2013-2014 California State Budget and Its Impact on Physicians June 28, 2013 Advocacy, Medi Cal, News, Politics and Medicine AB 110, ABX 1-1, Coordinated Care Initiative, MCO tax, Medi-Cal expansion, California state budget, CURES 0 Focused on finishing the task by the Constitutionally-mandated June 15 deadline, the Legislature took up—and passed—the budget bill (AB 110) on June 14. The measure passed on party-line votes of 54-25 in the Assembly and 28-10 in the Senate (with one abstention and one vacancy). On Thursday, the Governor signed it into law a $96.3 billion fiscal year 2013-2014 state budget plan (AB 110), along with ABX 1-1 to implement the Medi-Cal expansion in California. The budget as passed includes a number of significant actions impacting SFMS and our physicians, including the adoption of the MCO tax, enacting the ‘optional expansion’ of Medi-Cal to childless adults pursuant to federal healthcare reform, reauthorizing the Coordinated Care Initiative/Duals Pilots, and passage of a $200 million mental health wellness package. The MCO tax, originally proposed to be a permanent tax, now has a 3 year sunset. The tax will go to fund better rates for children, SPDs, and the Duals pilots. The Brown Administration indicated that they would work with the coalition to set up the “maximum rate allowed” by CMS without impacting the general fund. With this agreement, the health plans removed their opposition and changed the political dynamics of stopping the MCO tax without a provider solution. California continues its efforts to pioneer implementation of the Affordable Care Act by passing legislation today to expand the Medi-Cal program to childless adults making at or below 138% of the Federal Poverty Level beginning January 1, 2014. Language added to the bill yesterday allows the state to abandon the Medi-Cal expansion if the federal funding for it is reduced below certain levels. SFMS/CMA remains actively involved in the implementation of this expansion, as the state’s efforts to enact the expansion and modify managed care plans’ contracting processes could have significant impacts on physician practices throughout California. The budget also includes a reauthorization of the Coordinated Care Initiative/CCI, also known as the ‘duals pilots’ or CalMediConnect. This was a main item on the Governor’s wish list, allowing the Administration to continue to pursue federal approval for the CCI. Another trailer bill included a complicated new formula meant to alter the allocation methodology for counties’ 1991 realignment funds. One of the centerpieces of the Governor’s final commitment to expand Medi-Cal pursuant to federal health care reform was the need to adequately reassess counties’ funding needs once a large number of those currently uninsured are covered. There are multiple options for counties to choose as to how much of their funding is diverted to the state based on their having to cover potentially smaller numbers of uninsured. SFMS/CMA is following this issue closely as there will likely remain many uninsured following January 1st, as the take up rate for coverage, even with ACA implemented, could be slow. The counties rely on these realignment funds as a resource to provide coverage to the uninsured, and any substantial funding hit to the counties could adversely impact the physicians that work with them to treat the uninsured. On a positive note, the budget includes a significant investment of over $200 million for a mental health wellness package that will help develop critical infrastructure throughout the state allowing localities to better respond to the mental health needs of Californians, especially the poor and underserved. The budget also removed the 7 doctor visit limit from statute and also makes all Medi-Cal plan amendments and waiver proposals available to the public for review and comment, both items SFMS/CMA strongly supported and advocated for. Additionally, the budget deal included $3.9 million, using reserves from 10 licensing board contingent funds, for upgrading the Controlled Substances Utilization Review and Evaluation System (CURES). The Medical Board of California (MBC) will contribute $1.6 million of the total. The funding is authorized until 2015, so over two budget years. Comments are closed.
