CSAC Bulletin Article

Health and Human Services 04/29/2011

Health Care Reform

AB 1296 (Bonilla) – Support in Concept
As Amended on April 25, 2011

AB 1296, by Assembly Member Susan Bonilla, is a vehicle to attempt to 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, and was amended on April 25. 

The broad concept of AB 1296 is to ensure that California’s health care enrollment system is well-positioned to implement the ACA requirements, while also creating a system that works for individuals and families across the spectrum of income and needs. It was amended on April 25, and counties continue to support the following provisions: 

  • 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, despite the amendments, 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. 

CSAC, the Urban Counties Caucus, County Welfare Directors Association, County Health Executives Association of California, and County Mental Health Directors Association have taken a support in concept position on AB 1296, which will be heard by the Assembly Health Committee on May 3. 

Child Welfare Services

AB 823 (Dickinson) – Support
As Amended on April 12, 2011

AB 823, by Assembly Member Roger Dickinson, would create a California Children’s Cabinet tasked with ensuring better coordination and delivery of services to our children and youth. 

The bill would specifically create the Children’s Cabinet of California and give Governor Jerry Brown the authority to appoint the members. All state agencies that have jurisdiction over the well-being of children would be included, and the Cabinet must meet by March 1, 2012. This model is similar to Children’s Cabinets in approximately 20 states throughout the country, and will expand the existing Child Welfare Council (CWC) and State Interagency Team (SIT) models to align public resources for the healthy growth and development of all children and youth in California. 

By coordinating the continuum of children’s services in California and working to streamline and maximize available state and federal funding, counties believe that the creation of a California Children’s Cabinet will have long-term social and economic benefits for all residents. It is for these reasons that CSAC supports the bill, which is referred to Assembly Appropriations Committee. 

AB 846 (Bonilla) – Support
As Amended on March 31, 2011

AB 846, by Assembly Member Susan Bonilla, would provide assistance to foster youth who may have been victims of identity theft.

AB 846 is clean up to AB 2985 by Assembly Member Bill Maze (Statutes of 2006), which required county child welfare and probation agencies to request consumer credit disclosures on all foster youth turning 16 and to refer a foster youth to a credit counseling organization upon any indication of negative credit or evidence of identity theft. Specifically, AB 846 clarified that the request may be made by the state or a county and authorizes the requesting entity to refer the youth directly to a governmental or nonprofit organization that provides information and assistance with identify theft and other credit problems.

CSAC supports the bill, which was passed unanimously by the Assembly Human Services Committee on April 26. It now goes to the Assembly Appropriations Committee. 

Health and Public Health

AB 396 (Mitchell) – Support
As Amended on April 25, 2011

AB 396, by Assembly Member Holly Mitchell, would provide the opportunity for counties to receive federal funding for the inpatient medical costs of juvenile detainees. 

Specifically, AB 396 would allow counties to draw down federal matching funds for the inpatient medical treatment provided to minors who are outside of a county detention facility for more than 24 hours. The bill specifies that participating minors must be eligible for Medi-Cal and detained in either a juvenile detention facility or probation camp. While the measure would require the Department of Health Care Services to develop a process to allow counties to collect federal reimbursement for outpatient medical care, the author points out that current law already authorizes DHCS to implement a similar reimbursement system for adult detainees. 

SB 695 would allow counties to use the local funds that we are already expending for juvenile medical care to pull down federal Medicaid matching funds for those youths who are Medi-Cal eligible. It is for these reasons that CSAC supports the bill, which will be heard in the Assembly Health Committee on May 3. 

AB 581 (Pérez) – Support
As Introduced on February 16, 2011

AB 581, by Assembly Speaker John Pérez, would promote access to healthy food in communities throughout California. 

Assembly Bill 581 would require the state to seek federal Healthy Food Financing Initiative funds included in President Obama’s proposed fiscal year 2011 budget. The federal funding is intended to combat the prevalence of “food deserts” within communities – areas with little to no access to quality foods that are both healthy and affordable. 

The federal Healthy Food Financing Initiative is designed to eliminate “food deserts” within seven years through innovative financing, grants, and private sector partnerships. Assembly Bill 581 specifically establishes the California Healthy Food Financing Initiative Fund at the State Treasury and positions the state to access these federal funds. The bill also requires a stakeholder process to develop recommendations on promoting healthy food and accessing federal funding that will be presented to the Legislature.

Assembly Bill 581 is modeled on successful Healthy Food Financing Programs in New York and Pennsylvania, and counties believe that the great agricultural state of California can take these efforts to a new level that benefits the health of our communities. 

Counties support efforts to increase the number of fresh grocery stores, urban and rural farm stands, farmers’ markets, and community gardens in underserved communities. It is for these reasons that CSAC supports AB 581. The measure was passed by the Assembly Agriculture Committee on April 27, and now goes to the Assembly Health Committee. 

Medi-Cal

AB 43 (Monning) – Support
As Amended on April 25, 2011

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 passed the bill on April 26. It now goes to the Assembly Appropriations Committee. 

SB 677 (Hernandez) – Support in Concept
As Amended on March 22, 2011

SB 677, by Senator Edward Hernandez, would implement two provisions of the federal Affordable Care Act (ACA) related to determining eligibility for the Medicaid program. The measure would implement the new federal income standards – the modified adjusted gross income (MAGI) – for determining Medi-Cal eligibility. Additionally, the measure would eliminate the asset test for determining Medi-Cal eligibility. Both of these eligibility changes would become effective January 1, 2014, in conjunction with the effective date of the ACA.

Counties have long supported efforts to simplify the Medi-Cal program, such as elimination of the asset test. We believe that program simplification increases program efficiency. Reducing complicated eligibility tests at the time when over a million Californians will become newly eligible for Medi-Cal will assist with easing enrollment.

However, states do not yet know how the federal government will change underlying Medicaid rules to implement the ACA. Counties anticipate that more direction will be forthcoming from the federal government that will clarify how to structure the eligibility changes within California. Pending this federal guidance, counties have taken a support in concept position on Senator Hernandez’s SB 677. The Senate Health Committee passed the bill on April 27, and it now goes to the Senate Appropriations Committee. 

CalWORKs

AB 373 (Garrick) – Oppose
As Amended on March 31, 2011 

AB 373, a bill by Assembly Member Martin Garrick, would have reduced eligibility for the California Work Opportunity and Responsibility to Kids (CalWORKs) program from the current 48 month limit to 24 months. 

Counties believe that reducing the time on aid to 24 months – especially in light of the continuing economic downturn – will severely limit recipients’ chances to move into stable employment, and effectively gut the core CalWORKs concept of “welfare to work.” 

CSAC, along with the County Welfare Directors Association, opposed the bill. It failed passage in the Assembly Human Services Committee on April 26. 

AB 924 (Logue) – Oppose
As Amended on April 11, 2011

AB 924, by Assembly Member Dan Logue, would jeopardize counties’ successful efforts to provide subsidized employment programs for unemployed CalWORKs parents. It also goes beyond the agreement recently enacted as part of the budget trailer bill, SB 72, which made substantial changes to the CalWORKs program rules, time limits on aid, and substantially cut counties’ welfare-to-work service allocations. 

At the same time, the bill provides that any parent or caretaker relative who has reached the time limit, and would not otherwise be exempt from welfare-to-work participation requirements under current law, would have to meet those participation requirements or the family would lose its entire grant, essentially creating a full-family sanction in CalWORKs. 

AB 924 was scheduled for hearing in the Assembly Human Services Committee on April 26 but was pulled from the calendar. CSAC will continue to monitor this bill. 

AB 1140 (Donnelly) – Oppose
As Introduced on February 18, 2011

AB 1140, by Assembly Member Tim Donnelly, would reduce eligibility for the California Work Opportunity and Responsibility to Kids (CalWORKs) program from the current 48 month limit to 6 months. 

Like AB 373 (Garrick) above, Counties believe that reducing the time on aid to 6 months – especially in light of the continuing economic downturn – will severely limit recipients’ chances to move into stable employment, and effectively gut the core CalWORKs concept of “welfare to work.” 

AB 924 was scheduled for hearing in the Assembly Human Services Committee on April 26 but was pulled from the calendar. CSAC will continue to monitor this bill. 

AB 1182 (Hernández) – Support
As Introduced on February 18, 2011

AB 1182, by Assembly Member Roger Hernández, would allow CalWORKs applicants and recipients to own reliable cars. 

AB 1182 would specifically delete the requirement that counties assess the value of a motor vehicle when determining or redetermining CalWORKs eligibility. 

AB 1182 would increase the opportunities for recipients to find and maintain stable employment, while also increasing the state’s work participation rate, reducing grant costs in the long run and helping to avoid federal penalties. It is for these reasons that CSAC supports AB 1182, which was passed by the Assembly Human Services Committee on April 26. It now goes to the Assembly Appropriations Committee. 

CalFresh (formerly Food Stamps)

AB 402 (Skinner) – Support
As Amended on April 26, 2011

AB 402, by Assembly Member Nancy Skinner, builds on the eligibility similarities of the School Meal and CalFresh programs by giving school districts the option to help initiate a CalFresh application for students enrolled in the School Meal program. 

Both federally funded programs have a gross income threshold of 130 percent of the Federal Poverty Level and are administered by the Department of Food and Agriculture (USDA). Assembly Bill 402 will allow, at the option of the local school district and CalFresh administering agency, the School Meal application to be utilized to initiate a CalFresh application. 

In these tough economic times, counties and schools are searching for ways to meet the needs of children who suffer from hunger and food insecurity. Assembly Bill 402 will build a bridge between two federal programs to help feed our youngest and most vulnerable residents throughout the year, not just on school days. It is for these reasons that CSAC supports AB 402, which has been referred to the Assembly Appropriations Committee. 

Mental Health

AB 1297 (Chesbro) – Support
As Introduced on February 18, 2011

AB 1297, a bill by Assembly Member Wesley Chesbro, would ensure timely federal reimbursement to counties for providing Specialty Mental Health Managed Care services. 

Specifically, AB 1297 would align the state’s requirements for the Specialty Medi-Cal Mental Health Managed Care program with existing federal requirements by utilizing federal Medicaid Upper Payment Limits instead of the state’s current Statewide Maximum Allowances (SMAs) system. The SMAs system has been frozen since Fiscal Year 2006-07, and counties have incurred significant costs for serving eligible populations during this time. AB 1297 would allow counties to recover these costs from the federal government, all without impacting the state’s General Fund. 

AB 1297 also eliminates the state’s current 15 percent limit on reimbursement for administrative costs. Counties already certify the full public expenditure of funds in order to draw down federal matching funds, and, under AB 1297, counties would be fully reimbursed by the federal government for the cost of providing services. 

Lastly, AB 1297 would expand the timeframe for submitting Specialty Medi-Cal Mental Health Managed Care claims from the state’s six months to the federal standard of 12 months. We believe that this provision will give counties the flexibility in submitting claims that complex health care scenarios demand. 

AB 1297 will both streamline and enhance counties’ ability to draw down federal reimbursements for Specialty Medi-Cal Mental Health Managed Care services – all at no cost to the state’s General Fund. The bill is sponsored by the California Mental Health Directors Association and was passed on the consent calendar – meaning it had unanimous support – by the Assembly Health Committee on April 26. It now goes to the Assembly Appropriations Committee. 

Adult Protective Services

AB 518 (Wagner) – Support
As Amended on March 23, 2011

AB 518, a bill by Assembly Member Donald Wagner, would continue to protect elder and dependent adults from financial abuse by eliminating the sunset date on the reporting of suspected abuse by financial institutions.

Counties support AB 518, which was passed by the Assembly Public Safety Committee on April 26. It now goes to the Assembly Appropriations Committee.

SB 718 (Vargas) – Support
As Amended on March 29, 2011

SB 718, by Senator Juan Vargas, would make it easier to report suspected elder abuse.

Senate Bill 718 would allow a county or long-term care ombudsman program to implement a confidential Internet reporting tool that mandated reporters may use to report suspected elder abuse. Senate Bill 718 also would allow the state, in conjunction with counties and other stakeholders, to develop a form for written reports, as well. The bill also specifies the information to be gathered by both methods, which will speed efficiency in both making and processing reports of suspected elder abuse. 

Counties are responsible for investigating reports of suspected elder abuse, and have a vested interest in ensuring the safety and financial security of elder Californians living in our communities. Senate Bill 718 would serve this interest by giving counties the option to implement a new Internet-based system with the goal of increasing the ease by which a mandated reporter may submit a report of suspected elder abuse. The Senate Human Services Committee passed SB 718 on April 26, and it now goes to the Senate Appropriations Committee. 

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. 

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. 

For these reasons, CSAC supports SB 930. The Senate Human Services Committee passed the bill on April 26, and it now goes to the Senate Appropriations Committee.

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