Cash Assistance
Program For Immigrants (CAPI) and California
Food Assistance Program (CFAP)
The budget agreement rejected the Governor's proposal to
eliminate the CAPI and CFAP programs.
However, CAPI recipients (the approximately 12,000 aged, blind, and
disabled legal immigrants who would be eligible for the SSI/SSP program except
for their immigration status) will see a decrease in their program grants
consistent with the reductions adopted in the Supplemental Security
Income/State Supplementary Payment program
(SSI/SSP).
CFAP will continue to provide food assistance to more than
22,000 low-income legal non-citizens between the ages of 18 and 65, who meet
all the eligibility requirements for the federal Food Stamp program but have
resided in the United States
for less than five years.
Supplemental Security Income/State Supplementary Payment (SSI/SSP)
SSI is the federal program which provides monthly aid to
poor seniors and persons with disabilities.
SSP is the state's supplement to the SSI cash grant.
--Cuts SSI/SSP grants for the third time in 2009. The maximum grant for couples will be reduced
to the minimum level required by federal law ($1,407 per month) and the grant
for individuals will be reduced by 0.6%, to $845 per month. These cuts will take effect on October 1,
2009 for state savings of $115.9 million in 2009-10.
--Eliminates indefinitely the statutory COLA for SSI/SSP
grants starting January 1, 2012. This
change does not affect the "pass through" of any federal COLA for the SSI
portion of the grant.
Medi-Cal
Medi-Cal, which is California's version of the federal
Medicaid program, currently provides free health insurance, including regular
doctor's visits, hospitalization, dental and vision care, and prescription
drugs for approximately 17 percent of all Californians-6 million
beneficiaries. Approximately half of
Medi-Cal enrollees are Latino.
SB 6xxxx requires the Department of Health Care
Services (DHCS) to submit a Medi-Cal
waiver to the federal government that includes "restructuring proposals" that
are designed to slow the rate of growth of the Medi-Cal program, reduce the
number of uninsured, increase federal financial participation, and improve
health outcomes. The waiver is likely to
result in more Medi-Cal beneficiaries being required to enroll in managed care.
SB 6xxxx requires the
waiver to include processes and criteria by which DHCS will evaluate and grant
exemptions from mandatory enrollment in managed care. DHCS is also required to convene and consult
with a stakeholder advisory group to develop an implementation plan that
addresses "the multiple and complex needs of vulnerable populations," among
other things, according to the California Budget Project. The budget agreement aims to have the waiver
approved by the federal government by September 1, 2010 or when the state's
current Medi-Cal hospital waiver expires.
Summary of the significant cuts to the Medi-Cal program:
--The budget agreement assumes the receipt of $1 billion in
federal funds in 2009-10 to reimburse California
for prior state expenditures that the state indicates should have been funded
by the federal government. State funding
for Medi-Cal will be reduced by up to $1 billion in 2009-10 depending on the
amount of federal funds received.
--Cuts state funding for Medi-Cal by $323.3 million in
2009-10 without specifying how those savings would be achieved.
--$75.5 million reduction in 2009-10 by freezing rates paid
to certain nursing homes and other long-term care facilities.
--$18.3 million reduction by making several changes to Adult
Day Health Care (ADHC) including temporarily limiting participation for
enrollees to three days per week.
--$3.7 million reduction by freezing rates paid to ADHC
centers at the 2008 level.
--$109 million reduction in 2009-10 by adopting several
Medi-Cal prescription-drug reforms.
--$18.4 million reduction by cutting payments to private
safety-net hospitals 10%.
--$7.2 million reduction by cutting the fee-for-service
inpatient rate for certain small and rural hospitals, except those designated
as "critical access" hospitals and referral centers.
--$23.9 million reduction to the Distressed Hospital
Fund.The budget made deep cuts to health and human service
programs that are summarized below by program.
Most of these cuts hit the state's most vulnerable, particularly the
poor and minorities.
Healthy Families Program
The Healthy Families Program provides health care assistance
to eligible children in low-income families.
The budget agreement reduces state funding for the Healthy
Families Program by $124 million in 2009-10 and assumes that the First 5
California Children and Families Commission will backfill this reduction with
tobacco tax revenues. The agreement
adopted intent language that outside sources of funding would support the
program and establishes a waiting list for enrollment unless the funds become
available to continue enrollment.
The Healthy Families Program stopped enrolling eligible
children on July 17, 2009 and will soon have to begin dropping children from
the program unless an alternative source of funding is found, according to various
fiscal analyses. LCHC is redoubling
efforts to enjoin the state First 5 Commission to provide additional funds and
prevent children from getting dropped.
On
July 15, our executive director testified in front of the First 5 California commissioners
and joined Wendy Lazarus of The Children's Partnership, Wilma Chan of Children
NOW, and other advocates to urge the Commission to bail the program. The Commission committed "to join with
like-minded public and private partners" to provide an unspecified level of
financial assistance to Health Families, "contingent upon the availability of
funds."
California Work Opportunity
and Responsibility to Kids Program (CalWORKs)
CalWORKs is the state's cash-aid program, which is
recognized as TANF (temporary aid for needy families) at the federal level, and
provides cash-aid assistance to poor children and families.
--$375 million reduction in 2009-10 for the county operation
of the CalWORKs program.
--Eliminates the statutory cost-of-living adjustment (COLA)
for CalWORKs grants starting in 2010-11.
--Exempts parents and relative caregivers of young children
from having to meet participation requirements between July 1, 2009 and July 1,
20111, and allows counties to exempt additional categories of recipients.
The budget agreement includes several significant policy
changes to CalWORKs that are scheduled to take effect in 2011:
--Cuts by up to 50% grants for children in households in
which an adult has been sanctioned for not complying with CalWORKs rules, with
the size of the cut depending upon the length of time for which the adult has
not complied.
--Limits adults to 48 months of cash assistance in any
60-month period. Allows adults to come
back on aid for up to an additional 12 months at a later time (the children's
portion of the grant would apparently not be affected by this change).
--Requires counties to conduct a "self-sufficiency review"
every six months with CalWORKs adults who are required to participate in
welfare-to-work activities. Adults who
fail to attend this meeting would lose their grant (the children's portion of
the grant would apparently not be affected by this change).
--All families that have been on aid for more than 60 months
would see their child portion of the grant reduced by 25%, unless the family
can demonstrate that they have met federal work participation requirements or
are exempt from them. Counties would be
required to conduct an intensive assessment of families entering the
program.
The California Budget Project
reports that SB 8xxxx makes two additional changes that take effect in
2011. These changes were not mentioned
in the legislative analysis and the bill is not available in print yet:
--Cuts by 25% "safety-net" grants for children in households
in which the adults have "timed off" aid, unless the adults meet federal work
participation requirements.
--Cuts by 25% "child-only" grants for children who have
received cash assistance for more than 60 months, unless the adults in their
household meet federal work participation requirements.
In-Home Support Services (IHSS) Program
The IHSS program provides
support services for seniors and the disabled.
--Eliminates, with some exceptions, domestic and related
services for IHSS with a "functional index" (FI) rank-a measure of the need for
individual services-of below 4. The
budget agreement also eliminates, with some exceptions, all IHSS services for
individuals whose weighted-average FI score is below 2. These changes take effect on September 1,
2009, resulting in savings of $53.2 million in 2009-10.
--Eliminates the state subsidy for IHSS recipients who are
required to pay a share of cost for services, effective October 1, 2009, for
state savings of $41 million in 2009-10.
--Requires both IHSS recipients and providers to be
fingerprinted and requires providers to undergo background checks. The changes also require county social
workers to conduct unannounced visits for certain high risk IHSS cases and
establishes a civil penalty for timesheet fraud.
--The budget agreement also provides $10 million for local
anti-fraud investigations and activities.
Budget Agreement
Proposes the Privatization of Eligibility Processing for CalWORKs, Medi-Cal and
Supplemental Nutrition Assistance Program (formerly the Food Stamp Program)
Currently, public employees in each of the state's 58
counties determine eligibility for the CALWORKs, Medi-Cal, and Supplemental
Nutrition Assistance Program. The budget
agreement, as contained in SB 7xxxx, establishes a process to shift this
responsibility from the counties to a single entity by developing a "statewide
eligibility and enrollment determination process," according to the California
Budget Project. If implemented, this
change would likely result in a private contractor taking over eligibility
processing in California,
despite the fact that other states' privatized systems have failed.
The budget bill requires the Department of Health Care
Services and the Department of Social Services to jointly develop a plan for a
new system in consultation with a stakeholder steering committee. The bill permits the state "to proceed with
procurement activities...upon legislative approval of the comprehensive plan an
appropriation for this purpose."
Additional Health and Human Services Cuts
--Delays implementation of the California Prescription Drug
Program until July 1, 2010.
--$92 million reduction to Mental Health Managed Care
Services and the Early and Periodic Screening, Diagnosis and Treatment (EPDST)
Program.
--Eliminates $2.7 million in state support for Certified
Application Assistance for the Medi-Cal/Healthy Families joint
application.
--Eliminates $90 million in General Fund dollars for the
Prop. 36 Substance Abuse and Crime Prevention Act.
--Eliminates the Rural Health Care Equity Program for $17.2
million in savings in 2009-10, and ongoing savings of approximately $15
million.
--Shifts Proposition 99 tobacco tax funds from several
programs to generate General Fund savings in 2009-10. The budget agreement shifts $25.6 million in
Proposition 99 funds from County Health Services, $6.6 million from the Major
Risk Medical Insurance Program, $4.9 million from the Access for Infants and
Mothers (AIM) Program, $3.9 million from the Expanded Access to Primary Care
Program, and $438,000 from the Asthma Program.
--$35 million reduction in 2009-10 to the AIDS Drug
Assistance Program and other Office of AIDS programs.
--Eliminates, on a one-time basis, $18 million in state
funding for the Immunization Program in 2009-10.
--Reduces state funding for several community clinic
programs in 2009-10: $4.5 million
reduction to the Expanded Access to Primary Care Program, $2.2 million
reduction to Rural Health Services, $1.9 million reduction to the Seasonal
Migratory Worker Program, and $1.5 million for the Indian Health Program.
--Cuts state funding for Material, Child and Adolescent
Health (MCAH) programs in 2009-10: $2.1
million reduction for Local County Maternal and Child Health Grants, $1.75
reduction to Adolescent Family Life Program, $900,000 reduction to the Black
Infant Health Program, and a $3.5 million reduction to MCAH operations.
--$4.1 million reduction to the Domestic Violence Shelter
Program.
--$3.1 million reduction, a 50% reduction, for Alzheimer's
research centers.
--$2.9 million reduction by suspending state funding for the
Children's Dental Disease Prevention Program.
--$2.95 million reduction, a 50% reduction, to the
California Poison Control System.
--$2 million reduction by making several changes to the
Genetically Handicapped Persons Program (GHPP), including increasing the
enrollment fee for families with incomes of at least twice the federal poverty
line.
--Reduces by 10 percent the rates for substance abuse
treatment services for individuals who are eligible for Medi-Cal for savings of
$8.8 million in 2009-10.
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