CSAC Bulletin Article

Health and Human Services 05/06/2011

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 was passed by the Assembly Health Committee on May 3. It now goes to the Assembly Appropriations Committee.

Child Welfare Services

AB 212 (Beall) – Support
As Amended on March 29, 2011

AB 212, by Assembly Member Jim Beall, would implement technical provisions related to last year’s landmark foster care legislation, the California Fostering Connections to Success Act of 2010 (AB 12). 

AB 212 is the result of efforts by counties, co-sponsors, and Department of Social Services staff to “clean up” some provisions of AB 12. To that end, AB 212 mostly focuses on implementing KinGAP eligibility for young adults aged 18 to 21, and streamlining the assessment portion of the legal guardianship and adoptions process. 

The Assembly Judiciary Committee passed AB 212 on May 3. 

AB 652 (Mitchell) – Support
As Amended on April 25, 2011

AB 652, by Assembly Member Holly Mitchell, would ensure that health plans cover the initial health assessments and forensic medical evaluations for children in out-of-home placements. 

Assembly Bill 652 specifically would require commercial health plans, the Healthy Families Program, and the Medi-Cal program to reimburse providers for the cost of the initial health assessment and forensic medical evaluations for children in foster care. State regulations require an initial medical examination for all children newly placed in out-of-home care. The Lance Helms Child Safety Act of 1998 authorizes counties or local law enforcement agencies to refer a child who has been removed from his or her home due to suspected physical or sexual abuse, or neglect for a forensic medical examination. 

Los Angeles County is sponsoring this measure because the county is only reimbursed for these services if the child is enrolled in fee-for-service Medi-Cal. Most children who are removed from the home by the local child welfare agency and placed in out-of-home care are automatically eligible for fee-for-service Medi-Cal; however, the child must be disenrolled from prior coverage, if applicable. Counties cannot always obtain reimbursement from Medi-Cal managed or another health plan. The forensic medical evaluations may be deemed out-of-network without prior authorization. Please note that these exams must be conducted within 72 hours for high risk children and those ages zero to three. For all other children the exams must be conducted within 30 days.

CSAC is supportive of the goal of the bill to ensure that health plans are covering these medical examinations. It is for this reason that CSAC, along with the County Welfare Directors Association, have taken a support in concept position on AB 652. The Assembly Health Committee passed the measure on May 3 and AB 652 now goes to the 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 was passed on the consent calendar in the Assembly Health Committee on May 3. It now goes to the Assembly Appropriations Committee and is recommended for that committee’s consent calendar as well. 

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 on the consent calendar in the Assembly Health Committee on May 3. It now goes to the Assembly Appropriations Committee and is recommended for that committee’s consent calendar as well. 

SB 594 (Wolk) – Oppose Unless Amended
As Amended on April 28, 2011

SB 594, by Senator Lois Wolk, would greatly limit a county’s flexibility to organize and deliver public health laboratory services. 

Senate Bill 594, as of April 28, would eliminate the option for county health departments to contract with qualified private clinical laboratories to perform various laboratory services as needed. The author took a number of amendments in committee on Wednesday, May 4. The proposed amendments do not alleviate all county concerns. CSAC will be working with counties and county affiliate organizations to continue communicating issues to the author.

The Senate Health Committee passed the bill on May 4. 

SB 616 (DeSaulnier) – Support
As Amended on April 26, 2011

SB 616, by Senator Mark DeSaulnier, would promote the state’s efforts to receive federal health prevention program funds. 

Senate Bill 616 specifically directs the Department of Health Care Services (DHCS) to pursue new federal health prevention grants that were enacted as part of the federal Patient Protection and Affordable Care Act (Public Law 111-148). That Act authorizes the Centers for Medicare and Medicaid (CMS) to create the Medicaid Incentives for Prevention of Chronic Diseases Program (MIPCDP). The new program will send funding to states to provide nonfinancial incentives to beneficiaries who participate in prevention programs. 

Senate Bill 616 affirms California’s intention to apply for these grants to focus the state’s efforts on the Medi-Cal (Medicaid) population. Since the MIPPCDP grants specifically require participants to demonstrate changes in health risk and/or the adoption of healthy behaviors, the state’s plan to target Medi-Cal beneficiaries is a classic win-win situation: draw down federal funding to improve the health outcomes of the state’s low-income population, thereby reducing the state’s medical costs and improving the quality of life for this same population.

CSAC has taken a strong position in support of the federal Prevention and Public Health fund programs. Our Board of Directors adopted the attached resolution in support of the federal program on March 10, and counties intend to serve as core partners in the development of new community prevention and chronic disease programs in order to improve the health of all Americans.

Counties understand that DHCS has already indicated interest in the grants to the federal government, and SB 616 will help build momentum for these efforts. It is for these reasons that CSAC supports SB 616, which will be heard by the Senate Appropriations Committee on May 9.

Medi-Cal

SB 695 (Hancock) – Support
As Amended on April 12, 2011

SB 695, by Senator Loni Hancock, would allow counties to draw down federal funding to help defray the cost of providing medical care to juveniles awaiting adjudication in county facilities. 

SB 695 would allow counties to use the local funds that spent on juvenile medical care to pull down federal Medicaid matching funds for those youths who are Medi-Cal eligible. The measure also limits Medi-Cal services to the first 30 days of a youth’s stay in juvenile hall. 

The Senate Appropriations Committee placed SB 695 on the Suspense File on May 2.

CalWORKs

AB 1182 (R. 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. The Assembly Appropriations Committee passed the bill on May 4.

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