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June 17, 2013

Legislature Sends Budget, Trailer Bills, & Medicaid Expansion to the Governor’s Desk

On Friday, the Legislature passed the $96.3 billion 2013-2014 budget bill, and on Saturday it passed a number of trailer bills. Among these is the historic Medicaid expansion, which will make coverage available to over one million Californians.

The legislature has now sent the budget, subsequent trailer bills, and the Medicaid Expansion bills ABx1 1 (Perez) and SBx1 1 (Steinberg/Hernandez) to the Governor’s desk. We expect the Governor to sign these measures in the near future.

Highlights:

On the positive side, the budget reflects California’s commitment to the Affordable Care Act, and it also makes partial restorations to programs that serve California families in poverty like CalWORKs, Denti-Cal, and Mental Health Services.

CIPC is also pleased to report that the state-funded Medi-Cal program for newly qualified immigrants* has been maintained and preserved, despite the extremely concerning proposals we saw from the Brown administration both in January and as part of the May Revise.

Unfortunately, at the same time, this budget still takes too much money from counties who are responsible for covering those who may remain uninsured after implementation of the Affordable Care Act. We will continue to advocate for inclusive health policies for all Californians to ensure that everyone has access to preventative care.

On the education front, the budget includes a modified version of Governor Brown’s proposed Local Control Funding Formula, which would shift more education money to schools with low-income students and English Language Learners. 

*This refers to lawfully present recent immigrants, who are subject to the 5-year federal bar.

Summary

Medi-Cal Expansion:  The legislature passed two key bills, ABx1 1 (Perez) and SBx1 1 (Steinberg/Hernandez) which will simplify and expand Medi-Cal to US Citizens and lawfully present immigrants who earn under 138% of the Federal Poverty level. (That’s $15,415 per year for an individual and $26,344 for a family of three). These two bills also preserve the current state-funded program for newly qualified immigrants subject to the 5-year bar who are currently eligible but not enrolled. Meanwhile, childless adult recent immigrants who are subject to the 5-year bar will also get access to affordable health coverage in Covered California (The Exchange).

These bills represent a significant improvement over the Governor’s original proposals. In January, Governor Brown released a proposal to stop enrollment into the full-scope state-funded Medi-Cal program at the end of the year, effectively phasing it out for newly qualified immigrants, after 5 years. This population would have been expected to obtain coverage in Covered California. However, these people would have been the only individuals in the Exchange with incomes below 138% of the Federal Poverty Level, making it much less affordable for them. In fact, the original proposal would have essentially left them uninsured. The tide began to turn when, as part of the May Revise, Brown’s proposal shifted and affordability and benefit “wraparound” protections were included.

However, new amendments included prior to Saturday’s vote not only protect the current state funded program, but also ensure that newly qualified immigrant parents and caretakers stay in Medi-Cal with their children. For recent immigrants who are childless adults who go in to Covered California, the affordability and benefit wraps will ensure the same level of cost-sharing, affordable premiums, and benefits as if they were in Medi-Cal. Meanwhile, the state will leverage tax credits and subsidies available to lawfully present immigrants in the Exchange, which has no five year bar. This is certainly a victory for advocates to celebrate.

Remaining Uninsured: Again, even with new coverage options available under the Affordable Care Act, it is expected that 3-4 million Californians will still be without health coverage. One million or roughly one-third of the remaining uninsured are undocumented and are explicitly and unfairly excluded due to their immigration status.

CIPC worked very closely with health allies, counties, and labor to prevent the safety net from being eviscerated as part of Gov. Brown’s proposal to take money from counties that is used to fund public hospitals, access to care for the remaining uninsured, and public health programs.

 On Saturday, the legislature voted on SB80 & AB85, two key trailer bills which effectively realign and reallocate county safety-net funding. Specifically, these two bills will cut $300 million from county health services in the first six months and hundreds of millions more in the future, further reducing the capacity of the safety net to provide for those that remain uninsured. Additionally, the bills lock counties into a formula which could allow the state to take up to 60% of the $1.8B that goes to counties for health care services. CIPC is very concerned about the impact to the undocumented, as it will be much more difficult for counties to come up with money to expand eligibility in the future if they choose to do so. Instead, we would have preferred to see these existing health care dollars be used to expand health care and provide a medical home to all Californians, including the undocumented.

CIPC was proud to be a part of the Protect the Heath Care Safety Net Coalition and to work closely with the administration and legislators to develop a compromise which allowed us to avoid the surely devastating impacts to the safety net that would have resulted under the May Revise proposal.

Restorations to CalWORKs and Denti-Cal

The 2013-2014 budget also includes partial restorations to CalWORKs grants and to Denti-Cal Services.

For CalWORKS the budget included approximately $51 million of growth funding from the 1991 realignment for a 5% increase, beginning March 1, 2014. For 2014-15 and future years, a funding increase could be made on October 1 of each year based on the level of designated growth dollars.

For Denti-Cal, the Medi-Cal dental program, the budget includes $16.9 million in general fund money for this fiscal year, and $77 million in the following fiscal year to help partially restore Denti-Cal benefits for adults. This allocation restores preventative and diagnostic care, as well as some restorative services starting on May 1, 2014.

CAPI and CFAP

There were no major fiscal changes to the Cash Assistance Program for Immigrants (CAPI) and California Food Assistance Program (CFAP), or other state-funded programs that serve immigrants and their families.

Conclusion

As challenging as this year’s budget negotiations were, immigrant safety net programs are still intact and have been preserved, thanks to the hard work by supporters, advocates, allies, and legislative staff. 

As the ACA implementation moves forward, we must continue to advocate for access to quality care for all Californians.

CIPC will continue to monitor these legislative developments and keep you updated as new information becomes available. If you have any questions, please contact our Government Affairs Manager, Ronald Coleman at 916-448-6762, or rcoleman@caimmigrant.org.

 
 
 
 
 


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