Today, Senate Budget Subcommittee 3 on Health and Human Services, chaired by Senator Mark Leno, met to hear budget issues related to Healthy Families and Medi-Cal. Much of the discussion related to implementation of new federal laws, particularly ARRA (the federal recovery act) and CHIPRA (the re-authorization of kids’ coverage). No actions were taken, pending the outcome of the May 19th election and the subsequent May revision of the budget estimates.
A few things worthy of note from the hearing:
· The caps on dental benefits for kids on Healthy Families appear to violate the new federal law—good news again from our friends at the federal level. Oh, and our orthodontia benefit might need to be improved as well.
· As required by recent federal law, MRMIB is implementing citizenship documentation for kids on Healthy Families. They think that 90% of the kids can be done automatically by crosschecking birth certificates which have been computerized for some time now. For the remaining 10%, for those under age 16, they can accept attestation by the parent. They are still trying to figure out what to do about 17 and 18 year olds.
· The Medi-Cal program is focusing on national health reform, the hospital waiver renewal and fraud.
· Lots of discussion of implementation of the ARRA (American Recovery and Reinvestment Act). Complaints that some of the cuts made as a result of the infamous budget trigger violate the Maintenance of Effort requirements in the ARRA, mostly on home care and SSI. Sadly the elimination of adult dental, podiatric, and other key benefits does not appear to be contrary to federal law.
· Medi-Cal is moving to electronic verification of assets: the welfare directors and Western Center on Law and Poverty have letters in expressing concern about the broad vague language proposed for the trailer bill. And oh, by the way, did Congress forget study after study has shown that people poor enough for Medi-Cal don’t have assets? Most seniors and persons with disabilities who are poor enough to be on Medi-Cal would be lucky to have $2000 in the bank—and if they did, it would just be because they had first and last months rent saved up, as they are supposed to. Health Access ran a project and sponsored a bill and some years ago on eliminating the asset test: we lost that fight not because there’s a lot of low-income people with assets who want Medi-Cal, but because it was demonstrated that the elimination of this administrative barrier would lead to more people with little or no assets ending up enrolled in Medi-Cal, and thus it would be a cost to state government.
· Medi-Cal managed care: in our blog posts from 2005, you would have read screen after screen about the Administration proposals to expand managed care, including forcing seniors and people with disabilities into HMOs. While most of the Administration’s proposal failed, there were expansions of Medi-Cal managed care for working families into counties adjacent to those larger, urban counties where it already existed. Well, here we are four years later and four of the 13 counties are still not ready because of lack of provider networks (in Merced, Lake, and Mendocino? Gee, is that a surprise? Not to anyone who has sat through a CalPERS health benefits discussion.)
Compared to most budget hearings in recent months, it was a pretty quiet day. There was a Assembly Budget Committee earlier this week that also delved into some of these issues as well… but the tough stuff will come after the May Revise, when we know how big the damage is.