BILL ANALYSIS Ó
AB 168
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Date of Hearing: January 21, 2016
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Jimmy Gomez, Chair
AB
168 (Maienschein) - As Amended January 4, 2016
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|Policy |Health |Vote:|19 - 0 |
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Urgency: No State Mandated Local Program: NoReimbursable: No
SUMMARY:
This bill requires the Department of Health Care Services (DHCS)
to apply for, and places restrictions on, a federal
demonstration program that offers enhanced federal matching
funds for Medi-Cal behavioral health services offered through
clinics that meet certain standards.
Specifically, the bill specifies counties shall not be selected
to participate in the demonstration program, unless they
redirect funds freed up by the higher federal matching rate to
increase housing opportunities for individuals with severe
mental illnesses. It also requires stakeholder engagement to
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estimate unmet need for services, and makes related findings and
declarations.
FISCAL EFFECT:
Negligible state fiscal effect. The state intends to apply to
participate in the demonstration project.
If California is selected as a demonstration state, this bill
may indirectly affect the amount of local dollars spent to
provide housing for mentally ill individuals, though the extent
and magnitude of any such impact is unknown. It is unclear if
the requirement for counties to redirect a portion of savings to
providing housing would affect California's chances for being
selected as a demonstration state.
COMMENTS:
1)Purpose. The purpose of this bill is to ensure DHCS applies
for the specified federal demonstration project, and to ensure
that if money is freed up by increased federal funding for
Medi-Cal behavioral health services through the project, that
a portion of local savings be redirected to housing homeless
mentally ill people. The author asserts savings to the
counties will free up Proposition 63 funds and other county
mental health funds that are now expended on hospital care.
2)Background. Federal law authorizes a two-year state
demonstration project, whereby up to eight participating
states develop processes to designate and reimburse certified
community behavioral health clinics (CCBHCs) that meet certain
standards. Twenty-four states, including California, were
awarded planning grants that allow them to apply for
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participation in the two-year demonstration, which begins in
2017. California applied for a $2 million planning grant and
was awarded less than $1 million. Stakeholders, including
counties, advocates, the administration and the Legislature
are currently discussing how to ensure California's grant is
competitive, despite having fewer federal resources than
requested to develop the demonstration project application.
DHCS's application for the planning grant was made in
collaboration with the County Behavioral Health Directors
Association (CBHDA) of California, who represent the state's
key county partners in the delivery of Medi-Cal behavioral
health services to seriously mentally ill enrollees. These
services are largely delivered and managed by counties, and
local funds pay for the Medi-Cal non-federal share of cost.
If California is selected as one of the eight participating
states, federal matching funds for the specified behavioral
health services would be available at a very favorable federal
matching rate of at least 88% for two years.
3)Related Legislation. AB 847 (Mullin), pending in the Senate
Appropriations Committee, is substantially similar to this
bill.
4)Previous Legislation. AB 861 (Maienschein) of 2015 was
similar to this bill, but required DHCS to apply for the
related planning grant (which DHCS received in October 2015).
AB 861 was vetoed with a message stating, "This bill would
require the DHCS to mandate counties, as a condition of
participation in a federal behavioral health demonstration
program, to redirect a portion of any local savings to
increasing housing opportunities for individuals with severe
mental illness. The department has not been awarded the
federal grant nor approved as one of eight states to
participate in the federal demonstration program. As such,
this bill is premature." It is unclear whether this bill
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addresses the veto message in AB 861. On the one hand, the
department has still not yet been selected to participate in
the demonstration project, and stakeholder discussions and
other planning grant activities are currently underway. On
the other hand, this is the only appropriate time to consider
legislation with an intent to inform the design of the grant
application, which will be submitted this year. The selection
of the state as a participant in the demonstration project is
likely to take place late this year, and the demonstration
project would commence in January 2017.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081