CSAC Bulletin Article

Health and Human Services
Expanding Court Orders Conservatorships, Also, Legisalture Working Special Session to Fill $1B Revenue Gap from MCO Tax

Hot Bills

As the legislative session enters the final month, there are several bills still in play in the health and human services area – all of which will be heard on August 17 in the Senate Appropriations Committee: 

AB 193, by Assembly Member Brian Mainschein, would authorize a Probate Court judge to recommend a Lanterman-Petris-Short Act (LPS) conservatorship to the county officer providing conservatorship investigations. Essentially, AB 193 assumes that because a Probate conservatorship has been established, a person should also qualify for involuntary mental health treatment or a conservatorship. The LPS Act was created so that individuals could not be indiscriminately placed in involuntary settings without due process, which includes the involuntary hold process and LPS conservatorship. It is a very high bar that is in place to protect the patients, and AB 193 erodes this due process. 
AB 193 would also result in significant county costs due to increased investigations and potentially increased LPS conservatorships. CSAC, along with Los Angeles County, the Urban Counties Caucus and the County Behavioral Health Directors Association, all OPPOSE AB 193, which will be heard in the Senate Appropriations Committee on August 17. 
AB 1299, by Assembly Member Sebastian Ridley -Thomas, would make changes to how foster children placed outside of their county of original jurisdiction are able to access mental health services. It would require the Department of Health Care Services to issue policy guidance that establishes the presumptive transfer of responsibility for mental health services from the county of original jurisdiction to the foster child’s county of residence. 

CSAC has taken a SUPPORT IF AMENDED on AB 1299, as it seeks to ensure foster children receive services mental health services in a timely manner. However, CSAC continues to work with the author’s office and the sponsors – the California Alliance of Child and Family Services – to address county concerns regarding the bill language and implementation. It is unclear as of this writing if the county concerns regarding the July 16 version of the bill will be addressed. AB 1299 will be heard in the Senate Appropriations Committee on August 17.

AB 403, by Assembly Member Mark Stone and sponsored by the Department of Social Services (DSS), reflects DSS’ attempt to reform the continuum of care group home system for foster youth. In January, DSS released their Continuum of Care Report to the Legislature, which outlined a comprehensive approach to improving the experience and outcomes of children and youth in foster care. 

AB 403 reclassifies juvenile treatment facilities and the transition from the use of group homes for children in foster care and on probation to the use of short-term residential treatment centers (STRTCs) – defined in the amendments. AB 403 revises foster parent training requirements and provides for the development of Child-Family Teams to inform the process of placement and services to children. Additionally, the bill seeks to develop a new group home rate payment structure to fund placement options for children in foster care.

CSAC, along with our county affiliates – CWDA, CBHDA and CPOC – continue to work closely with the Department of Social Services on this significant measure, including on both the potential fiscal and policy impacts. CSAC continues to maintain a SUPPORT IN CONCEPT position on AB 403, which will be heard by the Senate Appropriations Committee on August 17. 

Special Session on Health Care 

Since the Health Care Special Session was convened in June, the Assembly has introduced an MCO tax measure, ABX2 4 by Assembly Member Marc Levine. 

Assembly Member Levine’s bill would institute a $7.88 monthly flat tax for each plan enrollee for 45 managed care organizations which cover 21 million Californians, of which 9 million are Medi-Cal patients. The Author has stated that it will raise at least the $1.1 billion needed to fund existing obligations as well as up to $1.9 billion to provide funding for additional special session priorities (the IHSS 7 percent restorations [$266 million], Medi-Cal provider rate increases [$250 million], and local disability services rate increases [$100 million]). 

As of this writing, the Administration has not yet formally introduced their MCO tax proposal in the extraordinary session. However, the measure that has been in print since March would also impose the new tax on most MCOs, not just those licensed for Medi-Cal Managed Care. It proposes a tiered tax structure based on enrollment size: 
For example, according to the Legislative Analyst’s Office, a MCO with 1 million taxable member months would pay $3.50 per unit for the first 125,000 member
months, $25.25 per unit for the next 150,000 member months, and $13.75 per unit for the remaining 725,000 member months, resulting in a total payment of $14.2 million. 

CSAC has supported past MCO tax proposals and is gathering feedback from partners and other stakeholders on the impacts of both proposals. Counties are especially concerned about the MCO tax revenues that help fund the Coordinated Care Initiative (CCI), and support concepts designed to continue that funding. 

A raft of tobacco legislation has also been introduced in the special session. CSAC will SUPPORT SBX2 7 (Hernandez)/ ABX2 8 (Wood) to increase the age of sale for tobacco products to 21 and SBX2 5 (Leno)/ ABX2 6 (Cooper), which would add e-cigarettes to existing tobacco product definitions. Based on feedback from the Health and Human Services Policy Committee and the CSAC Executive Committee, CSAC is not taking a position on SBX2 9 (McGuire)/ ABX2 10 (Bloom), which would allow counties to levy taxes on tobacco distributers subject to Proposition 218 rules local taxes (two-thirds local vote).

Senator Richard Pan, M.D., is also expected to introduce his $2 a pack tobacco tax increase in the specials session. It will mirror his SB 591, which is currently on the inactive file in the regular legislative session. It is still unclear how the revenue from the increased tax could be spent, but it is possible that it could be used to assist with the $1.1 billion budget hole that would result if the Legislature is unable to pass a new MCO tax. 

Any MCO or tobacco tax measure would require a two-thirds vote of the Legislature. CSAC will continue to monitor the special session and MCO tax issue closely. 

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