CDCAN REPORT #061-2011: Budget Conference Committee hears more on proposal to transfer certain state services to counties

• Budget Conference Committee Hears More On Governor’s Proposal To Shift Certain State Services To Counties – No Other Issues Taken Up
• Critical Issues Remain for Budget Conference Committee To Resolve Including Governor’s Proposal to Eliminate Adult Day Health Care, Multipurpose Senior Services Program (MSSP) – Could Meet Tuesday – More Likely on Wednesday

SACRAMENTO, CALIF  (CDCAN) [Updated 02/28/2011 – 10:14 PM  (Pacific Time)] –  The Budget Conference Committee, chaired by Assemblymember Bob Blumenfield (Democrat – Van Nuys, 40th Assembly District) met just under two hours Monday afternoon from about 3:15 PM to just before 5 PM focusing only on the Governor’s proposal to transfer, or “realign” certain state services to the counties, including certain public safety and mental health community-based services.

One issue dealing with “realignment”  critical to persons with disabilities and mental health needs are three mental health community-based services including  the mental health services for special education students under the AB 3632 mandate.  That specific issue was mentioned briefly by Brown Administration officials who said the estimates for funding the program during realignment was not high enough.   No action was taken and no other budget items were brought up.

No Firm Next Hearing Date for Budget Conference Committee

The next Budget Conference Committee hearings are “upon call of the chair,” meaning when the committee chair sets the time, which is not yet determined.   While the committee could meet on Tuesday (March 1), it appears the committee is more likely to meet next on Wednesday morning (March 2) to take action on a wide range of issues and possibly complete its work.

The Budget Conference  Committee began meeting last week on Wednesday (February 23) and again on February 24th (Thursday).  It last met on Friday, February 25th.

The Budget Conference Committee meets at the State Capitol in Room 4203. 

No public testimony is taken at Budget Conference Committee hearings since all budget items were previously heard where comments were taken).  Budget Conference Committee hearings are televised live and webcasted live on CalChannel (see www.calchannel.com)

Major Health and Human Services Remain on Agenda

• Remaining on the Budget Conference Committee agenda are several critical budget issues dealing with In-Home Supportive Services, Adult Day Health Care, Multipurpose Senior Services Program (MSSP) and realignment of several State programs and funding to counties.  The committee heard those items on Friday, February 25th, but after discussion, kept those items “open” for later action – possibly for Wednesday.. 
• The committee also heard on Friday (February 25) but kept “open” for later action possibly on Wednesday (March 2), budget items dealing with foster youth Transitional Housing Program Plus reductions, proposal to eliminate the mandates under the State’s open meeting law (called the “Brown Act”) impacting local government. 
• The Budget Conference Commmittee took final action on Friday (February 25th)  on the issue of budget legislative language (called budget trailer bill language) dealing with directing the Department of Developmental Services to develop and submit to the Legislature for review and possible approval (in June) a proposal for statewide standards to limit or reduce by at least $150 million in State general fund spending for regional center community-based services referred to as “Purchase of Services”.  That proposal was made by Governor Brown in January, and similar proposals were made by Governors Davis in 2002 and 2003 and Schwarzenegger in 2003 and 2004 – all rejected by the Legislature.  No other issues dealing specifically with the developmental services budget remain on the Budget Conference Committee Agenda.

Next Steps on Budget for Legislature

• Budget Conference Committee could meet Tuesday but is “upon call of the chair”.  As of late Monday it seems more likely that the Budget Conference Committee will meet next on Wednesday (March 2) to take final action and possibly complete its work. 
• Final vote on entire budget package could happen as early as late this week.
• Governor Brown wants the Legislature to send him the budget package no later than March 10th, in order to meet certain local and state deadlines for a special election in June that he wants to call for voters to consider approving.  Two of those measures he wants the Legislature to place on the ballot that would extend for five years temporary tax increases that are scheduled to end this year. 
• In addition a 3rd ballot measure – placed there by petition separate from Governor Brown’s proposals – calls for increase in the tobacco tax for cancer programs – will also be on a June special election ballot if one is called.  Tobacco companies have vowed to fight that initiative – and complicates the chances of passage of the proposals by Governor Brown to extend the temporary taxes.

CDCAN SUMMARY OF MAJOR HEALTH & HUMAN SERVICES ISSUES STILL ON BUDGET CONFERENCE COMMITTEE AGENDA

• Several key issues were agreed to in identical actions by the Assembly and Senate Budget Committees last week and so are not in the Budget Conference Committee including the Governor’s proposed cut to SSI/SSP (Supplemental Security Income/State Supplemental Payment) maximum individual grants from $845 to $830 – the lowest level allowed by the federal government; and the 10% permanent rate reduction to nearly all Medi-Cal providers. 
• Also not in the Budget Conference Committee because both houses took the same action last week was the overall reduction target for regional centers – rolled back from the Governor’s proposed $750 million reduction in State general fund spending to $523.5 million (of which $150 million in State general fund spending reduction is not specified – but could be achieved by developing and implementing statewide standards that would limit or contain spending for regional center community-based services – called “Purchase of Services”
• With the exception of Adult Day Health Care and the Multipurpose Senior Services Program (MSSP), the Budget Conference Committee took final action last week (February 23) on all Medi-Cal issues on its agenda and the one regional center budget item (dealing with budget “trailer bill” language directing the Department of Developmental Services to develop a proposal for statewide standards to limit or reduce spending of at least $150 million in State general funds for regional center community-based services )
• Not listed but on the Budget Conference Committee agenda still is the Governor’s proposed reduction to the foster youth Transitional Housing Program Plus (THP-Plus), and proposed changes to the Brown Act open meeting law requirements on local agencies.

MULTIPURPOSE SENIOR SERVICES PROGRAM (MSSP)

01/10/11 – GOVERNOR’S ACTION

• Proposed elimination of the entire program which, with over 30 sites coordinate services to over 11,000 Medi-Cal eligible seniors over the age of 65 who are certified for out of home placement but who want to remain in their own homes.

02/18/11 - SENATE BUDGET COMMITTEE ACTION

• Rejected the Governor’s proposal to eliminate the program, but instead approved $5 million reduction in State general funds.
• Approved budget bill language that would direct the Department of Health Care Services and the Department of Aging to consult with federal government on how to achieve savings. [“Budget Bill Language” is language in the actual budget bill]

02/18/11 - ASSEMBLY BUDGET COMMITTEE ACTION

Rejected the Governor’s proposal and restored funding to this program for 2011-2012 [action differs from Senate] 

02/25/11- BUDGET CONFERENCE COMMITTEE ACTION

Discussed budget item but kept issue “open” for later action the week of February 28th [this issue did NOT come up during the 2/28 Budget Conference Committee hearing] 

NEXT STEPS

Though the Budget Conference Committee could meet and take up this issue on Tuesday (03/01), it appears more likely it will do so on Wednesday (03/02). 

ADULT DAY HEALTH CARE PROGRAM

01/10/11 – GOVERNOR’S ACTION

Proposed elimination of the entire Medicaid funded program that over 300 community-based organizations employing thousands of workers who serve nearly 30,000 adults with disabilities (including developmental)  and seniors across the State. 

02/18/11 – SENATE BUDGET COMMITTEE ACTION

• Approved the Governor’s proposal to eliminate the program.
• This action would be an over-all reduction to the Medi-Cal Program by $151.6 million in State general funds.  Committee also approved the following related actions:  
• (1) Appropriated $25 million in State general funds, with possible federal match, to assist with transitioning individuals from Adult Day Health Care to other Medi-Cal health services and social services and respite programs.
• (2) Include with appropriation budget bill language that states: “Of the amount appropriated in this item, $25 million (GF) [General Fund] shall be allocated to grants to provide social activities and respite assistance for individuals who otherwise may have been receiving Adult Day Health Care Services.  The purpose of this funding is to facilities, as applicable and needed, transitions from ADHC [Adult Day Health Care] services. “
• (3) “Placeholder” Trailer Bill Language approved directing the Department of Health Care Services to provide assistance with transitioning individuals from ADHC [Adult Day Health Care] services to other Medi-Cal provided health and social services as offered under the Medi-Cal Program [“Placeholder” means the action or proposal requires some legislative language that still needs to developed or finalized]

02/18/11 – ASSEMBLY BUDGET COMMITTEE ACTION

• Rejected the Governor’s proposal to eliminate the Adult Day Health Care Program and instead approved reduction to program by $28.2 million in State general funds.  This reduction would be achieved as follows: 
• (1)  Stakeholder Process – create a stakeholder process with the Department of Health Care Services to identify chronically non-compliant Adult Day Health Care facilities and implement a new Adult Day Health Care Medical Necessity and Document Self-Audit tool for a 10% reduction in beneficiaries (recipients) based on tighter eligibility criteria. (Some field testing has already been completed). This would achieve a $21 million reduction in State general funds. 
• (2)  Streamline Administration – Move Adult Day Health Care unit from Department of Aging to Department of Health Care Services and streamline administration. This would achieve a $1.7 million reduction in State general funds. 
• (3) Consolidate Licensing and Certification – Consolidate licensing and certification at Department of Health Care Services and replace State general funds with federal funds. This would achieve a $1.2 million cut in State general funds.
• (4) Carry-Over Days – Eliminate reimbursement for “carry-over” days. This would eliminate the ability for beneficiaries (recipients) to make-up absences during the last week of one month in the first week of the next month. This would achieve $400,000 reduction in State general funds.
• (5) Non-Billable Holidays – Mandate 10 non-billable “holidays” [CDCAN Note: furlough days] for all Adult Day Health Care entities.  This would achieve $3.7 million cut in State general funds.

02/25/11- BUDGET CONFERENCE COMMITTEE ACTION

Extensive discussion by committee on this budget item but kept issue “open” for later action the week of February 28th [this issue did NOT come up during the 2/28 Budget Conference Committee hearing] 

NEXT STEPS

Though the Budget Conference Committee could meet and take up this issue on Tuesday (03/01), it appears more likely it will do so on Wednesday (03/02). 

IN-HOME SUPPORTIVE SERVICES (IHSS)

This federal-state-county funded program serves nearly 460,000 children and adults with disabilities (including developmental and persons with mental health needs), the blind and seniors. The program is largely matched by federal Medicaid dollars.  There were several IHSS issues on the Budget Conference Committee agenda:

IHSS – DOMESTIC & RELATED SERVICES REDUCTION

01/11/11 – GOVERNOR’S ACTION

• Proposed to eliminate domestic and related services for all children under age of 18 years living with a parent who is able and available to provide the domestic and related services
• Proposed to eliminate domestic and related services for all adults living in a shared living environment (there would be certain exemptions allowed) 
• Would impact an estimated 300,000 children and adults currently in the IHSS program and result in a reduction of $236.6 million in State general fund spending.

02/18/11 – SENATE BUDGET COMMITTEE ACTION

• Approved a modified version of the Governor’s proposal that included additional exceptions as follows:
• (1) households where the only occupants are all IHSS recipients
• (2) individuals whose housemates are neither their family members nor their IHSS providers (workers)
• (3) domestic and related tasks that require the use of universal precautions
• (4) individuals whose housemates are not both able and available to meet the recipient’s specified needs.

02/18/11 – ASSEMBLY BUDGET COMMITTEE ACTION

Took no action on this issue when it met. 

02/25/11- BUDGET CONFERENCE COMMITTEE ACTION

Discussed the IHSS budget items on the agenda overall but kept this issue “open” for later action the week of February 28th [this issue did NOT come up during the 2/28 Budget Conference Committee hearing] 

NEXT STEPS

Though the Budget Conference Committee could meet and take up this issue on Tuesday (03/01), it appears more likely it will do so on Wednesday (03/02). 

IHSS – ACROSS THE BOARD ADDITIONAL REDUCTION

01/11/11 – GOVERNOR’S ACTION

Proposed additional 8.4% across the board reduction in authorized service hours for all IHSS recipients [this would be in addition to existing 3.6% cut that went into effect February 1, 2011, which the Governor’s proposal would also make permanent] 

02/18/11 – SENATE BUDGET COMMITTEE ACTION

Approved an across-the-board reduction (though not necessarily the Governor’s proposed amount) to correspond to any remaining amount of reductions in State general fund spending (savings) to reach a over-all total of $486.1 million State general fund cuts (savings) to the IHSS program.  Later estimates from the Governor’s Department of Finance indicated that no across-the-board reduction was needed to reach the total $486.1 million reduction or savings target adopted. 

02/18/11 – ASSEMBLY BUDGET COMMITTEE ACTION

Took no action on this issue when it met. 

02/25/11- BUDGET CONFERENCE COMMITTEE ACTION

Discussed the IHSS budget items on the agenda overall but kept this issue “open” for later action the week of February 28th [this issue did NOT come up during the 2/28 Budget Conference Committee hearing] 

NEXT STEPS

·         Though the Budget Conference Committee could meet and take up this issue on Tuesday (03/01), it appears more likely it will do so on Wednesday (03/02).

IHSS – ADDITIONAL SAVINGS

This package of proposed savings to help reach the over-all $486.1 million reduction in State general fund spending to the IHSS program was put forward by advocates.

02/18/11 – SENATE BUDGET COMMITTEE ACTION

Did not take action on this proposal when it met

02/18/11 – ASSEMBLY BUDGET COMMITTEE ACTION

• Approved an additional reduction in State general fund spending (savings) of $160 million to the IHSS Program (which becomes $128.4 million given the change to estimates for the health certification proposal) to reach the overall target reduction level of $486.1 million in State general funds.
• Approved “placeholder” trailer bill language on proposals to be determined, which may include, but are not limited to, proposals regarding medication compliance, nursing home intervention and diversion, and expanded goals for the Community Transitions Program.  [“Placeholder” means the action or proposal requires some legislative language that still needs to developed or finalized]

02/25/11- BUDGET CONFERENCE COMMITTEE ACTION

Discussed the IHSS budget items on the agenda overall but kept this issue “open” for later action the week of February 28th [this issue did NOT come up during the 2/28 Budget Conference Committee hearing]

NEXT STEPS

Though the Budget Conference Committee could meet and take up this issue on Tuesday (03/01), it appears more likely it will do so on Wednesday (03/02).

The following were NOT on the Budget Conference Committee agenda because both the Assembly and State Senate took identical actions:

IHSS - HEALTH CARE CERTIFICATION

01/11/11 – GOVERNOR’S ACTION

• Proposed to narrow eligibility for IHSS with new requirement for all IHSS recipients to have certification from physician that personal care services are necessary to prevent out-of-home placement. 
• Over 40,000 persons currently in the program or applying in 2011-2012 would lose eligibility or not be eligible for IHSS, resulting in reduction of $152 million in State general funds.

02/18/11 – SENATE BUDGET COMMITTEE ACTION

Approved the Governor’s proposal.

02/18/11 – ASSEMBLY BUDGET COMMITTEE ACTION

Approved the Governor’s proposal

NEXT STEPS

Because both the Assembly and Senate actions were identical, this issue is not in the Budget Conference Committee and will be part of the over-all budget package that the full Assembly and Senate will vote on later this week or next and then send to the Governor.

IHSS – COMMUNITY FIRST CHOICE OPTION

This proposal was put forward by advocates and not the Governor

02/18/11 – SENATE BUDGET COMMITTEE ACTION

Approved $121.1 million reduction in State general funds achieved  by expected approval of 6% increase in federal Medicaid matching funds as a result of IHSS qualifying for the new federal “Community First Choice Option” Medicaid program.

02/18/11 – ASSEMBLY BUDGET COMMITTEE ACTION

Approved “Community First Choice Option” proposal. 

NEXT STEPS

Because both the Assembly and Senate actions were identical, this issue is not in the Budget Conference Committee and will be part of the over-all budget package that the full Assembly and Senate will vote on later this week or next and then send to the Governor.

IHSS – COUNTY ADVISORY COMMITTEES

01/10/11 – GOVERNOR’S ACTION

Proposed eliminating all $1.6 million in state general funding for IHSS county advisory committees composed of persons with disabilities and seniors who are IHSS recipients and provider representatives, and to eliminate the State mandate (requirement) that requires State funding for the counties to establish and maintain these committees. 

02/18/11 – SENATE BUDGET COMMITTEE ACTION

Approved the Governor’s proposal eliminating the mandate, but rolled back the reduction from $1.6 million in State general funds to $1.4 million, while retaining $3,000 for each of the 56 IHSS Public Authorities.

02/18/11 – ASSEMBLY BUDGET COMMITTEE ACTION

Approved the Governor’s proposal eliminating the mandate, but rolled back the reduction from $1.6 million in State general funds to $1.4 million, while retaining $3,000 for each of the 56 IHSS Public Authorities. [identical action as Senate]

NEXT STEPS

Because both the Assembly and Senate actions were identical, this issue is not in the Budget Conference Committee and will be part of the over-all budget package that the full Assembly and Senate will vote on later this week or next and then send to the Governor.

IHSS CASELOAD ADJUSTMENT

Adjustment reduced caseload estimates based on more recent actual data, for reduction (or savings) $83.2 million in State general funds to the IHSS program in the 2010-2011 and 2011-2012 State budget years.

02/18/11 – SENATE BUDGET COMMITTEE ACTION

Approved adjustment.

02/18/11 – ASSEMBLY BUDGET COMMITTEE ACTION

Approved adjustment. [identical action as Senate]

NEXT STEPS

Because both the Assembly and Senate actions were identical, this issue is not in the Budget Conference Committee and will be part of the over-all budget package that the full Assembly and Senate will vote on later this week or next and then send to the Governor.