State Public Policy Update – February 2012
Governor’s Budget Proposal Includes Further Cuts to Critical Programs & Services
On January 5th, Governor Brown released his 2012-13 budget proposal. With the state facing another budget deficit, the Governor’s budget proposes $4 billion in cuts and $7 billion in new revenues in order to address a budget problem of $9.2 billion The Governor’s plan is to fill the budget gap by seeking voter approval for a temporary half-cent sales tax increase and higher taxes on the wealthy. If voters do not approve the Governor’s November ballot measure the state will impose a $5.4 billion in automatic cuts to schools, courts and public safety.
The Governor’s proposed cuts included several of concern for California families living with Alzheimer’s disease, including:
- Reductions to In-Home Supportive Services: The Governor’s proposal would eliminate domestic services for recipients in a shared living arrangement, meaning that tasks such as housecleaning, grocery shopping and meal preparation would no longer be covered.
- Furthermore, the Governor’s 2011 budget action to implement a 20% across-the-board reduction to IHSS hours has been blocked by the California Supreme Court.
- The complete elimination of California’s Caregiver Resource Centers: The Governor has proposed the elimination of state funding – $2.9 million – for the Caregiver Resource Centers. The State Office is working with the statewide advocate for the centers, and is in the process of building an advocacy strategy to protect this vital funding.
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State Public Policy Update – July 2011
Governor Brown Signs Main Budget Bill & Retains $85 Million
On Thursday, June 30th Governor Brown signed the budget bills passed by the Legislature with a Democratic majority vote. While the Governor retained the $85 million included in the budget for partial restoration of Adult Day Health Care (ADHC) centers, he removed the language that specified that the funding was to support the transition of people out of the current ADHC program to other Medi-Cal services AND to support the transition to a new, redesigned program called Keeping Adults Free from Institutions (KAFI).
Intended Use of This Funding Remains Unclear
Due to the deletion of language specifying how the funds are to be used, it is unclear if the Governor intends to sign AB 96, which would direct the State to develop a proposal for the new KAFI model.
As of Wednesday, July 6th, AB 96 has not been sent to the Governor. It is being held by the Legislature until further conversations with the Brown Administration occur. The California Association for Adult Day Services (CAADS), the primary advocacy organization for ADHC, is in frequent communication with the leadership in the Legislature and will continue to monitor the discussions.
If AB 96 does not pass and the state does not request federal approval of a redesigned program, federal funds cannot be used to support this program. Funding for ADHC has already been reduced by 50%. The loss of federal funds would reduce funding by another 50% making it extremely difficult for the program to survive.
Given these uncertainties, it is important we keep up the pressure on the Governor with calls. Call his office at (916) 445-2841 and express your support for AB 96.
CALL GOVERNOR BROWN TODAY TO KEEP ADHC ALIVE
A MASSIVE GRASSROOTS OUTPOURING OF SUPPORT IS NEEDED ASAP IF WE ARE TO SAVE ADULT DAY HEALTH CARE
Contact Governor Brown’s office TODAY at (916) 445-2841 and ask him to:
1. Sign AB 96
AB 96 authorizes the state to proceed with submission of a waiver application to CMS (Center for Medicare & Medicaid Services) for a reconfigured ADHC program “Keeping Adults Free from Institutions” (KAFI). The only way to obtain a dollar for dollar federal match of state funding is to get ADHC authorized under a federal waiver.
2. Retain the $85 million appropriation in the budget
This was part of the March compromise to implement KAFI and keep some ADHC infrastructure in place to avoid the greater cost of nursing home admission, emergency room visits and hospital stays for our current ADHC population.
Background Information:
On Tuesday, June 28th the Legislature passed the budget bills with a Democratic majority vote. The bills now head to Governor Brown, who is expected to sign them by midnight, June 30th. Included in the budget bills is $85 million for partial restoration of ADHC centers; however, it is unclear where the Governor stands on this issue.
The Legislature will also send him AB 96 (Blumenfield), which directs the state to apply for a federal waiver for ADHC. The Governor has not indicated whether or not he will veto funding for the redesigned version of ADHC.
Given these uncertainties, it is important we keep up the pressure on the Governor with calls.
FACTS:
- ADHC is the only community AND medically-based long term support and service.
- The Lewin Group estimated that elimination of ADHC would cost the state $53 million more than it saves.
- In-Home Supportive Services cannot replace the skilled medical services, therapies and social work provided in ADHC.
- The strain on the health care system to absorb 38,000 chronically-ill patients will result in higher medical costs across the system.
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State Policy Update – May 2011
Legislature Defends Important Programs from Additional Cuts – Budget Negotiations Ongoing
On Monday, May 16th, Governor Brown released his revised state budget proposal, commonly referred to as the May Revise. Amongst his many proposals, there were two of interest for the Alzheimer’s Association and California families living with the disease:
- Proposal to completely eliminate the Adult Day Health Care (ADHC) program and appropriate $25 million for the purpose of transitioning those in the program to alternative services.
- The Governor’s continued preference to eliminate ADHC was disappointing. However, on Tuesday, May 24th, the Budget Sub-Committees stated they would not re-open the ADHC budget when they convene to discuss the May Revise. This was a promising sign that the members of the Legislature intend to follow through on their intent to create a new ADHC program under a federal waiver, known as the Keeping Adults Free from Institutions (KAFI) program, with $85 million in state funding. While the details regarding what this new program will look like, who it will serve and how it will function remain to be developed, the Alzheimer’s Association will continue to advocate for this option.
- Proposal to cut an additional $7.7 million for In-Home Supportive Services (IHSS) Public Authorities, which provides assistance to recipients in finding IHSS providers, investigates the qualifications and backgrounds of potential providers, and provides training for IHSS workers and recipients.
- On May 24th, the Assembly Budget Subcommittee on Health and Human Services voted 3-0 to reject this. The 52 public authorities operating throughout the state will continue to provide for specific functions related to the delivery of IHSS in counties, while the budget subcommittee staff works to develop trailer bill language to change how Public Authorities are allocated funding.
Budget subcommittees will continue to review the Governor’s May Revise proposals. Meanwhile, the Governor has resumed talks with Republican members of the legislature. He is seeking two Republican votes in both the Assembly and Senate and has stated publicly that he still wants the issue of tax extensions put before the California voters.
Update on Priority Legislation
In order for bills to continue in the legislative process this year, they must be passed out of their house of origin by Friday, June 3rd. As of Wednesday, May 25th, 21 of our 25 priority bills were on track to meet this deadline. The four bills that did not (AB 367, AB 594, SB 529 and SB 717) will not be eligible for further legislative discussion until the 2012 session begins (they are considered two year bills). For the full list of our priority bills, please visit www.caalz.org/policy/bill_report/.
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State Policy Update – April 2011
Governor Brown Signs Budget Cuts – Issue of Tax Extensions Remains Unresolved
On Thursday, March 24th, Governor Brown signed into law several budget trailer bills that will implement over $8 billion in cuts, including over $6 billion in cuts to health and human services programs.
While most of the cuts will not take effect until or after July 1, 2011 – when the new fiscal year begins – the elimination of Adult Day Health Care (ADHC) as a Medi-Cal benefit will take place in June. The Legislature did approve $85 million in Medi-Cal funding for a new program, called Keeping Adults from Institutions, that will draw dollar-for-dollar matching from the federal government, for a total funding level of $170 million. Consumer organizations are working with state officials to determine the specifics of this new program, who it will serve, and how the transition of approximately 37,000 individuals from ADHCs to this new program will work.
In addition to the elimination of ADHC, the recently signed budget trailer bills included cuts to In-Home Supportive Services (IHSS), the Multipurpose Senior Services Program (MSSP), and Medi-Cal. As previously reported, these cuts included:
IHSS – $486.1 million in reductions, including:
- Service hour reductions;
- Elimination of domestic and related services for recipients living with their provider;
- Requirement for physician certification to receive services; and
- Elimination of state funding for county advisory committees.
MSSP – Up to, but not more than, $2.5 million reduction. This reduction is to be achieved by identifying ways to reduce administrative costs in a way that limits the impact on the number of recipients served.
Medi-Cal – $584 million in savings, achieved through mandatory co-payments including:
- $3 and $5 for some prescription drugs;
- $5 for physician and dentist visits;
- $50 for emergency room visits; and
- A $200 maximum for hospital stays.
Next Steps
Governor Brown’s original proposal to balance California’s budget included an equal combination of cuts and revenue solutions. While the cuts were signed into law last week, the revenue solutions remain unresolved. The original proposal called on the Legislature to approve a budget-related bill, with a 2/3 majority vote, that would allow Californians to vote on a tax extension initiative in June, 2011. However, due to philosophical differences between the two parties, this bill has not been brought to the floors.
There had been some speculation that the Governor may try to amend the bill so it only required a simple majority vote; however, Governor Brown quelled that speculation this week when he stated he believed such a tactic was unconstitutional. Based on comments made by the Democratic leadership, including Senate Speaker pro Tempore Darrel Steinberg and Assembly Speaker John A. Pérez, and Governor Brown, it appears increasingly likely that there will be an initiative to gather signatures for a November ballot measure. Since the current taxes will expire June 30th, this ballot initiative would technically call for a tax increase, rather than an extension of current taxes, to balance the remaining budget deficit.
In the absence of other alternatives to solve the budget shortfall, the Legislature and Governor may be forced to examine the budget and achieve the additional savings through further cuts. This would likely include more cuts to health and human services programs, as well as other areas such as education and public safety. It remains difficult to say with certainty what will happen in the weeks ahead, due to the fluidity of the situation – however, complete elimination of some programs is a very real possibility in the absence of revenue solutions.
Call your member of the Legislature. Tell them your story and how Alzheimer’s has impacted your life. As a constituent, make it clear that complete elimination of programs and services is unacceptable.
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State Policy Update – February 2011
Assembly & Senate Budget Committee Actions
Both the Assembly and Senate Budget Committees met over the past few weeks to discuss and cast votes on Governor Brown’s various budget proposals. Included were multiple proposals to reduce or eliminate funding for programs and services that California families living with Alzheimer’s rely on. After multiple hearings, both committees took action on the Governor’s proposals.
While the committees took similar actions on some items, they took different actions on others. These differences will have to be resolved in the Budget Conference Committee over the next few weeks. The budget committee actions are outlines below:
Adult Day Health Care (ADHC)
Governor Brown’s proposal called for the complete elimination of ADHC, which would leave 27,000 beneficiaries without vital community services for seniors.
The Assembly rejected this proposal, andinstead approved a proposal that would cut $28 million from the program. The Senate voted to eliminate ADHC as a Medi-Cal benefit, and created a $25 million general fund grant. However, this grant would not cover medical services.
Multipurpose Senior Services Program (MSSP)
The Governor had proposed complete elimination of MSSP, which serves over 11,000 Medi-Cal eligible seniors who qualify for placement in a nursing facility but wish to remain in the community.
The Senate Budget Committee rejected this proposal, and instead unanimously approved a $5 million General Fund reduction.
The Assembly Budget Committee rejected this proposal and maintained the program at its currently funding level of $19.9 million.
In-Home Supportive Services (IHSS)
Governor Brown’s budget included $486.1 million in cuts to the IHSS program, including an 8.4% reduction in service hours, elimination of domestic and related services for recipients living with their provider, requirement of physician certification for IHSS services, and elimination of state funding for county IHSS advisory committees.
Below is a summary of the actions taken on the IHSS proposals:
o Reduction in service hours: The Assembly rejected this proposal, while the Senate approved a lesser reduction in service hours.
o Elimination of domestic and related services for recipients living with their provider: The Assembly rejected this proposal, while the Senate adopted a modified proposal, which included specified exemptions.
o Requirement of physician certification: Approved by both budget committees.
o Elimination of state funding for county advisory committees: Both budget committees approved a $1.4 million cut, leaving $3,000 per county for continued operation of advisory committees.
Medi-Cal
The Governor’s proposal included limiting prescriptions, monetary limits on durable medical equipment and supplies, and implementing mandatory co-payments for Medi-Cal beneficiaries for physician, clinic, dental and pharmacy services, emergency room services and hospital stays.
While the budget committees did not approve all these proposals, they did approve approximately $584 million in mandatory co-payments, including:
o $3 and $5 for some prescription drugs;
o $5 for physician and dentist visits;
o $50 for emergency room visits; and
o A $200 maximum for hospital stays.
Both committees rejected proposals to implement hard caps on physician visits and prescription drugs.
The Budget Conference Committee, comprised of members from both the Assembly and Senate will convene in the weeks ahead to reconcile the differences between the two budget plans.
