BILL ANALYSIS Ó
AB 784
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ASSEMBLY THIRD READING
AB 784 (Yamada and Knight)
As Amended May 9, 2011
Majority vote
HEALTH 17-0 APPROPRIATIONS 17-0
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|Ayes:|Monning, Ammiano, Atkins, |Ayes:|Fuentes, Harkey, |
| |Bonilla, Eng, Garrick, | |Blumenfield, Bradford, |
| |Gordon, Hayashi, Bonnie | |Charles Calderon, Campos, |
| |Lowenthal, Mansoor, | |Davis, Donnelly, Gatto, |
| |Mitchell, Nestande, Pan, | |Hall, Hill, Lara, |
| |V. Manuel Pérez, Silva, | |Mitchell, Nielsen, Norby, |
| |Smyth, Williams | |Solorio, Wagner |
| | | | |
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SUMMARY : Requires that two newly constructed Veteran's Homes in
Lancaster and Ventura that are equipped to provide adult day
health services be considered for inclusion as service
providers, in the event of the elimination of Adult Day Health
Center (ADHC) services as an optional Medi-Cal benefit and
enactment of a new successor program.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)Unknown fiscal effect on the Medi-Cal Program. ADHC has been
eliminated as a Medi-Cal state optional benefit. The design
and funding of a new program through which ADHC-like services
would potentially be provided is currently being discussed.
2)If the proposed new program was operated through a federal
waiver, as is being discussed, it would likely have a capped
enrollment and the addition of new facilities would not affect
the overall number of beneficiaries. However, if ADHC was
maintained as a Medi-Cal benefit, the cost could be up to $1
million (50% General Fund (GF)) annually based on the initial
expected number of enrollees.
3)Minor state costs to the Department of Public Health to
license and certify two new facilities, paid for through
licensure fees.
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COMMENTS : This bill, according to the author, was originally
intended to create an exemption to the ADHC moratorium on
Medi-Cal certification to permit two ADHCs operated by the
California Department of Veterans Affairs (CDVA) to become
eligible for Medi-Cal reimbursement. CDVA is constructing two
large veterans' campuses, one in Ventura County and another in
Lancaster, which will include multi-level housing and medical
services intended to incorporate ADHC within their planned care
continuum. According to the author, in 2004 a moratorium on new
ADHC Medi-Cal certification was instituted as part of that
year's health budget trailer bill, SB 1103 (Budget and Fiscal
Review Committee), Chapter 228, Statutes of 2004. Since the
enactment of this moratorium, legislation is required to exempt
ADHCs and receive this funding. The author argues that planning
for the veterans facilities in Ventura and Lancaster began two
years before the moratorium was enacted. The author further
states that the state had signed a contract with the federal
government to build these two veterans' facilities that included
future individual ADHCs and construction. The building of the
facilities was underway by the time the moratorium was enacted.
The author argues the state is bound by contract with our
federal government to open the two facilities and the two ADHCs.
The author asserts that it is the state's fiscal responsibility
to fund the centers in a cost-effective manner. By paying for
the ADHC operations with Medi-Cal funds and drawing down federal
matching funds, the state would offset the cost of these two
ADHCs by about $142,000 annually.
The author further states that while understanding the magnitude
of the potential elimination of ADHC in the 2011-12 Budget, the
author's intent is to pursue the prioritization of veteran's
enrollment into the newly created Keeping Adults Free From
Institutions (KAFI) program, specifically in the William J.
"Pete" Knight Veterans Home of California, Lancaster; and, the
Veterans Home of California, Ventura. These state veterans
homes are unlikely to close and have structured adult-day health
facilities co-located on the veterans home campuses. Including
veterans in the as yet-to-be-designed KAFI program will provide
opportunities to leverage federal veterans benefits with
shrinking state General Fund support for adult supportive
services.
In 2002, according to the CDVA Web site, planning for three
large veteran's facilities, one in Ventura County, one in
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Lancaster, and one in West Los Angeles, was initiated following
passage of the Veterans Home Bond Act of 2000 ÝAB 2559
(Wesson), Chapter 216, Statutes of 2002]. The construction of
the three facilities is financed with federal veteran's home
grants and state bond funding totaling $229 million, of which
60% is from federal sources. All three sites are intended to
provide multilevel housing and medical services for eligible
veterans. The two sites nearest completion, Ventura and
Lancaster, incorporate ADHC services as well as assisted living
and nursing care units within their continuum of care design.
Both projects had sought approval for up to 100 licensed ADHC
slots, but anticipate only 20 enrollees at each facility for the
first few years of operation.
In the 2010-11 Budget Governor Schwarzenegger proposed to
completely eliminate ADHC as a covered Medi-Cal benefit
effective June 1, 2010, but it was rejected by the Legislature.
Governor Brown also proposed a budget that assumed elimination
of ADHC services, effective June 1, 2011, for a reduction of
$3.4 million ($1.7 million GF) in the current-year, and $353.2
million ($176.6 million GF) in 2011-12. Trailer bill language
is required for enactment. The Budget Conference Committee
proposed a compromise as follows: Due to severe fiscal
constraints and the need to focus limited resources towards our
most medically fragile individuals, the following compromise is
proposed:
1)Eliminate the ADHC Benefit as a Medi-Cal Optional Benefit.
Trailer bill language would specify this elimination.
2)Proceed with legislation in the 2011-12 Session to develop a
federal waiver to provide a more narrow scope of services, and
to specify level of medical acuity for enrollment into this
waiver program. Budget Bill language would specify this
purpose.
3)Appropriate $170 million ($85 million GF) in the Budget Bill
to provide for a transition for existing ADHC enrollees to
other Medi-Cal appropriate services, and to facilitate when
applicable, transition to newly developed waiver services.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097
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FN: 0001054