State Will Not Pursue Legal Case Over Local First 5 Funding 

Local First 5 funding remains intact after the state declined to appeal a decision in last year’s legal battle to divert $1 billion in Proposition 10 revenue from counties to the state. 

Governor Brown had first proposed the $1 billion diversion of local First 5 funds in March of 2011 as part of his efforts to fill the state’s then-$26 billion budget gap. The diverted funds would have been earmarked to provide state health services for children under age 5. The state had argued that this scheme was in line with the voters’ intent to fund health, human services, and education programs for children in that age group. 
Ten county First 5 Commissions – Fresno, Madera, Merced, Solano, Los Angeles, Orange, Riverside, Marin, Sonoma, and San Diego Counties – joined the suit to halt the proposed diversion of funds, arguing that it went against the will of the voters and that the Legislature did not have the authority to amend the details of a voter-approved initiative. 

Fresno Superior Court Judge Debra J. Kazanjian agreed, calling the state’s proposal “disingenuous” in a ruling last November. The deadline to appeal that ruling was Monday, and the state declined to pursue the issue further. Further, the Brown Administration has not counted the proposed First 5 $1 billion diversion toward the state’s ongoing budget deficit for 2012-13. 

Senate Budget Discuss Medi-Cal Proposals

Senate Budget Subcommittee No. 3 on health and human services discussed a number of the Governor’s Medi-Cal budget proposals on Thursday, March 22. The subcommittee took action to adopt placeholder trailer bill language regarding improvements to dental health plan services in the Medi-Cal program. President Pro Tempore Steinberg proposed the trailer bill language after significant continuing problems were raised in the Sacramento GMC Dental Services model. The rest of the budget issues were held open.

The committee discussed the Administration’s proposal to shift children from the Healthy Families program into the Medi-Cal program, starting in October 12, as part of the state’s preparation for health care reform implementation. CSAC is supporting the Governor’s proposal and sent a detailed letter.

Benefits and Access

Early Periodic Screening Diagnosis and Treatment (EPSDT). The Governor’s proposal will provide EPSDT services to children up to 250 percent of the FPL. These services are more comprehensive than the behavioral health benefits under the Healthy Families Program. Counties want to be sure that the 2012-13 caseload estimate for EPSDT includes funding for the shift of children from Healthy Families to Medi-Cal. Please recall that the Administration is proposing to shift 100% of the EPSDT costs to counties starting on July 1, 2012. Providing an accurate estimate for EPSDT caseload will be especially critical to make the 2011 Realignment proposal is workable in the long-term. Counties also want to ensure that county mental health plans are able to access Title XXI federal matching funds at the enhanced FMAP for services for this group of children.

Substance Use Disorder Treatment. There is a limited benefit under Healthy Families for adolescents in need of alcohol or other drug treatment services. Unfortunately, access to these services has been problematic, and out of the thousands of eligible adolescents in California who are in need of substance use disorder treatment, less than 100 annually have been able to access services. Moving these children into the Medi-Cal program should enable them to receive treatment services that are more accessible and comprehensive than the benefits under the Healthy Families Program. 

California Children’s Services (CCS). Counties do have concerns about the proposed trailer bill language relating to county share of cost for the California Children’s Services (CCS) program. Specifically, we are asking that the proposed changes to Health and Safety Code Section 123940 be deleted, to assure that county financial obligations for CCS are not increased beyond the current requirements in Section 123940.

Access. Counties are aware that some children may either lose their current provider or their current health plan with the transition from Healthy Families to Medi-Cal. Some providers accept Healthy Families but not Medi-Cal. Some plans that are offered in Healthy Families may not be offered in Medi-Cal. As a result, there may be continuity of care and access issues, particularly in rural areas. We also are aware that dental health access issues could be exacerbated by this move and need to be addressed in the implementation. Further discussion and deliberation will be required to mitigate access issues.

Eligibility. County human services departments manage eligibility for health and human services programs for more than 8 million Californians, including Medi-Cal, CalWORKs and CalFresh. Counties have the capacity to provide comprehensive, integrated customer service across these programs to families with multiple needs, as well as serving families that are just seeking health coverage for their children and nothing more.

Automation. Counties’ modern eligibility automation systems, which include online application capacity, can accommodate the cases that would be added under this proposal. Counties have enrolled several hundred thousand new customers into Medi-Cal since the recession began and added millions of additional customers to CalFresh and CalWORKs. Statewide, we receive about 400,000 applications for the various programs each month. This proposal would add less than 20,000 monthly applications to that number, based on January 2012 data showing 16,152 applications forwarded from the Single Point of Entry to Healthy Families.

We look forward to working with the Administration and our automation system staff to identify the changes that will be required to implement the transition, such as new electronic linkages between the Single Point of Entry computers and our systems – an effort that has been discussed in the past, and which we support – and updates to the Medi-Cal eligibility thresholds.

Eligibility Rules and Costs. It is our understanding that the cases that are to be transitioned will be evaluated under simple eligibility rules (for example, without requiring asset tests for these children). Based on this, we are committed to working with the Administration and Legislature to develop a cost estimate for the eligibility work associated with these cases that we are confident will be in line with costs under Healthy Families today. The current average cost per case on Medi-Cal is higher than the cost for Healthy Families cases because Medi-Cal is significantly more complex. The Medi-Cal “program” is actually a collection of dozens of programs under the Medi-Cal umbrella, with more than 120 aid codes, compared to the single program under Healthy Families. Many adult Medi-Cal recipients are subject to mid-year status reporting that these children would not be required to meet, and adult applicants must provide in-depth detail about their assets, including retirement accounts, life insurance policies, jewelry and burial plots. 

Transition of Existing Cases. In order to ensure the smooth transition from Healthy Families to Medi-Cal, a number of technical questions need to be worked through, including the work flow of transferring applications from MRMIB’s Single Point of Entry to the counties, how the existing Healthy Families cases will be transitioned by counties into Medi-Cal over the proposed 12-month period, whether the transition time frame might differ for children at lower income levels (for example, under 150% of the Federal Poverty Level vs. 150%-250% of the Federal Poverty Level), and what reasonable performance expectations can be put into place for county human services agencies to process these applications. 

Ongoing Case Management. While the trailer bill language released by the administration proposes a possible continuing role for the Healthy Families vendor in ongoing case management for higher-income Medi-Cal cases, from a customer services perspective we recommend that ongoing case management be handled at the county human services department, rather than splitting these children off of cases that might be active for them or other family members in Medi-Cal, CalWORKs and CalFresh. It does make sense for the Healthy Families vendor to collect the premiums for higher-income children (between 150% and 250% of poverty) given the short transition time to the 2014 implementation of health care reform and the vendor’s existing infrastructure. However, changes that the vendor learns about that could affect the eligibility of a person’s case should be reported to the county where the child lives for processing, in accordance with current state law and to ensure the most comprehensive customer service for these children and their families.

Legislation

CalWORKs
AB 1640 (Mitchell) – Support
As Introduced on February 13, 2012

AB 1640, by Assembly Member Holly Mitchell, would change the state’s CalWORKs statute to allow for pregnant women (with no other children in the household) to become eligible for CalWORKs basic needs grants and full-scope 1931(b) Medi-Cal benefits upon verification of a pregnancy.
CSAC supports the bill, which was passed by the Assembly Human Services Committee on March 20. The measure will next be heard by the Assembly Appropriations Committee. 

AB 1691 (Lowenthal, B.) – Support
As Introduced on February 15, 2012

AB 1691, by Assembly Member Bonnie Lowenthal, would allow non-English speaking CalWORKs recipients, which include refugees and other legal immigrants, to participate in English as a Second Language (ESL) instruction for eight months. Time spent in ESL instruction would count as a core activity and counties would have the option of extending ESL participation for up to 12 months on a case-by-case basis. 
CSAC supports AB 1691, which was passed by the Assembly Human Services Committee on March 20. The measure will next be heard by the Assembly Appropriations Committee. 

SB 1060 (Hancock) – Support
As Introduced on February 13, 2012

SB 1060, by Senator Loni Hancock, would allow parents who have been convicted of a drug-related felony and completed a government-recognized treatment program to qualify for CalWORKs program employment services and benefits. 

Senator Hancock’s SB 1060 would allow California to join with 13 other states in opting out of the federal lifetime ban on receiving Temporary Assistance to Needy Families (TANF grants – CalWORKs here in California) funding for those with past drug felonies. California already allows those with certain drug-related felonies to receive Supplementary Nutrition Assistance Program (SNAP or food stamps, called CalFresh in California) benefits. 

Counties believe that SB 1060 provides an important tool for counties post-2011 realignment. By removing the lifetime ban on receiving CalWORKs benefits for parents convicted of drug-related felonies, counties will be able to provide employment activities and services to recipients with the goal of achieving employment and self-sufficiency, as well as safely reintegrating them back into our communities. Additionally, CalWORKs grants are primarily used by families towards housing costs. Access to CalWORKs will provide parents assistance with housing – a key component necessary to get and retain a job.

Counties believe that in the long-tern SB 1060 would assist in reducing recidivism, saving our counties, the state, and communities significant social and fiscal costs. The Senate Human Services Committee will hear 
SB 1060 on March 27. 

AB 1673 (Mitchell) – Support
As Introduced on February 14, 2012

AB 1673, as introduced by Assembly Member Holly Mitchell, would streamline eligibility for child care subsidies. Specifically, AB 1673 would require a 12-month eligibility period, and impose limited interim reporting requirements for families. These changes will make the eligibility process more efficient for both counties and families. 
AB 1673 was passed by the Assembly Education Committee on March 21. 

SB 970 (de Léon) – Support
As Introduced on January 17, 2012

SB 970, as introduced by Assembly Member Kevin de Léon, would help integrate the process for applying for public programs such as CalFresh and CalWORKs with the new online health coverage application process that is under development by the state. 

The federal Affordable Care Act (ACA) requires states to establish, by 2014, a seamless, “no wrong door” system for determining eligibility for and enrolling people into health coverage programs such as Medi-Cal and subsidized coverage through the Health Benefits Exchange. Federal law also provides for integration of these new systems with human services programs, which in California are administered at the county level by human services departments along with Medi-Cal. The California Health and Human Services Agency and Health Benefit Exchange are partnering to develop CalHEERS, an information technology system that will include the required front-end application as well as other needed technology changes, and will connect with existing computer systems used by the counties.

SB 970 would build on California’s existing service integration by ensuring that people applying for health coverage through CalHEERS can also begin the application process for other public programs, including CalFresh and CalWORKs. A comprehensive stakeholder workgroup, including representatives from county human services departments, among others, would be established by the bill to review whether additional programs should be included in the process.
SB 970 also provides that if a health program renewal form has the necessary information to renew eligibility for CalWORKs or CalFresh, that the renewal for those other programs is satisfied. This is important not only to ensure that applying for and retaining eligibility for multiple programs does not become more difficult after 2014, but so that the state can continue working towards full participation in federally funded human services and work support programs. 

Finally, SB 970 would maximize enrollment into health coverage by enabling CalFresh recipients who are uninsured to allow the information in their CalFresh case file to be used to file an application for health coverage. This will ensure that as many eligible individuals and families as possible get the health coverage they need through the Medi-Cal expansion and subsidies in the Exchange. The Senate Health Committee will hear SB 970 on March 28.