Policy Developments

August 20, 2012  – “The Legislature agreed to the difficult budget action in eliminating the optional ADHC benefit.  We did not agree with the dismantling of the services and neither did the courts.” This is the closing of an August 14 letter from the California Assembly Aging and Long Term Care Committee to Diana Dooley, California Secretary of Health and Human Services. The letter summarizes the multiple problems with the transition of Medi-Cal coverage for Adult Day Health Care (from optional benefit to a new program called CBAS) that are forcing centers out of business and frail participants into nursing homes. Read the Letter.

September 20, 2012  –  The November Ballot Initiative, Proposition 30, is key to preserving what remains of long term services and supports after years of state cuts.  Why?  Isn’t this tax increase for California’s wealthy targeted at preserving public school funding, along with community colleges and universities?  Yes, but the revenue infusion would attack the state’s “structural deficit,” freeing up an estimated $5.6 billion General Fund dollars this year and more over the next seven years.

Prop 30 would also put the recent “Realignment” into the state constitution, an important safeguard for counties that are taking on funding and responsibility for public safety and social services programs that once belonged to the state.  For more information, read the California Budget Project’s Brief on Prop 30.

August 10, 2012 – AB 2206 (Atkins) has passed the Senate Appropriations Committee and is moving on to a vote on the Senate Floor. The bill would require the Department of Health Care Services (DHCS) to include PACE — the Program of All-Inclusive Care For The Elderly — as one of the alternatives to Medi-Cal managed care in the eight counties where the CCI pilot is starting. If enacted, consumers will see the PACE alternative in the packets and on the forms that DHCS mails to dually eligible Alameda County residents starting in the fall of 2013.

November 4, 2013 – Concerned about the confusing messages that are flooding the press – and seniors’ mailboxes – regarding health coverage? You are not alone.

To address the confusion around health care coverage options in Alameda County, the Social Services Agency just released an updated Eligibility Chart to help social service providers identify coverage options for different people. Click here for a copy.

Also, our local HICAP provider, Legal Assistance for Seniors, has comparison charts for Medicare Advantage, prescription drug and MediGap plans on their web site at http://www.lashicap.org/hicap.

Here are some simple guidelines to point seniors in the right direction this Fall:

1. If you have Medicare, you do not need to purchase any coverage through the state’s health insurance exchange, called Covered California. Medicare open enrollment (from October 15 through December 7) is still the time for you to review your health and prescription drug coverage and make any changes for next year.  Contact medicare.gov or 1-800-MEDICARE for information, and call your local Health Insurance Counseling and Advocacy Program (HICAP) to get free, neutral help sorting through your options so you can make the choice that is best for you.  In Alameda County, the HICAP number is (510) 830-0393.  In Fremont, Hayward, Newark and Union City, seniors can also call the Senior Help Line at (510) 574-2041.

2. If you have Medi-Cal, you do not need to purchase coverage through Covered California.  Some changes in Medi-Cal coverage will start next year (as early as April 2014) for seniors and people with disabilities with Medi-Cal in Alameda counties, so watch your mail beginning in 2014.

3. For people younger than 65 who don’t have health coverage, Covered California is the place to go to find affordable coverage. Subsidies to help pay premiums may be available, depending on your income, and new eligibility rules (for instance, no asset test) will mean more people will be able to enroll in Medi-Cal.  Go to www.coveredca.com or call 1-800-300-1506.

4. Beware of scams.  People with Medicare and/or Medi-Cal do not need new identity cards, will not get calls from the government about their health coverage, and should never pay anyone to enroll in coverage.  If you suspect a scam, call the Senior Medicare Patrol at 1-855-613-7080.

Return to the Coordinated Care Initiative page here.

The Governor’s May Revise Budget

Potential Impact of Proposed FY 2013-14 Budget on Alameda County Seniors and Services

On May 14, 2013, Governor Brown released his May Revise, updating his proposed budget  for California’s 2013-14 fiscal year.  Even though state legislators continue to push to reinstate Medi-Cal dental benefits and increase provider rates in light of an improving economy and state finances stabilized by Proposition 30, the Governor’s Revise predicts a weaker economic picture for next year and maintains a spending plan characterized by restraint.  The Revise budget increases funding levels for education, adds greater detail to the expansion of Medi-Cal as part of California’s implementation of federal health care reform, and proposes a $1.1 billion reserve while paying down some of the state’s $35 billion debt. (For details, see California Budget Project’s summary at www.cbp.org )

While the wholesale scaling back of public programs and services is behind us, terribly deep cuts made to the safety net and to senior services over the last several years remain in place.  On top of this, federal Sequester cuts are about to hit senior housing, community development block grants, Older Americans Act programs and other essential senior services, putting the viability of supportive services for seniors in Alameda County at risk.

The following summarizes the proposals in the Governor’s May Revise and overall FY 2013-14 budget plan that would directly impact seniors and senior services in Alameda County.

COORDINATED CARE INITIATIVE

California’s Coordinated Care Initiative (CCI), is a multi-year plan to coordinate health care and long term services and supports for “Duals” (Medicare/Medi-Cal beneficiaries) and Medi-Cal Only seniors and people with disabilities.  The CCI has three major components.  The first incorporates Medi-Cal-covered Long Term Services and Supports (IHSS, ADHC, MSSP and skilled nursing facility) into Managed Care.  The second requires fee-for-service Medi-Cal beneficiaries to enroll in Managed Care (including Duals, nursing facility residents and others left out of last year’s mandatory enrollment into Medi-Cal Managed Care). The third component, the Duals Demonstration now known as CalMediConnect, integrates Medicare and Medi-Cal coverage into Managed Care Plans that coordinate both medical and long term services and supports.

The Coordinated Care Initiative was set to launch in eight counties – including Alameda County – as early as June 1, 2013.  The Governor’s May Revise moves the launch date to January 1, 2014 (**Since changed to July 2014**). This means that the first notices that any beneficiaries would receive about the transition would arrive no earlier than October 2013 (**April 2014 with the updated launch date**)).

The May Revise also aligns California budget policy with the Duals Demonstration Memorandum of Understanding between the state and Centers for Medicare & Medicaid Services (CMS) signed in March. These changes include the agreement that Duals may change or opt out of CalMediConnect plans at any time (no “lock in” period); the addition of vision, dental and transportation to the list of required benefits; and a 12 month phase-in (by birthday month) for enrollment in Alameda County.  The 12-month phase-in carries many exceptions, however, including that Duals in Medicare Advantage plans will all be enrolled on January 1, 2014 July 2014.

In Alameda County, over 60,000 seniors and people with disabilities will be affected in some way by the Coordinated Care Initiative, and over 31,000 will be eligible for CalMediConnect.

IN-HOME SUPPORTIVE SERVICES

The May Revise budget adopts the terms of a recent settlement of two lawsuits  –  one filed in 2011 that blocked the state from implementing a 20% across-the-board reduction in IHSS hours, the other filed in 2009 that blocked the termination or reduction of IHSS for many recipients based on their functional index score.  Instead, the state will:

• Replace the permanent 20% cut in IHSS hours with a temporary 8% cut starting in July 2013. (This is an additional 4.4% cut on top of the 3.6% current cut that was scheduled to expire in June.)

• Reduce the total cut to 7% in July 2014.

• Restore the hours lost from the 7% cut as early as the spring of 2015 if the State obtains federal approval of a provider fee which could bring significant new federal revenue to California.

• Commit any savings from retroactive federal approval of the new provider fee to fund a program to benefit IHSS recipients, such as the SSI Special Circumstances program, which was used to pay for refrigerators and stoves, rent to avoid eviction and other emergency needs but has not been funded in the budget for many years.

• Clarify that IHSS consumers have a right to request a reassessment based on a change in circumstances, even if this change is not medical. Recipients will not be required to provide medical certification of a change in their medical condition to obtain a reassessment. This will help ensure that consumers who need additional hours will be able to obtain them.

In addition, the May Revise:

• Continues the health care certification requirement enacted in the FY 2011-12 budget.

• Increases state funding for IHSS by $80 million in the current fiscal year and by $120 million in FY 2013-14 to cover increased costs per case and a higher than expected caseload (the result of more people securing health care certifications than expected).

• Includes $259,000 in General Fund costs (matched dollar-for-dollar with federal funds) to cover four new positions in the Department of Social Services to staff the Statewide Authority for IHSS that will be responsible for collective bargaining and other elements previously handled by Public Authorities in each county.  The Governor expects to convene the Statewide Authority prior to the transition of IHSS into Managed Care.

In Alameda County, almost 18,000 seniors and adults and children with disabilities rely on IHSS. The majority of them rely on a caregiver to provide domestic and related services: Over 14,000 cannot perform housework without help; over 11,000 cannot prepare meals without help; over 15,000 cannot shop for food without help.

MEDI-CAL

The Governor’s May Revise does not restore Medi-Cal dental or other optional benefits, and does not restore the 10% provider rate cut that has been blocked by litigation.  Legislators continue to push for both of these restorations, and the court ruling on the 10% cut is imminent.

The May Revise continues the Governor’s proposal to implement an Open Enrollment period for Medi-Cal, requiring that Medi-Cal beneficiaries select their managed care health plans annually, rather than being able to change plans as needed throughout the year.  In other words, Medi-Cal beneficiaries would be locked in to a plan – a potential problem for people with complex or changing medical needs. The Governor projects that this change would save $1 million in the 2013-14 fiscal year.  If this change is passes, it would affect people who are in Medi-Cal Managed Care as a result of the Coordinated Care Initiative.

SUPPLEMENTAL SECURITY INCOME/STATE SUPPLEMENTARY PROGRAM

While the Governor’s budget does not rescind the cuts made to the state’s share of SSI/SSP, it does allow the federal cost of living increases to grant levels.  Maximum SSI/SSP grant levels in 2013 would increase by 1.7 %, or $20 a month for individuals and $30 a month for couples, and CAPI benefits (Cash Assistance Program for Immigrants) would increase correspondingly.  This means that 2013 maximum grant levels for SSI/SSP would rise to $874 a month for individuals and $1,474 a month for couples.

In Alameda County, over 50,000 seniors and people with disabilities rely on SSI/SSP.

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For a clear and comprehensive understanding of the Duals Demonstration’s recently signed Memorandum of Understanding, The SCAN Foundation and National Senior Citizens Law Center (NSCLC) have created helpful summaries.

Both documents provide a background on the Duals Demonstration (now known as “Cal MediConnect”) as a whole, the scope of the implementation, the proposed timeline as well as eligibility details. Additionally, they provide details surrounding the enrollment processes, network adequacy, beneficiary protections and quality controls. To view The SCAN Foundation PDF, click here. To view the NSCLC PDF, click here.

The automatic cuts known as sequestration took effect on March 1, 2013. Under the requirements of the 2011 Budget Control Act (amended in January) both defense and non-defense programs were automatically cut, reducing total funding by $85.3 billion in the first year. Half the cuts were made to non-defense programs, including a cut to discretionary appropriations of 5%, or $25.8 billion.

Nestled in the discretionary budget category are programs funded through the Older Americans Act – the home and community-based supports that served over 49,000 seniors in Alameda County last year. But that’s where the hard data ends and our frustrating search for information begins.

What will the impact of sequester cuts be on Older American Act-funded programs in Alameda County? With only two months remaining in the current fiscal year and every organization that provides OAA services needing to plan their budgets and programs for next fiscal year, we don’t know. California’s Department of Aging has released only sketchy information to our local Area Agency on Aging. Worse, the CDA has waffled. First, the CDA described an approach to program cuts that would allow the AAA to buffer the current fiscal year impact with annual One-Time-Only funds, but last week the CDA changed its approach but offered no concrete details.

Without knowing the impact, our ability to marshal resources to mitigate the cuts is limited. SSC has begun calling on our colleagues in Sacramento for help in seeking information. We may be coordinating legislative visits in the near future and will ask stakeholders to join us. Stay tuned.

Return to the Senior Services in Alameda County page here.

May 2, 2013 – Over a year ago a court settlement saved Adult Day Health Care (ADHC) from being eliminated as a Medi-Cal benefit, and created the Community Based Adult Services (CBAS) benefit, which provides the same service. However, the settlement agreement is a temporary measure that expires after 18 months.

On May 8, the California Assembly Appropriations Committee will hear AB 518, by Assemblymember Mariko Yamada. The bill would, essentially, codify the court settlement, ensuring that the CBAS benefit cannot be dropped when state health officials eventually renew the federal waiver that spawned it. 

To voice your support, call:
Assemblymember Mike Gatto (Dist. 43)
Appropriations Committee Chair
(916) 319-2043

Assemblymember Bill Quirk (Dist. 20, Hayward)
Appropriations Committee Member
(916) 319-2020
Governor Jerry Brown
(916) 445-2841

Email Governor Brown via this link.

Return to the Senior Services in Alameda County page here.

March 27, 2013 – Today the Department of Health Care Services (DHCS) and the federal Centers for Medicare and Medicaid Services (CMS) announced that they have signed a Duals Demonstration Memorandum of Understanding (MOU). The Duals Demonstration is a key part of California’s Coordinate Care Initiative (CCI), and will integrate funding streams, health care, and Long Term Services and Supports for dual eligible beneficiaries.

The MOU does not address other parts of the CCI, such as the mandatory enrollment of Medi-Cal Only and Dual eligibles into Medi-Cal managed care, or the transition of Medi-Cal-covered LTSS in to managed care.

Looking at DHCS’s MOU Fact Sheet and CMS’s Announcement, there are significant changes from the state’s original proposal. What does the new MOU mean for Alameda County? Here are some highlights. We’ll have more in coming weeks.

• A new launch date of no sooner than January April 2014. In Alameda County most consumers would be passively enrolled over 12 months by birthday month, with some exceptions. For instance, consumers who are currently in Alameda Alliance for Health’s Duals Special Needs Plan (DSNP) will all be passively enrolled into Alliance’s Duals Demonstration Plan in March June 2014.

• New Benefits – all participating plans are required to offer vision, dental, and non-emergency transportation benefits to enrollees.

• Beneficiary protections are consistent with other capitated Financial Alignment Demonstrations, and there will be Ombudsman services to support individual advocacy of Medicare-Medicaid enrollees and to identify systemic problems and provide oversight for the Demonstration.

• Continuity of Care Requirements are in place to help ensure enrollees do not experience disruptions in care through the transition period. Enrollees will have access to current providers and service authorizations for up to 12 months for Medicaid and up to 6 months for Medicare (more later on the criteria that must be met for this to happen).

• No lock in – Consumers will be able to opt out of the Duals Demonstration at any time or change Demonstration plans. Consumers who are in Medi-Cal Managed Care Plans will be able to change plans at any time (but would not be able to opt out of Medi-Cal Managed Care), and it is important to know that legislation is moving through the state legislature that would create an open enrollment period with lock-in for the rest of the year for all Medi-Cal consumers.

• Home and Community Based Waivers will remain open.

• The size of the Duals Demonstration is limited to 456,000 statewide, and capped at 200,000 in Los Angeles County. Based on a first look at the numbers, this limit will not affect Alameda County consumers’ ability to enroll in the Duals Demonstration.

Click here to download the state’s MOU Fact Sheet. Click here to go to the MOU Document.

Return to the Coordinated Care Initiative page here.

**Update – April 10, 2013** NSCLC has prepared a notice about the settlement for consumers and providers, download it here.

March 20, 2013 – A settlement has been reached in the law suit to stop the State of California from reducing In-Home Supportive Services hours and services. The cuts had been enacted in the state’s FY 2011-12 budget and FY 2009-10 budget, but were blocked by court injunction. The Governor’s proposed FY 2013-14 budget still assumed the state would win the suit and implement the cuts.

In the settlement, the State has agreed to repeal and eliminate two major cuts to IHSS: (1) the 20% across-the-board reduction in IHSS hours from 2011, and (2) the termination or reduction in IHSS for many recipients based on their functional index score from 2009.

Instead, the settlement:

• Replaces the permanent 20% cut in IHSS hours with a temporary 8% cut in July 2013. (This is an additional 4.4% on top of the 3.6% current cut that was scheduled to expire in June.)
• Reduces the total cut to 7% in July 2014.
• Restores the hours lost from the 7% cut as early as the spring of 2015 if the State obtains federal approval of a provider fee which could bring significant new federal revenue to California.
• Commits any savings from retroactive federal approval of the new provider fee to fund a program to benefit IHSS recipients, such as the SSI Special Circumstances program, which was used to pay for refrigerators and stoves, rent to avoid eviction and other emergency needs but has not been funded in the budget for many years.
• Clarifies that IHSS consumers have a right to request a reassessment based on a change in circumstances, even if this change is not medical. Recipients will not be required to provide medical certification of a change in their medical condition to obtain a reassessment. This will help ensure that consumers who need additional hours will be able to obtain them.

We’ll have more details soon.

The settlement resolves a second lawsuit that challenged a cut to IHSS worker wages that was enacted in the state’s FY 2009 budget (a cut that was also blocked by the courts). The state agreed to rescind its reduction of the “state participation” share of IHSS worker wages.

The settlement is expected to win approval by the court.  The additional cuts in hours will cause hardship for many people who rely on IHSS, yet in light of the alternative, today’s settlement represents an important victory in protecting seniors, children and adults with disabilities from the terrible consequences of short-sighted public policy decisions. The plaintiffs in the suits were represented by lawyers from Disability Rights California, National Senior Citizens Law Center and others, and our hats off to them for this important accomplishment.

Return to the State Budget page here.