BILL ANALYSIS Ó
SB 36
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SENATE THIRD READING
SB
36 (Hernandez and De León)
As Introduced December 1, 2014
2/3 vote. Urgency
SENATE VOTE: 35-0
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|Committee |Votes|Ayes |Noes |
| | | | |
| | | | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Health |18-0 |Bonta, Maienschein, | |
| | |Bonilla, Burke, | |
| | |Chávez, Chiu, Gomez, | |
| | |Gonzalez, Roger | |
| | |Hernández, Lackey, | |
| | |Nazarian, Patterson, | |
| | |Rodriguez, Santiago, | |
| | |Steinorth, Thurmond, | |
| | |Waldron, Wood | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Appropriations |17-0 |Gomez, Bigelow, | |
| | |Bloom, Bonta, | |
| | |Calderon, Chang, | |
| | |Daly, Eggman, | |
| | |Gallagher, | |
| | | | |
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| | | | |
| | |Eduardo Garcia, | |
| | |Holden, Jones, Quirk, | |
| | |Rendon, Wagner, | |
| | |Weber, Wood | |
| | | | |
| | | | |
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SUMMARY: Requires the Department of Health Care Services (DHCS)
to submit an application to the federal Centers for Medicare and
Medicaid Services (CMS) for a waiver of federal Medicaid
requirements to implement a demonstration project. Contains an
urgency clause to ensure that the provisions of this bill go
into immediate effect upon enactment.
EXISTING LAW:
1)Establishes the Medi-Cal program to provide comprehensive health
benefits to low-income persons.
2)Establishes a demonstration project under the Medi-Cal program
until October 31, 2015, to implement specified objectives,
including better care coordination for seniors and persons
with disabilities and maximization of opportunities to reduce
the number of uninsured individuals.
FISCAL EFFECT: According to the Assembly Appropriations
committee, this bill in its current form does not result in
additional state costs. DHCS is currently incurring staff and
in-kind costs for development of a "Section 1115 Waiver," so
called for the section of federal law that provides CMS broad
authority to waive provisions of federal Medicaid law to seek
improved outcomes. Private foundations have committed about
$650,000, and about $250,000 in federal matching funds are
likely available for these purposes. Foundations are also
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funding additional consulting work related to waiver
development.
If this bill is amended to include specific waiver provisions,
such provisions are likely to have significant fiscal effects.
COMMENTS: According to the author, Section 1115 Medicaid waiver
renewal is critical to the long-term fiscal sustainability of
the Medi-Cal program and to California's ability to continue to
provide high quality health care to Medi-Cal beneficiaries. The
goals of the waiver are to continue to support Patient
Protection and Affordable Care Act implementation, improve the
health care outcomes of the over 12 million individuals enrolled
in Medi-Cal, and provide long-term fiscal stability of the
Medi-Cal program through delivery system transformation.
Specific strategies anticipated to be included in the waiver
renewal include a federal-state shared savings initiative;
housing and supportive services for vulnerable populations;
various health plan and provider delivery system transformation
and alignment incentive programs, including a new Delivery
System Reform Incentive Program at designated public hospitals
and non-designated public hospitals; workforce development
strategies to expand provider access and, capacity; and safety
net payment and delivery system transformation.
Federal Section 1115 Waiver and Expenditure Authority. Medicaid
(Medi-Cal in California) is a joint federal-state program to
provide health coverage to low-income individuals. Section 1115
of the federal Social Security Act gives the Secretary of the
Department of Health and Human Services (HHS) authority to waive
provisions of major health and welfare programs. This includes
certain federal Medicaid requirements in any experimental pilot
or demonstration project which, in the judgment of the HHS
Secretary, is likely to assist in promoting the objectives of
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Medicaid. In addition, Section 1115 also allows states to use
federal Medicaid funds to reimburse for costs in ways that are
not otherwise allowed under federal Medicaid law.
Bridge to Reform Waiver. California's existing Section 1115
waiver, commonly called "the California Bridge to Reform
Demonstration" is a five-year demonstration of health care
reform initiatives that was projected to provide an additional
$10 billion in federal funds over the lifetime of the waiver.
The waiver prepared the state for successful implementation of
health care reform through an early expansion of Medicaid, and
tested innovations in health care support for safety net
providers. California is currently in the fourth year of this
waiver, which began November 1, 2010, and expires October 31,
2015.
Support. The California Association of Physician Groups (CAPG)
supports this bill as a measure that encourages the
implementation of the Triple Aim which includes decreased cost,
improved patient experience and development of population health
management. CAPG writes the new "Medi-Cal 2020" waiver seeks
approximately $17 billion in federal investment to further the
achievements California has made in health care reform. The
California State Association of Counties supports this bill
because DHCS' Medi-Cal 2020 waiver renewal addresses the
counties' priorities, and introduces a new concept transforming
California's public safety net for the remaining uninsured by
creating a global payment system. There is no known opposition
to this bill.
Analysis Prepared by:
Roger Dunstan / HEALTH / (916) 319-2097 FN:
0001443
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