This morning, the Assembly Budget Committee approved, in one vote along partisan lines, a broad budget proposal package that adopted many–but not all–of Governor Brown’s proposals.
Most of the cuts are adopted, with a major exception of hard caps on doctor visits, prescription drugs, durable medical equipment and medical supplies.
The one major area where there isn’t conformity between the Assembly and the Senate is on Adult Day Health Centers, which Governor Brown proposed to eliminate. The Assembly rejects elimination and makes a partial cut of $28 million. The Senate, earlier today, basically cut all but $25 million for use as a block grant. This difference–and others–will likely be decided in a Budget Conference Committee which starts meeting on Tuesday.
From the analysis, here’s the relevant portions about health care cuts:
Medi-Cal Major Issues:
• Mandatory Co-pays. Cuts Medi-Cal by $557.2 million by mandating that beneficiaries pay co-payments as follows: 1) $5 for every physician or clinic visit; 2) $3 (generics) or $5 per prescription; 3) $50 for emergency room visits (for emergencies or non-emergencies) and $100 per day, with a maximum of $200 per admission, for inpatient services; and 4) $5 for every dental visit.
• Rate Reductions. Cuts Medi-Cal by $729.6 million General Fund by reducing rates paid to Medi-Cal providers and skilled nursing facilities by ten percent.
• Utilizations Controls. Cuts Medi-Cal by $17.2 million by eliminating coverage of over-the-counter cough and cold products, limiting coverage of enteral nutrition products to tube fed (giving discretion to DHCS to grant exemptions), and imposing an annual dollar maximum on hearing aids of $1,510 per year. Denies caps on physician visits, prescriptions, durable medical equipment and medical supplies.
• Adult Day Health Care. Cuts $28 million from ADHC by enforcing existing medical acuity eligibility criteria, consolidating state administration of the program, and making other reforms to the program, without eliminating the benefit.
• Medi-Cal Managed Care Tax. Secures on-going revenue by making permanent (with a 3-year sunset) the tax on Medi-Cal managed care organizations.
Healthy Families Major Issues:
• Healthy Families Premiums. Cuts Healthy Families by $22 million General Fund by increasing monthly premiums paid by families enrolled in the program.
• Healthy Families Co-pays. Cuts Healthy Families by $5.5 million General Fund by increasing co-payments paid by families for hospital services, consistent with hospital co-pays in Medi-Cal.
• Healthy Families Vision Coverage. Cuts Healthy Families by $3 million General Fund for support of vision coverage, without eliminating the benefit.
Other Health Major Issues:
• Proposition 10 Fund Shift to Medi-Cal. Cuts Medi-Cal by $1 billion General Fund by replacing it with $1 billion in Proposition 10 reserves and eliminates the State Prop 10 Commission for on-going savings of approximately $89 million annually, to cover Medi-Cal services for children 0-5 years of age. Denies proposal to shift fifty percent of local funding on an on-going basis.
• Proposition 63 Fund Shift to State Mental Health Programs. Cuts $900 million General Fund primarily from Medi-Cal by replacing it with $861 million in Proposition 63 funds for: AB 3632, EPSDT, and Mental Health Managed Care.
• AIDS Drug Assistance Program Cost Savings. Cuts $77 million in General Fund reflecting: $7 million in administrative savings and an increase in federal funds; and a $70 million allocation from the Safety Net Care Pool. Directs the administration to expand eligibility in the CARE/HIPP Program and facilitate enrollment of ADAP clients into the HIPP Program, the Pre-Existing Condition Insurance Program, and Low-Income Health Insurance Programs for additional General Fund savings in ADAP. Achieves equivalent savings without increasing cost sharing for ADAP clients.
• Emergency Preparedness Reductions. Cuts $5.8 million in General Fund for maintaining the state’s medical supplies stockpile and mobile field hospitals for major public health emergencies.