GOVERNOR ANNOUNCES SOME FUNDING OF COUNTY CHILDREN’S COVERAGE;
NO EXPANSION OF STATE HEALTH PROGRAMS; MAY REVISE RELEASED TOMORROW

  • May Revise to spend $23 million to cover 24,000 kids on County Health Initiative (CHI) waiting lists
  • No expansion of state programs, or further assistance for the rest of the 800,000 uninsured kids
  • Senate passes extension of emergency Rx coverage for low-income seniors and others
  • Action Item: Advocacy needed on Medicare emergency coverage, co-payments coverage

April showers at the Capitol typically spring May leaks–especially the week leading up to the governor’s May budget revision, which will be released tomorrow, Friday, May 12th.

At an orchestrated “leak’’ to health and Capitol reporters Thursday, Health and Human Services Secretary Kim Belshe announced that in the context of a budget that will “hold the line on spending in public programs,” one of the governor’s spending priorities this year would be to expand coverage to more uninsured children, by funding county programs that currently have waiting lists.

While 90% of California’s children are insured, about 800,000 children in California remain uninsured. About half of these children actually qualifies for Medi-Cal or Healthy Families, but are not enrolled. The other half are not eligible for any program.

The governor’s proposal would spend $23 million, to cover just a 3 percent sliver of the uninsured population – 24,000 children currently on waiting lists at County Health Initiatives. The governor’s new proposal supplements the $70 million Gov. Arnold Schwarzenegger already appropriated in his January budget proposal reach out and cover children eligible for Healthy Families and Medi-Cal.

“We believe this is a prudent and responsible initiative,’’ Belshe said.

Schwarzenegger’s new proposal, however, is less than half the amount that Assembly Democrats approved this week for County Health Initiatives for children’s coverage. Last Monday, the Assembly Budget Subcommittee on Health and Human Services approved a more ambitious effort on children’s coverage: it included a $5 million for the 2006-07 budget year to start the administrative process of expanding coverage to the remaining 800,000 uninsured children in Healthy Families and Medi-Cal. The proposal also allocated $40 million–about twice what Governor Schwarzenegger proposed–to go to county “Healthy Kids” programs to allow them to enroll more children now on waiting lists.

The overall Assembly proposal, which would not be implemented until July 2008, would raise the income ceiling for Healthy Families from 250 percent of poverty to 300 percent. It would also expand Medi-Cal’s income ceiling for Medi-Cal to 133 percent. Previously, children older than 5 were ineligible for Medi-Cal if their families earned above 100 percent of poverty. In effect, the changes would allow for universal coverage of *all* children under 300% of the federal poverty level, which is $49,800 for a family of three.

Both proposals would require additional funds in the 2007-2008 budget year. They could come from the general fund, or from other revenues, such as the tobacco tax that is pending for the November 2006 election. Secretary Belshe in fact mentioned the Schwarzenegger proposal as a “bridge” or “transition” proposal until the voters decide on that pending initiative.

The Governor’s proposal has no such planned expansion of eligibility for state public insurance programs.

California has 18 County Health Initiatives, toward the goal of covering *all* children. In most cases, they cover children:

  • Living in families with incomes up to 300 percent FPL
  • Up to 18 years old.
  • Otherwise ineligible for Healthy Families or Medi-Cal.

San Mateo County covers children up to 400 percent FPL; meanwhile Kern and Stanislaus only cover children up to age 5.

For more information on any of these issues, contact Hanh Kim Quach, Policy Coordinator, Health Access California, at 916-497-0923 x206 or hquach@health-access.org.

EMERGENCY DRUG COVERAGE TO HEAD TO ASSEMBLY MONDAY

AB813 by Senate Leader Don Perata and Assembly Speaker Fabian Nunez cleared the state Senate Thursday. AB813 would extend emergency coverage for Californians dually eligible for Medicare and Medi-Cal until January 31, 2007.

This extension is needed for the federal government and insurers to sort out problems for this population, which comprises the poorest, frailest seniors and people with disabilities.

The length of the emergency extension was hotly contested, but was agreed that this “coverage of last resort’’ should exist during November open enrollment period and the beginning of next year, when many prescription drug plans are expected to change their formularies or pull out of the market altogether, creating even more problems.

In order to prevent inappropriate usage of the $120 million maximum allocation, AB 813 also provides more restrictions on state coverage than the current emergency coverage. For example, in many circumstances it requires doctors and pharmacists to go through a prior authorization process before providing emergency drug benefits to dual eligible beneficiaries, to ensure that they truly are unable to obtain drug benefits from his or her Medicare Drug Plan.

AB813 will be considered in the Assembly on Monday, in order to get the bill to the Governor’s desk on late Monday or Tuesday, in time for a gubernatorial signature before the expiration of the program on Tuesday, May 16th.

ACTION NEEDED: Legislators from both parties need to be urged to protect these dual-eligible seniors and people with disabilities, to ensure that they get the drugs they need. Health advocates are urging their memebers and allies to call their Assemblymembers and Senators to:

  • Support AB813 (Perata/Nunez) to allow the state to continue emergency drug coverage for seniors and persons with disabilities so they get needed prescription drugs when Medicare Part D fails, including for the expected problems and prescription drug plan changes at the beginning of 2007.
  • Support a budget item that has the state, in the budget process, agree to cover the newly imposed co-payments for low income senior and disabled people living on fixed incomes, so they are not worse off than they were last year.

For more information on Medicare Part D, contact Elizabeth Abbott, Project Director, Health Access California, at 916-497-0923 x201, or eabbott@health-access.org. On all these issues, contact Hanh Kim Quach, Policy Coordinator, Health Access California, at 916-497-0923 x206 or hquach@health-access.org.

Health Access California promotes quality, affordable health care for all Californians.

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