Budget Committees Package Budget Proposals, Conference Committee to Begin Next Week
This week featured a series of budget actions as the Legislature works to meet the June 15 constitutional deadline to pass the budget.
Assembly Budget Subcommittee No. 1 convened on Tuesday to close out all remaining items. Acting Chair Eloise Gómez Reyes thanked all members and staff for their work throughout the spring and reiterated her appreciation for the plethora of proposals from members and stakeholders. Reyes indicated the subcommittee put forth the “best possible budget within its means” and one that prioritized the access to services and care needed by all Californians.
Of note, the subcommittee approved the Governor’s May Revision proposal for $40 million for local health departments and tribal communities for infectious disease prevention, testing, and treatment services. This action conforms with the Senate action taken last week and is not expected to be a conference item. Another health item of interest that conform with the Senate action include $500 million ($50m in Proposition 56 funds and $450m in federal funds) for Medi-Cal family planning services.
The Senate Budget & Fiscal Review Committee convened on Wednesday to hear subcommittee report-outs and an overview of the full Senate budget plan.
Among the items considered by the full Senate Budget & Fiscal Review Committee was the Governor’s May Revision proposal to institute a state-level individual health insurance coverage mandate and provide advanced premium affordability subsidies for health coverage. Recall, Subcommittee No. 3 previously augmented the Administration’s proposal for premium assistance by $300 million each year. Ultimately, the Senate Budget & Fiscal Review Committee voted to modify and adopt placeholder trailer bill language to:
- Allow premium subsidies for individuals below 200 percent FPL and eliminate set percentage allocations of subsidies to each income group
- Eliminate redetermination of program design based on availability of mandate penalty revenue
- Provide that the individual mandate penalty is only applicable in coverage years in which the state or federal government provides premium assistance or other subsidies at or exceeding a specified threshold
- Exempt consumers from reconciliation of premium subsidy amounts if the amount of reconciliation is less than a specified threshold
- Exempt individuals eligible for Medi-Cal from the individual mandate penalty
- Require the Franchise Tax Board to annually report statistics on individuals required to pay the individual mandate penalty
- Sunset the exemption from the Administrative Procedures Act in three years
- Eliminate exemptions for mandate penalty for health care sharing ministries
Today, the Assembly Budget Committee convened to hear subcommittee report-outs and adopt the Assembly’s version of the 2019-20 Budget.
With both the Assembly and Senate setting forth their respective budget plans, the Budget Conference Committee will begin its work to reconcile the differences between the two houses. Budget conference committee members have been announced and include:
| Senate | Assembly |
| Senator Holly Mitchell (D-Los Angeles), Chair | Assembly Member Phil Ting (D- San Francisco) |
| Senator John M.W. Moorlach (R-Costa Mesa) | Assembly Member Chad Mayes (R-Yucca Valley) |
| Senator Jim Nielsen (R-Tehama) | Assembly Member Kevin McCarty (D-Sacramento) |
| Senator Richard Roth (D-Riverside) | Asesmbly Member Jay Obernolte (R-Big Bear Lake) |
| Senator Nancy Skinner (D-Berkeley) | Assembly Member Shirley Weber (D-San Diego) |
The conference committee will face a series of high-profile proposed investments and issues, including the renewal of the managed care organization (MCO) tax, the state-level individual mandate, and advanced premium assistance subsidies.
Below, we detail a number of potential health- and public health-related items that may be heard by the conference committee.
| Issue | Proposal | Senate Action | Assembly Action |
| Sexually Transmitted Diseases (STDs) | Governor: $2m GF ongoing to LHDs Stakeholder: $20m GF ongoing to CBOs and LHDs | Approved Governor’s proposal and increased amount to $20m GF ongoing to LHDs and placeholder TBL to strengthen statutory guidance to CDPH | Approved Governor’s proposal of $2m GF ongoing and approved a separate action to provide an additional $10m GF ongoing to LHDs and CBOs |
| HIV Prevention | Stakeholder: $20m GF ongoing to LHDs and CBOs | Approved $20m ongoing for grants to LHDs and CBOs | Approved $10m GF ongoing and placeholder TBL |
| Hepatitis C Prevention | Stakeholder: $20m GF ongoing for innovative HCV prevention | No action | Approved $10m GF ongoing and placeholder TBL |
| California Home Visiting Program (CHVP) | Governor: $23m GF ongoing and $22.9m federal Title XIX matching funds | Approved GF expenditures, maintained state operations allocation of $2m, redirected GF expenditures offset by federal matching funds to additional local assistance | Approved as budgeted |
| Black Infant Health (BIH) Program | Governor: $7.5m GF ongoing and $12m federal Title XIX matching funds | Approved GF expenditures, maintained state operations allocation of $500k, adopted placeholder BBL to direct CDPH to allow BIH expenditures to be utilized by LHDs for PEI programs | Approved as budgeted |
| Alzheimer’s Disease | Stakeholder: $10m GF one-time for statewide public awareness campaign and pilot program to implement CDC Healthy Brain Initiative activities in eight counties | Approved as proposed | Approved $15m GF one-time and placeholder TBL to implement components of CDC Healthy Brain Initiative ($10m) and to fund respite care for people with Alzheimer’s and other related dementias through the CA Care Corps ($5m) |
| Medi-Cal Expansion to Undocumented Adults | Governor: Expand full-scope Medi-Cal coverage to undocumented young adults between 19-25 | Approved $98m and placeholder TBL for Medi-Cal expansion to undocumented adults 19-25, $62.5m and placeholder TBL for expansion to undocumented adults 65 and over, and placeholder TBL to increase Medi-Cal eligibility to undocumented individuals one year every fiscal year beginning with age 26 in 2020-21 | Approved as budgeted |
| Medi-Cal Optional Benefits | Governor: $11.3m Prop. 56 to restore optician and optical services for adult Medi-Cal beneficiaries Stakeholder: Various proposals to restore all benefits eliminated during Great Recession | Approved $21.1m and placeholder TBL to restore audiology, incontinence creams/washes, podiatry, and speech therapy | Approved $18m GF in BY to restore all optional benefits (including optical) beginning January 2020 and $42.2m GF ongoing |
| ACEs Screening Training | Governor: $60m one-time for healthcare provider trainings on conducting ACEs screenings | Approved $50m one-time | Approved as budgeted |
| Whole Person Care (WPC) Housing Services | Governor: $100m GF one-time to WPC Pilots and $20m MHSA funds one-time to non-WPC counties | Approved as budgeted | Approved $100m GF one-time for WPC Pilots and placeholder TBL requiring DHCS to work with counties on allocation methodology, target funds, and ensure flexibility; approved $20m GF one-time (in place of MHSA funds) for non-WPC counties |
| Office of Healthy and Safe Communities | Stakeholder: $6m GF one-time to establish Office under direction of Surgeon General to develop strategy and implementation plan on violence prevention | No action | Approved as proposed |
| MCO Tax Renewal | Governor: No proposal to renew MCO tax | Approved GF offset of $1.373b in 2019-20 and $1.831b in 2020-21 and 2021-22; approved placeholder TBL to extend MCO tax | Approved GF offset of $858m in 2019-20 and $1.844b in 2020-21 through 2022-23; approved placeholder TBL to extend MCO tax |