California’s legislative session came to a close in the early morning hours this week with hundreds of bills now awaiting action by Governor Gavin Newsom. The following provides an update on major bills of interest for the Health and Human Services policy area. CSAC staff will continue to monitor and advocate for County priorities during the signing period, which ends September 30, 2022.

Awaiting Governor’s Action:

AB 240 (Rodriguez) Local Health Department Workforce Assessment

This measure requires the Department of Public Health to conduct an evaluation of the adequacy of local health department infrastructure and to make recommendations for future staffing, funding, workforce needs, and resources, in order to accurately and adequately fund local public health. A broad county coalition including CSAC has supported the measure since its introduction last year.

AB 988 (Bauer-Kahan) Mental health: 988 Suicide and Crisis Lifeline 

This measure implements a statewide 9-8-8 suicide prevention and mental health crisis hotline as required by federal law. As recently amended, the bill requires the California Health and Human Services Agency to convene a state 988 advisory group consisting of various participants, including county representatives, to advise the Agency on a set of recommendations to support a five-year implementation plan for a comprehensive 988 system. Recent amendments also require health plans and insurers to cover medically necessary treatment, as specified, provided by call centers and mobile crisis teams.

To support ongoing costs, the measure establishes a new surcharge initially set at $0.08 per access line per month, and beginning January 1, 2025, at an amount specified by formula to be capped at $0.30 per access line per month. AB 988 was approved by the Legislature and moves to the Governor’s desk for consideration. CSAC will continue its advocacy for sufficient funding as the 988 system is developed and implemented, including adequate resources to operate mobile crisis teams and serve the expected influx of clients into the county specialty mental health system.

SB 1302 (Portantino) School-based Health Centers: Grant Program: Mental Health Services Act  

This measure appropriates $250 million from the Mental Health Services Fund to support school-based health centers through grants issued by the Superintendent of Public Instruction. Although the intent of establishing and improving the provision of behavioral health services to students at school-based health centers is meritorious, counties oppose any effort to redirect Mental Health Services Act (MHSA) funding to other services instead of the local services for which it was originally intended. As reported in a prior CSAC bulletin article, CSAC and county partners opposed the late August amendments to this measure. This measure was approved by the Legislature on August 30 and moves to the Governor’s desk for consideration.

SB 1338 (Umberg) Community Assistance, Recovery, and Empowerment Court Program

Sponsored by Governor Newsom, this measure which creates the new Community Assistance, Recovery, and Empowerment (CARE) Court process, received final approval by the Legislature on the last day of the legislative session and moves to the Governor’s desk for his signature. SB 1338 was amended on the Assembly Floor on August 25 to address various concerns raised by counties. Significant amendments sought and secured include:

• Contingent enactment: specifies the CARE Act to become operative only upon the Department of Health Care Services (DHCS), in consultation with county stakeholders, developing a CARE Act allocation to provide state financial assistance to counties to implement the CARE Court process.

• Phased implementation: specifies the following 7 counties in the first cohort to implement no later than October 1, 2023, unless the county is provided additional time:  Glenn, Orange, Riverside, San Diego, Stanislaus, Tuolumne, and City/County of San Francisco.

• Implementation delay: requires DHCS to issues guidelines under which counties may apply and be granted additional time to implement the CARE Court process:

  • Specifies DHCS shall approve implementation delay for counties in the first or second cohort if the county experiences a state or local emergency and the delay of provision of the CARE process is necessary as a result of the emergency.
  • Specifies DHCS will only grant delays once and no later than December 1, 2025.
• Sanctions/Fines: money from fines is to be allocated and distributed by DHCS back to the local government entity that paid the fines to serve individuals who have schizophrenia spectrum or other psychotic disorders and who are experiencing, or are at risk of, homelessness, criminal justice involvement, hospitalization, or conservatorship.

With regard to county funding concerns, AB 179, which amends the Budget Act of 2022, appropriates $57 million General Fund to DHCS for allocation to counties to support initial planning and implementation costs for the CARE Act, as follows:

• $31 million across all 58 counties to be used flexibly for planning, hiring, training, and information technology infrastructure costs.
• $26 million for the first cohort of counties implementing the CARE Act.
• The county allocation schedule is to be developed by DHCS in consultation with CSAC, and CSAC will consult with county partners.

CSAC looks forward to continuing discussions with the Administration and Legislature to develop and secure an ongoing fiscal investment for counties to support the successful implementation of the CARE Court process.

SB 1342 (Bates) – Aging multidisciplinary personnel teams

This bill would authorize counties and area agencies on aging to create aging multidisciplinary teams (MDTs) to allow for information sharing among entities providing services to older adults. Modeled off of the homelessness MDTs authorized by 2017 legislation, these aging services MDTs would improve service delivery, increase coordination, and support integrated case management. CSAC supports SB 1342, which is sponsored by Orange County.

Signed by the Governor:

SB 872 (Dodd) Pharmacies: Mobile units

This measure, co-sponsored by the Counties of Santa Clara and San Diego, and supported by CSAC, authorizes a county or a city and county to operate a licensed mobile unit to provide prescription medication to individuals within the county’s jurisdiction, subject to specified criteria. This bill was signed by Governor Newsom on August 29.

SB 928 (Wieckowski) Public Administrators: Compensation 

This CSAC-supported measure increases the minimum fee a county Public Administrator may charge for managing estates and making final arrangements for descendants without known or willing relatives. The minimum compensation threshold of $1,000, which was set nearly 20 years ago, will increase to $3,000 beginning on January 1, 2023. SB 928, while modest, will help Public Administrators recover some costs, where appropriate, associated with managing the estates and probate process for decedents.

Health and Human Services Budget Trailer Bills:

AB 179 (Ting) – Amendments to Budget Act of 2022 (Budget Bill Jr.) 

Public Health

Monkeypox (MPX) Funding

AB 179 includes a total of $41.5 million ($25.7 million for state operations and $15.8 million for local assistance) to the Department of Public Health (DPH) for purposes related to the MPX state of emergency proclaimed on August 1. Legislative intent language specifies that the Director of DPH consult with local health jurisdictions on how to most effectively distribute MPX vaccines, tests, outreach and education, and treatments, to communities most at risk, including marginalized and disadvantaged communities. The bill authorizes funding to be transferred up to specified amounts between state operations and local assistance needs at DPH’s request, subject to Department of Finance approval and Joint Legislative Budget Committee notification.

CARE Court

AB 179 appropriates $57 million General Fund to the Department of Health Care Services (DHCS) for allocation to counties to support initial planning and implementation costs for the CARE Act, as follows:

• $31 million across all 58 counties to be used flexibly for planning, hiring, training, and information technology infrastructure costs.
• $26 million for the first cohort of counties implementing the CARE Act.
• The county allocation schedule is to be developed by DHCS in consultation with CSAC, and CSAC will consult with county partners.

AB 179 reduces the $64.7 million in one-time funding initially provided in the Budget to state departments and the Judicial Council by a net $33.7 million to account for a phased implementation approach, with $31 million remaining for CARE Act implementation costs incurred by state departments and the courts, contingent on enactment of statutory changes codifying the program.

Healthcare Workforce

Clinic Workforce Stabilization Retention Payments

AB 179 includes $70 million to implement a clinic workforce stabilization retention payment program to provide funds to eligible qualified clinics, including but not limited to federally qualified health centers (FQHCs) and rural health clinics (RHCs), to provide retention payments to clinic employees. AB 204, the Health omnibus trailer bill, specifies retention payments of up to $1,000 per eligible clinic employee to support the public purposes of providing stability in the California qualified clinic workforce and retaining qualified health care workers. The retention payment program would only be implemented to the extent DHCS determines that federal financial participation under the Medi-Cal program is not jeopardized.

AB 207 (Committee on Budget) – Human services omnibus

This human services trailer bill contains several provisions significant to counties. First, this bill outlines the requirements of the $150 million for family finding, engagement, and support that was included in the 2022-23 budget to assist counties in identifying permanent connections for foster children and youth. The funding will be distributed through an allocation schedule and counties that elect to receive the funding will be required to provide a local match for 50% of the funding. Further, it specifies the type of services and supports that counties can provide with this funding. For the child support pass through, AB 207 includes statutory changes to implement a full pass through for formerly assisted families, a proposal that was included in the Governor’s January budget. It also outlines legislative intent to implement and provide a General Fund augmentation for a full pass through for currently assisted families starting January 1, 2025. Finally, this trailer bill contains a positive change related to the methodology for the state to fund the CalWORKs single allocation and CalFresh county administration. For each program, the state will be required to revisit the funding methodology every three years to account for the increased county costs to operate the programs.