CSAC Bulletin Article

Health and Human Services 08/24/2012

Spate of Budget Cleanup Bills Introduced This Week

The Senate Budget and Fiscal Review Committee met last night to discuss a number of measures related to the state budget. The measures are primarily technical clean-up to the 2012-13 state budget act passed in June. The Committee pulled the bills off the Senate floor; any additional amendments will be made on the Senate floor next week. Senator Leno indicated that the Committee may reconvene next week to hear additional bills. 

The health and human measures are as follows:

AB 1468 (ASM Budget Committee): Makes a number of technical changes related to the health aspects of the budget including the transition of the Healthy Families Program (HFP) to Medi-Cal, the Coordinated Care Initiative, hospital supplemental payments and primary care provider payments. 

AB 1471 (ASM Budget Committee): Makes technical changes related to the human services aspects of the state budget, including provisions related to CalWORKs, licensing, developmental services, the Coordinated Care Initiative and the collective bargaining changes to the In-Home Supportive Services (IHSS) program. The language clarifies that counties maintain the responsibility to establish emergency back-up services, requires the Department of Finance to consult with CSAC on implementation of the IHSS maintenance of effort (MOE), and clarifies immunity for the state, counties and health plans. The Committee indicated that AB 1471 will further amended, including adding clarifying language related to the IHSS MOE. CSAC worked collaboratively with the Administration, Legislature and labor unions on the technical clean-up in AB 1471. 

AB 1477 (ASM Budget Committee): Includes 2012-13 Budget Act payment adjustments, amending the two previous budget act measures, AB 1464 and AB 1497. Of note to counties, AB 1477 makes a technical adjustment to the cost-per-case for employment services in CalWORKs. The measure provides $80 million to CalWORKs with a reversion of funds from 2011-12.

AB 1488 (ASM Budget Committee): The bill as amended this week deleted references to the now-defunct Department of Mental Health. 

AB 1496 (ASM Budget Committee): Makes technical amendments related to 2011 Realignment. The measure makes corrective amendments specifying that 94.481 percent of Juvenile Justice Subaccount funds be allocated to the Youthful Offender Block Grant Special Account and that 5.519 percent be allocated to the Juvenile Reentry Grant Special Account. Additionally, the measure makes clarifying amendments related to the Controller’s allocation of funds deposited into the CalWORKs Maintenance of Effort Subaccount. CSAC was involved in the crafting of the technical amendments. 

Governor Plans Special Session on Health Care Reform Implementation

Governor Jerry Brown notified legislative leaders last week of his intent to call a special legislative session in December to work through the remaining fiscal and policy issues associated with California’s implementation of the federal Affordable Care Act.

The special session will allow lawmakers to continue work on legislative proposals that are not anticipated to make it out of the current two-year legislative session, which wraps up next Friday. It is not known how long the special session will run, but any legislation enacted during the session will take effect 90 days after passage. 

The state is facing numerous deadlines associated with implementing the ACA, with the largest policy shift – expanding Medi-Cal and private insurance coverage to millions of Californians – set to begin on January 1, 2014. However, the federal government is still developing rules and regulations pertaining to the state expansions, as well as significant details surrounding eligibility, enrollment, funding and jurisdiction. The special session will give the state more time to receive and digest federal directives on these issues. 

Some outstanding policy that remains to be settled is whether the state will implement a Basic Health Plan (BHP, embodied in SB 703 by Senator Hernandez), designing the Medi-Cal eligibility system for the expanded population (AB 43 by Assembly Member Monning and SB 677 by Senator Hernandez, among others), and specifying which benefits to include in the state’s Essential Health Benefits structure (embodied in AB 1453 by Assembly Member Monning and SB 951 by Senator Hernandez).
Blue Shield Foundation Announces New Safety Net Integration Grants

The Blue Shield of California Foundation has announced a round of grant funding for their Safety Net Integration 2012 initiative. 

Open to local governments, non-profits, and tribal healthcare organizations, grants up to $250,000 will be awarded to safety net healthcare providers working together to improve the integration of care delivery and coordinated care for low-income populations. The Foundation would strongly prefer one proposal per county to encourage collaboration across providers; however, regional or multi-county applications will also receive consideration. 

The Blue Shield Foundation of California has worked with many of our members to fund ACA implementation and safety net integration grants, including providing support for counties to erect Low-Income Health Programs (LIHPs) in the last two years. We strongly encourage all counties to join the conference call and consider submitting applications for this funding opportunity. 

For more information, please view the Request for Applications. The application deadline is September 14, and an informational conference call for interested parties will be held on August 29, from 10 to 11 a.m. The dial-in number is (800) 391-1709 and the bridge number/password is 390558. 

California’s Health Benefit Exchange Receives Hefty Federal Grants
The Secretary of the U.S. Health and Human Services Agency announced yesterday that California’s Health Benefit Exchange (HBEX) has been awarded a Level 1 grant to aid in establishing the state’s affordable insurance exchange as required by the Affordable Care Act. 

The HBEX will receive a grant, totaling $196.5 million, that will be used by the Exchange to, among other things, design enrollment and eligibility policy, mount an outreach and education campaign, and begin selecting health plans for participation in the Exchange.
Health Care Reform

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 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 measure is now on the Senate Floor. 

SB 677 (Hernandez) – Support 
As Amended on May 23, 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.
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 Appropriations Committee passed SB 677 out of their committee on August 16, and it is on the Assembly’s Third Reading File. 

SB 970 (de Léon) – Support
As Amended on August 20, 2012

SB 970, as amended on May 24 by Assembly Member Kevin de Léon, was intended to help integrate the process for applying for public programs such as CalFresh and CalWORKs with the new online health coverage application process that is under development by the state. 
SB 970, in its original form, would have allowed counties to cross-check eligibility for CalFresh and CalWORKs for people applying for health coverage through the state’s new CalHEERS program. Recent Assembly amendments to the bill instead clarify that an applicant must consent to the cross-check. 

As of August 23, SB 970 was in the Senate awaiting concurrence on Assembly amendments.


AB 1640 (Mitchell) – Support
As Amended on August 21, 2012

AB 1640, by Assembly Member Holly Mitchell, would change the state’s CalWORKs statute to allow for pregnant women (with no other children in the household) to become eligible for CalWORKs basic needs grants and full-scope 1931(b) Medi-Cal benefits in the three months prior to the last month of expected birth. 

CSAC supports AB 1640. It is on the Assembly floor awaiting concurrence in Senate amendments. 

CalFresh (Formerly SNAP, Food Stamps)

SB 1391 (Liu) – Support
As Amended on August 6, 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 was passed by the Assembly Human Services Committee on June 26. The Assembly passed SB 1391 on August 23, and it must return to the Senate for concurrence.

Public Health

SB 1329 (Simitian) – Support
As Amended on August 16, 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 on August 23. It must now go back to the Senate for concurrence on recent amendments. 

AB 2109 (Pan) – Support
As Amended on August 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 was passed by the Senate on August 22. It now goes to the Assembly for concurrence on the Senate amendments. 

AB 2246 (Pérez, J.) – Support
As Enrolled on August 22, 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 Assembly concurred in the Senate amendments and passed it on August 22. It now goes to the Governor. 

AB 2266 (Mitchell) – Support
As Amended on August 21, 2012 

AB 2266, by Assembly Member Holly Mitchell, would allow California to leverage significant federal funding 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 program would include comprehensive engagement and case management, hospital discharge planning, assistance with accessing social services, and other proven strategies to stabilize and effectively treat frequent hospital users. The program goal is to stabilize – and even increase – the health of frequent hospital users while reducing their utilization of costly medical care. 

Currently, 12 counties fund or manage home health programs for frequent hospital users, and have realized medical cost savings as a result. By allowing county Low Income Health Programs (LIHPs) to coordinate services and create medical homes in collaboration with local hospitals, community clinics, and behavioral health care providers, 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.

CSAC supports AB 2266, and it is on the Senate’s Third Reading File.


SB 1528 (Steinberg) – Support
As Amended on June 27, 2012

SB 1528, by Senate President pro Tempore Darrell Steinberg, would give counties and the state additional options to collect owed medical expenses.

Currently, counties and the state have a right of action to file a lien for medical expenses only in if the client/patient receive a judgment in a case. Senate Bill 1528 would expand the county’s options by allowing for collections on settlements, compromises, arbitration awards, mediation settlements, or recovery of past medical expenses obtained by the client/patient. 

CSAC supports SB 1528 as amended June 27; it is currently on the Assembly’s Third Reading File (floor).

Child Welfare Services/Foster Care

AB 823 (Dickinson) – Support
As Amended on June 13, 2012

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

The bill would specifically create the Children’s Coordinating Council and give Governor Jerry Brown the authority to appoint the members. By coordinating the continuum of children’s services in California and working to streamline and maximize available private and federal funding, counties believe that the creation of a California Children’s Coordinating Council will have long-term social and economic benefits for all residents. It is for these reasons that CSAC supports the bill, which was passed by the Assembly on August 23 and is now in the Senate awaiting concurrence on recent amendments. 

SB 1319 (Liu) – Support
As Amended on August 20, 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, crisis nurseries and treatment facilities that treat and house our state’s most vulnerable children.

Recent amendments also exempt public recreation programs for grades 1 to 12 that operate less than 20 hours a week for 14 weeks or less each year from its provisions. 

The technical changes in the measure were proposed by San Bernardino County and are supported by the County Welfare Directors Association. The Senate approved the Assembly’s amendments and passed it to the Governor on August 23. 

AB 1707 (Ammiano) – Support
As Amended on August 23, 2012

AB 1707, by Assembly Member Tom Ammiano, would amend the Child Abuse Central Index (CACI) statute to automatically remove the name of a person who is listed as a perpetrator of child abuse after 10 years if the incident occurred when the perpetrator was under 18 years old at the time of the incident. The perpetrator’s name would only be removed if no subsequent reportable incidents have occurred. 

Recent amendments also incorporate provisions from AB 1712 (see below) and indicate that both measures must be signed into law to become operative. 

CSAC supports AB 1707, which is now on the Senate Floor. 

AB 1712 (Beall) – Support
As Amended on August 22, 2012

AB 1712, by Assembly Member Jim Beall, is a technical clean up measure relating to 2010’s Fostering Connections to Success Act. The Act extended foster care services to youth up to age 21 and helps the state draw down additional foster care funding from the federal government. 

AB 1712 was created with input from counties, foster family agencies, and myriad other stakeholders, all with a singular goal in mind: To make foster care services as accessible and efficient as possible for all youth and non-minor dependents that need them. 

AB 1712 is now on the Senate floor. 

AB 1751 (Pan) – Support
As Introduced on February 17, 2012

AB 1751, by Assembly Member Richard Pan, would enable county child welfare agencies and probation officers to access child support information in order to locate noncustodial parents who could provide a stable placement for children who would otherwise be placed into foster care due to abuse or neglect.

CSAC, along with the County Welfare Directors Association, support the measure, which was passed by the Assembly Judiciary Committee on April 17. AB 1751 is on the Senate floor.

Adult Protective Services

AB 2149 (Butler) – Support
As Amended on June 26, 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. It would go into effect on January 1, 2013. 

AB 2149 is on the Assembly Floor awaiting concurrence on the Senate’s amendments.

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