Medicaid Section 1115 Waiver Update

The Department of Health Care Services (DHCS) convened its final Medicaid Section 1115 waiver workgroup meeting this week. The safety net financing workgroup met via webinar to discuss merging the Disproportionate Share Hospital (DSH) and Safety Net Care Pool funding into what DHCS is calling global budgets.

During the course of the meeting, DHCS shared additional information about the Medicaid Section 1115 waiver renewal process, including:

• DHCS is planning to host a webinar in mid-March detailing the waiver proposal that California will be submitting to the Centers for Medicare and Medicaid Services (CMS)
• There will be a brief public comment period after the webinar; stakeholders can submit comments to DHCS in writing
• DHCS is planning to submit the waiver proposal to CMS by March 31, 2015

In terms of the global budgets proposal, it remains an open question how the funding pool will be allocated among public hospitals and how the funding will change over time (as DSH funds decline). The global budgets proposal is for designated public hospitals. It is unclear when designated public hospitals could transition to global budgets, which will hinge on the outcome of negotiations between CMS and California. Note that DSH funding is not part of the current waiver. Global budgets, as conceived of by DHCS, would be worth approximately $1.35 billion in the first year of the waiver.

If you have questions about the 2015 1115 Waiver, please contact Kelly Brooks-Lindsey atkbl@hbeadvocacy.com.

Specialty Mental Health Services Waiver Renewal

This week the Department of Health Care Services (DHCS) hosted a webinar on California’s 1915(b) Specialty Mental Health Services Webinar. DHCS provided an overview of Medicaid Waivers available to states. A Section 1915(b) waiver is a ‘Freedom of Choice’ waiver which:

• Allows states to implement managed care delivery systems, or otherwise limit individuals’ choice of a provider;
• May not be used to expand eligibility to individuals not eligible under the approved Medicaid state plan; and
• Cannot negatively impact beneficiary access, quality of care of services, and must be cost effective.

While California’s current SMHS waiver expires in June 30, 2015, the Waiver Renewal Application must be submitted to the federal Centers for Medicare and Medicaid Services (CMS) by March 31, 2015. CMS has 90 days to approve, deny or request additional information from California.

California’s renewal application includes four sections:

• Section A: Program Description
• Section B: Monitoring Plan
• Section C: Monitoring Results
• Section D: Cost Effectiveness

Sections A and B have been released for stakeholder review and are linked above. DHCS is required to distribute all sections to stakeholders 10 days prior to submitting to CMS. Comments and questions regarding the Waiver Renewal Application can be directed to:DHCSMHSD@dhcs.ca.gov.

Future Stakeholder Meetings and Resources are posted to the website:http://www.dhcs.ca.gov/services/Pages/CalendarofEvents.aspx.

Speaker Atkins Announces Select Committees

Assembly Speaker Toni Atkins has appointed membership to Select Committees for the 2015-16 session, including:

• Foster Care
• Homelessness
• Infectious Diseases in High Risk Disadvantaged Communities
• Mental and Behavioral Health and Proposition 63 Implementation
• Workforce Development and Vocational Development

Select Committee membership can be found here.

Adult Protective Services

SB 196 (Hancock) – Support
As Introduced on February 10, 2015

Senate Bill 196, by Senator Hancock, would authorize a county adult protective services agency to file a petition for a protective order on behalf of an elder or dependent adult if the elder or dependent adult has been identified as lacking the capacity to do so and conservatorship is being sought. Current law authorizes the following persons to seek an order: a conservator or trustee, an attorney-in-fact, a person appointed as a guardian ad litem, or other person legally authorized to seek the order. SB 196 seeks to add a county adult protective services agency as an authorized entity.

SB 196 is sponsored by the County Welfare Director’s Association of California.

CalWORKs

SB 23 (Mitchell) – Pending
As Introduced on December 1, 2015

Senate Bill 23, by Senator Holly Mitchell, would repeal the exclusion of an additional child born into a family that has been on CalWORKs for ten consecutive months prior to the birth of the child, for purposes of determining a family’s maximum aid payment. It would also prohibit the conditioning of applicant or recipient’s eligibility for aid on their disclosure of information regarding rape, incest and contraception.

The County Welfare Director’s Association is a cosponsor of SB 23, and the measure will be heard by the Senate Human Services Committee on March 24.

Continuum of Care

AB 403 (Stone) – Pending 
As Introduced on February 19, 2015

AB 403, by Assembly Member Mark Stone, would express the intent of the Legislature to enact legislation that would reform the continuum of care for foster youth. This bill, sponsored by the Department of Social Services (CDSS), comes on the heels of the CDSS’ Continuum of Care Report released in January 2015.

SB 1013 (Chapter 35, Statutes of 2012) required stakeholders to examine all programs provided by Foster Family Agencies and group homes and to look beyond the continuum of care and placement settings to include the array of services and supports for children in these placements. CSAC is one of the stakeholders involved in these discussions, along with other county affiliates.

The CCR report is an important first step in the process of reforming the group home system to better meet the needs of foster youth. However, reform this large must be cautiously examined to ensure that successful and innovative county programs can continue to meet the regional needs of foster youth. CSAC will continue to work with the County Welfare Directors Association, the California Behavioral Health Directors Association, the Chief Probation Officers of California, individual counties and other stakeholders as these discussions evolve.

Foster Care

SB 238 (Mitchell) – Support 
As Introduced on February 17, 2015

SB 238, by Senator Mitchell, would state the intent of the Legislature to enact legislation that would improve the ability of the child welfare system to track and oversee the use of psychotropic medications for children in foster care. SB 238 would require:

• The Department of Social Services and the Department of Health Care Services to develop monthly data reports that match prescription and claims data with child welfare services records;
• The development of a system that triggers alerts to child welfare social workers and others serving the child such as attorneys and courts, when medications that could have dangerous interactions with psychotropic medications have been prescribed or when foster youth are prescribed unusual dosages;
• An update to the JV-220 court form to allow key stakeholders to provide information, feedback and details on the overall mental health and treatment plan for the child; and
• Training for child welfare social workers, foster children, caregivers and attorneys and Court-Appointed Special Advocates regarding psychotropic medications.

SB 238, sponsored by the County Welfare Directors Association of California (CWDA), will soon be amended to correct a drafting error regarding medical practitioners but has not yet been set for hearing.

AB 423 (Cooley) – Pending 
As Introduced on February 11, 2015

Assembly Bill 423, by Assembly Member Ken Cooley, would revise the provisions of the Approved Relative Caregiver Funding Option Program to authorize a relative caregiver to receive to receive payments on behalf of a child pursuant to the program, regardless of whether the child resides, or will be residing, outside of the state or participating county pursuant to their placement. In addition to establishing procedures for the distribution of payments to relative caregivers, AB 423 would also require that an infant supplement be paid under CalWORKs and the Approved Relative Caregiver Funding Option program for a teen parent who is placed with their child in the home of a relative caregiver. Additionally, this bill would require the county to evaluate and approve or deny the home for purposes of CalWORKs eligibility if the child is found to be ineligible for the Aid to Families with Dependent Children-Foster Care program and requires the county social worker to explain the eligibility requirements and benefit amounts for the aforementioned programs to the relative.

The Approved Relative Caregiver Funding Option Program is a county opt-in program that pays an approved relative caregiver a per child, per month rate equal to the base rate paid to foster care providers for a federally eligible AFDC-FC child. Currently to be eligible for the program, a child must meet all of the following criteria:

• The child must be a dependent or ward of the California juvenile court, or placed under a voluntary placement agreement;
• The child must reside in California and be placed with an approved relative caregiver; and
• The child must be ineligible for federally funded foster care benefits (AFDC-FC).

Relative Caregivers must reside in California and be approved by the county. This requirement hinders the ability to place a child with a relative that resides outside of California as the lack of additional resources may be a barrier. AB 423 seeks attempts to change the eligibility requirement that the child resides in California when placed.

Public Health

SB 203 (Monning) – Pending 
As Introduced on February 11, 2015

Senate Bill 203, as introduced by Senator William Monning, would establish the Sugar-Sweetened Beverages Safety Warning Act, which would require safety warnings on sugar sweetened beverages. It would require those who own, lease and control premises where a vending machine or beverage dispensing machine is located, or where sugar-sweetened beverages are sold in an unsealed container to place warnings in specified locations. Under current law, the Department of Public health may authorize the local health department of a city, county, city and county, or local health district to enforce these provisions.

CSAC is monitoring the bill for potential duties that may be imposed on counties as a result of the Act as well as from the county public health perspective.

Child Welfare

ACR 24 (Chu) – Support 
As Introduced on February 13, 2015

CSAC supports Assembly Concurrent Resolution 24 to acknowledge the month of April 2015 as Child Abuse Prevention Month, and encourage the people of the State of California to work together to support youth-serving child abuse prevention activities in their communities and schools.

Emergency Medical Services

ACR 10 (Rodriguez) – Support
As Introduced January 21, 2015

CSAC supports Assembly Concurrent Resolution 10 by Assembly Member Rodriguez to proclaim the week of May 14, 2015 to May 23, 2015, as Emergency Medical Services Week.