels of service. Both suits indicate that the state’s taking of the funds is illegal and a violation of Proposition 10. 

CSAC will continue to monitor and report on this issue as it moves through the legal process.

Hospital Funding 

We reported that the Legislature fast-tracked two measures related to hospital funding and the state budget last week. Governor Brown signed SB 90 by President pro Tempore Darrell Steinberg and AB 113 by Assembly Member Bill Monning. For more information about these bills, please see theApril 7 edition of The CSAC Bulletin.

Adult Protective Services

SB 33 (Simitian) – Support
As Introduced on December 6, 2010

SB 33, by Senator Joe Simitian, would repeal the sunset date for statute that designates certain financial institution employees as mandated reporters for suspected financial abuse of elder or dependent adults. 

Senator Simitian authored SB 1018 in 2007 to expand the definition of mandated reporters of elder or dependent adult abuse to those who work at financial institutions. SB builds that statute by removing the January 1, 2013 sunset date, and makes other small technical changes to the statute. 
The Senate Judiciary Committee passed the bill on April 13, and it is now on the Senate Floor.

Foster Youth

AB 194 (Beall) – Support
As Amended on March 24, 2011

AB 194, a bill by Assembly Member Jim Beall, would grant foster youth priority enrollment in a public university or community college system. 

AB 194 specifically would allow foster youth and former foster youth to receive priority enrollment in the California State University and community college system, if the specific campus utilizes the required technology to grant priority enrollment. AB 194 also requests the participation of the University of California system. 

Counties support efforts to ensure the long-term success of foster youth and former foster youth and therefore support AB 194. The Assembly passed the bill on April 11 and it now goes to the Senate. 

SB 578 (Negrete McLeod) – Support
As Amended on March 31, 2011

SB 578, a bill by Senator Gloria Negrete McLeod, would help foster children graduate from high school by establishing a system to recognize and properly classify previous coursework or credit from other schools and institutions. 

SB 578 would require each public school district and county office of education to apply full or partial credits for completed coursework by a dependent or ward to that school’s core curriculum for graduation requirements. 

Counties believe that SB 578 will give foster youth the opportunity to apply prior satisfactorily completed work toward a high school diploma and thereby increase the numbers of foster youth who graduate from high school. The Senate Appropriations Committee passed the bill on April 13 and it is now on the Senate Floor.

Health and Public Health

AB 300 (Ma) – Support
As Amended on March 10, 2011

AB 300, by Assembly Member Fiona Ma, would establish clear standards for the tattoo, piercing and permanent cosmetics industry in California.

AB 300 establishes a clear scope of local authority, clear requirements for registration of body art practitioners and consistent enforcement of mobile and fixed body art sites. The bill also requires body art practitioners, as a provision of registration, to complete courses on the transmission of blood borne pathogens and first aid.

The Assembly passed the bill on April 11, and it now goes to the Senate. 

SB 36 (Simitian) – Support
As Amended on March 29, 2011

SB 36, by Senator Joe Simitian, would allow counties to draw down federal Children’s Health Insurance Program (CHIP) funding for children’s health insurance. 

SB 36 builds upon AB 495 (Chapter Number 648, Statutes of 2001), which established a mechanism for California counties to voluntarily put up the non-federal share of funding in order to draw down federal funding through the CHIP. Counties that elect to do so are able to attract federal matching dollars for children’s health coverage and build upon the foundation of the state’s Healthy Families Program. However, the state’s dire fiscal situation may result in reductions to the Healthy Families Program, which serves more than 1 million children in California by offering low-cost health insurance. If this happens, SB 36 would allow counties to also draw down federal CHIP funding for children’s health insurance, helping to stem the predicted tide of thousands of California children without health care. 

Additionally, SB 36 would allow counties to draw down new federal CHIP Reauthorization Act (CHIPRA) funding upon gaining federal approval through the Managed Risk Medical Insurance Board (MRMIB). Enacted in 2009, the federal government raised the eligibility level to households with incomes up to 400 percent of the Federal Poverty Level (FPL). SB 36 would allow counties to draw down some of the new funding for families between 300 percent and 400 percent of the FPL at the state’s Medicaid matching rate.

SB 36 is similar to Senator Simitian’s SB 1431 from the 2009-10 legislative session. That bill was vetoed by Governor Schwarzenegger. The Senate Appropriations Committee placed the bill on their Suspense File on April 11, despite the fact that the bill requires no state funding.

Medi-Cal

AB 43 (Monning) – Support
As Introduced on December 6, 2010

AB 43, by Assembly Member William Monning, would require the state Department of Health Care Services to begin planning for the transition of individuals into Medi-Cal as required in 2014 by the federal Affordable Care Act. 

Specifically, AB 43 requires state planning to transition adults from county-run Low Income Health Plans (LIHP), established under California’s Bridge to Reform Section 1115 Medicaid Demonstration waiver approved in 2010, into Medi-Cal. The Department would be required to submit the plan to the federal government.

Counties are supportive of developing a plan to transition the LIHP enrollees into Medi-Cal. CSAC has been working with Assembly Member Monning’s staff to develop language that broadens the transition plan. This language ensures that individuals served in counties that may ultimately choose not to develop an LIHP, as well as individuals who might not be eligible for a county’s LIHP, for example, due to income slightly above the set limits, be included in transition planning. We understand this language will be amended into the bill and appreciate the author’s willingness to work with us.

Counties also support the bill’s ambitious timeline, i.e. erecting an eligibility process for transitioning LIHP participants to Medi-Cal by July 1, 2013, but recognize the technical realities associated with achieving it may be challenging. Counties will be critical partners in providing Medi-Cal eligibility determinations and enrolling individuals in the Medi-Cal program. It will be important for counties to have a role in this process, along with other key stakeholders. We have requested that the author consider adding language to this effect into the bill.

Counties look forward to working with the Legislature to achieve the goal of developing a realistic and robust transition plan for expanding Medi-Cal under the Affordable Care Act in 2014. CSAC, along with the Urban Counties Caucus, County Welfare Directors Association, and County Health Executives Association of California support AB 43. The Assembly Health Committee will hear the bill on April 26. 

AB 1296 (Bonilla) – Support in Concept
As Introduced on February 18, 2011 

AB 1296, by Assembly Member Susan Bonilla, would streamline the eligibility and application process for the Medi-Cal, Healthy Families Program, and the new Health Care Exchange. It is being developed with the goal of meeting the requirements of the federal Affordable Care Act (ACA) in 2014. The sponsor is working on additional amendments.

In concept, Assembly Bill 1296 would ensure that California’s health care enrollment system is well-positioned to implement the ACA requirements, while also ensuring that the system works for individuals and families across the spectrum of income and needs. 

Counties support some of the provisions of the bill, including: 

  • Creation of a “no wrong door” system.
  • Streamlining eligibility rules among Medi-cal, premium subsidies in the Exchange, Healthy Families and county programs.
  • Coordinating and simplifying citizenship and identity verification at application and renewal.
  • Requiring the creation of a single statewide application – paper and electronic – for all systems and entities accepting and processing applications and eligibly.
  • Maximizing coordination and enrollment in other public programs, such as CalWORKs and CalFresh.

However, there are numerous technical issues to work through as California contemplates an integrated approach to enroll health care consumers. For example, the federal government will be issuing guidance that will impact how to incorporate county-based programs in the enrollment provisions. Until such guidance is issued, it will be difficult for California to fully design its enrollment system. Additionally, AB 1296 lacks specificity about how the enrollment system will interact with other public benefit programs. Counties want to assist in further developing these provisions of the measure.

Counties are supportive of the intent of AB 1296, and look forward to working with the Legislature to achieve the goal of developing the Health Care Eligibility, Enrollment, and Retention Act. It is imperative that counties be included in the planning and implementation process for transforming the enrollment system in California. 

CSAC, the Urban Counties Caucus, County Welfare Directors Association, and County Health Executives Association of California have taken a support in concept position on AB 1296, which will be heard by the Assembly Human Services Committee on April 26.

CalWORKs

AB 959 (Jones) – Support
As Amended on April 12, 2011

AB 959, by Assembly Member Brian Jones, will increase efficiency in the CalWORKs and CalFresh programs by allowing for a one-month grace period during the discontinuance process. 

Assembly Bill 959 is a San Diego county-sponsored measure that is aimed at increasing efficiency at the county level by allowing county eligibility staff to restore eligibility for cases that have been discontinued due to missing information if that information is received within 30 days of the discontinuance notice. 

Counties believe that AB 959 will simply reduce the number of CalWORKs and CalFresh applications processed at the local level and save the time and effort of both county staff and program recipients. It was passed by the Assembly Human Services Committee on April 5 and now goes to the Appropriations Committee. 

Mental Health

AB 154 (Beall) – Support
As Amended on March 24, 2011

AB 154, by Assembly Member Jim Beall, would require Knox-Keene licensed health plans to expand mental health coverage to include the diagnosis and treatment of any mental health condition or disorder as defined in the Diagnostic and Statistical Manual IV (DSM-IV) (or subsequent editions), including substance abuse and nicotine treatment. 

AB 154 was also recently amended to allow the newly established California Health Benefit Exchange to offer mental health services that conform with the minimum essential benefits package as outlined in the federal Patient Protection and Affordable Care Act (PL 111-148). 

AB 154 builds upon the original California mental health parity legislation, AB 88 (Thomson, Chapter 534, Statutes of 1999), which requires health plans to provide coverage for the diagnosis and medically necessary treatment of severe mental illnesses of a person of any age, and serious emotional disturbances of children, under the same terms and conditions applied to other medical conditions.

AB 154 would help ensure that private health plans treat individuals with mental health, substance abuse or co-occurring disorders in a comprehensive and meaningful way. It is for these reasons that CSAC and the California Mental Health Directors Association (CMHDA) jointly support AB 154. However, the bill was placed on the Appropriations Committee’s Suspense File on April 13.

Adult Protective Services

AB 1288 (Gordon) – Support
As Amended March 25, 2011 

AB 1288, by Assembly Member Rich Gordon, would protect the assets of vulnerable seniors or dependent adults from misuse and fraud while a conservatorship petition is pending in court. 

Assembly Bill 1288 specifically would extend the period of time in which a public guardian or conservator may petition to protect the assets of seniors and dependent adults from 15 to 30 days. The bill also would expand the scope of the possession or control of property by the guardian to include assets held in the name of a proposed conservatee’s trust.

Counties often encounter these issues during Adult Protective Services investigations, and it is challenging to complete a petition for conservatorship within 15 days. AB 1288 is a common sense, simple measure to provide appointed guardians a suitable amount of time and authority to protect the assets of vulnerable seniors and dependent adults. It is for these reasons that CSAC, Urban Counties Caucus, Regional Council of Rural Counties, and County Welfare Directors Association support AB 1288. The Assembly Judiciary Committee will hear the bill on May 10.

First 5 Commissions

SB 486 (Dutton) – Oppose
As Introduced on February 17, 2011

Senate Bill 486, by Senator Bob Dutton, would redirect First 5 funding away from statewide and local children’s programs and into the state General Fund for children’s health programs. 

SB 486 would divert the voter-approved Proposition 10 revenue from First 5 Commissions into the state’s General Fund, where the Legislature could appropriate it to provide health care services and funding for children’s health care initiatives, such as the Healthy Families Program or Medi-Cal. 

SB 486 was set for hearing in the Senate Health Committee on April 13, but was pulled at the request of the author.

Section 1115 Medicaid Waiver

AB 1066 (Pérez) – Support
As Amended on April 4, 2011

AB 1066, by Assembly Speaker John Pérez, has been introduced to clean up some of the technical language contained in last year’s Section 1115 Medicaid Hospital Financing Demonstration Waiver bills, SB 208 (Steinberg) and AB 302 (Pérez). 

AB 1066 clarifies some items related to the county-run coverage expansion projects, including renaming the county Coverage Expansion and Enrollment Demonstration (CEED) projects referred to in previous legislation to Low Income Health Program (LIHP). Also, under AB 1066, the state’s deadline for authorizing new LIHP’s would be July 1, 2011, and counties could opt to offer coverage to those with incomes above 133 percent of the federal poverty level (FPL) and up to 200 percent FPL. Lastly, the bill authorizes and clarifies the transfer of some funds from the previous Medicaid Hospital Financing Waiver.

CSAC, along with the County Welfare Directors Association and the County Health Executives Association of California, support the bill. It was approved by the Assembly Health Committee on April 12 and now goes to the Assembly Appropriations Committee.

In-Home Supportive Services

SB 930 (Evans) – Support
As Introduced on February 18, 2011

Senate Bill 930, by Senator Noreen Evans, would eliminate the requirements for counties to collect the fingerprints of each IHSS consumer and have both providers and consumers to submit fingerprints on each IHSS timesheet (a provision of current law that is scheduled to go into effect on July 1 of this year). The bill would also repeal statute that prohibits providers from using a Post Office Box (P.O. Box) for IHSS forms, including for paychecks. 

The above provisions in SB 930 represent some of the components of Governor Schwarzenegger’s “IHSS Anti-Fraud” initiative in 2009. Many of the provisions of this package were designed to prevent fraud and duplicative aid within the program, but few were evaluated on their cost-effectiveness to deploy and implement. In fact, the requirement to fingerprint all consumers in their homes requires specialized and costly equipment that has not yet been purchased by the state. The state has estimated that it would need $8.2 million this year alone, as well as a total of $41.6 million over the next seven years, to implement this provision. Clearly, in these difficult fiscal times, the expenditure of millions to implement an anti-fraud initiative in the absence of demonstrated or widespread fraud would be imprudent at best. 

Counties are also perplexed by the prohibition on using P.O. Boxes for providers. In many of our rural areas, P.O. Boxes are often the only option for residents to receive mail. Limiting the use of P.O. Boxes does will not have a significant effect on fraudulent activities, and in fact, may harm the ability of counties and consumers to recruit and retain providers. 

The IHSS Program has numerous safeguards against fraud, including a state and county-level IHSS Quality Assurance (QA) Initiative. Counties have dedicated QA staff performing desk reviews and home visits of recipients and providers, according to state-established guidelines, looking specifically for potential fraudulent activity and adequacy and quality of care issues. In addition to these reviews, the counties perform more in-depth or “targeted” case reviews that focus on specific issues or cases which may be problematic or signal potential fraud.

Additionally, the incidence of IHSS fraud is overstated. According to 2006-07 results of state/county Quality Assurance efforts, of the nearly 24,000 total cases reviewed, only 523 were referred for further investigation for potential fraud – just 2 percent. County data of actual fraud referrals shows even fewer potentially fraudulent cases, including Los Angeles County with less than 1 percent of cases over a three-year period referred for fraud. 

For these reasons, CSAC supports SB 930. The Senate Human Services Committee will hear the bill on April 26.

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