May 17, 2019 Edition

Budget Subcommittees Hear May Revision Issues, Senate Sub. No. 3 Closes out Open Items

With 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.

The 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.

Members 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 future.  

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.

Senate Sub. No. 3 Actions:

  • Approved $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.
  • Approve $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 language.
  • Approve $105 million ($52.5m Prop. 56 and $52.5 FF) for adverse childhood experiences and developmental screenings.
  • Approve $50 million ($25m Prop.56 and $25m FF) for provider trainings on delivering trauma screenings.
  • Approve $500 million ($50m Prop. 56 and $450m FF) and placeholder trailer bill language for family planning services.
  • Approve $240 million ($120m Prop. 56 and 120m FF) for the physician and dentist loan repayment program.
  • Approve $33 million ($11.3m Prop. 56 and $22.1m FF) for restoration of optician and optical lab services authorized in the 2017 Budget Act.
  • Reject 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.

While 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.

Senate Sub. No. 3 Actions:

  • Approve $100m GF as budgeted to WPC pilots.
  • Approve $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.

The 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.

Senate Sub. No. 3 Actions:

  • Approve $4 million GF for state operations.
  • Approve $36 million GF for local assistance for grants to local health jurisdictions and tribal communities.
  • Approve 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.

The 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 applied.

Senate Sub 3 ActionsNo 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.

Senate Sub. No. 3 Actions:

  • Approved $23 million GF for CHVP and $7.5 million GF for BIH as requested.
  • Maintain state operations funding at $2 million for CHVP and $500,000 for BIH.
  • Redirect additional Federal Fund reimbursements of $22.9 million CHVP and $12 million BIH to local assistance.
  • Adopt placeholder budget bill language to allow BIH expenditures to be used by local health jurisdictions for programs implemented under the California Perinatal Equity Initiative.

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.

Senate Sub. No. 3 Actions:

  • Approve May Revision adjustments to the IHSS maintenance-of-effort (MOE).
  • Adopt 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.

Additional Resources

Over 1,000 Bills Considered During Appropriations Suspense File Hearings

Yesterday, both 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.

Looking ahead, 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.

Below, we highlight Suspense File results of particular interest to CHEAC Members. This latest edition of the CHEAC Weekly Bill Chart is available here.

Access to Health Services

AB 1494 (Aguiar-Curry) –SUPPORT – Do Pass as Amended

Requires 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.

SB 66 (Atkins) – SUPPORT – Do Pass

Authorizes 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 Promotion

AB 388 (Limón) –SUPPORT – Do Pass as Amended

Requires CDPH 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.

SB 347 (Monning) – SUPPORT – Do Pass as Amended

Requires health warning labels on sugar-sweetened beverage (SSB) containers, vending and dispensing machines, and point of purchase for any unsealed SSB.

Communicable Disease Control

SB 276 (Pan) – SUPPORT – Do Pass as Amended

Requires 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

AB 316 (Ramos) ­– SUPPORT – Held on Suspense  

Requires DHCS to implement a special needs treatment and management benefit for Medi-Cal dental program beneficiaries with special dental needs.

Drug & Alcohol Services

AB 1031 (Nazarian) –SUPPORT – Do Pass as Amended

Requires DHCS to establish regulations regarding community-based nonresidential and residential treatment and recovery programs for youth under 21 years of age.

SB 445 (Portantino) –SUPPORT – Do Pass

Requires DHCS to convene an expert panel and adopt regulations for youth SUD treatment, early intervention, and prevention quality standards.

Emergency Medical Services (EMS)

AB 1544 (Gipson) – OPPOSE UNLESS AMENDED – Do Pass as Amended

Allows LEMSAs 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.

Environmental Health

AB 1500 (Carrillo) – SUPPORT – Do Pass

Authorizes LHO 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

AB 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.

AB 50 (Kalra) –SUPPORT – Do Pass

Requires DHCS to submit to CMS an amendment request to expand slots for the Assisted Living Waiver (ALW) program.

AB 414 (Bonta) – SUPPORT – Do Pass as Amended

Institutes a 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 California.

SB 175 (Pan) –SUPPORT – Do Pass

Institutes a 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 coverage.

AB 537 (Wood) –SUPPORT – Held on Suspense

Requires DHCS 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.

AB 1004 (McCarty) –SUPPORT – Do Pass

Requires screening services under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program to include developmental screenings for individuals zero to three years of age.

AB 1088 (Wood) –SUPPORT – Do Pass

Extends 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.

SB 207 (Hurtado) – SUPPORT – Do Pass

Requires asthma preventive services to be included as a Medi-Cal covered benefit.

Jail and Community Corrections Services

SB 433 (Monning) – SUPPORT IN CONCEPT – Held on Suspense

Requires CDSS 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 department.

Maternal, Child, & Adolescent Health Services (MCAH)

AB 577 (Eggman) –SUPPORT – Do Pass as Amended

Allows an 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.

SB 464 (Mitchell) –SUPPORT – Do Pass

Requires 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.

Tobacco Control

AB 1718 (Levine) andSB 8 (Glazer) –SUPPORT – Do Pass

Both measures ban smoking and disposal of cigar/cigarette waste at all state coastal beaches or in state parks.

SB 38 (Hill) –SUPPORT – Do Pass as Amended

Prohibits tobacco retailer from selling or offering to sell any flavored tobacco product.

Vector Control

AB 320 (Quirk) –SUPPORT – Do Pass as Amended

Establishes the 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 Embarks on Statewide Health Care Tour, Announces Additional County Participation in Prescription Drug Single-Purchaser System

Governor Gavin 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.

In San 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.

Press releases from the Governor’s Office are available here: California For All Health Care Tour and Prescription Drug Single-Payer Purchasing System

Next Week’s CDPH Oral Health Webinar to Focus on Community Health Improvement Plan Development

The California 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 here.