Budget Update: Health Priorities for California Consumers

This post was written by Tam Ma, Policy Counsel. 

The Assembly and Senate budget committees completed their review of the Governor’s May Revision and finalized their respective versions of the 2016-17 budget. The budget conference committee will begin meeting next week to reconcile the differences between actions taken by the two houses. The Legislature must pass the budget bill by June 15. This post highlights some important actions the budget subcommittees took as well as issues that will be addressed in conference committee. You can also view our 2016 Budget Scorecard.

ITEMS AGREED TO BY BOTH LEGISLATIVE HOUSES: The following items have been included in both the Senate and Assembly budgets, meaning it is likely these proposals will be in the combined Legislative state budget. However, that proposal still is the subject of a negotiation with Governor Brown and may or may not be included in the final budget passed in June.

Medi-Cal Estate Recovery: Both the Senate and Assembly approved funds ($26M GF) to limit Medi-Cal estate recovery to long-term care services, consistent with federal requirements. The federal government requires states to recoup certain medical costs – mostly related to nursing home care – from the estates of some Medi-Cal patients after they die. California, however, seeks repayment beyond the federal minimum and a patient’s estate is expected to pay back the value of ALL coverage, including premiums for managed care plans, received after a patient turns 55. This policy unfairly targets older Medi-Cal recipients (higher income Covered California patients don’t have to repay their subsidies), and discourages enrollment and home ownership. Health advocates have made this a top priority and are pleased the Legislature has prioritized limiting estate recovery to the minimum required by federal law, aligned with 40 other states.

Interpreters for Medi-Cal: The Senate and Assembly approved $15 million for in-person interpreters to assist Medi-Cal patients who do not speak English well. Both federal and state law give all patients access to a medical interpreter who need one. About 40% of California residents regularly speak a language other than English, and many of the newly insured have language access needs. Language barriers can cause patients to be misdiagnosed, not get appropriate or timely treatment, and cause medical errors that jeopardize safety.

Delay of the Newly Qualified Immigrant (NQI) Wrap: Both houses approved the Administration’s May Revision proposal to delay implementation of the NQI wrap program for one year. The program would transition Medi-Cal expansion adults who have less than five years in a “qualified immigration status” to Covered California with wraparound services. Advocates, including Health Access, Western Center on Law and Poverty, and California Pan Ethnic Health Network had raised concerns about the transition given its complexity and workability.

Children’s Dental Disease Prevention Program (CDDPP): Both the Assembly and Senate restored $3.2M GF funding for CDDPP, which provided school-based oral health prevention services to 300,000 low-income school children in 32 counties for nearly three decades before it was eliminated during the recession.

Both houses acted to improve access and affordability for individuals living with HIV or AIDS by eliminating cost-sharing for individuals enrolled in the AIDS Drug Assistance Program (ADAP) with annual incomes between 400 and 500 percent of the Federal poverty level, making it more affordable and accessible to patients, which will result in savings to the state. The Legislature also approved the development of a Pre-Exposure Prophylaxis (PrEP) Affordability Program affordability program to cover PrEP-related copays, coinsurance, and deductibles incurred by all individuals accessing PrEP in California with annual incomes below 500 percent of the federal poverty level. Finally, both houses proposed $8.6 million (federal funds and ADAP rebate funds) for the Office of AIDS’ Health Insurance Premium Payment (OA-HIPP) Program, which covers premiums, copays, coinsurance, and deductibles incurred by all eligible people living with HIV/AIDS in California.

ITEMS IN CONFERENCE COMMITTEE: Other proposals are included in the budget proposal for just one legislative house. In these cases, the Budget Conference Committee, which guidance from legislative leadership, decides how to reconcile differences between the two proposals from the Assembly and Senate.

Restoration of Acupuncture Benefit in Medi-Cal: The Assembly allocated $3.7 million GF in 2016-17 (and $4.4 million ongoing) to restore the acupuncture optional benefit in the Medi-Cal program.

Medi-Cal Data Collection: The Assembly approved $200,000 GF and trailer bill language to align Medi-Cal’s health plan data collection and reporting requirements for race/ethnicity, language, and sexual orientation and gender identity (SOGI) data with Covered California’s proposed 2017 qualified health plan standards.

Aged & Disabled Eligibility Level Increase: The Assembly approved $30M GF to increase the amount of income that is disregarded in calculating eligibility for the Medi-Cal aged and disabled (A&D) program. When the A&D program was enacted in 2000, it had an income eligibility standard of 199% federal poverty level (FPL) plus income disregards, making the eligibility criteria equivalent to 133% of the FPL. However, the disregards lose real value every year, with the resulting income standard today at only 123% of the FPL.

Hepatitis Initiatives: The Senate included $1.4 million in funding for Hepatitis Initiatives that increase Hepatitis B vaccinations for high-risk adults and provide resources for rapid Hepatitis C and HIV test kits.

ITEMS NOT IN LEGISLATIVE BUDGET PROPOSALS: Health and community advocates will continue to pursue additional restorations and investments, even if they are not included in this year’s budget.

#Health4All adults: Thanks to actions taken in last year’s budget, all California kids became eligible for full-scope Medi-Cal this month. Remaining work needs to be done to expand Medi-Cal to cover adults regardless of immigration status. Senator Lara’s SB 1418 would accomplish this goal.

Medi-Cal rates and benefits: Californians enrolled in Medi-Cal coverage continue to experience the cuts made during the Great Recession to Medi-Cal rates and benefits. This includes less access to doctors due to a 10% cut to provide reimbursement rates. A number of other non-federally mandated benefits, including full adult dental ($98M), audiology ($2.4M), chiropractic ($3M), incontinence creams & washes ($5.6M), optician/optical labs ($5.9M), podiatry ($13.5M), optician/optical lab ($5.9M), and speech therapy ($160K), were also eliminated during the Great Recession and have not been restored. Adult dental benefits were partially restored in the 2013-14 budget, but still left uncovered are gum treatments, rear root canals, and partial dentures.

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