California Budget


Budget Deal Restores Some Health Programs — While Slashing Others



After years of devastating cuts to the health and human services budget, this year’s small surplus brought restoration of some programs.

Mental health programs will get a one-time boost of $140 million. The adult dental program, Denti-Cal, cut back in 2009 and leaving tooth extraction as just about the only service being covered, has been restored, albeit partially. Benefits won’t start until next May.

But lost in the deal was a proposal to provide some therapies to 500 children with autism. Those children had lost some services when the state moved them from Healthy Families and to Medi-Cal.

Then there’s the issue of funding to county health programs. Counties bear the cost for providing health care to the uninsured. Gov. Brown has been arguing since he introduced his budget in January that counties will gain federal money in January under the full implementation of the Affordable Care Act and so the state could reduce its own health funding to counties. But counties have fought that idea, saying that there would still be plenty of uninsured people after Jan. 1 — and that now is not the time to cut the safety net. Continue reading

Brown Backs State-Run Medi-Cal Expansion

By Mina Kim

(Justin Sullivan/Getty Images)

(Justin Sullivan/Getty Images)

Gov. Jerry Brown’s revised budget plan is a mixed bag for health advocates and some county officials.

Brown said the state would take the lead on a key provision of the federal health law — expanding Medi-Cal to more than one million Californians. Brown scrapped earlier plans to consider a more complicated, county-based system.

But Brown anticipates recouping more than $300 million from the counties next fiscal year — money that pays for public health programs and care for the uninsured. Brown’s rationale? With the full implementation of federal health reform next year, more people will enroll in Medi-Cal and fewer people will show up to county emergency rooms.

Farrah McDaid Ting with the California State Association of Counties says Brown’s proposal makes no sense. She says plenty of people will still rely on county services in 2014.

They are “people who qualify for Medi-Cal but don’t sign up, people who have a hard time signing up or staying on programs, the undocumented in our communities and those who are in between private health plans,” McDaid Ting said. “We need to retain enough funds to serve those people.” Continue reading

Gov. Brown’s State of the State — on the Health Care Overhaul

(Justin Sullivan/Getty Images)

In Thursday’s State of the State speech, Gov. Brown called for a special legislative session to address the Affordable Care Act. (Justin Sullivan/Getty Images)

In his State of the State speech Thursday morning, Gov. Brown spent about 60 seconds addressing health and human services — and all those seconds were devoted to the rollout of the Affordable Care Act.

Early in his speech, Brown reiterated his theme of fiscal discipline and seemed to urge caution in implementing the Affordable Care Act, stating, “The ultimate costs of expanding our health care system under the Affordable Care Act are unknown. Ignoring such known unknowns would be folly.”

Later in the speech came the bulk of his comments about the ACA. Here’s the transcript:

“California was the first in the nation to pass laws to implement President Obama’s historic Affordable Care Act. Our health benefit exchange, called Covered California, will begin next year providing insurance to nearly one million Californians. Over the rest of this decade, California will steadily reduce the number of the uninsured. Today I’m calling for a special session to deal with those issues that must be decided quickly if California is to get the Affordable Care Act started by next January. Continue reading

State vs. County Showdown Over Funding the Medi-Cal Expansion?

(Justin Sullivan/Getty Images)

Gov. Brown is proposing California's counties relinquish some of their state health funding once the Affordable Care Act is in place. (Justin Sullivan/Getty Images)

We’re now 354 days from the rollout of the Affordable Care Act next Jan. 1. While the governor declared the state’s participation in the Medicaid expansion at his budget unveiling yesterday, he also proposed two ways to handle that expansion.

Under one scenario, the state will continue to administer the program. Under the other, each of California’s 58 counties will oversee running Medi-Cal, California’s version of Medicaid, for its own residents.

The Affordable Care Act dictates that the federal government will pay 100 percent of the cost for those people newly eligible for Medicaid, and in both proposals, the state’s position is that California counties will get some fiscal relief once those federal dollars start flowing.

But don’t get too excited, counties.

California Secretary of Health and Human Services Diana Dooley yesterday referred to a “conversation” around “appropriate sharing” that needs to happen between the state and its counties around financial responsibilities.

“There’s an assumption we’ve been fully funded. That is simply not accurate.”

“Conversation” might prove to be a euphemism for what could become a vocal debate between the state and the counties. And maybe between counties themselves.

Alex Briscoe, Director of Alameda County’s Health Care Services Agency, told me this morning that “sharing” presumes that current state funding is sufficient to meet the needs of the indigent poor, an idea he called “simply preposterous.” Continue reading

Governor’s Proposals for Medicaid Expansion

(Military Health/Flickr)

(Military Health/Flickr)

Gov. Jerry Brown has released his new state budget, including plans for implementing the Affordable Care Act in California. In a press conference this morning, the governor said he plans to handle that implementation “cautiously.”

“We are committed to expanding Medi-Cal, we’re committed to bringing more people into the healthcare system, but we recognize there are big costs out there,” the governor told reporters. “There are big unknowns so we’re going to move carefully, but we’re going to move with commitment, because I believe people do need decent healthcare, and I believe what Pres. Obama did was historic. It was heroic, and I’m going to do everything I can to be a good partner to make sure his plan works.”

The ACA calls for an expansion of the Medicaid program, known as Medi-Cal in California. The federal government will pay 100 percent of the costs of the new enrollees through 2016. After that, the federal contribution will decline to 90 percent by 2020.

The governor is proposing two ways to handle the expansion. Continue reading

California Budget Proposal Would Move 880,000 Children Off Healthy Families

A kindergartner visits the dentist, one of the services parents and advocates are worried about accessing when they switch to Medi-Cal. (heraldpost/Flickr)

Jacqueline Dandeneau understands why children’s health advocates are so upset.

The Humboldt County resident, and mother of a 12-year-old and a 6-year-old, was a longtime subscriber to Healthy Families. That’s California’s medical insurance program for kids whose parents make just too much to qualify for Medi-Cal, but struggle to afford private health insurance payments.

“We were a ‘Healthy Families’ family and very happy to be so. The paperwork was easy and we had great dental access,” said Dandeneau.

Then, came the economic downturn, their fortunes changed for the worse and their coverage changed to Medi-Cal.

Dandeneau says in their county there are few providers and they are waiting up to a year for appointments.

“We have to drive 3 hours to go to Redding,” said Dandeneau, pointing out it’s a challenging system for working parents struggling to juggle commitments. “So I see right now the system is taxed as it is. We as a Medi-Cal family can’t get enough coverage as it is. Let alone if we have all the Healthy Families kids fall into that service.”

Wendy Lazarus with Children’s Partnership says the idea that all of the 880,000 children in Healthy Families would immediately be moved in Medi-Cal as part of the budget solution was a big surprise. Continue reading

Governor’s New Budget Slices — Again — Into Health Care

(Max Whittaker: Getty Images)

(Max Whittaker: Getty Images)

Governor Jerry Brown released his revised budget this morning and the cuts to health and human services are significant. Since the economy soured in 2007, state cuts to health and services programs have exceeded $15 billion .

Today the governor announced:

  • An additional $400 million in cuts to Medi-Cal, mostly to hospitals and nursing homes
  • Reductions to the “Healthy Families” program which covers children, effecting their access to health care. Potential savings are $48 million
  • Reducing In-Home Support Services hours by seven percent for a savings of $99 million
Anthony Wright of Health Access, a statewide advocacy group said these cuts would effect virtually all Californians. “These ugly cuts are a body blow to the health system on which we all rely,” Wright said in a statement. “These are the wrong cuts at the wrong time, during an economic downturn when Californians need this help the most, and when we need to get ready for health reform to maximize the benefit for our families and our state.”

In a conference call with reporters today, Secretary of Health and Human Services Diana Dooley said the cuts to her agency were inevitable. “The problem we have and always have in health and human services is this is where most of the spending is. The spending is in education and health and human services to a very large degree, and the only place you can cut back are the places where you are spending.”

The governor’s revised budget depends on voters passing his tax increase proposals expected to land on the November ballot.  A poll last month by the Public Policy Institute of California showed 54 percent support for the governor’s plans — but tax increases require a two-thirds majority to pass. If his tax proposals do not pass, more cuts will be necessary to balance the state’s budget.