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Senate Passes Budget - Now Heads To Assembly


 

CALIFORNIA UCP CAPITOL REPORT #110-2003
JULY 27, 2003 - Sunday evening

SENATE PASSES BUDGET BY VOTE OF 27-10; BUDGET NOW HEADS FOR ASSEMBLY VOTE THIS WEEK; CUTS TO DISABLED COMMUNITY MINIMIZED

As expected, the State Senate voted Sunday evening (July 27) 27-10, to pass the compromise budget proposal that essentially minimized cuts impacting people with developmental and other disabilities, that was put together by Senate President Pro Tem John Burton (D-San Francisco) and Senate Republican Leader Jim Brulte (R-Rancho Cucamonga).  With California now 27 days without a budget, the spending plan now heads to the State Assembly, where it will be taken up for a vote probably early this coming week.

Approval there, while not certain, seems likely given the vote in the Senate this evening.  Governor Davis, facing an historic unprecedented recall election, is not likely to make further reductions (through line item or blue pencil).  A budget seems likely before the end of this month.  Also approved were several related pieces of legislation's to implement the main budget bill (referred to as "budget trailer bills).

The cuts and reductions impacting people with developmental and other disabilities were far below what Governor Davis proposed in January - and far less than what the Assembly and Senate Republicans proposed earlier this month.  The reductions were very close to what was in the original Senate Democratic Budget proposal - and similar to the Assembly Democratic Budget proposal.  Cuts include a 5% rate reduction to Medi-Cal providers - but long term care nursing homes, adult day health, clinical laboratories and services, intermediate care facilities for the developmentally disabled (ICF/DD) and some other smaller service categories related to long term care were exempted from the rate reduction.  A major key point for advocates was the rejection of the Governor's proposed "statewide purchase of services standards" for community-based services funded through regional centers.  The budget proposal also made no cuts to In-Home Supportive Services as initially feared.

The budget, raises no new taxes, pays off about $10 billion of the deficit through loans, and calls for additional cuts to Medi-Cal and other human services programs - though far below what the Governor proposed originally in January, and still far below what the Assembly and Senate Republicans proposed earlier this month.  The reductions are also below that what was proposed in a bi-partisan proposal, which never went anywhere, offered in June by Assemblyman Joe Canciamilla (D-Pittsburgh) and Assemblyman Keith Richman (R-Northridge).

SUMMARY OF BUDGET ACTIONS BY SENATE IMPACTING PEOPLE WITH DISABILITIES:

MEDI-CAL
* PROVIDER RATE REDUCTION - WITH MANY EXEMPTIONS:
What the Senate Did: Passed rate reduction of 5% for Medi-Cal providers ($115.117 million cut - and savings to the state General Fund) but EXEMPT from this reduction are long term care nursing facilities, adult day health, intermediate care facilities for the developmentally disabled (ICF/DD), clinical laboratories and services (as defined) and some smaller service categories related to long term care.
Total Cut/Savings to General Fund: $115,117,000
What Does This Mean:This is obviously bad for Medi-Cal doctors, etc with the impact of reducing access to medical services for people with developmental and other disabilities, seniors because doctors will continue to leave the Medi-Cal program due. However,the exemption of this reduction for ICF/DDs, nursing homes, adult day health centers, etc is VERY good news. Many of these facilities would have faced closure if any rate reduction was imposed.
What Is Next: Assembly still needs to approve
* MEDI-CAL OPTIONAL BENEFITS
What the Senate Did: NO Medi-Cal optional benefits were eliminated, though the Senate did approve some "cost containment" measures relating to hearing aids (and accessories), and also regarding rental of durable medical equipment, and cost controls for prosthetic and orthotic appliances.
Total Cut/Savings to General Fund: $580,000 (General Fund) for cost containment for hearing aids; $500,000 (General Fund) for cost containment regarding durable medical equipment rentals; $2 million (General Fund) savings for controls for prosthetic and orthotic appliances.
What Does This Mean:Medi-Cal optional benefits remain in place - though with some cost containment measures (not certain how this will impact benefits).
What Is Next: Assembly still needs to approve.
* OTHER MEDI-CAL/HEALTHY FAMILIES REDUCTIONS
- Reduced by $6.1 million (state General Fund) to reflect changes of estimating methodology for the Early Periodic Screening and Diagnosis Program (EPSDT) for mental health services.
- Eliminates Second Year of Transitional Medi-Cal ($2 million savings)
- Implements a 6% "Quality Assurance Fee" for Intermediate Care Facilities for the Developmentally Disabled as requested by providers.  A portion of this assessment would be used by the state to obtain federal matching funds. Some of this assessment would be used to offset State cots, and another portion would be used to provide a rate adjustment (increase) to ICF/DDs. This fee would be computed to return at least 100% of the fee paid by the ICF/DDs at the end of the particular quarter.
- Savings of $1.263 million (state General Fund) as a result of anti-fraud legislation in SB 857 (Speier), as soon as this bill is signed by Governor. [savings not actually reflected in the budget bill because it is not enacted yet]
- Savings from budget trailer bill AB 1762, including 2004-2005 budget year structural issues as follows -
* Freezes rates for long term care nursing facilities at their 2003-2004 levels and will NOT be increased in 2004-05.
* Freezes hospital inpatient rates at their 2003-2004 levels and will NOT be increased in 20042-2005
* Freezes health, dental, and vision plans participating in the Healthy Families Program at their 2003 levels.

DEVELOPMENTAL SERVICES
* REGIONAL CENTERS (Purchase of Service Budget - funds community-based services and supports that community organizations actually provide)
What the Senate Did: Made the following reductions, freezes or other changes in the "purchase of services" budget.
- Parental Co-Payment System (to be implemented 7/1/2004)
- Unallocated Reduction to purchase of service budget which funds community-based services and supports ($10 million for 2003-2004 budget year)
- Changes Eligibility to Partially Conform With Federal Law (about 400 new persons a year would no longer be eligible for regional center services, cut of about $2 million)
- Intake and Assessment - increases timeframe for regional centers to conduct intake and assessment of people with developmental disabilities from 60 days to 120 days, for cut (savings) of about $4.5 million
- Startup of New Programs Restriction - continues to restrict start-up of new programs except for health and safety reasons or its a part of the community placement program, for a cut (savings) of $5.9 million
- Freeze of Contracts for Adult Day Services, look-alikes, transportation, and supported living for one year (assuming the budget year) for cut (savings) of $18.942 million
- Freeze of Contracts for Residential Services for one year for cut (savings) of $7 million.
- Client Rights Contract - extends for 2 more years the contract for client rights in an effort to not incur administrative expenses during the 2003-04 budget year
- Self Determination Projects: makes technical changes to existing law to enable Regional Centers to identify cost efficiencies and to draw down additional federal dollars. Also eliminates the "sunset" for these projects, meaning these projects have no ending date.
Total Cut/Savings To General Fund: About $65 million (this includes the operations cuts of $8.6 million below, and all the freezes, cuts resulting from narrowing of  eligibility, and the $10 million unallocated reduction.
What Does This Mean: Purchase of Service standards were NOT approved or part of the budget. And the cuts were far, far less than what the Governor proposed in January - or what the Assembly and Senate Republicans proposed earlier.
What Is Next: Assembly still needs to approve.
* REGIONAL CENTERS - OPERATIONS (CHANGES TO CLIENT & CASE MANAGER RATIOS)
What The Senate Did: Makes changes to existing client to case manager ratios by:
- Modifies from the existing 1 to 62 ratio (service coordinator to consumer) for all people with developmental disabilities who have not moved from a Developmental Center to the community since April 14, 2002 and in no case shall a service coordinator have an assigned caseload in excess of 79 consumers for more than 60 days. This proposal would end (sunset) as of July 1, 2007.
- Modifies from the existing 1 to 45 ratio for consumers who have moved from a Developmental Center but have resided in the community for at least 12 months shall receive service coordination as stated above. This proposal ends (sunsets) as of July 1, 2007.
Total Cut (Savings to General Fund): $8.6 million
What Does This Mean:Could mean some staffing reductions or changes in regional centers. This proposal is the same that was previously approved by the budget conference committee.
What Is Next: Assembly still needs to approve.
* HABILITATION SERVICES - TRANSFER
What the Senate Did: Moved the Habilitation Services Program effective July 1, 2004 (AB 1753) from the Department of Rehabilitation to the Department of Developmental Services.
Total Cut/Savings To General Fund: $2.2 million (General Fund)  for the 2004-05 budget year
What Does This Mean:Previously in all other budget proposals - would transfer this program, but not until July 1, 2004. Stakeholders will be involved in helping to make the transfer work.
What Is Next: Assembly still needs to approve.
* HABILITATION SERVICES - RATE REDUCTIONS/FREEZE
What the Senate Did: Suspends the adjustment of work activity program rates for the 2003-04 budget year. Reduces the work activity program provider rates by 5% and reduces supported employment provider rates by 2.5%. (AB 1752)
Total Cut/Savings to State General Fund: $16.7 million (state General Fund)
What Does This Mean:This action was previously in the Senate Democratic budget proposal in June (and in all other budget proposals). It has significant and potentially devastating impact for community-based organizations, already reeling from staggering increases in workers compensation costs.
What Is Next: Assembly still needs to approve.
* COMMUNITY CARE FACILITIES
What the Senate Did: Reduced by $1.570 million (state General Fund), to eliminate the federal pass through portion of the SSI/SSP adjustment for Community Care Facilities that serve people with developmental disabilities.  The state - according to the Senate analysis of this action, can use these funds to offset its General Fund support of these providers. (AB 1762)
Total Cut/Savings to General Fund: $1.570 million
What Is Next: Assembly still needs to approve.

SSI/SSP (SUPPLEMENTAL SECURITY INCOME/STATE SUPPLEMENTAL PAYMENT)
* COST OF LIVING ADJUSTMENT (COLA)
What The Senate Did: Suspends the state cost of living adjustment for SSI/SSP grants for the 2003-2004 budget year (a cost of living adjustment is scheduled for January 2004 - which this would suspend)
Total Cut/Savings: $104 million (general fund) for 2003-2004 budget year and $213.2 million (general fund) for the 2004-2005 budget year.
What Does This Mean:About 1.1 million Californians who are seniors, blind or with developmental or other disabilities would be impacted. They would not receive a $14 increase to their grant, which would have increased their monthly grant to $805. The Senate plan did NOT roll back the SSI/SSP grants back to the federal "maintenance of effort" level - which the Assembly and Senate Republican (and Governor) proposals contained.
What Is Next: Assembly still needs to approve.

MENTAL HEALTH
* Community Treatment Facilities - continues supplemental rate payment for these facilities that service children in foster care who have a serious mental health diagnosis. The 2003-04 budget continues the same level of funding as provided in the 2002-2003 budget.
* Managed Care Regulations - provides for up to 1 year of emergency regulation authority for the Department of Mental Health to draft managed care regulations that conform with recent changes in federal law.
* Second Level Appeals - codifies the second level appeals process and requires the loser of the appeal to fund it.
* Restitution Fund - eliminates the Department of Mental Health's authority to access this fund for crime victims
* Psychologists - deletes the "sunset" for health facilities operated by the state offering care of services within the scope of practice of a psychologist to establish rules and medical staff by-laws that include provisions for medical staff membership and clinical privileges for clinical psychologists within the scope of their licensure.
What Is Next: Assembly still needs to approve.

NEXT STEPS
The Senate budget deal as announced by Sen. Burton and Sen. Brulte on Thursday was a major breakthrough, with passage in the Senate Sunday a major step in ending the budget stalemate.
STATE SENATE:
* Senate passed the budget compromise proposal (AB 1765 as amended). The Senate also passed several related bills (referred to as budget "trailer bills" including AB 1762 as amended, and AB 1752 as amended).
* The Senate adjourned at about 9 PM, for summer recess and will not return back to Sacramento until Monday, August 18.
ASSEMBLY:
* Assembly will now need to consider the Senate budget proposal, and will need to pass it with at least 54 votes of its 80 members. The Democrats control the Assembly 48-32 and need at least 6 Republican votes.
* The Assembly will meet next on Monday, July 28, 12 noon, though it is not certain they will take up the budget then. They could take it up on Tuesday possibly.
* Though the outcome is not certain, approval however appears likely - at this point. IF the Assembly changes the Senate budget plan in any way, the Senate will then need to return and approve those changes before it can be sent to the Governor. The pressure is on the Assembly now, to accept the budget spending plan passed by the Senate, "as is".
GOVERNOR
* Facing an historic recall election, now set for October 7, the Governor will need to approve the budget bill, which he is almost certain to do without major changes.
* Faced with an uphill recall battle and poll approval ratings plummeting to less than 22%, the Governor is not likely to use his "blue pencil" or line item veto to reduce spending or expenditures further than what is already in the Senate budget plan - for fear of further enraging constituencies already angry with cuts he proposed in January.  That actually has been the case since April when the recall was gaining steam.

WHAT DOES THIS ALL MEAN
* California is now 27 days without a budget - and the impact of no budget is growing daily as more and more people who need programs and services and workers are affected, but it now seems likely the budget stalemate will end before the end of this month.

WHAT CAN YOU DO
* WATCH FOR UCP/CALIFORNIA COMMUNITY ADVOCACY NETWORK ACTION ALERT ON BUDGET (to be released later today which will cover all possible cuts impacting people with developmental and other disabilities (including SSI/SSP, Medi-Cal, community-based services and supports funded through regional centers, Habilitation Services, IHSS)
* SAVE THE DATE: AUGUST 20th WED LANTERMAN UNIFIED ACTION MEETING - beginning at 10 AM, "Unified Action" meeting in  Sacramento, bringing together people with developmental and other disabilities, their families, providers, direct care workers, regional centers, independent living centers and others to continue efforts for unified action and strategy that responds effectively to the continuing funding crisis.  "Action Groups" or task forces will be formed to develop alternatives, options, solutions, on the many issues impacting people with developmental and other disabilities including purchase of services (and purchase of service standards, direct care wages and provider rates/costs), parental co-payments; expanding federal funding; workers compensation; crimes and victims; special education; narrowing of eligibility standards for people with developmental disabilities, transportation, housing, and also a proposed statewide constitutional initiative campaign, and other issues. These "action groups" or task forces will report back for a follow-up meeting in mid-September with the hope that people can mobilize toward a unified action and strategy on each of those issues and proposed solutions.  This meeting will also include (tentative) people from the Centers on Medicaid and Medicare Services to speak about the Home and Community Based Waiver and other federal resources, and also (tentative) Lt. Governor Cruz Bustamante.

FOR MORE INFORMATION ABOUT THIS REPORT
* This is a report  for Californians with developmental (& other disabilities), families, providers and other advocates, from the California Coalition of United Cerebral Palsy Associations, a link to the California Community Advocacy Network.
* If you would like to get on this distribution (and conversely, get off of it) please send an email with that request to:   martyomoto@rcip.com.  Sharing information is part of our organizing effort. Please feel free to forward or copy this (attribution is nice). We're all in this together!
Marty Omoto, advocate/brother of Alana, sister with developmental disabilities
CA Coalition of United Cerebral Palsy Associations
1225 8th Street Suite 480 Sacramento, CA 95814  916/446-0013 (NEW phone number!)
NEW fax number: 916/446-0026        email: martyomoto@rcip.com
Coalition Chair: Philip Ksarjian (UCP of Greater Sacramento)
Past Chair: Ron Cohen (UCP of LA, Ventura and Santa Barbara Counties)

SAVE THE DATE: AUGUST 20TH LANTERMAN UNIFIED ACTION MEETING - THE WHOLE WORLD IS WATCHING!

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Last Updated on 04/14/04   webmaster@namiscc.org

 

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