June 1, 2017

CSAC is supporting two additional health and mental health-related budget issues in Budget Conference Committee this week. The first has to do with a proposal from CSAC Affiliate California Association of Public Hospitals and Health Systems (CAPH) to use existing public hospital funding as a match to resurrect a sorely-needed Graduate Medical Education (GME) program. The second asks for more time for counties to create brick-and-mortar locations offering services for individuals experiencing a behavioral health crisis. 

California has the second-largest number of teaching hospitals and residents in the country and is one of only eight states without a Medicaid-funded GME program.

The Senate’s version of the GME trailer bill language will allow public hospitals to match existing Medicaid funding to strengthen our medical workforce – with no cost to the state’s General Fund. However, the Assembly adopted an unrelated amendment to the proposal that would require all public health care systems to contract with all Medi‐Cal Managed Care plans in order to receive GME funding. Public hospitals are already core safety net providers serving more low-income Californians than any other system, with roughly 70 percent of patients either eligible for Medi-Cal or uninsured. Further, this amendment mandating that public systems contract with all plans will negatively impact the ability of public health care systems to negotiate reasonable rates and contracts, and will be extremely complicated in some areas with three or more managed care plans. Lastly, this amendment is not needed, as public hospitals are already required to contact with at least one Medi-Cal plan in their county under the current federal Section 1115 Medicaid waiver.

CSAC is in support of the Senate version of the proposal before the Budget Conference Committee. View the CSAC letter here.

The second proposal is also supported by a CSAC Affiliate, the California Behavioral Health Directors Association (CBHDA). Counties are asking for additional time to expend critical Investment in Mental Health Wellness Act of 2013 (SB 82 or Chapter 34, Statutes of 2013) funding for the creation of brick-and-mortar locations offering crisis stabilization services for individuals experiencing a behavioral health crisis. 

The Investment in Mental Health Wellness Act of 2013 was passed in 2013 with about $180 million in new financing for local crisis projects. Since that time, The California Health Facilities Financing Authority has worked hard to make the funding available to counties for projects ranging from the purchase of mobile crisis vans to the creation of crisis triage teams with local law enforcement to the purchase and construction of custom structures to house new crisis stabilization units.

However, large capital projects require a significant amount of time and funding to execute. In some counties, especially those in which the acquisition of land is expensive and complicated, the original SB 82 deadline of June 30, 2018 to expend funding is arriving all too quickly. Other projects have been slowed by neighborhood opposition and siting concerns, as well.

It is for these reasons that CSAC joined the county behavioral health directors and a number of individual counties to request an extension of SB 82 grant expenditure authority to December 31, 2021 within the 2017-18 Budget Act. Of course, counties remain committed to the goals of the Investment in Mental Health Wellness Act of 2013. View the CSAC letter on this issue here.