2019 Legislative & Budget Priorities
The California Legislature is in full swing, as is our state legislative program. CaliforniaHealth+ Advocates (Advocates) is working hard to strengthen California’s community health centers by advocating for not only our own sponsored legislation, but also for legislation that aims to improve access to care for everyone.
CaliforniaHealth+ Advocates Sponsored Legislation
Advocate’s bill package reflects a commitment to our core policy priorities. Advocates, working with CPCA and other legislative partners, successfully introduced three new bills that have all successfully moved through their initial policy committees. These bills include:
Senate Bill 66 (Atkins/ McGuire) Same Day Visits: Advocates is cosponsoring SB 66 along with the Steinberg Institute, California Association of Public Hospitals, and the Local Health Plans of California. Authored by Senate President pro Tempore Toni Atkins and Senator Mike McGuire, this bill will allow community health centers to bill Medi-Cal for two visits if a patient is provided mental health services on the same day they receive other medical services. Advocates consortia and other partners have been participating in an advocacy campaign to encourage State Senators to submit their names as official coauthors. The goal is to show the Administration the bipartisan support for this bill by having all Senators coauthor SB 66. As of May, we’ve had over two dozen legislators agree to coauthor SB 66. This strategy will be duplicated in the Assembly as the legislative process moves forward. Additionally, we are exploring various media opportunities to highlight the importance of SB 66 and are working with our co-sponsor, the Steinberg Institute, to facilitate a tour of a health center specializing in behavioral health for Governor Newsom. SB 66, recently released from the Senate Suspense file, now heads to the Senate Floor for a vote.
Assembly Bill 899 (Wood) Streamlining Expansion of Primary Care Facilities: Advocates is cosponsoring AB 899 with the Health Alliance of Northern California, North Coast Clinics Network, and the Redwood Community Health Coalition. Authored by Assemblymember Jim Wood, AB 899 would maximize the ability of community health centers to expand access to health care for all Californians, by giving them the option to utilize an existing outpatient clinic or previously licensed primary care clinic to meet the growing demand for services. We have been working closely with Assemblymember Wood throughout the legislative session who has shown tremendous leadership in ushering this bill through the legislative process. As of early May, AB 899 passed the Assembly and is now awaiting a hearing date in the Senate.
Assembly Bill 1494 (Aguiar-Curry) Declared Emergencies: Advocates is cosponsoring AB 1494 with the Redwood Community Health Coalition. Authored by Assemblywoman Cecilia Aguiar-Curry, is the critical next step to ensure that communities continue to receive timely access to care when disaster strikes by guaranteeing that CHCs can continue to provide, and be reimbursed for, services for their patients that have been impacted by a declared emergency. Last year, AB 2576 (Aguiar‐Curry), signed by Governor Jerry Brown in 2018, was a critical first step to ensure that communities continue to receive timely access to care when disaster strikes. However, challenges remain for CHCs who wish to offer services outside of their actual health center location during an emergency and AB 1494 aims to address this issue. We are grateful to Assemblymember Aguiar-Curry for her ongoing support for community health centers. AB 1494, recently released from the Assembly Suspense file, now heads to the Assembly Floor for a vote.
Additional Bills of Interest
In the first year of the legislative session (2019-20), there have been a number of bills introduced that impact community health centers and our patients in a positive way. Working with our broad array of partners including CPCA, the regional consortia, and health care stakeholders (providers and consumers), Advocates is also prioritizing the following bills:
Senate Bill 29 (Durazo)/ Assembly Bill 4 (Bonta/Chiu/Santiago) Win #Health4All: This bill would expand access to Medi-Cal benefits to all Californians, regardless of immigration status.
Senate Bill 175 (Pan) / Assembly Bill 414 (Bonta): This bill would create an Individual Mandate to replace the federal version which was repealed along with the federal tax code overhaul. Funds would support subsidies for severely low-income Californians.
Senate Bill 65 (Pan) CA / Assembly Bill 174 (Wood): This bill would create the Affordable Care Access Plus Program to provide financial subsidies to low-income Californians at or below 600% FPL.
Senate Bill 154 (Pan) Medi-Cal restorative dental services: AB 154 allows for the application of, and reimbursement for, silver diamine fluoride to treat dental cavities.
Assembly Bill 138 (Bloom) California Community Health Fund: AB 138 will create a fee or tax on the distribution of sugar and sweetened beverages.
Assembly Bill 341 (Maienschein) CalHEERS- Application for CalFresh: AB 341 will streamline the CalFresh application process by ensuring that the California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS) transfers an individual’s application to the county for processing of a qualified CalFresh application.
Senate Bill 361 (Mitchell) Medi-Cal - Health Home Program: SB 361 will amend the Health Homes Program to remove the two-year budget neutrality clause and create more defined goals for the program.
Assembly Bill 515 (Mathis) Medi-Cal Overpayments: FQHCs and RHCs: AB 515 will lower the interest rate that a community health center can be charged in the case of an overpayment by the state. The rate would be based on the surplus money invest fund or 3% per annum, whichever is lower.
Assembly Bill 715 (Wood) Medi-Cal Program for Aged and Disabled Persons: AB 715 aims to increase the income eligibility for the Aged, Blind, and Disabled Federal Poverty Level from 100%, plus standards, to 138% FPL. This increase would expand Medi-Cal eligibility for these individuals.
Assembly Bill 769 (Smith) FQHCs and RHCs - Licensed professional clinical counselor (LPCC): AB 769 seeks to expand the number of Medi-Cal reimbursement eligible providers for FQHCs/RHCs. The addition of LPCCs would trigger a PPS rate adjustment.
Assembly Bill 770(Garcia) FQHCs: AB 770 seeks to make changes to the FQHC PPS rate process including adjustments to per-visit rates, scope of services changes, time frames for adjustment requests, incentive payments, and appeals processes.
The State Budget: Governor Newsom’s Budget Priorities
Governor Newsom’s 2019-20 Proposed State Budget, and recently released May Revision, demonstrates a strong commitment to children, families, health care, and education, with a particular focus on underserved populations. The budget is fiscally disciplined with an aim to build a strong foundation for California. The May Revise includes important investments, while also paying down California’s debt and liabilities, and aims to increase the rainy day fund. We are strongly encouraged by the Administration’s commitment to universal health care demonstrated by the expansion of coverage to undocumented adults ages 19 through 25 and expanding coverage subsidies for families up to 600 percent of the Federal Poverty Level. We are also tremendously supportive and excited that the Administration is committing $33 million annually to the Song-Brown workforce residency funding as part of a package of workforce investments.
While grateful for the commitment to health care reflected in the Governor’s May Revise, we remain deeply concerned about the proposal in the Executive Order (EO), N-01-19 to carve out pharmacy from the Medi-Cal managed care program, as it will negatively impact the Medi-Cal Managed Care 340B program. One component of the EO is to carve out the pharmacy benefit from Medi-Cal Managed Care and move it to Fee-For-Service (FFS). This will effectively eliminate all of the 340B savings in Medi-Cal Managed Care, which could cost health centers statewide as much as $150 million. This could also result in the closure of 45 in-house pharmacies, at least 20 health center sites, and 36 new sites will not be opened as a result. Protecting 340B is a top priority for Advocates and we will continue to work with the Administration, the Department of Health Care Services (DHCS), and all of our partners across the state to ensure the resources from 340B stay with health centers.
Over the past few months, Advocates’ CEO, staff and health center advocates have had the opportunity to meet with Governor Newsom, Secretary for the California Health and Human Services Agency, Mark Ghaly, and Deputy Cabinet Secretary, Richard Figueroa, to highlight the importance of 340B savings to health centers and what’s at stake if those savings are eliminated. The Administration acknowledged the potential loss of funds and promised no undo harm will come to health centers. Advocates will continue conversations with the Administration to find a solution that both supports the Governor’s vision and strengthens health centers.
Additionally, the proposed January budget includes a new incentive program to enhance value and services in Medi-Cal. The May Revise includes a $500 million commitment (with $250 million from Prop 56 funding) to create a Value Based Payment (VBP) program that would provide incentives to Medi-Cal Managed Care providers that achieve benchmarks and goals in managing chronic disease, integrating behavioral health, and improving pre and postnatal care. These added resources demonstrate the Administration’s commitment to assuring the needs of California’s vulnerable populations are met and that Medi‐Cal providers are focused in the most important areas. While Advocates’ wholly supports the investment and program being proposed, we know the state does not believe health centers should participate, and thus we are working to ensure that all Medi-Cal providers, including community health centers, are eligible. California’s health centers serve 4 million Medi-Cal beneficiaries who should also be included in this targeted investment.
There are numerous additional areas in Governor Newsom’s state budget proposal that Advocates supports:
Workforce - Residency: The proposed budget includes a one-time $40 million General Fund ($3.5 million base adjustment and $36.5 million investment) investment of Proposition 56 funds supporting medical residency programs. This investment is in addition to the$33.3 million ongoing investment in Song-Brown.
Workforce – Mental Health Workforce: To help address the increasing need for public mental health practitioners, the proposed budget includes $50 million General Fund to increase training opportunities for workforce programs. Additionally, the May Revise places $100 million from the Mental Health Services Fund (one-time funding available over five years) to be directed towards the new 2020-25 Workforce Education and Training (WET) Five-Year Plan.
Reproductive services: The Governor’s proposed FY 2019-20 budget increasing funding to ensure access to reproductive and family health services.
Immigration: The proposed budget includes $20 million to help establish a state Rapid Response Program to address emergencies around human trafficking and immigration and another $5 million towards addressing immigration related emergencies.
SDOH: The Governor’s proposed budget includes increased funding to address the social determinants which affect the health and well-being of many Californians, and includes prioritizing funding to address housing, homelessness and Adverse Childhood Experiences (ACEs).