Sweeping changes to the State’s Medicaid program – called “Medi-Cal” – is the focus of two identical bills before the Assembly Health Committee (SB 208) and Senate Health Committee (AB 342). The Schwarzenegger Administration proposal submitted to the federal government earlier this month will have a major impact on hundreds of thousands of children and adults with disabilities, mental health needs, the blind, seniors, and persons without health insurance. 

    The proposal submitted to federal Centers on Medicare and Medicaid Services (CMS) under the US Department of Health and Human Services, is known as the “Section 1115 Medicaid Waiver Demonstration Project”, and includes mandatory enrollment for hundreds of thousands of people with disabilities, mental health needs, the blind and seniors into Medi-Cal managed health care plans.

    During the budget subcommittee hearings in May, both houses agreed that further detailed review by the Legislative policy committees – and not the budget subcommittees on several major pieces of the proposal was needed.  The two bills – SB 208 and AB 342 – were amended June 22nd and are in response to the budget subcommittee actions. A 26 page pdf copy of SB 208, which is identical to AB 342, is attached to this CDCAN Report – and can also be viewed and downloaded from the CDCAN website at www.cdcan.us (including AB 342).  

    Both Bills To Speed Up Process Due to Urgency of Issue

    · The two bills – SB 208 by Senate President Pro Tem Darrell Steinberg (Democrat – Sacramento, 6th State Senate District) and AB 342 by Assembly Speaker John Perez (Democrat – Los Angeles, 46th Assembly District) are identical except for the bill number – and the addition of Assemblymember Bill Monning (Democrat – Santa Cruz, 27th Assembly District) as a co-author for AB 342. 

    · The reason for the two identical bills that will be heard the same week is due to the urgency of the issue. 

    · The Schwarzenegger Administration, as authorized last July by the Legislature as part of the 2009-2010 State Budget as revised last July, has already developed and submitted the proposal to the federal government earlier this month.  

    Advocates Concerned About Impact of Proposal

    · The proposal has raised controversy among advocates for people with disabilities, mental health needs, seniors and others who have raised major concerns about certain aspects of the proposal submitted to the federal government, including proposed required enrollment of persons with disabilities and seniors who are eligible for both Medicare and Medicaid (Medi-Cal) – sometimes referred to as “dual eligibles” or “Medi-Medis” – and also proposed mandatory enrollment in certain parts of the State of other people with disabilities, mental health needs, the blind and seniors currently in Medi-Cal in managed care health plans. 

    · Some advocates say major concerns remain regarding whether existing or new models of managed health care plans are ready to serve persons with disabilities and seniors and others, including issues relating to access and accessible health care equipment.  Other issues raised concern quality of care. 

    · The Schwarzenegger Administration however says there are existing Medi-Cal managed health care plans that already serve people with disabilities and seniors who they claim have a demonstrated record of good quality of care and accessibility. 

    Proposal Seeks to Renew and Dramatically Expand Existing Waiver – Legislature Already Gave Okay Last July For Schwarzenegger Administration To Proceed

    · As mentioned, the Legislature, as part of the 2009-2010 State Budget as revised last July, gave the Schwarzenegger Administration approval to develop and submit a proposal to the federal government to renew and dramatically expand an existing Medicaid funded demonstration pilot project – referred to as the “Section 1115 Medicaid Waiver”

    · [CDCAN Note: Section 1115 refers to a part of the federal Social Security Act that allows the federal government to waive existing federal Medicaid laws to allow a state to do a pilot project to try out different ideas]  

    · California’s existing Section 1115 Medicaid Waiver demonstration project is set to expire in August this year and deals primarily with funding for hospitals that serve persons not insured or covered by Medi-Cal.  

    · The Governor last year proposed renewing and expanding that waiver to cover hundreds of thousands of people with disabilities, mental health needs, and seniors in the Medi-Cal program and persons not insured or currently eligible for Medi-Cal who would be enrolled into various “organized delivery systems of care” including existing Medi-Cal managed health care plans. 

    · The objective policymakers hope for would be to significantly control the rising health care costs in the Medi-Cal program while maintaining and increasing quality of care.  The inclusion of persons not insured with health insurance or eligible for Medi-Cal is in response to the requirements of the federal health care reform act.