Earlier this week, the Legislature passed a budget trailer bill
that included a solution for the reversion of unused Prevention
and Early Intervention and Innovation funds under the Mental
Health Services Act (MHSA, or Proposition 63 of 2004). It will
now move to the Governor’s desk for his signature or veto.
CSAC, along with the County Welfare Directors Association, Urban
Counties of California, and Rural County Representatives of
California, recently moved to an oppose position on AB 85
(Rodriguez). This bill would require counties to alter their
locally-established General Assistance (GA) or General Relief
(GR) eligibility levels to provide additional county-funded
assistance to veterans.
The second round of Whole Person Care Pilot Projects was just
announced by the Centers for Medicare and Medicaid Services. The
goal of the Whole Person Care Pilots is to expand efforts to
provide comprehensive health care to medically-complex patients.
Of the 15 pilots approved in the second round, eight of the
pilots build upon previously-approved pilots.
Grants of up to $350,000, for as long as three years, are available from the Office of Minority Health at the US Department of Health and Human Services. The grants, available through the Empowered Communities for a Healthier Nation Initiative, are aimed at reducing the impact of significant health disparities among racial and ethnic minorities and/or disadvantaged populations by implementing evidence-based strategies.
As both houses prepare to vote on the final 2017-18 Budget Act, there are a number of HHS-related items that will be included. Please refer to the forthcoming CSAC Budget Action Bulletin for more detail on the following:
California’s counties continue to communicate significant
concerns with current efforts underway in the U.S. Senate to
repeal the fiscal underpinnings of the Affordable Care Act (ACA)
and impose a new cap on federal Medicaid spending. Senate
leadership has indicated that they hope to vote on the new plan,
which builds off of the lower house’s American Health Care Act,
the week of June 26. However, work on the proposal continues in
secret and it is unclear whether counties will have a chance to
weigh in before the vote.
The AB 85 (Chapter 24, Statutes of 2013) estimates for
redirecting 1991 Realignment health subaccount funding released
in the May Revision contained an error in the calculation for
County Medical Services Program (CMSP) redirections.
CSAC has joined a chorus of counties and county human services
departments to support funding for local California Work
Opportunity and responsibility to Kids Act (CalWORKs) activities,
called the county CalWORKs Single Allocation.
The CSAC Health and Human Services Policy Committee met this week
to discuss a number of important issues. The In-Home Supportive
Services cost shift and the recently-announced plan to spare
counties from the worst of those costs for two years was on top
of the agenda. CSAC led a coalition of County affiliates and
partners to negotiate an alternative solution that would reduce
the impact to counties and allow for long-term stability to
County budgets and to IHSS and other programs funded by the 1991
Realignment.
The Department of Housing and Community Development has
approximately $6.2 million in funding available for technical
assistance grants to help counties develop and implement the No
Place Like Home program. The program provides loans and
grants to counties investing in permanent supportive housing for
people who need mental health services and are currently
homelessness, are chronically homelessness, or are at risk of
chronic homelessness.
Up to $47.5 million over five years in Grants for the Benefit of
Homeless Individuals is now available through the Substance Abuse
and Mental Health Services Administration (SAMHSA). SAMHSA
expects to fund up to 23 grantees for up to $400,000 per year for
up to five years. Applications from domestic public and private
nonprofit entities are due on April 25.
State Controller Betty Yee recently issued a letter to California
counties and cities urging compliance with the recent Uniform
Grants Guidance from the federal Office of Budget and Management.
The Controller’s letter discusses that these new rules were
designed to “simplify and improve relations between government
and nonprofit organizations.” This includes counties paying a
minimum overhead rate of 10% to non-profits for any program with
federal funding attached to it.
A joint informational hearing was held by the Assembly Health
Committee and Senate Health Committee on Tuesday to receive an
update on the status of the implementation of the Federal
Medicaid Managed Care Rule in California. The committees received
an update on the rule from the Department of Health Care Services
and its impact on consumers.
As the Legislature begins discussing the Governor’s proposed
2017-18 budget, a top issue is the unwinding of the Coordinated
Care Initiative (CCI) and the In-Home Supportive Services (IHSS)
Maintenance of Effort (MOE).
Several county affiliate organizations presented a webinar
yesterday to present a detailed overview of how 1991 Realignment
works, the impact of eliminating the Coordinated Care Initiative
on 1991 Realignment, and the potential impacts on counties.
Organized and developed by the County Health Executives
Association of California (CHEAC), the California Behavioral
Health Directors Association (CBHDA), the County Welfare
Directors Association (CWDA), the webinar drew mora than 400
participants.
Governor Jerry Brown has appointed several new people to
serve on the No Place Like Home Technical Committee,
including Sacramento County Supervisor Patrick Kennedy, Yuba
County Administrator Robert Bendorf, and San Diego County
Director of Behavioral Health Alfredo Aguirre. The other new
members include:
County staff are invited to join a webinar on February 22 from
3-5 p.m. to learn about the substantial 1991 Realignment impacts
that would be triggered by the Governor’s proposal to dismantle
the Coordinated Care Initiative and shift additional In-Home
Supportive Services costs to counties. Get more information about
this issue on our website. And
information and registration for the webinar is available
here.
While little data is available regarding the co-occurrence of
opioid addiction and serious mental illness among adults, a new
report by the federal Substance Abuse and Mental Health Services
Administration (SAMHSA) helps provide more insight into the
issue. According to the report, approximately 1.5 million adult
Americans who live with a serious mental illness in the past year
also misused an opioid during that period.
County department directors and fiscal managers are invited to
join a webinar on February 22 from 3-5 p.m. to help build their
understanding of the substantial 1991 Realignment impacts that
would be triggered by the Governor’s proposal to dismantle the
Coordinated Care Initiative and shift additional In-Home
Supportive Services costs to counties. Additional information and
registration is available here.
Some new analysis of the Governor’s plan to shift costs for
In-Home Supportive Services (IHSS) back to Counties shows the
impact is larger and grows faster than originally thought.
Counties stand to lose $625 million in the first fiscal year, and
the total cumulative cost is more than $7 billion by the 2022-23
fiscal year. Tables showing the increased costs are available at this link.
The Kresge Foundation’s Emerging Leaders in Public Health Program
is seeking applications from teams of local public health
leaders. Each team selected will receive leadership coaching and
developing, as well as a grant up to $125,000 to implement a
concept designed to deliver a new model of public health in its
community. Applications are due on February 20, and can be found
here, along with additional
information on the program.
This Friday the Department of Health Care Services will be
hosting a webinar for new entities interested in participating in
the second round of the Whole Person Care Pilots. Registration
information for the webinar, which will cover the application,
budget, and program requirements, is available
here.
The CSAC Health and Human Services (HHS) Policy Committee will
meet January 25 to continue a discussion on Platform
Updates. CSAC staff will also provide an update on the state
budget and the Affordable Care Act.
The Department of Housing and Community Development (HCD)
released a Draft
Framing Paper for the No Place Like Home Program in December,
and will accept public comments on it until January 31.
Along with the Draft Framing Paper, HCD has been hosting a
series of workshops to discuss the No Place Like Home
Program.
A series of deadlines are looming for counties that choose to
participate in the Medi-Cal County Inmate Program (MCIP). The
MCIP is voluntary, but counties that do not participate in MCIP
remain responsible for arranging for and paying for medical care
for its inmates. Counties that do choose to participate can be
reimbursed for a significant portion of those costs, but they
must enter into an agreement with the Department of Health Care
Services (DHCS).
The UC Berkeley Labor Center has released two briefs that help
illuminate the impact of the Affordable Care Act (ACA) on
California and its counties. The first brief examines the
data on Medi-Cal enrollment through the ACA, as well as how many
Californians receive subsidized health care coverage through
Covered California. The brief includes a county-by-county
breakdown of both populations, as well as the number of uninsured
residents by county.
The Health and Human Services Policy Committee started an ongoing
discussion on developing the 2017 HHS Platform updates and
priorities at its November 29 meeting in Palm Springs. The policy
committee’s work is complicated by the change in federal
administration and the uncertain future of health care funding.
Inaugural Meeting of No Place Like Home Technical Committee
Tomorrow
The first meeting of the CSAC, CBHDA, UCC, and RCRC Joint No
Place Like Home (NPLH) Technical Committee will take place
tomorrow. The NPLH Technical Committee is composed of interested
county persons to assist in the implementation of the new No
Place Like Home Program.
The Department of Health Care Services has released a list of
background documents on the controversial Final Rule on
Managed Care approved earlier this year by the Centers for
Medicare and Medicaid Services (CMS).
The 2016-17 Budget Act included nearly $180 million for
repayments to counties for fiscal year 2013-14 AB 85
redirections, but the actual amount repaid to counties is
$164,612,348.98 due to a calculation error. These repayments to
counties were made pursuant to AB 85, which requires the state to
“true up” redirections from each formula county’s 1991 Health
Subaccount to actual data. The State Controller’s Office sent
lump-sum payments to the following counties in early
October:
AB 85 2013-14 True-Up Payments to Counties (October 2016)
SB 815 (Hernandez) Medi-Cal: demonstration project: Support –
Signed. Implements the PRIME and Global Payment Program portions
of California’s new Medicaid Section 1115 “Medi-Cal 2020” Waiver.
The new waiver – approved on December 30, 2015 – builds on the
successes California has achieved in expanding coverage,
transforming care, and improving health outcomes.
The deadline for the Governor to sign or veto bills was September
30. A large number of HHS-related bills were signed into law or
vetoed, and a couple bills CSAC supported that the Governor
signed are described below:
The Department of Health Care Services (DHCS) is proposing to
amend the Medi-Cal 2020 waiver Special Terms and Conditions to
try to implement the Health Homes Program in the Medi-Cal managed
care delivery system.
Under the Affordable Care Act, the Medicaid Health Home State
Plan option is afforded to states to encourage the creation of
health homes that can better coordinate a full range of physical
health, behavioral health, and community-based long-term services
and supports for patients with chronic conditions.
