ACA Expansion Bills Passed by the Legislature

The Senate and Assembly both passed the Medicaid expansion bills, SBX1 1 (Hernandez) and ABX1 1 (Pérez) as part of the budget process over the weekend. Both bills were amended to clarify two different aspects to the expansion: SBX1 1 focuses primarily on Medi-Cal benefits issues, while ABX1 1 focuses on eligibility changes. 

These historic measures now go to the Governor’s desk. CSAC strongly supports both bills and wishes to give a special nod of appreciation to Cathy Senderling of the County Welfare Directors Association (CWDA). She was instrumental in ensuring that the county perspective was heard and incorporated into the bills and her work will inform both the state and counties as the largest health care expansion in a generation is implemented.

Medi-Cal

AB 720 (Skinner) – Support
As Amended on May 24, 2013

AB 720, by Assembly Member Nancy Skinner, would help reduce recidivism and assist counties in our responsibility for post release community supervision of individuals in county jails by enrolling them in the federally funded Medi-Cal program before their release.

Assembly Bill will give counties an important tool to reduce repeat crime and recidivism by allowing newly released inmates to access critical health care and substance use disorder services through Medi-Cal, or, if they qualify, through a qualified health plan in the state’s health benefits exchange. By pre-enrolling incarcerated individuals, counties can get a jump on providing wrap-around services to the most high-risk inmates to ensure adequate supervision and successful and sustainable reentry in our communities. Amendments will clarify that the county may designate which agency and staff is assigned to the jail to make eligibility determinations. 

CSAC supports efforts to increase local flexibility and innovation in serving the AB 109 and county jail population because the benefits of successful reintegration of incarcerated individuals accrue to a variety of stakeholders, including counties, the state, our local communities and families. We are working with the sponsor, author, and county organizations to ensure a viable measure that is implementable at the local level. The Senate Health Committee passed AB 720 on June 19. It goes next to the Senate Judiciary Committee. 

AB 900 (Alejo) – Support
As Amended May 24, 2013

AB 900, by Assembly Member Luis Alejo, would restore significant cuts to the reimbursement rate for Medi-Cal services provided by distinct part skilled nursing facilities (DP/SNFs). These significant rate cuts were passed in 2011at the height of the Great Recession and during a time when California’s legislators were grappling with a $25 billion budget deficit. Compounding the devastating effects of the cuts is the fact that DP/SNFs must retroactively reimburse the state for more than two years of the rates paid to them before the cuts were declared legal. 

Many small urban and rural hospitals with skilled nursing facilities cannot pay the large retroactive amounts due for the rate cuts, which run into the hundreds of thousands of dollars. Further, many individual facilities cannot absorb the rate cut for this fiscal year, as health care costs have continued to rise. These small facilities are struggling financially, and their ability to continue to provide medically necessary services in communities throughout the state hangs in the balance. 

The restoration of the rate cuts – but not the retroactive payments – was included in the Senate’s version of the 2013-14 budget, but the Joint Conference Committee remove d the $32 million appropriation on June 10. 
The Senate Health Committee heard and passed AB 900 on June 19 with broad support. The measure will be heard next in the Senate Appropriations Committee.

Public Health

SB 191 (Padilla) – Support
As Introduced on February 7, 2013

SB 191, by Senator Alex Padilla, would remove the sunset date for local Maddy Emergency Medical Services Funds (Maddy Funds) to allow counties to continue to assist hospitals and emergency physicians with the costs of treating uninsured patients, local emergency services, and pediatric trauma care. 

Senate Bill 191 simply removes the January 1, 2014 sunset date for local Maddy Funds. 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. 

California’s counties continue to grapple with a reduction of resources for the health care safety net. These changes are also felt by hospitals and emergency physicians, as well as by Californians who need emergency medical services. In rural areas, access to emergency department services is increasingly difficult, and urban areas are experiencing the same problem as fewer hospitals are able to finance emergency departments. Maddy funding statewide is small – about $50 million in non-state General Funds – but it is an important element in the local emergency services safety net and availability of pediatric trauma care.

For these reasons, CSAC supports SB 191. The Assembly Health Committee passed the measure on June 18. 

Human Services

AB 260 (Gordon) – Support
As Amended on April 24, 2013

AB 260, by Assembly Member Richard Gordon, would remove the sunset date for the Child Care Subsidy Pilot projects in San Mateo County and extend the sunset date in San Francisco City and County to July 1, 2016.

The Senate Education Committee passed AB 260 on June 19, and it goes next to the Senate Floor. 

SB 346 (Beall) – Support
As Amended on May 30, 2013

SB 346, by Assembly Member Jim Beall, would allow county social services and health departments within a county to share limited eligibility information. 

Senator Beall’s SB 346 will streamline the eligibility and enrollment process for public social services and health programs at the county level. By allowing county social services and health departments to share eligibility information, SB 346 will break down the eligibility siloes that may exist between health departments and social services departments in counties and encourage a “client centered” model of integrated services. Further, this measure will result in easier access to health care and social services for the most needy and vulnerable eligible residents in our communities. 

On the eve of the implementation of the Affordable Care Act, counties are seeking innovative processes and solutions to comply with the Act’s “no wrong door” approach for health care enrollment. We believe that SB 346 is a simple solution that will enable counties to improve service and access to health care services and other public social service programs. The measure is sponsored by Santa Clara County. 

The Assembly Human Services Committee passed SB 346 on June 20, and it goes next to the Assembly Floor. 

AB 419 (Lowenthal) – Support
As Introduced on February 15, 2013

AB 419, by Assembly Member Bonnie Lowenthal, will allow full CalWORKs basic needs assistance and services to continue for families whose child or children are hospitalized. 

Under current law, a child being treated in a public hospital is considered to be “temporarily absent” from the home for the first two months of his or her hospital stay. However, this designation does not apply to children who are treated in private hospitals, where they are instead deemed “temporarily absent” for their entire stay, regardless of length. While this situation does not happen often, it can be devastating for the families who lose a portion of their CalWORKs basic needs assistance and services while their child or children are hospitalized. Assembly Bill 419 would correct this small loophole.

AB 419 is sponsored by CSAC affiliate County Welfare Directors Association (CWDA) and was passed by the Senate Human Services

Committee on June 11. The Senate Appropriations Committee will hear AB 419 on June 24.