State Releases Financing Detail on Medicaid Section 1115 Waiver 

The Department of Health Care Services (DHCS) provided an overview of their financing proposal for the renewal of California’s “Bridge to Reform” Medicaid Section 1115 waiver on January 30. The current waiver has provided approximately $10 billion in federal funds over the five-year life of the waiver. The Brown Administration unveiled a $17 billion federal waiver renewal proposal last week.

DHCS is proposing to continue a number of elements from the current budget neutrality calculation into the 2015 waiver renewal, which assists in California’s case for $7 billion in additional federal funds.

Funding details include:

• Delivery System Reform Incentive Program (DSRIP) successor: $750 million in federal funds each year for five years ($3.75 billion total). The current waiver contains approximately $3.3 billion for DSRIP. DHCS is proposing to include non-designated hospitals, or district hospitals, in the DSRIP successor in the 2015 waiver. Currently DSRIP is available only to designated public hospitals.
• State designated health programs: $400 million in federal funds each year for five years ($2 billion total) for state designated health programs. The current waiver contains $2 billion for state designated health programs.
• Former Safety Net Care Pool (SNCP): $236 million each year in federal funds for five years to transform SNCP payments into global budgets ($1.18 billion total). The current waiver includes $236 million in SNCP funds in the final 16-months of the waiver.

Please note that the Administration is proposing to combine SNCP and Disproportionate Share Hospital (DSH) funds into global budgets as part of its safety net payment reforms. Currently DSH and SNCP are only available for designated public hospitals; the global budgets proposal funding source would only be available for designated public hospitals in the 2015 waiver. 

The current waiver does not include DSH payments in the budget neutrality calculation. The Administration is assuming that the federal DSH allotment that California would otherwise receive will be part of the global budgets. It is anticipated DSH payments will be approximately $1.1 billion in 2016. DSH payments will decline over the life of the waiver due to cuts slated to occur at the federal level. DSH payments are included in the 2015 waiver budget neutrality calculation on both the “without” and “with” waiver.

• Delivery system incentive payments: $2 billion each year for five years in federal funds ($10 billion total) for the delivery system changes under discussion in the various workgroups, including workforce, housing and supportive services, and plan/provider incentive payments. DHCS has no detail regarding how the $2 billion would be allocated across the various proposals that will be developed to address workforce, housing/supportive services, regional partnerships through managed care incentives and fee-for-service quality improvement initiatives. The $2 billion figure assumes that the federal government agrees to allow California to keep the state and federal shares of savings associated with the budget neutral calculation.

Vaccination Legislation on the Horizon

This week, Senators Richard Pan and Ben Allen announced they would soon introduce legislation to abolish the personal belief exemption for vaccinations. The legislation would also require parents to be notified of the vaccination rates in their schools. 

Senator Pan, a pediatrician, is no stranger to legislation related to vaccinations. In 2012, Senator Pan successfully authored AB 2109, which required parents to obtain a signed attestation from a health care practitioner indicating that the practitioner provided the parent or guardian information regarding the benefits and risk of immunization and the risks of specified communicable diseases. CSAC, along with the County Health Executives Association of California strongly supported AB 2109. Since the enactment of AB 2109, there has been a 20 percent decrease in unvaccinated kindergarteners. Senator Pan warned that opting not to vaccinate threatens the health of vulnerable Californians.

In-Home Supportive Services

AB 211 (Gomez) – Watch
As Introduced February 2, 2015

AB 211, by Assembly Member Jimmy Gomez, would de-link the transfer of collective bargaining for In-Home Supportive Services (IHSS) providers to the state from the Coordinated Care Initiative. The measure proposes a January 2016 start date for transferring collective bargaining from all counties to the state. 

Assembly Member Gomez introduced a similar bill, AB 485, in September 2013, which was opposed by the Brown Administration. In January 2014, the Senate Health Committee passed an amended version, which eventually was passed by the full Senate. However, the Assembly did not concur with the amendments and measure died during the legislative session. 

CSAC will closely monitor AB 211 and will provide updates as it moves through the legislative process. 

Mental Health

AB 193 (Maienschein) – Pending
As Introduced January 28, 2015

AB 193, as introduced by Assembly Member Brian Maienschein, would authorize the court, after a hearing attended by the proposed conservatee or the proposed conservatee’s counsel, or both, to recommend a conservatorship to the officer providing conservatorship investigation if the court in a conservatorship proceeding determines, based on the evidence presented to the court, including medical evidence, that a person for whom a conservatorship has been established may be gravely disabled as a result of a mental disorder or impairment by chronic alcoholism and is unwilling to accept, or is incapable of accepting, treatment voluntarily. 

This bill raises concerns for counties as it is similar to last session’s AB 1725, also by Assembly Member Brian Maienschein. AB 1725 would have allowed a Probate Court to make a recommendation of conservatorship to the county Conservatorship Officer (CO) and require the CO to conduct the investigation and file a report within 30 days of the probate court recommendation.

While the proposed language did not require the CO to recommend conservatorship to the Superior Court, it did compel the CO to conduct a conservatorship investigation. This was contrary to current law, whereby a CO retains the authority to determine whether an investigation is warranted upon receiving a referral by a medical professional.

Had the mandate in AB 1725 become law, counties anticipated a significant increase in workload and county costs for conservatorship investigations. Further, the measure would have also imposed an arbitrary and frankly unrealistic 30-day mandated timeline for the investigation and submission of a report to the Superior Court.

AB 1725 was held by the Senate Appropriations Committee and did not move forward in the last legislative session.

CSAC’s position is currently pending; however we anticipate participating in further discussions and tracking this bill closely.