Health Services Making Shift to Counties

Compared to the past two weeks of painful deliberations in budget subcommittee hearings, yesterday’s discussion of the proposed shift of health services to the counties was like a breath of realigned air.

“In a normal year, we wouldn’t contemplate a hundred percent takeover [of some health services] in counties,” Kelly Brooks of the California State Association of Counties said. “But this isn’t a normal year, so we’re willing to consider taking on probably more than we would.”

Gov. Jerry Brown’s budget proposal shifts responsibility and funding to the counties for foster care, adult protective services, mental health programs and drug and alcohol treatment programs..

There’s only one potential pitfall to the plan, according to Frank Mecca, the executive director of the County Welfare Directors Association of California.


“The underfunding of the current program is significant,” Mecca said. Asking the counties to take over a program without paying for that service just isn’t fair, he said. “This isn’t about what you legally owe us,” he said, “but given the results you expect to see, we would like to talk about an augmentation to the base [reimbursement].”

After the deal is struck, there’s little likelihood of revisiting reimbursement levels, he said. “Once you transfer full freight to the counties, it seems to be out of sight, out of mind,” Mecca said.

The Legislative Analyst’s Office agreed, suggesting the Legislature might need to establish a procedure to share risk with the counties and that the federal government may not want to deal with 58 separate entities. The LAO suggested the state might act as some kind of liaison.

“In general, realignment has merit,” Christine Frey of the LAO said. “But counties will look for a higher level of funding.” Governor Brown proposed shifting $1.6 billion to the counties with one-time tax extension money, but Frey said, “You may also need to think about allocating in future years.”

There are three main issues the state and counties need to work out, Frey said: state control; federal oversight; and funding.

Mecca suggested that despite transferring responsibility for health services to local government, the state still has a responsibility to help deal with outside powers. “We’d like to see some [legislative] changes so there’s some obligation to the state to in some way reimburse mandates that come from courts and federal government,” Mecca said.

“We’re greeting the realignment as workable,” Brooks said. “We want to make sure this is workable from all angles, and we want to make sure people get the care they need.”


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