BILL ANALYSIS Ó
SB 36
Page 1
SENATE THIRD READING
SB
36 (Hernandez and De León)
As Amended September 4, 2015
2/3 vote. Urgency
SENATE VOTE: Vote not relevant
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|Committee |Votes|Ayes |Noes |
| | | | |
| | | | |
| | | | |
|----------------+-----+----------------------+-------------------|
|Health | | | |
| | | | |
|(vote not | | | |
|relevant) | | | |
| | | | |
|----------------+-----+----------------------+-------------------|
|Appropriations | | | |
| | | | |
|(vote not | | | |
|relevant) | | | |
| | | | |
|----------------+-----+----------------------+-------------------|
|Health |18-0 |Bonta, Maienschein, | |
| | |Bonilla, Burke, | |
| | |Chávez, Chiu, Gomez, | |
| | |Gonzalez, Lackey, | |
| | |Nazarian, Patterson, | |
SB 36
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| | |Ridley-Thomas, | |
| | |Rodriguez, Santiago, | |
| | |Steinorth, Thurmond, | |
| | |Waldron, Wood | |
| | | | |
| | | | |
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SUMMARY: Authorizes the Department of Health Care Services
(DHCS) to request one or more temporary waiver extensions to
continue the operation of, and the authorities provided under,
the current "California Bridge to Reform Demonstration," the
state's Section 1115 Medicaid waiver which is set to expire on
October 31, 2015. Contains an urgency clause to ensure that the
provisions of this bill go into immediate effect upon enactment.
Specifically, this bill:
1)Requires DHCS to extend and apply the existing hospital
payment methodologies and allocations on a state fiscal year,
annual, partial year, or other basis, to the extent permitted
under any approved temporary waiver extension, an approved
subsequent waiver, or as otherwise permitted under federal
Medicaid law.
2)Conditions the provisions of this bill on DHCS obtaining any
necessary federal approvals and continuing eligibility to
obtain federal matching funds.
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,
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including better care coordination for Seniors and Persons
with Disabilities (SPDs) and increased opportunities to reduce
the number uninsured.
FISCAL EFFECT: This bill, as amended, has not been analyzed by
a fiscal committee.
COMMENTS:
1)Purpose. According to the author, this bill bridges the gap
between the current Medicaid Section 1115 waiver which expires
October 31, 2015, and the new waiver by allowing DHCS to
request one or more temporary waiver extensions, and by
requiring DHCS to extend the current hospital payment
methodologies. The author states a new waiver agreement has
not been reached between the state and federal government and
is unlikely to be reached before the Legislature adjourns on
September 11, 2015. An extension of the current hospital
financing methodologies would continue to provide essential
funding for safety net hospitals in the event of a delay in
completion of the next waiver.
2)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
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in any experimental pilot or demonstration project which, in
the judgment of the HHS Secretary, is likely to assist in
promoting the objectives of 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.
3)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. Under the current waiver,
California is required to submit an extension request no later
than six months prior to the expiration date of the current
demonstration. California also operates its Medi-Cal managed
care delivery system under this federal waiver.
4)Support. According to the California Association of Public
Hospitals (CAPH), in the event of a delay in negotiating a new
waiver, it is critical for the state to maintain existing
expenditure authority, in order to ensure that funds can
continue to flow to public safety net providers. CAPH argues
this bill includes two important provisions to allow for
continuity during these negotiations. The Association of
California Healthcare Districts argues in support because the
waiver extension will build on the priorities of the
association, which include access to care, workforce
development, expanding the use of telehealth and improving
mental health and substance use disorder treatment.
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5)Opposition. There is no known opposition on file.
Analysis Prepared by:
Roger Dunstan / HEALTH / (916) 319-2097 FN:
0002342