Today the Budget Conference Committee made the first pass through the health part of the budget. The Conference Committee, chaired by Senator Denise Ducheny, works to reconcile the budgets approved by the Assembly and the Senate.
In many cases the two budget had already agreed–most notably, on rejecting the worst of the proposed cuts to Medi-Cal, like the limits on prescriptions and doctor visits for Medi-Cal patients–and so those items were not discussed. (Those proposals are still in the Governor’s proposal, and without revenues, those items could be reinserted in final negotiations, but they are not in the current working proposals in the legislature.)
As is often true, this was a first review that left unresolved most of the differences between the Assembly and the Senate: the conference committee will return to these issues later in their deliberations, perhaps next week, perhaps the week after.
* Mandatory enrollment of seniors and people with disabilities into Medi-Cal managed care: The committee voted to book savings from this proposal, which is being discussed as part of the Medi-Cal waiver in health policy committees later in the month. The budget item provoked a long discussion where Senator Ducheny said that mandatory enrollment of SPDs into managed care is existing law, from trailer bill language last year. Governor Schwarzenegger’s Department of Finance pointed out that Medi-Cal continued to grow at 8% per year and both houses had rejected $500 million in cuts proposed by the Governor. Senator Leno asked about the “standards that will be used to improve care and reduce costs,” asking about whether we were going to require people in wheelchairs to go to doctors that were not accessible? He also asked what was the definition of medical home? Assembly Democrats asked if booking the savings were “boxing in” the policy committees before they had finalized the policy proposals but after discussion about whether the savings were an accounting device that did not affect the policy decisions, the conference committee adopted the savings.
* The California discount prescription drug program, which has never been implemented dur to lack of start-up funding, was delayed again another year. The two budget disagreed on when to sunset the program altogether. It was decided to extend the sunset to the year 2015, after the implementation of federal health reform, to evaluate its need then.
Issues left open, that is unresolved:
* Funding for staff to implement the 1115 Medi-Cal waiver.
* Extending the hospital provider fee for six months.
* Rate freeze for hospitals retroactive to Jan. 1, 2010: This provoked considerable discussion about the vulnerability to litigation.
* 10% rate reductions for public and private hospitals.
* Medi-Cal eligibility processing: There was a long discussion about methodology for funding county eligibility workers. Apparently Medi-Cal enrollment is up by 1.5 million people while funding for county case workers has remained flat or declined.
* Community clinic funding: Both the Assembly and Senate included $10 million in funding for EAPC. The Assembly included an additional $25 million for EAPC, American Indian clinics, migratory worker clinics, and rural clinics–funding that was line-item vetoed by the Governor last year. Assemblyman Blumenthal said they were “resolute” on this funding, given that they felt the Governor went beyond the cut that was agreed upon last year. The Administration made a point about the $1.4 billion in new federal funding for clinics over the next 5 years. Ducheny called clinic funding “the most useful money we spend” but in a difficult budget, she suggested they leave the item open, which they did.
Thanks to Beth Capell for her report from the committee…