February 23, 2017

Several county affiliate organizations presented a webinar yesterday to present a detailed overview of how 1991 Realignment works, the impact of eliminating the Coordinated Care Initiative on 1991 Realignment, and the potential impacts on counties.

Organized and developed by the County Health Executives Association of California (CHEAC), the California Behavioral Health Directors Association (CBHDA), the County Welfare Directors Association (CWDA), the webinar drew mora than 400 participants.

The webinar provided an overview of the health, mental health, and social services programs that were realigned in 1991, including county indigent health programs, child welfare services, and in-home supportive services. The webinar explained how 1991 Realignment is funded by two sources: a ½ cent sales tax and dedicated Vehicle License Fee revenue, and explained the complex distribution method among the 1991 Realignment subaccounts. Additionally, following 2011 Realignment, additional changes were made to 1991 Realignment – the CalWORKs MOE subaccount changes and AB 85, which was an ACA implementation bill. The webinar explained how growth and caseload growth are calculated under 1991 Realignment, as well as the restrictions placed on counties’ transfers between 1991 Realignment Subaccounts.

After providing attendees with a background in how 1991 Realignment functions and is funded, the webinar delved into the Coordinated Care Initiative (CCI). The CCI allows individuals who are eligible to receive both Medi-Cal and Medicare to receive coordinated services from a single health plan (called Cal MediConnect), and was implemented in seven counties: Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara. The CCI also included a shift of collective bargaining responsibility for IHSS from CCI counties to the state, as well as a maintenance-of-effort requirement in place of the traditional county share of IHSS costs. This MOE applied to all counties, regardless of their participation in the CCI.

The January 10 budget estimates that the CCI will no longer be cost effective, a situation that current law requires the Director of Finance to then end the CCI project, which includes the county MOE and shift of collective bargaining. While current law does not require legislative action, the Administration has indicated that it will seek legislative approval to continue the underlying functions of Cal MediConnect.

However, the discontinuance of the CCI will end the county MOE, which will increase county costs by and estimated $623 million in 2017-18. These additional costs to counties will reach over an estimated $1 billion by 2022-23. The webinar went on to demonstrate the 1991 realignment revenues will be insufficient to cover a cost shift of this magnitude and that other realigned programs will be impacted due to the underlying fiscal structure of 1991 Realignment, since the Caseload Subaccount has the first call on 1991 Realignment Sales Tax Growth. The webinar warned participants that the transfer provisions in 1991 Realignment may need to be used to help absorb the IHSS costs.

Additional information on the IHHS MOE/CCI is available on the CSAC website. Stay tuned for more details, including the posting of the webinar slides and recording of the webinar. We wish to thank CHEAC, CBHDA, and CWDA for their efforts to develop, organize, and present this helpful webinar.