Health Care Reform

AB 43 (Monning) – Support
Failed Passage

AB 43, by Assembly Member William Monning, would have required 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 required 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. 

Counties are supportive of developing a plan to transition the LIHP enrollees into Medi-Cal. CSAC had been working with Assembly Member Monning’s staff to develop language that broadens the transition plan. This language ensured 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. Counties also supported 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 look forward to working with the Legislature in the health care special session to achieve the goal of developing a realistic and robust transition plan for expanding Medi-Cal under the Affordable Care Act in 2014. 

SB 677 (Hernandez) – Support 
Failed Passage

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

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), all supported SB 677. We anticipate these ACA implementation issues to come up in the health care special session, and look forward to working with the Governor and Legislature to develop efficient and sustainable solutions to ensure health care for low-income Californians. 

SB 703 (Hernandez) – Support
Failed Passage

SB 703, by Senator Ed Hernandez, would have allowed the state to create a Basic Health Plan (BHP), a more affordable insurance option for low-income adults who fall into the income “gap” between Medi-Cal eligibility and being able to afford commercial health plan premiums. 

The BHP would cover individuals earning between 133 percent and 200 percent of the Federal Poverty Level, and offer an equal level of benefits to commercial health plans available in the California Health Benefits Exchange. 

The CSAC Executive Committee voted to support SB 703 on August 2. Counties believe a BHP will allow low-income individuals to affordably purchase health insurance, thereby lowering the number of uninsured adults in California. Clearly, those who participate in the BHP will also see improved health outcomes. Finally, from a county perspective, a BHP option will help reduce the spiraling uncompensated care costs that many public hospitals and local health clinics are currently experiencing.

The Assembly Appropriations Committee declined to move SB 703 off of the Suspense File on August 16. We anticipate that the establishment of a Basic Health Plan will come up again in the health care special session. 

SB 970 (de Léon) – Support
Vetoed

SB 970, by Assembly Member Kevin de Léon, would have helped 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 would have created a workgroup to implement strategies for counties to cross-check eligibility for CalFresh and CalWORKs for people applying for health coverage through the state’s new CalHEERS program with a client’s consent.

However, the Governor vetoed the measure with this message: 

“I am returning Senate Bill 970 without my signature. This bill is well-intentioned but overly prescriptive in its requirements. Codifying another workgroup and requiring another report are not necessary. My administration has worked and will continue to work with the Legislature and stakeholders in transparent and cooperative ways to implement the requirements of the federal Patient Protection and Affordable Care Act.”

SB 951 (Hernandez) & AB 1453 (Monning) – No Position
Chapter No. 866 & Chapter No. 854 respectively, Statutes of 2012

The chairs of the Senate and Assembly Health Committees both introduced bills regarding the package of essential health benefits required by the Affordable Care Act. 

Senator Ed Hernandez (Chair, Senate Health Committee) and Assembly Member Bill Monning (Chair, Assembly Health Committee) sought to define the state’s essential health benefits package. SB 951 establishes in the Insurance Code the Kaiser Foundation Health Plan Small Group Health Maintenance Organization (HMO) 30 plan contract as California’s Essential Health Benefits (EHB) benchmark plan. AB 1453 also establishes the Kaiser Small Group HMO 30 plan as the Essential Health Benefit (EHB) benchmark plan for individual and small group health plan products licensed by the Department of Managed Health Care (DMHC).

Both measures were linked in that they each required the other to be signed into law to become effective. The Governor did just that, signing both into law on September 30, 2012. 

SB 1081 (Fuller) – No Position
Chapter No. 453, Statutes of 2012

SB 1081, by Senator Jean Fuller, allows nondesignated public hospitals owned by a local health care district to operate a Low Income Health Program (LIHP) in a county that does not have a designated public hospital and if the county has declined the opportunity to implement and fund a LIHP. 

The Governor signed SB 1081 into law on September 22, 2012.

AB 1580 (Bonilla) – Support
Chapter No. 856, Statutes of 2012

AB 1580, by Assembly Member Susan Bonilla, clarifies some provisions of AB 1296 which was signed into law in 2011. 

AB 1580 was developed with stakeholder input to clarify who may be eligible for Medi-Cal, both before the implementation of the Affordable Care Act in 2014 and beyond. It was also intended to clarify that AB 1296 did not grant presumptive eligibility to any new category of beneficiaries. 

The Governor signed AB 1580 into law on September 30, 2012. Some of the issues related to this measure may also be taken up in the health care special session. 

CalWORKs

AB 1560 (Fuentes) – Support
Failed Passage

AB 1560, by Assembly Member Felipe Fuentes, would have helped low-income families who are eligible for the state’s Medi-Cal program to also receive CalFresh nutritional benefits. 

Specifically, AB 1560 would have waived the gross income test for any individual who receives, or is eligible to receive, Medi-Cal medical benefits. The measure would also have allowed those who live in households with those who receive or are eligible to receive Medi-Cal benefits to qualify for the CalFresh program. 

CSAC supported AB 1560, but the measure died in the Senate Appropriations Committee on August 16. 

AB 1640 (Mitchell) – Support
Chapter No. 778, Statutes of 2012

AB 1640, by Assembly Member Holly Mitchell, changes the state’s CalWORKs statute to allow for pregnant women under age 18 (with no other children in the household) to become eligible for CalWORKs basic needs grants and full-scope 1931(b) Medi-Cal benefits upon the verification of pregnancy. 

CSAC supported AB 1640 and wishes to thank Governor Brown for signing this small, but important measure to ensure the health of young mothers and their children. 

AB 1691 (Lowenthal, B.) – Support
Failed Passage

AB 1691, by Assembly Member Bonnie Lowenthal, would have allowed 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 had the option of extending ESL participation for up to 12 months on a case-by-case basis. 

CSAC supported AB 1691, but the measure died in the Senate Appropriations Committee on August 16. 

AB 1970 (Skinner) – Support
Failed Passage

AB 1970, by Assembly Member Nancy Skinner, would have streamlined the eligibility structure across the CalWORKs, CalFresh, and Medi-Cal programs.

This measure, titled the Social Services Modernization and Efficiency Act of 2012, would have conformed eligibility requirements for the above programs to existing federal law, allow recipients to choose electronic forms for certain types of communication, interviews, and notices, and simplifies the interview process for people in immediate need of benefits. 

CSAC supported AB 1970, but it was held in the Senate Appropriations Committee on August 16. 

AB 1998 (Achadjian) – Support
Chapter 245, Statutes of 2012

AB 1998, by Assembly Member Katcho Achadjian, will help counties bridge the “digital divide” for human services recipients by allowing counties to donate surplus computer property directly to recipients. 

Each county may choose to create the donation program, and recipients would receive surplus computer components based on a randomized lottery. The donated computers and equipment will help recipients of public assistance search for, secure, and maintain employment and participate in other required program services. 

CSAC strongly supported AB 1998, and the Governor signed the measure into law on September 7, 2012. 

AB 2352 (Hernández) – Support
Failed Passage

AB 2352, by Assembly Member Roger Hernández, would have allowed 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 was 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 supported the measure and will support similar measures in the future. 

The Senate Appropriations Committee held the measure on August 16. 

CalFresh (Formerly SNAP, Food Stamps)

SB 1391 (Liu) – Support
Chapter No. 491, Statutes of 2012

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

The new procedures, which will be implemented in January of 2014, will apply to current and former CalFresh recipients. They will help streamline the collection process for overissuances resulting from administrative errors, while also keeping the existing regulatory structure for cases of inadvertent household error, intentional program violation, and fraud in place.

Counties and county welfare directors supported 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. 

CSAC, along with the County Welfare Directors Association, supported SB 1391, which was signed by the Governor on September 23. 

Public Health

SB 1329 (Simitian) – Support
Chapter No. 709, Statutes of 2012

SB 1329, by Senator Joe Simitian, simplifies 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) supported SB 1329, which the Governor signed into law on September 28, 2012. 

AB 2002 (Cedillo) – Oppose
Failed Passage

AB 2002 by Assembly Member Gil Cedillo, would have expanded the definition of a safety net provider in instances where a Medi-Cal beneficiary must be automatically assigned to a managed care plan. 

CSAC, along with the County Health Executives Association of California (CHEAC), the California Association of Public Hospitals (CAPH), and Los Angeles County, opposed AB 2002. The Assembly Appropriations Committee placed AB 2002 on the Suspense File declined to pass it by the May 25 legislative deadline. CSAC wishes to thank Assembly Member Cedillo for his careful consideration of our concerns on this measure. 

AB 2109 (Pan) – Support
Chapter No. 821, Statutes of 2012

AB 2109, by Assembly Member Richard Pan, requires 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) supported AB 2109, which was signed into law by the Governor on September 30. 

AB 2246 (Pérez, J.) – Support
Chapter No. 446, Statutes of 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 Governor signed AB 2246 into law on September 22, 2012. 

AB 2266 (Mitchell) – Support
Failed Passage

AB 2266, by Assembly Member Holly Mitchell, would have allowed 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 have allowed 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.

However, AB 2266 was placed on the Inactive File on August 29 in the Senate.

Medi-Cal

AB 540 (Beall) – Support
Vetoed

AB 540, by Assembly Member Jim Beall, would have allowed counties to draw down federal funding for providing confidential alcohol and drug screening and brief intervention services to pregnant women and women of childbearing age who also qualify for Medi-Cal benefits. It would have cost the state no General Fund moneys and provided counties with a much-needed federal revenue stream for these valuable services. 

CSAC strongly supported the bill, but the Governor vetoed AB 540 with this message:

“I am returning Assembly Bill 540 without my signature. I commend the author for his efforts to mitigate the risks of alcohol and drug use for pregnant women and women of childbearing age in the Medi-Cal program. The federal Patient Protection and Affordable Care Act requires comprehensive health care coverage to be provided in the private market and through public programs. Rather than embarking on this piecemeal effort, my administration will consider whether a more comprehensive approach to screening for all Medi-Cal beneficiaries, including pregnant women and women of childbearing age is possible, as we implement the changes that are necessary to comply with the Affordable Care Act.” 

SB 1528 (Steinberg) – Oppose
Failed Passage

SB 1528, by Senate President pro Tempore Darrell Steinberg, would have given counties additional options for counties and the state to collect owed medical expenses. However, it was amended late in the Legislative Session with new provisions that would have counteracted the benefit of the medical lien provisions and create additional costs for counties. 

The August 29 amendments undermined the intent of California’s Medical Injury Compensation Reform Act (MICRA) and established case law. It is for this reason that counties changed to an oppose position on SB 1528. 

MICRA allows for the recovery of all economic damages or out-of-pocket costs for medical expenses. The August 24 amendments to SB 1528 would substitute the term “value” for “costs,” thereby allowing for significant increases in the dollar amounts sought by plaintiffs in suits against medical providers and healthcare professionals. This will, in turn, increase medical liability rates for the same providers. 

Because of the recent amendments, SB 1528 posed a significant threat in the way of new and potentially exponential costs for our community health care system. This is why CSAC changed positions from support to oppose, and we were pleased to see SB 1528 placed on the Senate’s Inactive File. 

AB 1785 (Lowenthal, B.) – Support
Failed Passage

AB 1785, by Assembly Member Bonnie Lowenthal, would have allowed federally qualified health centers (FQHCs) and rural health clinics to draw down federal funding for patient visits with marriage and family therapists.

CSAC supported the measure, but the Assembly Appropriations Committee placed AB 1785 on their Suspense File and it died in May. 

Child Welfare Services/Foster Care

AB 823 (Dickinson) – Support
Vetoed

AB 823, by Assembly Member Roger Dickinson, would have created 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 have created the Children’s Coordinating Council and given 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 believed that the creation of a California Children’s Coordinating Council would have had long-term social and economic benefits for all residents. It was for these reasons that CSAC supported the bill, but the Governor vetoed it on September 17. Here is his veto message: 

“I am returning Assembly Bill 823 without my signature. This bill establishes a ‘Children’s Coordinating Council,’ consisting of members of government, to advise itself on how it can improve collaboration amongst itself when it comes to delivering services to the children of this state. For almost two years now, my administration has worked to eliminate unnecessary boards, commissions, advisory bodies, and reports, so that government is not so overloaded with the work of form over the work of function. I commend the author’s heartfelt desire to improve the lot of all children in the state, but the creation of another Council is not the solution. If anything, it lulls us into the fallacy that forms can solve our problems. Instead, let’s try to be honest and thoughtful about the good we can do, and then do the good without the statutory decree, not because of it.” 

SB 1319 (Liu) – Support
Chapter No. 663, Statutes of 2012

SB 1319, by Senator Carol Liu, is a highly technical measure that makes three small changes to existing law by streamlining 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 supported by the County Welfare Directors Association. The Governor signed SB 1319 into law on September 27, 2012. 

AB 1707 (Ammiano) – Support
Chapter No. 848, Statutes of 2012

AB 1707, by Assembly Member Tom Ammiano, amends 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 was signed by the Governor on September 30, 2012. 

AB 1712 (Beall) – Support
Chapter No. 846, Statutes of 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. Recent amendments link it to AB 1707 (above). 

AB 1712 was signed by the Governor on September 30. 

AB 1751 (Pan) – Support
Chapter No. 637, Statutes of 2012

AB 1751, by Assembly Member Richard Pan, enables 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, supported the measure, which was signed into law by the Governor on September 2, 2012. 

AB 1928 (Cook) – Support
Chapter No. 120, Statutes of 2012

AB 1928, by Assembly Member Paul Cook, clarifies current regulations to help increase the number and availability of specialized foster care homes in counties by enumerating 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, supported the bill, which was signed into law on July 13 by the Governor. 

Adult Protective Services

AB 2149 (Butler) – Support
Chapter No. 644, Statutes of 2012 

AB 2149, by Assembly Member Betsy Butler, allows 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 goes into effect on January 1, 2013. 

CSAC supported the measure, which was signed into law by the Governor on September 27, 2012. 

Emergency Medical Services (EMS)

AB 1944 (Gatto) – Oppose
Failed Passage

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

Counties were concerned that AB 1944 weakened 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), opposed the measure. The Senate Appropriations Committee placed AB 1944 on their Suspense File on August 6 and it died at the end of the legislative session on August 30. 

Mental Health

AB 154 (Beall) – Support
Failed Passage

AB 154, by Assembly Member Jim Beall, would have required 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. 

Assembly Bill 154 would also have allowed 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). 

Counties believe that AB 154 would have reduced costly hospitalizations, incarcerations, and homelessness, thereby reducing overall health care costs in the state. For example, according to the 2009 Almanac of Chronic Disease, people diagnosed with depression have nearly twice the annual health care costs of those without depression. AB 154 would have helped ensure that private health plans treat individuals with mental health, substance use or co-occurring disorders in a comprehensive and meaningful way. 

However, AB 154 failed passage in the Senate Health Committee on June 27.