5 Things California: Medi-Cal in the budget, Homelessness funding, Office of Health Care Affordability

While DJ is away on vacation, I’m delighted to bring you the newest edition of “5 Thing We’re Watching” in California. My name is Eli and I’m a reporter at State of Reform, covering health policy in California, Colorado, and Texas.

If you have any tips or suggestions for what you think I should be writing about, I encourage you to email me with your thoughts.

Thank you!

Eli Kirshbaum
State of Reform

1. Health funding in finalized state budget

The legislature and Newsom came to a “final” agreement on a $262.6 billion state budget late last month, just three days before FY 2021-2022 began. The agreement included two key victories for legislative Democrats: $48 million GF for expanding Medi-Cal coverage to undocumented individuals 50 and older and $197 million GF (reserved for FY 2022-2023) for removing the Medi-Cal asset test. Lawmakers and Newsom’s office will continue to add provisions – such as how to spend $6 billion in broadband expansion funding – through “trailer bills’‘ in the months to come.

$4.4 billion over 5 years is dedicated to an “innovative” youth behavioral health program, and $300 million per year is reserved for rebuilding California’s public health infrastructure, starting in FY 2022-2023. DHCS intends to submit its $5.2 billion HCBS spending plan to CMS on July 12, taking advantage of enhanced federal funds made available through ARPA. Since some items in the new budget agreement are also eligible for this federal support, it’s possible that some parts of the plan will be eliminated when reconciled with the budget.


2. Bill to create Office of Health Care Affordability Advances

Asm. Jim Wood’s bill to create an Office of Health Care Affordability – an effort one member of our Los Angeles Convening Panel described as the most important thing currently happening in California health policy besides the budget – awaits discussion in the Senate after passing the Assembly on a party-line, 51-14 vote in June. The new office would evaluate state health care spending and produce policy solutions to reduce health care costs.

Supporters say the office is critical in addressing increasing health care costs in the state and reflects public desire to see action on reducing costs. Opponents believe it would interfere with the state’s insurance market. Bill Kramer, Purchaser Business Group on Health’s Executive Director for Health Policy, told me he thinks the plan is “one of the best-designed cost commissions in the country.”

3. Historic investments in homelessness

The budget deal dedicates a record $12 billion to address homelessness, including $1 billion for each of the next two fiscal years for local municipalities to use to combat homelessness. It also provides the Department of Social Services with $4 billion over the next two years for anti-homelessness programs.

Housing California Policy Director Chris Martin says the most impactful homeless-related bill this session is Asm. David Chiu’s AB 816, which would create a new inspector general position, responsible for evaluating state homelessness data and using it to craft a policy response. Asm. Luz Rivas – who was instrumental in securing the $1 billion for local jurisdictions – is sponsoring AB 1220 to establish a state interagency council on homelessness, as well as AB 27 to help the state better identify homeless youth.


4. Statewide HIE effort stalls

The Assembly Appropriations Committee turned AB 1131 – Asm. Wood’s effort to create a statewide health information exchange – into a two-year bill in May, prolonging the push to establish a centralized HIE. According to a staff member from the Assembly Health Committee, the bill’s supporters are hoping to implement aspects of AB 1131 into the budget through the trailer bill process.

Advocates of a statewide HIE argue that streamlining health data in the state will reduce patient costs, allow for more timely medical decision-making, and improve health equity. Opposition comes from organizations that have already established their own private health data sharing systems. While the finalized budget includes Newsom’s request of $2.5 million for HIE activities, it’s unclear whether aspects of AB 1131 will also be implemented or if the effort will resume next session.


5. Three lessons from Vox’s story on physician mental health

In a 4,700-word piece titled “The doctors are not all right,” Vox explores the structural barriers in place that make it difficult for doctors to access mental health care. The article highlights stories of physicians who have died by suicide, COVID-19’s impacts on physician mental health, and efforts to make it easier for doctors to access care. Here are our three lessons learned from the piece.

Vox Correspondent Julia Belluz describes suicide as an “occupational hazard” in the medical field. “The problems emerge in the high-stress years of medical school, and by the start of residency — when doctors’ DNA was found to age six times faster than that of their non-physician peers — rates of depression increase fourfold in the first four months. Across all residency programs, an average of one-third of doctors meet the diagnostic criteria for major depression.”