Study Examines Who Will Gain Health Coverage Under the ACA

The UCLA Center for Health Policy Research and the UC Berkeley Labor Center have released a series of reports detailing regional and county estimates of coverage under the Affordable Care Act in 2014. 
The reports, funded by a grant from the California Endowment and released on June 14, estimate that between 1.8 million and 2.7 million previously uninsured Californians will gain coverage by 2019. 
However, the researchers estimate that California will still have between 3 million and 4 million people without insurance by the time the ACA is fully implemented in 2019, of which about 1 million will be ineligible for coverage due to their immigration status.

To view the reports, which include a county-by-county breakdown of the residual uninsured, eligible adults, health care exchange enrollment, and Medi-Cal enrollment, visit the UC Berkeley Labor Center website.

CalWORKs

AB 1691 (Lowenthal, B.) – Support
As Introduced on February 15, 2012

AB 1691, by Assembly Member Bonnie Lowenthal, would allow non-English speaking CalWORKs recipients, which include refugees and other legal immigrants, to participate in English as a Second Language (ESL) instruction for eight months. Time spent in ESL instruction would count as a core activity and counties would have the option of extending ESL participation for up to 12 months on a case-by-case basis. 
CSAC supports AB 1691, which passed out of Senate Human Services and will be heard by the Senate Appropriations Committee on June 25. 

AB 1998 (Achadjian) – Support
As Amended on May 25, 2012

AB 1998, by Assembly Member Katcho Achadjian, would help bridge the “digital divide” by allowing counties to donate surplus computer property directly to recipients of public assistance to aid in employment and assistance efforts.

CSAC supports AB 1998, which will be heard by the Senate Governance and Finance Committee on June 27. 

AB 2352 (Hernández) – Support
As Introduced on February 24, 2012

AB 2352, by Assembly Member Roger Hernández, would allow CalWORKs applicants and recipients to own reliable cars by deleting the requirement that counties assess the value of a motor vehicle when determining or redetermining CalWORKs eligibility. 

AB 2352 is similar to last year’s AB 1182, which was vetoed by the Governor. Counties believe that this change will promote work participation and self-sufficiency among low-income California families and eventually help CalWORKs recipients move off of public aid. It is for these reasons that we support Assembly Member Hernández’s measure again this year. 
CSAC supports AB 2352, which will be heard by the Senate Appropriations Committee on June 25. 

Child Welfare Services/Foster Care

SB 1319 (Liu) – Support
As Amended on June 11, 2012

SB 1319, by Senator Carol Liu, is a highly technical measure that would make three small changes to existing law, but it will streamline certain components of the foster care system for the foster family homes, agencies, and treatment facilities that treat and house our state’s most vulnerable children.

The technical changes in the measure were proposed by San Bernardino County and are supported by the County Welfare Directors Association. The Assembly Human Services Committee will hear SB 1319 on June 26.
 
AB 1928 (Cook) – Support
As Amended on May 10, 2012

AB 1928, by Assembly Member Paul Cook, would clarify current regulations to help increase the number and availability of specialized foster care homes in our counties by clarifying the conditions under which the number of foster children placed in a specialized foster care home may be increased from two to three. 

CSAC, along with the County Welfare Directors Association, support the bill. AB 1928 is awaiting hearing in Senate Appropriations Committee. 
CalFresh (SNAP, Food Stamps)

SB 1391 (Liu) – Support
As Amended on June 15, 2012

SB 1391, by Senator Carol Liu, would establish procedures for recovering CalFresh overissuances of more than $125 in accordance with federal law. 

The new procedures would apply to current and former CalFresh recipients and would help streamline the collection process for overissuances resulting from administrative errors, while keeping the existing regulatory structure for cases of inadvertent household error, intentional program violation, and fraud in place.

Counties and County Welfare Directors support raising the threshold for recovering CalFresh overissuances to $125 because it will allow our eligibility workers to focus on the more egregious instances while also providing more time for caseload work. 

The author and sponsor (Western Center on Law and Poverty) of the measure are also working with counties to establish a realistic implementation timeline, possibly October 2012. 

CSAC, along with the County Welfare Directors Association, support SB 1391, which will be heard by the Assembly Human Services Committee on June 26.

Health

AB 43 (Monning) – Support
As Amended on May 27, 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. 

AB 43 was recently taken off of the Inactive File and continues to move through the policy committee process. 

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. 

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 Senate Appropriations Committee will hear AB 43 on June 25. 

SB 677 (Hernandez) – Support 
As Amended on May 23, 2011

SB 677, by Senator Ed 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.
CSAC, along with the Urban Counties Caucus (UCC), County Welfare Directors Association (CWDA), California Mental Health Directors Association (CMHDA), and the County Health Executives Association of California (CHEAC), have joined together to take a support position on SB 677. The Assembly Health Committee will hear SB 677 on June 26.

Public Health

SB 1329 (Simitian) – Support
As Amended on May 14, 2012

SB 1329, by Senator Joe Simitian, would simplify the way counties may establish a local prescription drug collection and distribution program.
Senator Simitian’s SB 798, signed into law in 2005, allows counties that pass a local ordinance to collect unused prescription medications from skilled nursing facilities and pharmaceutical manufacturers for the purpose of distributing these surplus supplies to those who may not be able to afford medications. This program has been successfully implemented in San Mateo and Santa Clara counties. SB 1329 would simplify the process for counties to authorize a program by a Board of Supervisors action or by the action of the county’s public health officer. The bill also widens the pool of entities that may participate in a local program thereby casting a wider net for eligible pharmaceuticals available for the program.

CSAC and the County Health Executives Association of California (CHEAC) support SB 1329, which was passed by the Assembly Health Committee on June 19.

AB 2109 (Pan) – Support
As Amended on June 20, 2012

AB 2109, by Assembly Member Richard Pan, would require a parent or guardian seeking an immunization personal belief exemption for their child to provide a document signed by themselves and a licensed health care practitioner acknowledging that the parent or guardian has been informed by the health care practitioner of the benefits and risks of immunization as well as the health risks associated with communicable diseases. 
CSAC and the County Health Executives Association of California (CHEAC) support AB 2109, which will be heard by the Senate Health Committee on June 27. 

AB 2246 (Pérez, J.) – Support
As Amended on April 23, 2012

AB 2246, by Assembly Speaker John A. Pérez, requires the new California Healthy Food Financing Initiative Council to establish and maintain a web site that outlines information on the Council’s actions to support access to healthy foods by March 31, 2013. 

The measure builds upon the Speaker’s AB 581 from 2011, which created the California Healthy Food Financing Initiative to promote access to healthy food throughout California. Counties support these efforts to combat “food deserts” within communities – areas with little to no access to quality foods that are both healthy and affordable. 

CSAC supported AB 581 last year and now supports AB 2246. The Senate Health Committee passed AB 2246 on June 20.

Adult Protective Services

AB 2149 (Butler) – Support
As Amended on May 21, 2012 

AB 2149, by Assembly Member Betsy Butler, would allow victims of elder abuse to continue to contact, cooperate with or file a claim of elder abuse regardless of whether a civil settlement action has been rendered. 
The Senate Judiciary Committee passed AB 2149 on June 19. 

Emergency Medical Services (EMS)

AB 1944 (Gatto) – Oppose
As Amended in Committee on June 20, 2012

AB 1944, by Assembly Member Mike Gatto, would give employers increased authority over disciplinary investigations and actions for paramedics in their employ. 

Counties are concerned that AB 1944 would weaken the authority of local and state EMS agency medical directors to protect patients from individuals that pose a threat to the public’s health and safety, regardless of employer. 

CSAC, along with the County Health Executives Association of California (CHEAC), oppose the measure. The Senate Health Committee amended the measure on June 20, and passed it.