Latest News On State Budgets

Latest California Healthline Stories

Douglas Updates Legislators on Health System Changes

California’s health care system is undergoing its biggest changes in almost 50 years. Toby Douglas, director of the agency at the eye of the health care storm, updated legislators on the progress of some of the changes in a hearing last week in Sacramento.

Financial Concerns for Ambulance Services

Health care providers in California are waiting for judicial rulings to see if they will be hit by a 10% cut in Medi-Cal reimbursement rates as a result of a law passed in 2011 and currently tied up in federal appeals court.

Ambulance service providers are among those who would be hit by the cut but they say they shouldn’t be included for one large and simple reason: Unlike physicians, ambulance providers are required by law to transport Medi-Cal beneficiaries. They’re not allowed to refuse them.

“We cant say ‘no’ like everyone else. We’re required by law to provide those services,” said Klark Staffan, vice president and chief operating officer for Sierra Medical Services Alliance  in Lassen County. “And so we’re stuck. We have to provide the service, but we lose money with every Medi-Cal transport. We’re the only type of medical provider who can’t say we wouldn’t accept [Medi-Cal] patients. We think we’re unfairly treated.”

Uncertain Assumptions in Health Care Budget Estimate, LAO Says

Two reports released yesterday by the Legislative Analyst’s Office analyzing Gov. Jerry Brown’s proposed health care budget for 2013-14 found a number of points of concern, according to Mark Newton, deputy legislative analyst at the LAO.

“What we wanted to do is lay out that there are some budget risks here,” Newton said. Many of those risks, he said, should still be in the budget, but they remain important fiscal unknowns, rather than dependable income sources.

“[Some of this] is not meant so much to be a critique, but more a recognition of budget uncertainty,” Newton said.

Health Care Stakeholders Await State of State, Special Session

The State of the State speech today by Gov. Jerry Brown (D) could kick off a flurry of health care activity in California.

The governor is expected to address the state’s decision to join the Medicaid expansion (Medi-Cal in California) in today’s speech. Two options proposed by Brown — county- and state-based plans — will be hashed out in the upcoming month or two, most likely during the Legislature’s special session on health care. State health officials have said the special session will be called by Brown by the end of January.

All of that has to be worked out relatively soon, according to Lucien Wulsin, executive director of the Insure the Uninsured Project.

Budget Called a ‘Godsend’ for Health Care Community

California Health and Human Services Secretary Diana Dooley summed up the health care impact of yesterday’s budget proposal this way:

“The good news is, there are no cuts,” Dooley said. “While we are not restoring anything, we are not cutting, either.”

That was a tremendous relief to Senate member Ed Hernandez (D-West Covina), chair of the Senate Committee on Health. After enduring year after year of multi-billion-dollar cuts to health programs, he said no budget news is good budget news.

Health Proponents Watching Budget for Medi-Cal Provider Rate Cut

Governor Jerry Brown today will release his plan to fix a projected $1.9 billion deficit in the state’s budget. Despite the recently rosier financial outlook for the state, many in the California health community still hold concerns that those new cuts may come out of the hide of health care.

“It sounds like education is going to be made whole, it sounds like prisons are going to be made whole, so yes, we’re fearing further cuts to health care,” said Francisco Silva, general counsel for the California Medical Association. “There is still a $1.9 billion deficit, after all.”

Silva was discussing the possible inclusion in the budget of a 10% Medi-Cal provider rate reimbursement cut that was approved by the state Legislature but has not gone into effect because it’s being challenged in court.

At-Home Nursing Services Rules Challenged

A lawsuit filed yesterday urges state health officials to alter California’s limit on adult at-home nursing services.

The limit doesn’t make sense, the Disability Rights California lawsuit said, because a higher limit would allow some beneficiaries to remain home, which would cost the state less than the price of institutionalization.

DHCS officials said the department has a policy of not commenting on pending litigation.

No Agenda Yet for Special Session

The one-month delay in the legislative special session on health care should not affect the content of the discussion, according to Assembly member Richard Pan (D-Sacramento), who chairs the Assembly Committee on Health.

“The purpose of the special session is that there’s legislation that is really important to get passed prior to the Jan. 1, 2014 [Affordable Care Act] deadline,” Pan said. “So this will allow us to pass these bills and have them take effect prior to that time. So in [terms of the special session move from December to January], it doesn’t change anything.”

In August, Gov. Jerry Brown (D) announced he would convene a special session in the Legislature after the national election in November, to address elements of the Affordable Care Act. That special session was expected to happen sometime in December.

‘California’s Budget Situation Has Improved Sharply’

Yesterday’s long-term budget forecast for sunnier skies in California by the Legislative Analyst’s Office could also mean good things for the state’s health care programs, according to the LAO and health experts.

“For the first time in a decade, we’ve stabilized our budget problem,” said Mac Taylor, head legislative analyst at the LAO. “We are looking at a much more positive outlook in the future. This is nothing like we’ve had to look at in the past.”

The state still faces a $1.9 billion deficit for the fiscal year 2013-14 — that’s about half current shortfall and half operating deficit for next year, according to Taylor — but that is just the current projection and could shift, based on a number of factors, Taylor said.