May 17, 2019 Edition
the release of Governor Newsom’s May Revision, budget subcommittees
have been working in earnest throughout the week to hear all May Revision
proposals. While the Senate Budget and Fiscal Review Subcommittees completed
their work by voting on all remaining open items this week, the Assembly Budget
Subcommittees are set to do so early next week. In the coming days and weeks,
the budget committees of both houses will be provided a report of subcommittee
actions, adopt their preliminary version of the budget, and convene a
Conference Committee (still to be named) to reconcile differences between the
houses. As a reminder, the constitutional deadline for the Legislature to pass
the budget is June 15.
Full Scope Medi-Cal Coverage for Undocumented Young Adults. The Administration presented their proposal to delay the expansion of full-scope Medi-Cal to undocumented young adults ages 19-25 for six months to allow time for implementation. The Legislature and advocates expressed concern that the Administration’s proposal does not expand coverage to a broader population of undocumented adults.
AB 85 Redirection. The Department of Finance (DOF), noting the concerns shared by the four non-CMSP/non-formula counties (Sacramento, Santa Barbara, Stanislaus, and Placer), discussed the Governor’s action to rescind the January proposal to increase the redirection from 60 percent of 1991 health realignment to 75 percent. In addition, DOF noted that the May Revision proposes to treat Yolo as a CMSP county for purposes of AB 85 moving forward. Lastly, DOF shared the May Revision proposal to withhold realignment revenues from the CMSP Board until the Board’s reserves equals two years of operating expenses and then redirect 75 percent from the Board thereafter.
LAO indicated that the priority to forego increasing the additional redirection
for non-formula/non-CMSP counties and to withhold realignment revenues from the
CMSP Board are reasonable policy choices. Further, the LAO indicated that the
Legislature could delay specifying the percentage to be redirected for AB 85
purposes in the future as they predict it would take several years for the Board
to spend down the reserve.
of the Assembly expressed considerable concern with the high reserve level of
the Board. However, members of the Assembly and Senate also underscored the
need to ensure the viability of the CMSP Board to provide services in the
Senate Sub. No. 3 Actions:
- Approve expenditure authority of $98 million ($74.3m GF and $23.3m FF) and placeholder trailer bill language to expand full-scope Medi-Cal coverage to undocumented young adults age 19 to 25, effective January 1, 2020.
- Approve additional expenditure authority of $62.5 million ($49.6m GF and $12.8m FF) and placeholder trailer bill language to expand full-scope Medi-Cal coverage to undocumented seniors age 65 and over, effective January 1, 2020.
- Adopt placeholder trailer bill language to increase eligibility for full-scope Medi-Cal for undocumented individuals one year every fiscal year, beginning with expansion to individuals age 26 in 2020-21.
- Adopt placeholder trailer bill language to approve the Administration’s updated May Revision trailer bill proposal for redirection of county realignment funding.
- Approve as budgeted two positions to support implementation.
Proposition 56 – Tobacco Tax Initiative. The May Revision provides an additional $263 million in Proposition 56 revenues due to a one-time fund reconciliation and makes investments in loan repayments for physicians and dentists, value-based payment program for behavioral health integration, provider training for trauma screenings for adult and children, and restoration of the optician and optical laboratory services benefit for Medi-Cal adult beneficiaries. These investments are in addition to the January investments which included Medi-Cal supplemental payments and rate increases for health care providers, care facilities and specified health services, funding for the Oral Health Program, family planning services, and funding for adverse childhood experiences and developmental screenings. Legislators and advocates expressed considerable concern with the Administration’s intent to sunset these investments in December 2021 and reiterated the voter intent of Proposition 56 funding.
Sub. No. 3 Actions:
$2.1 billion ($712.5m Prop. 56 and $1.4b FF) in FY 2018-19 and $2.2 billion
($769.5m Prop. 56 and $1.4b FF) for supplemental provider payments in Medi-Cal
and adopt placeholder budget bill language requiring DHCS to seek a three-year
state plan amendment for supplemental provider payments in Medi-Cal fee-for-service
and managed care.
$544.2 million ($250m Prop. 56 and $294.2 FF) for the implementation of the
Value-Based Payments program and adopt placeholder implementing trailer bill
$105 million ($52.5m Prop. 56 and $52.5 FF) for adverse childhood experiences
and developmental screenings.
$50 million ($25m Prop.56 and $25m FF) for provider trainings on delivering
$500 million ($50m Prop. 56 and $450m FF) and placeholder trailer bill language
for family planning services.
$240 million ($120m Prop. 56 and 120m FF) for the physician and dentist loan
$33 million ($11.3m Prop. 56 and $22.1m FF) for restoration of optician and
optical lab services authorized in the 2017 Budget Act.
the Administration’s proposed sunset of Prop. 56 DHCS investments.
Whole Person Care (WPC) Expansion. The Department of Health Care Services provided overviews of the additional $20 million included in the May Revision to expand WPC to new counties. The May Revision maintained the $100 million investment into WPC for supportive housing services.
CHEAC and our county affiliates are supportive increased funding for WPC to
support both current and new programs, we did raise concerns regarding the
potential differences between allowable target populations, the inability to
use funding on tenancy-based services and lack of consultation in the
allocation methodology. DHCS expressed concern that current pilots are not
maximizing tenancy-based services that are currently allowable under the Waiver.
Sub. No. 3 Actions:
$100m GF as budgeted to WPC pilots.
$20m MHSA (state administration) as budgeted for new WPC counties.
Infectious Disease Control. The California Department of Public Health briefly described the Governor’s May Revision proposal to provide $40 million to local health departments and tribal communities for infectious disease prevention, testing, and treatment. The proposal would allocate $8 million to state operations for four positions and contracts for expert support and $32 million for local assistance.
LAO raised questions about the high share of state operations funding, whether
funds would be provided in a one-time grant or on an annual basis over four
years, and how CDPH would coordinate with tribal communities. The Department of
Finance indicated the disbursement of funding would be determined by CDPH in
consultation with stakeholders. Legislators expressed further concerns with the
large share of state operations funding and the need to ensure the effective
use of this funding.
Sub. No. 3 Actions:
$4 million GF for state operations.
$36 million GF for local assistance for grants to local health jurisdictions
and tribal communities.
placeholder budget bill language to require CDPH to provide grants in a lump
sum available for four years, create an allocation methodology in consultation
with local health jurisdictions and allocate $1 million of the $36 million
local assistance grant funding to tribal communities.
Proposition 64 – Cannabis Surveillance and Education. CDPH presented their May Revision proposal to dedicate $12 million in Proposition 64 funding for cannabis surveillance and education. The Administration seeks to build a robust real-time data system that would inform their education and prevention strategies.
LAO inquired about whether the data system would include other substances
beyond cannabis. In both the Senate and Assembly, legislators were interested
in the data sets to be collected and education and messaging of CDPH to be
Sub 3 Actions – No action required.
California Home Visiting Program (CHVP) and Black Infant Health (BIH). In Senate Subcommittee No. 3, CDPH briefly presented their May Revision proposal to further maximize the General Fund investments included in the January budget proposal through the drawing down of federal funding.
Sub. No. 3 Actions:
$23 million GF for CHVP and $7.5 million GF for BIH as requested.
state operations funding at $2 million for CHVP and $500,000 for BIH.
additional Federal Fund reimbursements of $22.9 million CHVP and $12 million
BIH to local assistance.
placeholder budget bill language to allow BIH expenditures to be used by local
health jurisdictions for programs implemented under the California Perinatal
In-Home Supportive Services. The Administration briefly presented their May Revision proposal related to IHSS, which remains the same proposal from January (including eliminating the diversion of health and mental health growth beginning in FY 2019-20) with updated caseload, realignment projections, and cost estimates. As a result, the Administration is requesting an additional $55 million.
Sub. No. 3 Actions:
May Revision adjustments to the IHSS maintenance-of-effort (MOE).
placeholder trailer bill language to reduce the IHSS MOE inflation factor to four
percent only when a collective bargaining agreement is in place with wages
above the state minimum wage.
the Senate and Assembly Appropriations Committees held Suspense File hearings
ahead of today’s deadline for fiscal committees to hear and report bills in
their house of origin. In hearings each lasting just over one hour,
Appropriations Committees advanced or shelved over 1,000 bills. As a result of
the hearings, over 700 bills remain in play this year where they will be
further debated and acted upon by the Legislature.
the next several weeks in the Legislature will be heavily budget focused as committees
work to finalize items considered throughout the spring, as well as proposals
included in the Governor’s May Revision. The Legislature will soon enter a
floor only session for the last week of May, at which point all bills must be
advanced out of their house of origin.
highlight Suspense File results of particular interest to CHEAC Members. This
latest edition of the CHEAC Weekly Bill Chart is available
Access to Health Services
1494 (Aguiar-Curry) –SUPPORT – Do Pass as Amended
Medi-Cal reimbursement for telehealth, telephonic, of off-site services when
delivered by specified clinic or provider during or within 90 days after
expiration of a state of emergency.
66 (Atkins) – SUPPORT – Do Pass
Medi-Cal reimbursement for a maximum of two visits on the same day at a single
FQHC/RHC location if: 1) after first visit, patient suffers illness/injury
requiring additional diagnosis/treatment; or 2) patient has a medical visit and
a mental health or dental visit.
Chronic Disease Prevention and Wellness
388 (Limón) –SUPPORT – Do Pass as Amended
to implement action agenda items from CDC Healthy Brain Initiative, conduct
statewide Alzheimer’s disease and related dementia public awareness campaign,
and award one-time competitive grants to up to eight counties for local
planning and preparation activities.
347 (Monning) – SUPPORT – Do Pass
warning labels on sugar-sweetened beverage (SSB) containers, vending and
dispensing machines, and point of purchase for any unsealed SSB.
Communicable Disease Control
276 (Pan) – SUPPORT – Do Pass
physicians/surgeons to utilize a CDPH-developed statewide standardized request
form for immunization medical exemptions. Specifies only medical exemption
request forms shall be approved or denied by the state public health officer of
designee. Requires CDPH to create and maintain a medical exemption request
database and make available the database to local health officers. Authorizes
state public health officer or local public health officer to revoke medical
exemption under specified circumstances.
Dental Health Services
316 (Ramos) – SUPPORT – Held on
to implement a special needs treatment and management benefit for Medi-Cal dental
program beneficiaries with special dental needs.
Drug & Alcohol Services
1031 (Nazarian) –SUPPORT – Do Pass as Amended
to establish regulations regarding community-based nonresidential and
residential treatment and recovery programs for youth under 21 years of age.
445 (Portantino) –SUPPORT – Do Pass
to convene an expert panel and adopt regulations for youth SUD treatment, early
intervention, and prevention quality standards.
Emergency Medical Services (EMS)
1544 (Gipson) – OPPOSE UNLESS AMENDED – Do Pass as Amended
to develop local community paramedicine programs for specified services and
alternate transport of patients to behavioral health facilities and sobering
centers. Requires LEMSAs, if the county elects to establish a paramedicine or
alternate transport program, to use or establish a local emergency medical care
committee (EMCC). Establishes the Community Paramedicine Medical Oversight Committee
to advise EMSA. Requires LEMSA to provide right of first refusal to every
public agency located within its jurisdiction to provide community paramedicine
program specialties prior to offering private EMS providers. Adds two members
to the Commission on Emergency Medical Services.
1500 (Carrillo) – SUPPORT – Do Pass
to issue order to responsible part of hazardous waste release to suspend or
discontinue operations, conduct specified environmental testing, and/or assist
exposed individuals. Expands UPA authority to suspend, revoke, or withhold
unified program facility permit under specified circumstances.
Health Coverage/Health Care Reform
4 (Bonta) andSB
29 (Durazo) –SUPPORT – Do Pass as Amended
Both measures expand
Medi-Cal to all undocumented adults with income at or below 138 percent FPL.
50 (Kalra) –SUPPORT – Do Pass
to submit to CMS an amendment request to expand slots for the Assisted Living
Waiver (ALW) program.
414 (Bonta) – SUPPORT – Do Pass
state-level individual health insurance coverage mandate. Requires Covered
California to determine a financial penalty for not obtaining health insurance
and directs penalty revenues to improve affordability of health coverage in
175 (Pan) –SUPPORT – Do Pass
state-level individual health insurance coverage mandate. Requires Franchise
Tax Board to determine a financial penalty for not obtaining health insurance
and expands purposes of penalty revenues to be available for Covered California
operational costs of administering the individual mandate and financial
assistance program. Requires Covered California to conduct annual outreach and
enrollment efforts among individuals who do not maintain minimum essential
537 (Wood) –SUPPORT – Held on Suspense
to establish a quality assessment and performance improvement program for all
Medi-Cal managed care plans. Requires plans to meet minimum performance levels
to improve quality and reduce health disparities. Requires DHCS to develop a
plan for value-based financial incentive program.
1004 (McCarty) –SUPPORT – Do Pass
services under the Early and Periodic Screening, Diagnosis, and Treatment
(EPSDT) Program to include developmental screenings for individuals zero to
three years of age.
1088 (Wood) –SUPPORT – Do Pass
eligibility without a share of cost for individuals who would otherwise be
eligible if not for a state buy-in of their Medicare Part B premiums.
207 (Hurtado) – SUPPORT – Do Pass
preventive services to be included as a Medi-Cal covered benefit.
Jail and Community Corrections Services
433 (Monning) – SUPPORT IN CONCEPT – Held
to establish and oversee the Office of Youth Development and Diversion (OYDD)
Grant Program, consisting of up to five three-year pilot programs to be
administered by a county health department or county health services
Maternal, Child, & Adolescent Health
577 (Eggman) –SUPPORT – Do Pass as Amended
individual to stay on Medi-Cal for up to one year following the last day of
pregnancy if diagnosed with an eligible maternal mental health condition.
464 (Mitchell) –SUPPORT – Do Pass
specified health facilities providing perinatal care to implement an evidence-based
implicit bias program for all healthcare providers in perinatal care. Requires
hospitals to provide information on filing a discrimination complaint. Requires
modifications to death certificates. Requires CDPH to track and publish
specified maternal morbidity and mortality data.
1718 (Levine) andSB
8 (Glazer) –SUPPORT – Do Pass
ban smoking and disposal of cigar/cigarette waste at all state coastal beaches
or in state parks.
38 (Hill) –SUPPORT – Do Pass as Amended
tobacco retailer from selling or offering to sell any flavored tobacco product.
320 (Quirk) –SUPPORT – Do Pass as Amended
California Mosquito Surveillance and Research Program and requires the
development of an interactive website for the management and dissemination of
mosquito-borne virus and surveillance control data.
Newsom this week embarked on a statewide “California for All” Health Care Tour
to highlight his Administration’s “major, first-in-the nation” proposals to
improve health care affordability, lower prescription drug costs, and move
California closer to the goal of health care for all. Governor Newsom’s proposals
include expanding full-scope Medi-Cal coverage to all undocumented young adults
ages 19-25, expanding financial assistance to individuals to purchase health
insurance in the private market and providing monthly discounts to middle-income
families purchasing insurance, creating a single-purchaser system for
prescription drugs, working with Congress to secure a federal waiver to move
closer to a single-payer health system, and making additional investments in reproductive
and sexual healthcare.
One week after
releasing his May Revision, Governor Newsom began his tour in Sacramento at a
Covered California location, hosting a roundtable with individuals who would
receive financial assistance to help afford health coverage. Other stops throughout
the state to highlight his Administration’s proposals included events in Los
Angeles, San Diego, and San Francisco.
Francisco, Governor Newsom was joined by San Francisco Mayor London Breed and
officials from Alameda and Santa Clara counties to announce that the three Bay
Area counties would be joining the state’s prescription drug single-purchaser
system. Recall, last month, Los Angeles County joined the state’s efforts. The
Newsom Administration contends that by establishing the statewide purchasing program,
more California residents and private employers would be able to bargain with
prescription drug companies in negotiating drug prices.
from the Governor’s Office are available here: California
For All Health Care Tour and Prescription
Drug Single-Payer Purchasing System
Department of Public Health (CDPH) Office of Oral Health (OOH) will host a
webinar on Wednesday, May 22 from 2:30 pm to 3:30 pm, featuring the work of the
San Francisco Department of Public Health (SFDPH) in developing a community
health improvement plan. Representatives from the San Francisco Local Oral
Health Program, CavityFree San Francisco, and the University of California, San
Francisco (UCSF) School of Dentistry will discuss their kindergarten dental
screening program, community health assessment process, and the development of
the San Francisco Children’s Oral Health Strategic Plan. Registration for the
webinar is available