May 24, 2019 Edition

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:

Senator Holly Mitchell (D-Los Angeles), ChairAssembly 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.

IssueProposalSenate ActionAssembly 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 CDPHApproved Governor’s proposal of $2m GF ongoing and approved a separate action to provide an additional $10m GF ongoing to LHDs and CBOs
HIV PreventionStakeholder: $20m GF ongoing to LHDs and CBOs Approved $20m ongoing for grants to LHDs and CBOsApproved $10m GF ongoing and placeholder TBL
Hepatitis C PreventionStakeholder: $20m GF ongoing for innovative HCV preventionNo actionApproved $10m GF ongoing and placeholder TBL
California Home Visiting Program (CHVP)Governor: $23m GF ongoing and $22.9m federal Title XIX matching fundsApproved GF expenditures, maintained state operations allocation of $2m, redirected GF expenditures offset by federal matching funds to additional local assistanceApproved as budgeted
Black Infant Health (BIH) ProgramGovernor: $7.5m GF ongoing and $12m federal Title XIX matching fundsApproved 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 programsApproved as budgeted
Alzheimer’s DiseaseStakeholder: $10m GF one-time for statewide public awareness campaign and pilot program to implement CDC Healthy Brain Initiative activities in eight countiesApproved as proposedApproved $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 AdultsGovernor: Expand full-scope Medi-Cal coverage to undocumented young adults between 19-25Approved $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 2020-21Approved as budgeted
Medi-Cal Optional BenefitsGovernor: $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 therapyApproved $18m GF in BY to restore all optional benefits (including optical) beginning January 2020 and $42.2m GF ongoing
ACEs Screening TrainingGovernor: $60m one-time for healthcare provider trainings on conducting ACEs screeningsApproved $50m one-timeApproved as budgeted
Whole Person Care (WPC) Housing ServicesGovernor: $100m GF one-time to WPC Pilots and $20m MHSA funds one-time to non-WPC countiesApproved as budgetedApproved $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 CommunitiesStakeholder: $6m GF one-time to establish Office under direction of Surgeon General to develop strategy and implementation plan on violence preventionNo actionApproved as proposed
MCO Tax RenewalGovernor: No proposal to renew MCO taxApproved GF offset of $1.373b in 2019-20 and $1.831b in 2020-21 and 2021-22; approved placeholder TBL to extend MCO taxApproved GF offset of $858m in 2019-20 and $1.844b in 2020-21 through 2022-23; approved placeholder TBL to extend MCO tax

Legislature Advances Bills Out of Houses, Faces Floor Deadline Next Week

The California Legislature maintained a steady pace of floor sessions this week, working to advance measures out of their house of origin ahead of next Friday’s deadline to do so. Both the Senate and Assembly face another busy week of floor session again next week, and no other committees other than the conference committees or rules committees may meet for any purpose.

Below, we highlight several actions of interest this week that occurred on the Senate and Assembly floors. Our full CHEAC Weekly Bill Chart is available here.

Access to Health Services

SB 66 (Atkins) as amended March 21, 2019 – SUPPORT

SB 66 by Senate President pro Tempore Toni Atkins was advanced on consent from the Senate Floor to the Assembly this week. The measure authorizes Medi-Cal reimbursement for a maximum of two visits on the same day at a single FQHC or RHC location if: 1) after the first visit, the patient suffers an illness or injury requiring additional diagnosis or treatment, or 2) the patient has a medical visit and a mental health or dental visit.

Chronic Disease Prevention & Wellness Promotion

SB 347 (Monning) as amended May 17, 2019 – SUPPORT

Senator Bill Monning’s SB 347 would require safety warning labels on sugar sweetened beverages (SSBs) and SSB vending machines and dispensing machines. SB 347 was advanced from the Senate Floor to the Assembly on a 21-11 vote with six members not voting. Recall, this measure has been proposed in previous years by Senator Monning and Assembly Member Rob Bonta, but both were unsuccessful in making their way through the Legislature.

Communicable Disease Control

SB 276 (Pan) as amended May 17, 2019 – SUPPORT

SB 276 by Senator Richard Pan received extensive debate on the Senate Floor this week, where it was ultimately passed to the Assembly on a 24-10 vote with four members not voting. The measure would require physicians to submit a statewide standardized immunization medical exemption request form and require the state public health officer or designee to approve or deny the request upon determining sufficient medical evidence that the immunization is contraindicated utilizing guidance from the U.S. Centers for Disease Control and Prevention (CDC). The California Department of Public Health (CDPH) would be required to create and maintain a database of approved medical exemption requests and make available the database to local health officers. The state public health officer and local public health officers would also be authorized to revoke a medical exemption if it is determined that the exemption if fraudulent or inconsistent with applicable CDC guidelines.

AB 362 (Eggman) as amended April 25, 2019 – WATCH

Assembly Member Susan Talamantes Eggman’s AB 362 would authorize the City and County of San Francisco to approve entities to operate overdose prevention programs, including supervised injection sites. The measure was advanced from the Assembly Floor to the Senate on a 44-26 vote with 10 members not voting. Recall, Assembly Member Eggman carried a measure last year which would have authorized a similar program, but the measure was vetoed by then-Governor Jerry Brown.

Emergency Medical Services (EMS)

SB 438 (Hertzberg) as amended May 2, 2019 – OPPOSE

SB 438 by Senator Robert Hertzberg was passed off the Senate Floor earlier this week on a 32-4 vote with two members not voting and now moves on to the Assembly. This bill contains troubling provisions that would undermine medical control and place alarming restrictions contracting dispatch services.

A coalition of county organizations including CSAC, UCC, RCRC, CHEAC, EMSAAC, and EMDAC are all opposed to the measure. We encourage counties to review the language in the bill and consult with your EMS Administrators regarding the impact to your jurisdictions.

Tobacco Control

AB 1718 (Levine) as revised May 16, 2019, and SB 8 (Glazer) as introduced December 3, 2018 – SUPPORT

AB 1718 by Assembly Member Marc Levine and SB 8 by Senator Glazer were advanced from the Assembly Floor and Senate Floor, respectively. These companion measures would prohibit the smoking and disposal of cigar and cigarette waste at all state coastal beaches and state parks. Recall, both authors have pursued similar bans the past several years, all of which have been vetoed by then-Governor Jerry Brown. AB 1718 was advanced on a 57-19 vote with four members not voting, and SB 8 was advanced on a 28-10 vote.

SB 38 (Hill) as amended May 17, 2019 – SUPPORT

Senator Jerry Hill moved SB 38 to the Senate Inactive File this week in light of recent amends taken through the Senate Appropriations Committee Suspense File. SB 38 would prohibit tobacco retailers from selling any flavored tobacco product. Amendments taken last week exempted products with patents issued prior to January 2000 and products designed for nonelectric hookah. With these hostile amendments, the measure lost support from its original co-sponsors – American Cancer Society Cancer Action Network, the American Heart Association, and the American Lung Association – due to potential harms posed by hookah products. Given the pending floor deadline next week, the measure is unlikely to be pursued further.

CHEAC Members Invited to Participate in 2019 ITUP Regional Workgroup Convenings

The Insure the Uninsured Project (ITUP) invites CHEAC Members to participate in its 2019 Regional Workgroup Convenings. ITUP regional workgroups bring together local leaders and community members to engage in constructive dialogue, problem-solving, and identification of creative policy solutions that expand access and improve the health of Californians. The workgroup findings are used to inform ITUP’s broader policy work and future convenings.

This year’s workgroups will focus on:

  • Health Reform in California – Workgroups will share and discuss federal and state reform updates, including state efforts to cover the remaining uninsured and stabilize the individual market.
  • Care Coordination – Local attendees will be engaged in a discussion on the status of local care coordination efforts for Medi-Cal beneficiaries. This topic will build on the recently-concluded state-level discussions organized by DHCS and will further explore screenings, health assessments, case management, data, transitions in care, communication, governance, training, and monitoring.

Local experts and stakeholders are invited to share information about county and regional programs and initiatives, including Whole Person Care, Whole Child Model, Coordinated Care Initiatives, and other programs to ensure meaningful access to care through the managed care delivery system.

Regional workgroup dates begin in June and run through October. Registration and additional information, including specific dates and locations, are available here. A flyer is also available here.

If you plan to attend any of the regional convenings, please also notify CHEAC via email. If there are any topics or issues you would like to be discussed during the regional convenings, individuals are encouraged to contact ITUP staff directly.

CDPH to Host Suicide Prevention Webinar on June 13

The California Department of Public Health (CDPH) Violence Prevention Initiative (VPI) will host a webinar on suicide prevention on Thursday, June 13 from 1:00 to 2:30 pm. The webinar will include an overview of CDPH suicide-related data briefs, statewide suicide prevention plan update from the Mental Health Services Oversight and Accountability Commission (MHSOAC), and local level efforts and best practices. Registration for the webinar is available here.