Budget Trailer Bill

SB 98 (Committee on Budget and Fiscal Review) – Request for Signature
Enrolled September 10, 2013
SB 98, by the Senate Committee on Budget and Fiscal Review, is a technical cleanup measure related to AB 85, the budget trailer bill outlining the county health realignment “savings” framework under the Affordable Care Act (ACA), which was signed into law in June.  SN 98 is the product of weeks of effort and collaboration between CSAC, the Department of Finance, legislative staff, county affiliates and other stakeholders. 
SB 98 was passed by the Senate on September 10 and has been sent to the Governor’s desk. The measure includes several policy changes strongly supported by counties, including:

Hard Cap on 2013-14 Contribution.  SB 98 includes a “hard cap” on the $300 million in 1991 health realignment payments that counties will make to the state in the first six months of 2014. Under AB 85, a county that elected to determine savings related to indigent health care through the cost/revenue formula option might have had to pay more than their proportional share of the $300 million under the “true up” mechanism. SB 98 clarifies this provision, ensuring that counties that choose the formula option will pay no more than their original proportional share of the $300 million. 
Deadline Extensions. SB 98 extends key deadlines for counties and the state, which will ensure the accuracy of the data processes outlined in AB 85. Many of the deadlines have been moved back at least 30 days, including the date by which a county must formally choose either the 60/40 split or cost/revenue formula route from December 4, 2013 to January 22, 2014. The table below illustrates the date changes that are now expected to become law:

1991 Realignment Structure. AB 85 created a new “base” account in the 1991 Realignment structure: the Family and Support Services Account. While CSAC and our county partners were initially concerned about this development, further analysis has confirmed that, under normal fiscal circumstances, the new account will not negatively affect the existing Health, Mental Health, and Social Services Accounts. As above, CSAC will continue to monitor the operation of this provision and raise concerns should any arise in the future. 

Each of the above provisions, as well as the myriad technical changes embodied in SB 98, has – as mentioned above – received extensive thought and review from counties. The measure now awaits the Governor’s signature.

Inmate Medicaid

AB 720 (Skinner) – Request for Signature
Enrolled September 11, 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. 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 passed by the Senate on September 11 and now awaits the Governor’s signature. 
Coordinated Care

AB 485 (Gomez) – Two Year Bill
Amended on September 6, 2013
AB 485, by Assembly Member Jimmy Gomez, would have severed the link between the implementation of the Coordinated Care Imitative (CCI) and the transfer of collective bargaining for In Home Supportive Services (IHSS) workers from county Public Authorities to the state. AB 485, as amended late in the session, would also have accelerated the transfer of collective bargaining from all 58 counties to a new state Public Authority. This acceleration was opposed by the Brown Administration and AB 485 is now a two-year bill.  

Quality Assurance

SB 239 (Hernandez) – Request for Signature
As Amended on September 11, 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 amended last week to include a provision that removes 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 supports both the quality assurance fee and the DP/SNF exception. SB 239 was passed by the Assembly on the last night of session and now awaits the Governor’s signature.