Health Care Expansion/Health Care Reform

AB 85 (Committee on Budget) and SB 98 (Committee on Budget and Fiscal Review) – Chaptered, Chapters 24 and 358 respectively, Statutes of 2013

Please see the October 18 edition of the CSAC Bulletin for information about these two important Budget Act measures. 

ABX1 1 (Pérez, J.) – Chaptered
Chapter 3, Statutes of 2013-14 First Extraordinary Session

ABX1 1, by Assembly Speaker John A. Pérez, implements the Affordable Care Act Medicaid expansion in California by January, 1 2014. 
ABX1 1 was passed in the First Extraordinary Legislative Session, or Health Care Reform Special Session, in June. It streamlines the eligibility and enrollment for Medi-Cal recipients and expands coverage to well over 1 million Californians who are under age 65, not pregnant, and not otherwise currently eligible for Medi-Cal coverage, with incomes up to 138% of the federal poverty level (FPL). The measure also converts Medi-Cal income eligibility to a Modified Adjusted Gross Income (MAGI)-based standard, for most categories, except seniors and people who are blind or disabled and prohibits use of an asset or resources test. 
CSAC and counties strongly supported the Medicaid expansion in California and we wish to thank Assembly Speaker Pérez for authoring and shepherding ABX1 1 through the special session process. 

SBX1 1 (Hernandez and Steinberg) – Chaptered
Chapter 4, Statutes of 2013-14 First Extraordinary Session

SBX1 1, by Senators Ed Hernandez and Senate President Pro Tempore Darrell Steinberg, establishes the benefit package for the Medi-Cal expansion authorized by ABX1 1 (above). 
SBX1 1 expands the Medi-Cal benefit package to include mental health and substance use disorder services required under the Affordable Care Act’s essential health benefits, both of which are not currently covered by Medi-Cal.  
Additionally, this bill implements a number of the Medicaid ACA-related provisions to simplifying the eligibility, enrollment and renewal processes for Medi-Cal, including the repeal of semi-annual status reporting and allowing hospitals to conduct presumptive eligibility screens. SBX1 1 also extends Medi-Cal benefits to former foster children until age 26. 
CSAC and counties strongly supported SBX1 1 and the Medicaid expansion and we wish to thank Senators Hernandez and Steinberg for carrying this important technical implementation measure. 

SBX1 3 (Hernadez) – Chaptered
Chapter 5, Statutes of 2013-14 First Extraordinary Session

SBX1 3, by Senator Ed Hernandez, requires Covered California, the state’s health benefits exchange, to contract with qualified Medi-Cal Managed care plans so that beneficiaries who  move to the exchange may retain their providers and vice versa. The measure also requires the Exchange to work with counties to ensure seamless transfers and coverage changes. CSAC supported SBX1 3 and wishes to thank the Governor for signing it into law. 

AB 361 (Mitchell) – Chaptered
Chapter 642, Statutes of 2013

AB 361, by Assembly Member – and now Senator – Holly Mitchell, allows the state and counties to work together to leverage significant federal funding by creating a patient-centered “health home” program for Medi-Cal beneficiaries who are frequent hospital users. 
The Health Homes for Enrollees with Chronic Conditions option (Health Homes option) under Section 2703 of the Affordable Care offers an opportunity for California to draw down a 90 percent federal match to address chronic and complex health conditions through a “whole person” approach. 
Specifically, the measure allows California to create a comprehensive program for frequent hospital users. The funding can be used to implement comprehensive engagement and case management services to high-risk populations and will help promote an integrated approach (“health home”) to health care and wellbeing for the most chronically ill people in our communities. The program goal is to stabilize – and even increase – the health of frequent hospital users while reducing their utilization of costly medical care. 
Currently, a dozen counties fund or manage health home integrated programs for frequent hospital users, and have realized medical cost savings as a result. Counties, many of which are working to implement the integrated health model, welcome an opportunity to opt into the health home services funding offered through the Affordable Care Act. We believe counties and the state can achieve significant cost savings for the sickest and most expensive users of hospital care, and CSAC supported AB 361. The Governor signed the measure into law in September. 

Children’s Issues

AB 260 (Gordon) – Chaptered
Chapter 731, Statutes of 2013

AB 260, by Assembly Member Rich Gordon, clarifies the sunset dates for Child Care Subsidy Pilot projects in San Mateo County and San Francisco City and County. 
CSAC supported AB 260 because it clarifies the sunset date and reporting requirements for these projects and phases in changes to allow for both counties’ unique situations and needs in serving children and families in their areas. The Governor signed AB 260 into law on October 11. 

AB 787 (Stone) – Chaptered
Chapter 487, Statutes of 2013

AB 787, by Assembly Member Mark Stone, is a critical implementation piece for issues related to the 2010 landmark legislation, the California Fostering Connections to Success Act. The Act leverages federal funding to increase services and supports for the state’s foster youth, and CSAC was a proud supporter of these efforts. As counties have moved to implement the Act, the County Welfare Directors Association has identified a few specific areas in need of more clarity. AB 787 will provide clarity on the items related to the KinGap program, which provides foster youth over the age of 18 with the option to remain in care up to age 21 with federal funding.
First, the measure revises statute to allow probation officers to place foster youth over the age of 18 into approved transitional services placements. AB 787 also allows re-entry into dependency for non-minor dependents whose guardian or relative or adoptive parent dies before the youth’s 21st birthday. Finally, the measure will resolve confusion over the courts’ role in terminating jurisdiction of a non-minor dependent while retaining the judicial branch’s ability to monitor the youth as a non-minor. 
Each of these changes will assist counties and the state in providing the necessary services and supports to our state’s foster youth population. Costs are minimal and the impact on the lives of this vulnerable population will be tangible, and it is for these reasons that CSAC supports AB 787. The Governor signed the measure into law on October 2. 

Mental Health

SB 585 (Steinberg) – Chaptered
Chapter 288, Statutes of 2013

SB 585, by Senate President Pro Tempore Darrell Steinberg, clarifies that Mental Health Services Act (MHSA) funds   and various county realignment accounts may be used to provide mental health services under the Assisted Outpatient Treatment (AOT) Demonstration Project Act of 2002, or Laura’s Law, and  allows counties to opt to implement Laura’s Law through the county budget process rather than a resolution by the Board of Supervisors. 

CSAC remained neutral on the measure and the Governor signed it into law on September 9. 

SB 664 (Yee) – Failed Passage

SB 664, by Senator Leland Yee, would have removed the authority of county Boards of Supervisors to determine whether the implementation of Assisted Outpatient Treatment (AOT) services, commonly known as Laura’s Law, is appropriate in their communities. The measure had also sought to clarify that Mental Health Services Act funds may be used for AOT services in those counties that have authorized implementation. However, this provision, which CSAC supported, was amended out of the measure on April 11 and included in SB 585 (Steinberg).  
CSAC opposed SB 664 because it is critical that county Boards of Supervisors retain the authority and flexibility to determine whether implementing Laura’s Law AOT services in their communities is appropriate. County Supervisors also have authority over the county budget and may exercise their choice through that channel, as outlined in SB 585 above. 
SB 664 died in the Senate Appropriations Committee on May 16. 

AB 1054 (Chesbro) – Chaptered
Chapter 303, Statutes of 2013

AB 1054, by Assembly Member Wes Chesbro, reduces the annual rate increase that counties pay to Institutions for Mental Disease (IMD) for inpatient psychiatric treatment from 4.7 percent to 3.5 percent. 
Counties believe 3.5 percent is consistent with a reasonable cost of living adjustment and CSAC supported the measure. The Governor signed it into law on September 9. 

AB 1225 (Maienschein) – Failed Passage

AB 1225, by Assembly Member Brian Maienschein, would have allowed for an additional 10 percent fund transfer from other subaccounts to the mental health subaccount within the 1991 Realignment financing structure. CSAC worked with the County Welfare Directors Association (CWDA), the California Mental Health Directors Association (CMHDA) and the County Health Executives Association of California (CHEAC) to communicate our concerns with the measure to Assembly Member Maienschein. The bill was held in the Assembly Local Government Committee in April. 
Public Health

AB 506 (Mitchell) – Chaptered
Chapter 153, Statutes of 2013 

AB 506, by Assembly Member Holly Mitchell, authorizes social workers to consent to an HIV test for a child under the age of one year who is in temporary custody or is a dependent child of the court. The measure was sponsored by Los Angeles County and supported by CSAC. The Governor signed AB 506 on August 26. 

Medi-Cal 

SB 239 (Hernandez) – Chaptered
Chapter 657, Statutes of 2013

SB 239, by Senator Ed Hernandez, O.D., enacts the Hospital Quality Assurance Fee, which helps draw down federal funds for public and private hospitals, children’s health coverage, state administration costs, and better rates for Medi-Cal managed care plans. Under the measure, the quality assurance structure will be in place through December 2016.  
SB 239 was also late in the legislative session to remove Distinct Part/Skilled Nursing Facilities (DP/SNFs) from the Medi-Cal provider rate cuts enacted in SB 97 in 2011. The SB 97 provider rate cuts would have slashed the federal reimbursement for these facilities. SB 239 relives DP/SNFs from the rate cuts moving forward, but these facilities are still subject to the retroactive provisions of SB 97. The state has indicated a willingness to work out payment plans for the retroactive cuts to help ensure the continued operation of DP/SNFs. These facilities operate in both rural and urban settings, and this small provision, while not a panacea, will help ensure continued access to these services throughout the state. 
CSAC strongly supported both the quality assurance fee and the DP/SNF exception, which was originally included in two other measures that did not make it to the Governor’s desk: AB 900 (Alejo) and SB 640 (Lara). SB 239 was signed by the Governor on October 8. 

Human Services

AB 197 (Stone) – Failed Passage (see note)

AB 197, by Assembly Member Mark Stone, would have allowed California Work Opportunities and Responsibility to Kids (CalWORKs) program applicants and recipients to own reliable cars. NOTE: While it failed in the Assembly Appropriations Committee, a budget bill, AB 74 (Chapter 21, Statutes of 2013) included the provisions of AB 197. 
Under AB 74 and starting January 1, 2014, the allowable value of a licensed vehicle will be $9,500, and any equity value that exceeds $9,500 will be attributed toward the family’s resource level.
CSAC supported AB 197 and AB 74, and has supported similar measures in years past. We are pleased to see this change in policy that will allow CalWORKs program applicants and recipients to own reliable cars. The Governor signed AB 74 into law on June 27. 

SB 283 (Hancock) – Failed Passage

SB 283, by Senator Loni Hancock, would have allowed those who have been convicted of a felony after 1996 and who meet all current eligibility requirements to receive CalFresh services. SB 283 was held in the Assembly Appropriations Committee and is now a two-year bill. 

SB 346 (Beall) – Chaptered
Chapter 658, Statutes of 2013

AB 346, by Senator Jim Beall, allows county social services and health departments within a county to share limited eligibility information. 
Senator Beall’s SB 346 allows county social services and health departments to share eligibility information and encourage a “client centered” model of integrated services. The measure was sponsored by Santa Clara County and supported by CSAC. The Governor signed it into law on October 8. 

AB 419 (B. Lowenthal) – Chaptered
Chapter 293, Statutes of 2013

AB 419, by Assembly Member Bonnie Lowenthal, allows full CalWORKs basic needs assistance and services to continue for families whose child or children are hospitalized. 
AB 419 was sponsored by CSAC affiliate County Welfare Directors Association (CWDA) and supported by CSAC. The Governor signed the measure on September 9. 

AB 720 (Skinner) – Chaptered
Chapter 646, Statutes of 2013

AB 720, by Assembly Member Nancy Skinner, will help reduce recidivism and assist counties in our responsibility for post release community supervision of individuals in county jails by clarifying statute related to inmate Medicaid eligibility.
AB 720 authorizes a Board of Supervisors to work with their Sheriff to designate an entity or entities to ensure inmates receiving offsite inpatient hospital services are enrolled in Medi-Cal, as allowed by federal law. The measure also makes a key change in Medi-Cal eligibility rules that is strongly supported by counties: AB 720 allows counties to suspend, rather than terminate, an inmate’s Medi-Cal eligibility while incarcerated for less than one year. This small change will reduce the administrative workload for both counties and the state and accelerate an inmate’s access to health, mental health, and substance use disorder services upon release. 
Counties have worked with county sheriff organizations, the sponsors, and other stakeholders to ensure the practical application of this measure at the local level. CSAC also wishes to thank Assembly Member Nancy Skinner for working with the abovementioned stakeholders to ensure safer communities and effective implementation. AB 720 was signed into law by Governor Brown on October 8, 2013.  

Emergency Medical Services

SB 191 (Padilla) – Chaptered
Chapter 600, Statutes of 2013

SB 191, by Senator Alex Padilla, simply extends the January 1, 2014 sunset date for the successful local Maddy Emergency Medical Services Funds (Maddy Funds) mechanism to January 1, 2017. Counties supported measures creating and sustaining Maddy Funds, and nearly all counties currently operate a Maddy Fund by collecting an additional $2 for every $10 penalty for all criminal offenses and moving violations. This funding is allocated to hospitals and emergency physicians to reimburse them for care given to uninsured patients and allows counties to supplement local emergency services. Fifteen percent of the funds collected are also directed to pediatric trauma care (Richie’s Fund), representing the only statewide funding source for these critical services for kids.
CSAC supported SB 191, which was signed by the Governor on October 5.