May 11, 2018 Edition
This morning, Governor Jerry Brown released the 2018-19 May Revision which provides updated figures to the Governor’s January budget proposal. CHEAC details the key areas of interest to our members in our May Revision Budget Memo.
Additional links related to the May Revise and Budget process are available below:
Governor’s May Revision Summary
Proposed Trailer Bill Language
DHCS May Revision Highlights
The California Legislature today reached the deadline to hear and report all non-fiscal bills in their house of origin. As a result, a number of bills met their fate by either being advanced out of policy committees to the floor or not moving further in the legislative process. The Legislature will face another deadline in two weeks, for fiscal committees to hear and report all fiscal bills in their house of origin.
For a full update of action taken on bills this week, the latest version of the CHEAC Weekly Bill Chart is available here.
This week, Assembly Members Phil Ting (Chair of the Assembly Budget Committee), Arambula (Chair of Assembly Budget Sub 1) and Wood (Chair of Assembly Health Committee) announced a $1.044 billion package to fund significant improvements to California’s Health Care System. The measure was debated in Assembly Subcommittee No. 1 on Monday, where it was eventually passed. The two Republicans on the Subcommittee, voted ‘No’ or opted not to vote.
The package proposes investments in four key areas:
- $300 million – Provide enhanced premium assistance to low-income individuals and families with incomes between 200 – 400% of the FPL, enrolled in Covered California.
- $200 million – $250 million – Establish a refundable tax credit for people enrolling in the individual market, with income between 400 – 600% of FPL.
- $50 million – Extend Medi-Cal to undocumented adults between ages 19-25.
- $26 million – Streamline Medi-Cal eligibility to uninsured children and pregnant women who are enrolling in the Women, Infant and Children Nutrition Program.
- $30 million – Increase Medi-Cal eligibility for low-income seniors and disabled persons to 138% FPL.
- $24 million – Extend Transitional Medi-Cal from 6 months to 12 months.
Accountability and Transparency
- $50 million – Establish an all-payer payments database to obtain information on payments made for health care services, to promote greater transparency.
- $84 million – Expand Song Brown and other OSHPD healthcare workforce programs for multiple years.
- $30 million – Expand the UC Programs in Medical Education (PRIME) program over three years.
At Thursday’s hearing in Senate Budget Subcommittee No. 3, a panel of experts including representatives of the California Department of Public Health and Dr. Arnold Leff, Santa Cruz County Health Officer, discussed recent infectious disease outbreaks. Discussions ranged from the detailed plans and practices employed during an outbreak to the capacity at the state and local level.
Dr. Leff provided insights about the Hepatitis A outbreaks that reached Santa Cruz and touched on both collaboration with CDPH, in addition to their local needle exchange as key factors in stopping the outbreak. He further expressed the lack of surge capacity in the county needed to contain the outbreak much quicker.
Senator Monning asked whether California was closing the gap in the number of individuals that lack immunizations. Both Dr. Leff and Dr. Gil Chavez did indicate that the vaccination rate is increasing despite the encroachment of the number of medical exemptions without merit.
In Senator Pan inquired about infectious disease control funding and where any funding for surge capacity does and/or would come from. He noted the adverse impacts to the local health department that commenced during the recession years and acknowledged that many jurisdictions have not yet returned to pre-recession staffing levels. He urged the LAO, CDPH and locals to explore what the appropriate staffing level for local health departments would be to ensure California is adequately prepared to respond to outbreaks.
The item was for discussion only and no action was taken.
This week, the Trump Administration announced its plans to utilize a rare budgetary exercise to request a “rescission” – or claw-back – of $15 billion in federal funds, including those set aside for the Children’s Health Insurance Program (CHIP), Ebola response, and other health-related items. The Trump Administration rescission request targets federal funds appropriated but not expended and is the largest such rescission request by any U.S. President.
While the request proposes to claw-back $7 billion for CHIP, no impact to CHIP coverage is expected over the 2018-2028 period during which the program is authorized, according to the Congressional Budget Office (CBO). Of the $7 billion request, $5.1 billion in previously authorized funds would be rescinded; the expenditure authority period for the $5.1 billion to be sent to states expired on September 30, 2017. The remaining $1.9 billion that is proposed to be rescinded is a part of the Child Enrollment Contingency Fund, which is intended to be used only in the event of a budget shortfall. The Trump Administration argues that with the economy improving, demand for CHIP will decrease, rendering little need for such contingency fund.
Also included in the Trump Administration’s rescission request is a claw-back of $252 million in excess funds from the 2015 Ebola outbreak response and $800 million from the Centers for Medicare and Medicaid Innovation (CMMI) which is in excess of funds needed for FY 2018 and 2019.
Congress has 45 days to respond to President Trump’s request. The House and Senate must approve of the request by a majority vote in both chambers for the rescissions to take effect. The full rescission request from White House is available here.
The U.S. House of Representatives this week continued its discussion and markup of the Farm Bill Reauthorization (H.R. 2) with the measure set for a vote in the House next week.
Included in the measure are significant modifications for the Supplemental Nutrition Assistance Program (SNAP) and SNAP-Education (SNAP-Ed). The measure would propose to consolidate SNAP-Ed funding with the existing Expanded Food and Nutrition Education Program (EFNEP) and shift funding from state and local agencies to state land grant universities. In California, a large portion ofthe SNAP-Ed funding goes to the California Department of Public Health and in turn, down to local health departments. This arrangement, has allowed SNAP-Ed programming and activities to occur in virtually all jurisdictions throughout the state in thousands of community-based sites.
Other provisions included in the Farm Bill would likely adversely impact beneficiaries through work requirements and eligibility modifications. The measure would require all able-bodied adults between 18 and 59 years old to work or be enrolled in a job training program for at least 20 hours per week to remain eligible for benefits. Beneficiaries that are elderly, disabled, or pregnant would be exempt from these requirements.
CHEAC this week joined CSAC and CWDA in a letter to House leaders expressing opposition to provisions related to SNAP included in the Farm Bill. The measure is likely to garner significant attention as it is considered in the House next week, and it remains to be seen what action Congress will ultimately take on the matter.
On Monday, a federal rule requiring calorie and nutrition information to be posted on menus of certain establishments throughout the United States took effect. The Food and Drug Administration (FDA) regulation applies to chain restaurants and similar retail food establishments with 20 or more locations that sell prepared food items, including grocery stores and movie theaters. Businesses are also required to provide, upon request, written nutrition information for standard menu items and post statements about daily calorie intake.
The menu labeling rule was initially promulgated through the Affordable Care Act (ACA) passed by Congress in 2010, and has long been a point of contention among the food and restaurant industry. After eight years and several delays, consumers will now have access to nutrition information for all menu items in certain restaurants throughout the country. Additional information, including a statement from FDA Commissioner Scott Gottlieb, is available here.
Also this week, the FDA announced it was delaying the compliance deadline for food manufacturers to update nutrition facts labeling and serving sizes on food packaging. According to FDA Commissioner Gottlieb, manufacturers need additional time to implement the nutrition facts labeling changes. As such, the FDA pushed back the deadline 18 months, requiring manufacturers with annual food sales in excess of $10 million to be in compliance by January 1, 2020, and manufacturers with annual food sales less than $10 million to be in compliance with January 1, 2021.
Recall, in May 2016 under the Obama Administration, the FDA announced the new requirements for nutrition fact labeling to reflect new scientific information, including the link between diet and chronic disease conditions such as obesity and heart disease. Nutrition fact label requirements have not been updated in over 20 years, and the new label will require larger, bolder font detailing serving sizes and calories, updated daily values, a field for added sugars, and a change in listed nutrients. These changes are intended to more closely reflect the amount of food a person actually eats. Additional information on the updated required nutrition facts labeling is available here.
The California Department of Public Health (CDPH) will hold a Cannabis Initiative Local Partners Webinar next Thursday, May 17 from 9:30 am to 10:30 am. The webinar will feature a presentation from the City of Pasadena Public Health Department, as well as a local campaign update from the Los Angeles County Public Health Department. The webinar will be available here.
The Department of Health Care Services (DHCS) will be holding an overview webinar on the California Children’s Services (CCS) Whole Child Model (WCM) on Friday, May 18 from 1:00 pm to 2:30 pm. The webinar is intended for youth, parents, caregivers, and interested stakeholders and will detail the new approach to care for children and youth with special health care needs under WCM.
Recall, the passage of SB 586 in 2016, created the WCM which shifted the care coordination and service authorization for CCS beneficiaries to the health plans in County Organized Health System counties. Phase 1 of the WCM will be implemented in six counties on July 1, 2018, and WCM Phase 2 in 15 counties on January 1, 2019.
Advanced registration for Friday’s webinar is required and is available here. Additional information, including a flyer, is available here.