May 5, 2017 Edition

Humboldt County Names New Public Health Director

Michele Stephens was recently named the new director for Humboldt County’s Public Health Branch as of March 12, 2017.  Michele has been with the Humboldt County Department of Health & Human Services since 2006, and has served as both a supervisor and manager in the department’s Child Welfare Services Division.  Please join us in welcoming Michele to her new role.

House Passes the American Health Care Act

Yesterday, House Republicans managed to pass the American Health Care Act with 217 ‘Yes’ votes and 213 ‘No’ votes and one member not present to vote. Events leading up to the House passage of the bill include:

March 6 – House Republicans released the first iteration of the AHCA language; key provisions included:

Medicaid Expansion. The Supreme Court ruling allowing states to opt into the Medicaid expansion is codified. However, the ability for states to opt into expansion expires December 31, 2019. After January 1, 2020, the enhanced match for newly eligible beneficiaries is repealed and the traditional matching rate (FMAP), which is currently 50%, is reinstated.  For new eligibles enrolled prior to January 1, 2020, the enhanced match only continues so long as the enrollee does not have a break in coverage for more than one month, otherwise, the enhanced match is no longer available for that enrollee and instead the traditional matching rate is applied.

Per Capita Cap. A per capita cap model (per enrollee limits on federal payments) is implemented beginning in FY 2020. State spending in FY 2016 is used as the base year to set targeted spending in enrollee categories (elderly, blind and disabled, children, non-expansion adults, and expansion adults) in FY 2019. The amount is adjusted annually based on the consumer price index. In FY 2020, states that spend higher than their targets will receive reductions to Medicaid funding in the following fiscal year.

Refundable Tax Credits. A refundable and advanceable tax credit for the purchase of health insurance is created. Credits are adjusted by age and cannot exceed $14,000. The credits are available to those making up to $75,000 and phases down by $100 for every $1,000 in income higher than that threshold.

Health Savings Accounts. The use of health savings accounts is encouraged through increasing the limit on aggregate health savings account contributions per year to cover the annual deductible and out-of-pocket expenses under a high deductible plan ($6,550 for an individual; $13,100 per family) beginning in 2018.

Essential Health Benefits. The requirement that plans provide the 10 essential health benefits is repealed and the decision regarding required benefits is deferred to states beginning December 31, 2019.

Changes to Current Eligibility Determinations. There are several changes to eligibility including:

  • Providing a temporary 5% FMAP increase for states that increase the frequency of their eligibility redeterminations to every 6 months.
  • Reverting the Medicaid income eligibility level for children back to 100% of the FPL from 133% of the FPL as the ACA allowed. States can continue to cover children at a higher FPL through the State Children’s Health Insurance Program (CHIP).
  • Eliminating the current retroactive eligibility coverage, which goes back three months and only limit retroactive coverage to the month the applicant applied.
  • Repealing expanded authority to make presumptive eligibility determinations beyond those for children, pregnant women, and cervical cancer patients. This includes eliminating hospital presumptive eligibility, which California implemented.
  • No longer allowing individuals to enroll and receive Medicaid benefits prior to providing documentation verifying citizenship or eligible immigration status.

DSH. The Disproportionate Share Hospital (DSH) cuts imposed by the ACA are eliminated for expansion states in 2020 and non-expansion states in 2018.

Safety Net Funding for non-expansion states. $10 billion over five years is provided to non-expansion states based on the number of individuals below 138% of the FPL, made available through increased matching rates through CY 2022.

Stability Funds. A Patient and State Stability Fund is created, that a state may access if their uninsured population for individuals below 100% FPL increased from FY 2013 to 2015 or if fewer than three plans offer coverage on the exchange individual market in 2017. $15 billion per year is appropriated in FY 2018 and FY 2019. From 2020-2026, $10 million is annually appropriated. A state match will be phased in.

Continuous coverage. The individual mandate is repealed after December 31, 2015, and instead a penalty is assessed for gaps in coverage. Beginning in open enrollment for FY 2019, a 30% late-enrollment surcharge is assessed on market entrants that had a lapse in coverage for greater than 63 days.

March 13 – Congressional Budget Office (CBO) Scores the AHCA

The CBO score estimated 14 million people would become uninsured in 2018, increasing to 21 million in 2020, and 24 million in 2026.

March 24 – House Republicans pull the AHCA from a vote

House Leadership intended to put the bill before the full House for a vote; however, were not able to attain the needed votes and as such pulled the bill. The Freedom Caucus – representing Conservative Republicans – didn’t believe the AHCA did enough to repeal the provisions of the Affordable Care Act and offered amendments to eliminate the essential health benefits and provisions prohibiting insurers from denying coverage for pre-existing conditions. However, these amendments lost the support of moderate Republicans.

April 6 – MacArthur Amendment is introduced

To address the concerns from moderate Republicans, the MacArthur Amendment was introduced which would:

  • Reinstate the essential health benefits;
  • Maintain key provisions of the AHCA including prohibiting denying coverage due to pre-existing conditions and maintaining the community rating rules.

However, an essential aspect of the MacArthur amendment is the ability for states to obtain limited waivers which would allow states to not require the essential health benefits or community rating rules.

May 4 – House Passage

This is the version of the AHCA the house passed yesterday with the addition of $8 billion in supplemental funding for high-risk pools, without conducting any hearings on the bill, and absent an updated CBO score.

Next Steps

The bill now moves to the Senate, which has significant policy concerns on impacts to Medicaid and individuals with pre-existing conditions, among others. Reports indicate the Senate will not support the AHCA in its current form. Senator Lamar Alexander (R-Tenn) publicly stated that the Senate is writing a Senate bill and are not passing the House bill.  Senator Lindsey Graham (R-S.C.) stated that any bill posted for less than 24 hours… needs to be viewed with suspicion.

What will be of interest is whether the Senate takes a more procedural approach and moves the bill through policy committees or whether the bill is moved directly to the Senate floor.

CHEAC will continue to provide updates as events progress.

Legislature Presses on as May Deadlines Approach

With the passing of the policy committee fiscal deadline last week, the Legislature was relatively quiet this week.  Several policy committees met to review bills with no fiscal considerations, and will wrap up their work next week.  Appropriations committees in both houses also met, with lengthy bill calendars, and the majority of bills heard were referred to their Suspense Files.  They have three more weeks to dispense with all bills in their fiscal committees, including those on the suspense file.  The deadline for all bills to pass out of their house of origin is Friday, June 2.

Below, CHEAC highlights a few bills heard or amended this week. For a full update, please see this week’s edition of the CHEAC Bill Chart.

Environmental Health

AB 626 (Garcia) as amended on 5/2/17 – Oppose

AB 626 by Assembly Member Eduardo Garcia would create a new type of food facility under the California Retail Food code for “microenterprise home kitchens.” Entities would be allowed to prepare and sell meals from private home to the general public, with limitations on the number of meals sold and gross sales. The operations would be subject to local approval.

The bill initially granted the local enforcement agency, the ability to decide whether to allow this activity in their jurisdiction. However, recent amendments allow a county, city and county, or city to authorize the permitting of these operations, yet still requires a permit issued from a local enforcement agency. These amendments raise concerns around whether a city can authorize these activities in a county that does not and what role the local environmental health departments, which are primarily county departments, would play.

CHEAC continues to oppose the measure along with HOAC, CSAC, UCC and RCRC.

Communicable Disease Control

AB 511 (Arambula) as amended on 3/27/17 – Support

AB 511 by Assembly Member Joaquin Arambula, M.D., updates existing statute requiring those who work with children and others to have tuberculosis tests to instead receive a tuberculosis risk assessment with targeting testing as specified. The measure passed Assembly Appropriations Committee this week and moves to the Assembly Floor.

Access to Health Services

AB 1591 (Berman) as amended on 3/28/17 – Support

AB 1591 by Assembly Member Marc Berman seeks to expand Medi-Cal reimbursement eligibility to include Licensed Professional Clinical Counselors (LPCCs) in FQHCs and RHCs. The measure was up in Assembly Appropriations Committee on Wednesday, where the measure was moved to the Suspense File.

Health Coverage

SB 152 (Hernandez) as amended on 3/23/17 – Watch

SB 152 by Assembly Member Ed Hernandez would change the frequency of DHCS reporting enrollment data on Medi-Cal and Covered California from quarterly basis to a biannual basis.  Additionally, the measure requires DHCS to provide the Whole Child Model program report by January 1, 2021, or 3 years from the date when all required counties fully implement the Whole Child Model, whichever is later.

Senate Joint Subcommittee, including Sub. No. 3 on Health and Human Services Hear Cannabis Trailer Bill

This week, the Senate convened a joint hearing on Cannabis Regulatory Implementation with Budget Subcommittees No. 2 on Resources, Environmental Protection, Energy and Transportation, No. 3 on Health and Human Services (HHS) and No. 4 on State Administration and General Government.

Members were provided with updates/overviews from the State Board of Equalization, the Department of Consumer Affairs – Bureau of Medical Cannabis Regulations, the Department of Public Health and the Department of Food and Agriculture. Discussion focused around the banking needs of the industry, funding and timelines for developing the state IT system for Track-and-Trace, and state staffing needs. Members also questioned the State’s likelihood of meeting the January 1, 2018, implementation date and contingency plans.

Senator Pan, chair of Budget Subcommittee No. 3 on HHS, inquired about what is required in the physician’s recommendation. This discussion was in light of the State’s proposal to eliminate the state marijuana identification card program. All items were held open.

Legislative and Stakeholder Proposals heard in Assembly Budget Subcommittee No. 1

On Monday, the Assembly Budget Subcommittee No. 1 on Health and Human Services heard items related to the California Department of Public Health (CDPH) and the Department of Health Care Services (DHCS).

Several Assembly Members presented legislative proposals involving CDPH on topics including a Parkinson’s Disease Registry, a health and human services grant program for boys and men of color, Valley Fever data collection, and Sickle Cell treatment centers. As the May Revised budget is expected this month, discussion on these proposals was brief and all the items were held open.

Related to DHCS, Subcommittee members heard a handful of stakeholder proposals related to Medi-Cal budgeting and programming, including the elimination of the New Qualified Immigrant (NQI) Wrap, delay of FQHC alternative payment methodology pilot, and expansion of Medi-Cal coverage of beneficiaries up to age 26. Similarly, all items related to DHCS were held open.

The agenda from the subcommittee hearing is available here.

CDPH to hold Naloxone Grant Program Webinar in May

The California Department of Public Health will be holding an additional webinar for local health departments to address questions regarding the receipt and distribution of naloxone. The webinar will give participants the opportunity to hear from other LHDs about their experiences distributing naloxone, including issuing standing orders and addressing liability concerns. Two webinars were held in early April; the presentation and written questions and responses may be accessed here. CDPH will provide more information about this month’s webinar in the coming week, and CHEAC will pass along any relevant information to members at that time.