State Seeks Two-Month Extension on Waiver Negotiations

The state Department of Health Care Services has asked the Centers for Medicare and Medicaid Services (CMS) for a two-month extension of the existing hospital financing waiver as negotiations on a new five-year waiver continue. 

The state had hoped to wrap up negotiations on a new waiver by August 31, but has not been able to pin down major pieces of the proposal with CMS. There is speculation that most of the sticking points revolve around the financing portion of the waiver, including hospital financing and the total amount of federal funding available to the state. 

If CMS grants the extension, then the state and hospitals can continue to operate under the funding scheme in the current waiver. The two pieces of legislation related to the waiver (SB 208 [Steinberg] and AB 342 [Pérez]) are also on the inactive files in the Legislature, and it is unclear what will happen to them once the Legislative session ends on August 31. The Legislature must implement the waiver agreement, so options past August 31 include doing it in a special session (which is likely to be called for the overdue state budget), or attaching it to a budget agreement. 

The CSAC Health and Human Services met yesterday to hear the latest waiver update and will meet again on September 23. 

Foster Youth 

AB 12 (Beall and Bass) – Support
As Amended on August 20, 2010

AB 12, by Assembly Members Jim Beall and Karen Bass, is a 200-page bill that would allow the state to draw down federal funding for the Kin-GAP program and expand foster youth services up to age 21. 

AB 12 (Beall/Bass) would extend foster care, guardianship, and adoption assistance to age 21, at the option of the youth – they could still choose to go on their own, but could come back if they later decided they wanted to participate. In order to participate they would have to be working, in school or job training, or have a mental or physical disability that prevented them from doing so. 

The bill has a second major component in addition to the expansion to 21. The same federal legislation that allows states to extend care to 21 also allows them to draw down federal funds for children placed in guardianships with relatives, such as a grandma or aunt. California’s program, called Kin-GAP, has more than 16,000 children in it today at state and county cost (50 percent state, 50 percent county). AB 12 will allow the state to refinance the care for the vast majority of these children with 50 cents on the dollar from the federal government, resulting in estimated savings of more than $40 million (combined state/county) to the program. The bill would take effect January 1, 2012, and be phased in over a three-year period, so full implementation would occur in 2015-16. 

The authors have accepted recent amendments to address cost concerns, including language in which counties will share in the cost of the expansion only up to the amount of savings each county realizes from refinancing the kin guardian program. So, for example, if there turns out to be $10 million in county Kin-GAP savings statewide, counties would offset the $45 million estimated cost of the expansion portion by that amount, and the state general fund would end up picking up the other $35 million. Furthermore, negotiated amendments ensure that the costs and savings would be calculated on a county-by-county basis. This is to ensure that no county will be required to put in more than its share of the Kin-GAP savings toward the expansion costs than the savings that are actually realized by the county. 

Counties may also realize savings outside of the above structure. One example would be for youth where a judge has continued dependency past 18, which before AB 12, meant the county would pay for 100 percent of the costs unless the youth met some strict federal definitions. For some counties with high numbers of these cases, the savings could be significant. This also is outside of the other, out-year savings as costs in other systems borne by counties – justice and human services for the most part – will drop as these youth are supported up-front and helped to find employment, training and education.

CSAC, along with some of the larger counties and a wide coalition of child welfare advocates, supports the bill. At the time of this writing, it was on the Senate third reading file. 

AB 973 (A. Strickland) – Support
As Enrolled on August 24, 2010

AB 973, a bill by Assembly Member Audra Strickland, would make it easier for prospective adoptive parents to take temporary custody of a drug-exposed baby, thus keeping that child out of the foster care system. 

AB 973 would allow prospective adoptive parents or a licensed adoption agency to take temporary custody of a child if several conditions are met, including the provision of a written form that states the child is the subject of a proposed adoption and that includes a listing of contact information for both the adoptive and birth parents, if known.

Adoptive parents must also provide this form to the county child welfare agency within five days of taking temporary custody of the child, after which either the county child welfare agency or law enforcement must complete an investigation regarding the health and safety of the child. 

Furthermore, AB 973 builds upon two previous measures by Assembly Member Jay La Suer (AB 2279 – Chapter 920, Statutes of 2002 and AB 962 — Chapter 568, Statutes of 2003) to help prevent situations in which babies who are born with drug exposure are automatically referred to the child protective system if they are the subject of a legitimate adoption petition. Assembly Member Strickland’s measure seeks to further clarify the responsibilities of adoptive parents, licensed adoption agencies, county child welfare agencies, and law enforcement when these situations arise. 

CSAC supports the measure, which was passed by the Assembly on August 19 and enrolled on August 24, now awaits the Governor’s signature. 

AB 1758 (Ammiano) – Support
Enrolled on August 23, 2010

AB 1758, a bill by Assembly Member tom Ammiano, would eliminate the pilot status of the existing wraparound and adoption services program already operating in the great majority of counties. 

The wraparound services pilot program, created in 1997, currently operates in 40 counties. It seeks to maintain seriously emotionally disturbed children safely in their own homes rather than placing them in expensive residential treatment facilities. The program provides the necessary services and assistance to help parents for children with mental health issues and provide treatment services to the children.

Counties support the continuation of wraparound services as a voluntary and ongoing program rather than as a pilot project. The wraparound model has repeatedly been shown to be successful and cost effective. Counties would also like to thank Assembly Member Tom Ammiano, who worked hard to ensure continuation of Medi-Cal eligibility as outlined in current law for these children, which is a key component to the wraparound model. 

AB 1758 was passed by the Senate and enrolled on August 23. It now awaits the Governor’s signature. 

AB 1905 (Cook) – Support
Enrolled on August 23, 2010

AB 1905, a bill by Assembly Member Paul Cook, would ensure the continuity of federal funding to relative foster homes by simplifying the state’s reassessment regulations. 

AB 1905 would address a significant problem that results in federal and state funding being lost. Currently, a restrictive state regulation requires an annual reassessment of relative homes in which foster children have been placed. State law differs in the annual renewal requirement for relative caregiver and foster homes: Currently, once a foster family home has been licensed, the funding remains in place. This is not so for relative caregiver placements, where state law requires a halt to Title IV-E funding in the form of CalWORKs aid until an assessment is completed.

In today’s fiscal climate, where counties and the state are straining to meet restrictive and expensive regulatory requirements while struggling to keep up with increasing workloads, it is no surprise that many of these relative caregiver homes are losing their state and federal benefits due to tardy reassessments. The loss of these benefits ultimately harms the foster children in these homes and may even cause a disruption in placement. 

It should be noted that the current state regulations exceed the federal Adoptions and Safe Families Act. Nothing in federal law prohibits continued payment to a foster care provider once they are initially licensed or approved by the state to provide care. Furthermore, the state’s reassessment requirement often causes additional state and county costs as DSS struggles to reconcile federal and state payments in the event that payments to these homes have been made in error under state law. Counties must also process the application renewals, stop and start payments, issue Notices of Action and attempt to collect overpayments, all of which exacerbate the lack of administrative funding under which all counties must currently operate. 

In short, counties support AB 1905 as an economical way to streamline the continuation of critical funding for foster children residing with relative caregivers, and will also help to conserve scarce state and county dollars and staff time. Recent amendments to the bill do still require an assessment not later than every 24 months, which conforms to the sponsor’s goals of efficiency and quality placements for foster youth. 

The measure was passed by the Assembly and enrolled on August 23, and now awaits the Governor’s signature. 

AB 2698 (Block) – Support 
Enrolled on August 23, 2010

AB 2698, by Assembly Member Marty Block, would provide assistance to foster youth who may have been victims of identity theft.

Specifically, AB 2698 would permit foster youth who may have been victims of identity theft to be referred to a government or nonprofit organization that provides information and assistance to victims of identity theft. Current law says the youth would be referred to “an approved counseling organization.”

The bill was passed by the Assembly on August 23 and enrolled. It now awaits the Governor’s signature. 


SB 179 (G. Runner) — Support
Chaptered on July 9, 2010, Chapter 66, Statutes of 2010

SB 179, by Senator George Runners, streamlines the appeals process for termination of parental rights (TPR) in child welfare services cases. 

SB 179 makes three modifications to the appeal process to terminate parental rights due to child abuse or neglect. The bill will shorten timeframes and is designed to reduce stress for families and improve permanency outcomes for children. 

SB 179 will reduce the time period for a birth parent to file a notice of appeal from 60 to 30 days. This will expedite decision-making while still preserving the birth parents’ rights to due process and minimize delayed adoptive placements. Many adoptive parents choose not to proceed with adoptive placement until after the appeal period has expired. 

Currently, notices of TPR orders and appeal rights must be delivered via certified mail to the birth parents. SB 179 would instead allow notices of the TPR order to be personally served to parents in court. 

Finally, this legislation would allow any TPR order to automatically finalize after 180 days have elapsed, avoiding indefinite appeal timeframes and reducing stress on prospective adoptive parents. 

SB 179 will reduce appellate delay and minimize stress and anxiety for families during the appeal process. At the same time, this bill will enhance timely permanency for adopted children and may result in better outcomes for children and families. It was signed into law by Governor Schwarzenegger on July 9, 2010. 

SB 654 (Leno) – Support
As Enrolled on August 23, 2010

SB 654, by Senator Mark Leno, would enable foster youth placed with non-related legal guardians to receive critical independent living services to help them more successfully transition to adulthood.

SB 654 would allow youth living with non-related guardians approved by the dependency court to participate in ILP. This bill will not only help these youth learn valuable skills and maintain positive relationships, it will also save the state money by allowing more youth in stable living situations to exit foster care to guardianship. Surveys by the County Welfare Directors Association and the Children’s Law Center of Los Angeles indicate that hundreds of youth across the state are remaining in the juvenile dependency system, at a greater cost to the state, counties, and the court system, just to maintain eligibility for ILP.

SB 654 recognizes that it is better for these youth to exit the dependency system to stable homes with guardians, and doing so will also benefit the state and counties, attorneys, and the dependency courts. For these reasons, CSAC supports SB 654, which was passed by the Senate on August 23 and enrolled. It now goes to the Governor’s desk. 

Public Health

AB 223 (Ma) – Support
As Enrolled on August 26, 2010

AB 223, a bill by Assembly Member Fiona Ma, would establish clear standards for the tattoo, piercing and permanent cosmetics industry in California.

AB 223 establishes a clear scope of local authority, clear requirements for registration of body art practitioners and consistent enforcement of mobile and fixed body art sites. The bill also protects consumers through informed consent requirements and promotes the public’s health through strong provisions requiring body art practitioners, as a provision of registration, to complete courses on the transmission of blood borne pathogens and first aid.

This measure is needed because counties cannot currently regulate the body art industry in any way, even when responding to complaints. Furthermore, by requiring practitioners to follow clear standards and guidelines, AB 223 will serve a clear public health purpose. 

AB 223 was passed by the Senate and enrolled on August 26, and now goes to the Governor’s desk. 

Mental Health 

AB 1600 (Beall) – Support
Enrolled on August 26, 2010

AB 1600, by Assembly Member Beall, would require Knox-Keene licensed health plans to expand mental health coverage to include the diagnosis and treatment of any mental health condition or disorder as defined in the Diagnostic and Statistical Manual IV (DSM-IV) (or subsequent editions), including substance abuse conditions. 

AB 1600 builds upon the original California mental health parity legislation, AB 88 (Thomson, Chapter 534, Statutes of 1999), which requires health plans to provide coverage for the diagnosis and medically necessary treatment of severe mental illnesses of a person of any age, and serious emotional disturbances of children, under the same terms and conditions applied to other medical conditions.

AB 1600 would help ensure that private health plans treat individuals with mental health, substance abuse, or co-occurring disorders in a comprehensive and meaningful way. CSAC supports the bill, which was passed by the Senate and enrolled on August 26. The measure now awaits the Governor’s signature. 

AB 2645 (Chesbro) — Support
Enrolled on August 19, 2010

AB 2645, by Assembly Member Wesley Chesbro, would conform the reimbursement rates for services in Institutions for Mental Disease (IMDs) to the nursing home rates that were frozen in the Budget Act of 2009. The bill, if enacted, will not impact the state’s General Fund, and would only enact the rate freeze until 2012. 

IMDs are skilled nursing facilities with 16 or more beds that provide 24-hour care to individuals who need continuous nursing care, and are primarily engaged in diagnosing, treating, and/or caring for individuals with severe mental illnesses. 

All IMD costs are paid by counties, including the current mandatory 4.7 percent annual rate increase. Under current law, counties must use Realignment funds, which have significantly declined over the past few years, for the increased annual cost of services provided in IMDs, leaving less funding available for other types of community-based care. AB 2645 will freeze IMD rates at their current levels to bring them in line with the Legislature’s budget action last year to freeze the rates for other types of licensed facilities. 

The mandatory 4.7 percent annual IMD rate increase is unsustainable for counties, and is diverting as much as $2.5 million per year in Los Angeles County, half a million dollars in Riverside County, and over $200,000 in Sacramento County from other less restrictive, community-based levels of care. During difficult fiscal times for counties, AB 2645 will remove only the mandatory cost of living increase that is enjoyed only by IMDs until 2012, and not any other part of the public mental health system. 

The bill was passed by the Assembly on August 19 and enrolled. It now awaits the Governor’s signature. 

SB 1392 (Steinberg) – Support
As Amended on August 18, 2010

SB 1392, by Senate Pro Tempore Darrell Steinberg, would expedite the flow of mental health funds to counties. 

It was amended on August 18 with language that clarifies that the California Department of Mental Health (DMH) is authorized to distribute the full state appropriation for the Medi-Cal Specialty Mental Health Managed Care program to counties upon the adoption of a state budget. 

The bill also would streamline the distribution process for state-approved Mental Health Services Act (MHSA) funds to counties.

CSAC supports the measure, which is sponsored by the County Mental Health Directors Association. It was passed unanimously by the Senate Health Committee on August 26 and now goes to the Senate floor. 

Integrated Service Delivery

AB 2039 (Logue) – Support
Vetoed on August 18, 2010

AB 2039, a bill by Assembly Member Dan Logue, would have allowed Placer County to continue to operate an integrated, coordinated, and seamless approach to health and human services delivery in the County. 

Sponsored by the Placer County Board of Supervisors, AB 2039 would have repealed the sunset date (July 1, 2011) and pilot status of the County’s innovative Health and Human Services blended services pilot program. Operated in conjunction with the State, Placer County’s Integrated Health and Human Services Program serves as a model of family centered and needs-based delivery of services to children and families by providing blended education, mental health, probation, and child welfare services in a seamless team approach. The program also allows the county to consolidate 14 public health programs into a single claiming process with the California Department of Public Health, allowing for a more efficient delivery of public health services throughout the County. 

This innovative approach has significantly improved the efficiency and outcomes for Placer County families. According to the County, since 2005, the integrated approach has resulted in a 20 percent reduction in the number of children entering foster care and helped more than 100 children in the child welfare services system find stable loving homes with adoptive parents. 

AB 2039 would have allowed this nationally recognized and proven approach to health and human services claiming and service delivery in Placer County to continue to operate indefinitely. However, the Governor vetoed the measure on August 18 over concerns about allowing the program to operate indefinitely without “some ability to periodically evaluate its usefulness and effectiveness.” The Assembly has placed the bill on its unfinished business file, and it is possible that members will vote again on the measure to override the Governor’s veto. A two-thirds vote in both houses is required to override a gubernatorial veto. 

Elder Abuse

AB 2435 (B. Lowenthal) – Support
Enrolled on August 23, 2010

AB 2435, a bill by Assembly Member Bonnie Lowenthal, would encourage the Board of Psychology and Board of Behavioral Sciences to include coursework on elder and dependent adult abuse assessment and reporting. 

Both boards are responsible for certifying psychologists, professional clinical counselors, clinical social workers, and marriage and family therapists. As such, the boards set the required coursework for licensure for each profession. Currently, those seeking to enter the above professions must complete coursework on child abuse assessment and reporting, and AB 2435 would simply add elder and dependent abuse assessment and reporting to the required coursework. 

Counties believe that Assembly Member Lowenthal’s AB 2435 will help detect and even prevent elder and dependent adult abuse. The bill was passed by the Assembly on August 23 and enrolled. It now awaits the Governor’s signature. 

Emergency Medical Services

AB 2456 (Torrico) – Oppose
As Enrolled on August 25, 2010

AB 2456, by Assembly Member Alberto Torrico, would allow the director of the Emergency Medical Services Authority (EMSA) to overturn or abrogate any local EMS policies and procedures. Furthermore, AB 2456 will result in increases to fees charged to EMT and paramedic applicants to offset state costs imposed with the implementation of this bill.

Counties continue to oppose the bill despite several rounds of amendments, including August 4 language that will greatly expand the prior scope of the bill and create a major shift of power from local Emergency Medical Services Agencies (LEMSAs) to the director of EMSA allowing him or her to overturn years of local EMS Agency policy development carried out at the direction of Boards of Supervisors and developed with the concurrence of county counsel, county medical societies, hospital administrators and other EMS system stakeholders. 

Counties are also concerned about the unfunded mandates that will likely result from AB 2456. The bill shifts the state’s administrative costs to local EMT certifying authorities (including county EMS agencies) as well as giving EMSA the authority to assess penalties on LEMSAs. Such costs will be borne by local government and local EMS providers in a climate of unprecedented economic uncertainty. 

For these reasons, CSAC and many individual counties opposed the measure. Despite this, the Assembly passed AB 2456 on August 26 and it is now headed to the Governor’s desk. We urge counties to submit letters in opposition to this measure to the Governor as soon as possible. 

Health Insurance

SB 1088 (Price) – Support
As Enrolled on August 25, 2010

SB 1088, by Senator Curren Price, would assist California in conforming to newly enacted federal law that requires insurers to cover dependent children up to age 26. 

SB 1088 would require certain health care service plan contracts and health insurance policies to conform with Public Law 111-148, the federal Patient Protection and Affordable Care Act, requires all insurers to offer dependent care coverage up to the age of 26. Senator Price’s bill would conform California law to this requirement by formally defining a depended as a child of the named insured up to 26 years of age. 

By raising the dependent age, SB 1088 will assist many young adults in obtaining health insurance through their parents. It will also immediately decrease the ranks of uninsured Californians, and it is for these reasons that CSAC supports SB 1088. The bill was passed by the Senate and enrolled on August 25, 2010. It now goes to the Governor’s desk. 

Medi-Cal

SB 1091 (Hancock) – Support
As Enrolled on August 26, 2010

SB 1091, by Senator Loni Hancock, would allow counties to draw down federal funding to help defray the cost of providing medical care to juveniles awaiting adjudication in county facilities. 

SB 1091 allows counties who wish to do so to use the county share of spending that is already expended for juvenile medical care as match for federal Medicaid matching funds for those youths who are Medi-Cal eligible. The measure also limits the Medi-Cal services to the first 30 days of a youth’s stay in juvenile hall. 

Senator Hancock has also amended the bill on the advice of the Department of Health Care Services, but it is not clear whether the Department will support the bill at it moves forward. 

Counties believe that the prospect of drawing down available federal Medicaid funding for youths awaiting adjudication in a county facility is a worthy goal. Some counties estimate that SB 1091 would help them recover up to 40 percent of their medical costs for individuals in juvenile hall. 

The Senate passed the bill on August 26 and it was enrolled the same day. SB 1091 now goes to the Governor’s desk. 

Children’s Health Insurance

SB 1431 (Simitian) – Support
Enrolled on August 18, 2010

SB 1431, by Senator Joe Simitian, would allow counties to draw down available federal funds for children’s health insurance. 

SB 1431 builds upon AB 495 (Chapter Number 648, Statutes of 2001), which established a mechanism for California counties to voluntarily put up the non-federal share of funding in order to draw down federal funding through the Children’s Health Insurance Program (CHIP). Counties that elect to do so are able to attract federal matching dollars for children’s health coverage and build upon the foundation of the state’s Healthy Families Program. However, the state’s dire fiscal situation may result in reductions to the Healthy Families Program, which serves more than 1 million children in California by offering low-cost health insurance. If this happens, SB 1431 would allow counties to also draw down federal CHIP funding for children’s health insurance, helping to stem the predicted tide of thousands of California children without health care. 

Additionally, SB 1431 will allow counties to draw down new federal CHIP Reauthorization Act (CHIPRA) funding upon gaining federal approval through the Managed Risk Medical Insurance Board (MRMIB). Enacted in 2009, the federal government raised the eligibility level to households with incomes up to 400 percent of the Federal Poverty Level (FPL). SB 1431 would allow counties to draw down some of the new funding for families between 300 percent and 400 percent of the FPL at the state’s Medicaid matching rate.

In short, SB 1431 will enable qualified counties to draw down much-needed federal funding for children’s health care. The bill was passed by the Senate on August 18 and now goes to the Governor’s desk.