SUBCOMMITTEE.
ONE ON HEALTH AND HUMAN SERVICES
WE'RE GOING TO BEGIN AS A
SUBCOMMITTEE OF THE SUBCOMMITTEE.
TODAY IS APRIL EIGHTH.
AND I'D LIKE TO BEGIN WITH.
ISSUE NUMBER ONE AFFORDABILITY
AN INDIVIDUAL MANDATE PROPOSALS
AND ASKED OUR PANELISTS PLEASE
COME UP
[inaudible]
EVERYTHING.
ALL RIGHT I I WOULD ASK THAT WE
GO IN THE ORDER LISTED AND I
UNDERSTAND WE HAVE.
AN ADDITIONAL PERSON.
YOUR THE CONSUMER TELL ME YOUR
NAME PLEASE [inaudible]
CLEAR [inaudible]
COST [inaudible]
ALL RIGHT [inaudible]
KATY REBEL.
SEE CAN YOU HEAR ME.
THAT'S A NOON THANK YOU MADAM
CHAIR AND MEMBERS APOLOGIES FOR
MY BACK.
UP FOR THE OPPORTUNITY TO
PARTICIPATE IN TODAY'S HEARING.
THE AFFORDABLE CARE ACT PROVIDED
A STRONG FOUNDATION FOR THE
INDIVIDUAL MARKET THROUGH A
COMBINATION OF MARKET REFORMS AN
INDIVIDUAL MANDATE.
SUBSIDIES TO MAKE PREMIUMS AN
OUT OF POCKET COSTS MORE
AFFORDABLE AND PROGRAMS TO
BALANCE RISK BETWEEN PLANTS.
SINCE TWENTY FOURTEEN
CALIFORNIA'S MADE REMARKABLE
PROGRESS UNDER THE AFFORDABLE
CARE ACT BY REDUCING THE RATE OF
THE UNINSURED TO HISTORIC LOWS
THROUGH EXPANSION OF MEDICARE
AND COVER CALIFORNIA.
DESPITE THESE GAINS
AFFORDABILITY OF COVERAGE
REMAINS A VERY REAL CHALLENGE
FOR CONSUMERS IN CALIFORNIA AND
ACROSS THE NATION.
RECENT FEDERAL POLICY ACTIONS
THREATEN TO TAKE US IN THE WRONG
DIRECTION [inaudible]
ABSOLUTELY.
PURSUANT TO OUR LEGISLATIVE
MANDATE COVER CAL BETTER.
COVER CALIFORNIA DEVELOPED AND
SUBMITTED A SET OF POLICY
OPTIONS TO THE LEGISLATURE
GOVERNOR AND THE COUNCIL ON
HEALTH CARE DELIVERY SYSTEMS TO
ADDRESS THESE CHALLENGES.
AND IMPROVE AFFORDABILITY FOR
LOW AND MIDDLE INCOME CONSUMERS.
THE BULK OF THIS WORK I WOULD
JUST NOTE WAS DONE AT THE END OF
TWENTY EIGHTEEN SO BEFORE THE
ADMINISTRATION'S PROPOSAL BUT WE
THINK IT HAS SOME HELPFUL
TAKEAWAYS WHICH A HIGHLIGHT
TODAY.
OF THE OPTIONS THAT WE PRESENTED
WERE DEVELOPED THROUGH A
COLLABORATIVE PROCESS WITH THE
STAKEHOLDER WORK GROUP COMPRISED
OF CONSUMER ADVOCATES.
PLANS PROVIDERS ASSOCIATIONS AND
LEGISLATIVE STAFF.
THE MODELING IN THE REPORT WAS
PERFORMED BY ECONOMIST DR%
WESLEYAN AT UCLA.
AND DR NICOLAS TELAMON AT THE
UNIVERSITY OF ILLINOIS.
THE WORK GROUP CONSIDERED A
VARIETY OF OPTIONS BUILDING ON
THE TOOLS OF THE AFFORDABLE CARE
ACT INCLUDING PREMIUM AND COST
SHARING SUPPORT.
AN INDIVIDUAL MANDATE WITH A
PENALTY AND REINSURANCE.
WE PROVIDED OPTIONS UNDER TWO
DIFFERENT APPROACHES.
AN APPROACH ONE WE MODELED
ENHANCE PREMIUM AND COST SHARING
SUBSIDIES WITHIN LAYERED ON A
PENALTY AND FINALLY WE LAYERED
ON REINSURANCE.
PLEASE OPTIONS WERE DESIGNED TO
BUILD ON EACH OTHER TO INCREASE
AFFORDABILITY FOR EVERYONE
PURCHASING COVERAGE IN THE
INDIVIDUAL MARKET.
I WOULD NOTE THAT THE FIRST TWO
OPTIONS CAN BE ADMINISTERED BY
THE STATE INDEPENDENTLY BUT THE
THIRD OPTION REINSURANCE WOULD
REQUIRE FEDERAL ENGAGEMENT
THROUGH A WAIVER PROCESS.
IN APPROACH TO WE DEVELOPED A
SERIES OF DISCRETE OPTIONS
TARGETED TO SPECIFIC INCOME
GROUPS.
OUT OF A RECOGNITION THAT
POLICYMAKERS WOULD BE TO MAKE
TRADE OFFS DUE TO BUDGET
CONSTRAINTS.
THESE OPTIONS WERE PROJECTED TO
COST LESS THAN FIVE HUNDRED
MILLION IN THE FIRST YEAR OF
IMPLEMENTATION AND WOULD
INCREASE ENROLLMENT BY ABOUT
FIFTY TWO HUNDRED TWENTY FIVE
THOUSAND CALIFORNIANS.
OF THE STAFF ANALYSIS THAT YOU
HAVE SUMMARIZES THE IMPACT OF
SEVERAL OF THE OPTIONS SO I WILL
JUST PROVIDE SOME HIGH LEVEL
TAKE AWAYS FROM OUR WORK.
OF FIRST REINSTATEMENT OF THE
INDIVIDUAL MANDATE PENALTY HAS A
SIGNIFICANT IMPACT WHEN PAIRED
WITH POLICIES THAT MAKE PLANS
MORE AFFORDABLE.
IN ADDITION TO GENERATING
OFFSETTING REVENUE.
AND INDUCES A SIGNIFICANT AMOUNT
OF NEW ENROLLMENT WHICH CAN IN
TURN PUT DOWNWARD PRESSURE ON
PREMIUM INCREASES.
AND IT INDUCES MORE FEDERAL
FUNDING BECAUSE THOSE WHO ENROLL
WITH INCOME BELOW 4100% OF THE
FEDERAL POVERTY LEVEL WILL
RECEIVE FEDERAL PREMIUM TAX
CREDITS IN ADDITION TO NEW STATE
SUBSIDIES.
BUT AS WE KNOW PREMIUM AND COST
SHARING SUBSIDIES MAKE COVERAGE
MORE AFFORDABLE AND CREATE
SIGNIFICANT GAINS IN ENROLLMENT.
THIS IS THAT ADDRESS THE TAX
CREDIT CLIFF FOR WHICH WE
MODELED SEVERAL.
OF THE POINT AT WHICH FEDERAL
SUBSIDIES ABRUPTLY AND MEAN THAT
PEOPLE ABOVE 4100% OF THE
FEDERAL POVERTY LEVEL WOULD
RECEIVE HELP PAYING FOR THEIR
PREMIUMS FOR THE FIRST TIME.
THE IMPACT OF THIS POLICIES
PARTICULARLY STRIKING FOR
INDIVIDUALS LIVING IN HIGH COST
REGIONS AND APPROACHING MEDICARE
ELIGIBILITY. FOR THOSE UNDER
4100% OF THE FEDERAL POVERTY
LEVEL BIGGER SUBSIDIES DO MATTER
AND GENERATE SIGNIFICANT NEW
ENROLLMENT.
AS EXPECTED OR MODELING SHOWS
THAT PREMIUM SUBSIDIES GENERATE
GREATER ENROLLMENT GAINS AND
COST SHARING SUBSIDIES BUT COST
SHARING SUBSIDIES ARE AN
EFFECTIVE TOOL TO INDUCE
CONSUMERS TO ENROLL MORE
GENEROUS COVERAGE.
WITH THAT HIGH LEVEL SUMMARY I
WILL CLOSE WE HOPE THAT THESE
OPTIONS HELP INFORM YOUR EFFORTS
TO ADDRESS AFFORDABILITY IN
CALIFORNIA'S INDIVIDUAL MARKET.
WE STAND READY TO WORK WITH YOU
IN THE ADMINISTRATION THANK YOU
[inaudible]
THANK YOU [inaudible]
JACOB LAMB.
GOOD AFTERNOON JACOB LAMB
DEPARTMENT OF FINANCE SO I THINK
THE AGENDA DOES A GOOD JOB OF
SUMMARIZING THE ADMINISTRATION'S
PROPOSAL RELATED.
TO AFFORDABILITY ON THE
INDIVIDUAL MARKET PLACE AND
REINSTATE INDIVIDUAL MANDATE SO
TO BE BRIEF.
THE ADMINISTRATION PROPOSES TO
BEGIN THE MANDATE AND THE
SUBSIDY PROGRAM BEGINNING
JANUARY -- ONE TWENTY TWENTY AND
WE BELIEVE THAT THESE TWO
PROPOSALS WILL WORK IN TANDEM TO
INCREASE AFFORDABILITY.
INCREASE ACCESS TO COVERAGE KEEP
THE UNINSURED RATE LOW.
AND SLOW PREMIUM GROWTH -- AND
DESIGNING THIS PROPOSAL WE MADE
A FEW KEY POLICY DECISIONS --
FIRSTLY OUR MANDATE AND SOLVE
THE PROGRAM RELY HEAVILY ON THE
FEDERAL FRAMEWORK THAT'S ALREADY
IN PLACE OUR PROPOSAL LOOKS TO
BUILD UPON THE SUCCESS OF THE
ACA.
AND SO WE MODELED A LOT OF OUR
PROPOSALS BASED OFF WHAT'S
CURRENTLY IN FEDERAL LAW -- NEXT
IN TOWN THE ADMINISTRATION'S THE
FUN THE SUBSIDY PROGRAM WITH ANY
PENALTY REVENUE GENERATED BY THE
INDIVIDUAL MANDATE -- BASED ON
IRIS TAX YOUR DATA.
FOR TWENTY SIXTEEN CALIFORNIANS
PAID APPROXIMATELY FIVE HUNDRED
MILLION. FOR THE FEDERAL MANDATE --
KIND OF BASED OFF ADDITIONAL
RESEARCH WE'VE DONE WITH FTP AND
THE DIFFERENCES IN THE FEDERAL --
FILING THRESHOLDS FOR CALIFORNIA.
AND THE FEDERAL GOVERNMENT THESE
RUN A PROJECTIONS MAY BE A
LITTLE BIT TOO HIGH THE FEDERAL
FALLING AT THRESHOLD IS 26%
LOWER THAN CALIFORNIA'S SO FEWER
CALIFORNIA'S WOULD BE PAYING THE
PENALTY UNDER.
OUR PROPOSAL.
UP.
NEXT WITH THIS PROPOSAL WE
INTENDED TO BE AN ANNUAL GENERAL
FUND APPROPRIATION SO THIS WOULD
NOT BE AN ENTITLEMENT PROGRAM --
WE ACKNOWLEDGE THAT THE REVENUE
ESTIMATES MAY VARY SIGNIFICANTLY
FROM YEAR TO YEAR FOR THE THREE
YEARS OF THIS PROPOSAL -- WE ARE
CURRENTLY ADDRESS LOOKING AT
CONCERNS RELATED TO VERY ABILITY
IN THE SYSTEM AND HOW THAT MIGHT
IMPACT INDIVIDUAL SUBSIDY
AMOUNTS.
ON AN ANNUAL BASIS I THINK THERE
ARE A NUMBER OF WAYS WE CAN LOOK
AT THIS WEATHER WE'RE LOOKING AT
IT IN THE BUDGET YOU'RE ONLY --
FOR LOOKING OUT OVER THE THREE
YEAR FORECASTS PERIOD I THINK
LOOKING AT THAT THREE YEAR
FORECAST PERIOD WILL HELP US
INFORMED.
WHAT SUBSIDIES ARE ULTIMATELY --
BUILT INTO THE BUDGET ACT THIS
YEAR.
AND THEN.
THERE HAVE BEEN QUESTIONS ABOUT
OUR SUBSIDY PROPOSAL
SPECIFICALLY SO WE'RE PROPOSING
TO OFFER SUBSIDIES TO
INDIVIDUALS BETWEEN TWO HUNDRED
FIFTY AND SIX ARE PERCENT OF THE
FEDERAL POVERTY LEVEL LEVEL --
2100524100% INDIVIDUALS ALREADY
RECEIVE A FEDERAL SUBSIDY
HOWEVER THE SUBSIDIES ARE NOT
PARTICULARLY GENEROUS. FOR
INDIVIDUALS ABOVE 4100% OF THE
FPL WE WOULD BE THE FIRST DAY IN
THE NATION TO OFFER SUBSIDIES TO
THIS INCOME RANGE.
OF RELATED TO WHY WERE.
OF PROPOSING TO BEGIN THE
SUBSIDY THAT TWO HUNDRED PER
PERSON 50% OF THE FEDERAL
POVERTY LIMIT -- IT'S FEDERAL
SUBSIDIES FOR THOSE UNDER TWO
HUNDRED FIFTY WHILE.
THERE MAY BE CONCERNS AND
SPECIFIC INSTANCES ARE
RELATIVELY GENEROUS COMPARED TO
THOSE ABOVE 210050% THE FEDERAL
POVERTY LEVEL.
BUT ALSO NOTE THAT THE
GOVERNOR'S BUDGET INCLUDES A
NUMBER OF DIFFERENT.
PROPOSALS TO ADDRESS
AFFORDABILITY MORE GENERALLY --
AND HOUSING AND TRANSPORTATION
OTHER HEALTH PROPOSALS -- ALSO
FOR A STATE SUBSIDY PROGRAMMER
PROPOSING TO SUB THAT THE
PROGRAM BEGINNING DECEMBER.
SUNSET THE PROGRAM DECEMBER
THIRTY FIRST.
TWENTY TWENTY TWO ALL WERE
PROPOSING THE SUNSET PERIOD
BECAUSE WERE A KNOWLEDGE JING
THAT WITHOUT FURTHER FEDERAL
PARTNERSHIP IN ACTION IT WILL BE
DIFFICULT TO ADDRESS THE BROADER
AFFORDABILITY CHALLENGES THAT WE
CURRENTLY ARE SAYING ON THE
MARKET PLACE.
AND WE'RE HOPING THAT.
WITH THIS SUNSET PERIOD WILL
HAVE THE OPPORTUNITY TO RE
EVALUATE THE PROGRAM TO MAKE
SURE THAT IT'S ACCOMPLISHING.
OUR GOALS OF MAINTAINING
AFFORDABILITY ON THE MARKET
PLACE.
FINALLY OUR PROPOSAL WOULD ALLOW
DATA SHARING BETWEEN FTV AND
COVERED CALIFORNIA.
SO I HAVE TO BE WOULD BE ABLE TO
TELL COVER CALIFORNIA WHAT
INDIVIDUALS HAVE BEEN SUBJECT TO
A PENALTY.
AND HOPEFULLY THAT WOULD
FACILITATE -- COMMUNICATION TO
GET TO LOWER THE UNINSURED RATE
FURTHER -- WITHOUT HAVING TO
ANSWERING QUESTIONS AND THANK
YOU PROP ME [inaudible]
THANK YOU.
ALEC POLEMIC.
THE MAC -- I COVERED FOR BOTH OF
US WELL THEN WE'LL JUST CROSS
ALEC OUT [inaudible]
WELL.
BETH CAPELL HERE ON BEHALF OF
HEALTH ACCESS CALIFORNIA FIRST
TO SAY HOW PLEASED WE ARE TO
ONCE AGAIN BE IN THIS ROOM WERE
LAST YEAR.
THE ASSEMBLY TOOK THE STEP OF
COMMITTING A BILLION DOLLARS TO
GET CALIFORNIA TO UNIVERSAL
COVERAGE.
OF APPRECIATED DOCTOR WOODS
LEADERSHIP ON THAT IN THE
LEADERSHIP OF THE ASSEMBLY THAT
WAS A GOOD SOLID FIRST STEP
TOWARD UNIVERSAL COVERAGE WE
AGREE WITH YOU.
THINK I'M USUALLY AGREE WITH YOU.
I CAN'T THAT PROVIDES THE BASIS
FOR A LOT OF WHAT WE'RE SEEING
IN THE GOVERNOR'S PROPOSAL I WAS
A LOT OF WORK COME FROM DOCOR
WOULD DOCTOR ARAMBULA.
UNDER THE LEADERSHIP OF SPEAKER
ANTHONY RENDON ABSOLUTELY AND
WE'RE PLEASED TO BE HERE BECAUSE
WE COMPLETELY WHOLEHEARTEDLY
AGREE WITH YOU MADAM CHAIR THAT
IT WAS THE LEADERSHIP OF THE
ASSEMBLY THAT SET THE STAGE FOR
THE PROPOSAL THE GOVERNOR -- AND
WE SHARE THE GOVERNOR'S GOAL OF
GETTING TO UNIVERSAL COVERAGE
AND WE SHARE THE GOAL OF GETTING
TO IT.
IN THE REASONABLY FORESEEABLE
FUTURE -- WE WERE ALSO VERY
PLEASED THAT THE ASSEMBLY
LANDING CREATED THE AB EIGHTEEN
TEN AFFORDABILITY WORKGROUP WITH
THE WORK.
THE RESULTS THAT YOU'VE HEARD
ABOUT FROM COVERED CALIFORNIA
WHAT THEIR ANALYSIS SHOWS IS
THAT IT TAKES A SIGNIFICANT
INVESTMENT TO REALLY REDUCE THE
NUMBER OF UNINSURED TO CUT THE
NUMBER OF UNINSURED IN HALF.
IN THE INDIVIDUAL MARKET WOULD.
REQUIRE SOMETHING ON THE ORDER
OF TWO BILLION DOLLARS WE
UNDERSTAND THAT THAT'S NOT
LIKELY TO HAPPEN IN A SINGLE
YEAR BUT WE HOPE OVER THE COURSE
OF THE NEXT SEVERAL YEARS.
THE TRUST AS CALIFORNIA MADE A
COMMITMENT TO IMPROVE CAL WORKS
AND A COMMITMENT MULTI YOUR
COMMITMENT TO IMPROVE THE
MINIMUM WAGE SIMILARLY WE CAN
MAKE A COMMITMENT TO GETTING TO
UNIVERSAL COVERAGE [inaudible]
SPECIFICALLY -- WITH RESPECT TO
OF THEM.
WE ALSO SUPPORT THE MANDATE
PENALTY AND THINK IT'S AN
IMPORTANT PART OF A BALANCED
PACKAGE WE HOWEVER DO NOT THINK
THAT THE MANDATE REVENUE.
ALONE IS SUFFICIENT TO PROVIDE
THE LEVEL OF AFFORDABILITY THAT
IS NECESSARY ONE OF THE THINGS
WE LEARNED IN THE AFFORDABILITY
WORK GROUP IS THAT ABOUT A THIRD
OF THE PEOPLE WITH INSURANCE AS
INDIVIDUALS.
SAY THEY HAVE A TROUBLE
AFFORDING FOOD AND AFFORDING
RANCH AND THEY CAN'T AFFORD THE
PREMIUMS AND THEY CAN'T THEY
HAVE TROUBLE AFFORDING THE%
COPAYS AS WELL.
WITH RESPECT TO PEOPLE BELOW
210050% OF POVERTY I THINK WE
HAVE A DIFFERENCE OF OPINION
WITH THE ADMINISTRATION WE THINK
FOLKS IN THAT THOSE INCOME
LEVELS.
NEED HELP AS WELL WE HAVE
CALIFORNIANS WHO MAKE LESS THAN
A HUNDRED AND 38% OF POVERTY
THAT'S ABOUT SEVENTEEN THOUSAND
DOLLARS A YEAR.
MOST OF THEM ARE ELIGIBLE FOR
MEDICARE ALL BUT A SMALL NUMBER
OF THEM OUR EYES ARE THERE
LAWFUL IMMIGRANTS OR P..
PEOPLE MOSTLY WOMEN WHO ARE NOT
ELIGIBLE FOR MEDICARE AND WHO
HAVE TO PAY 2% OF THEIR INCOME
FOR PREMIUMS WHICH DOESN'T SOUND
LIKE A LOT OF MONEY UNLESS
YOU'RE TRYING TO LIVE ON FIFTEEN
THOUSAND DOLLARS A YEAR.
AND MORE FOR COPAYS AND
DEDUCTIBLES.
AND SIMILARLY WHEN PEOPLE HIT
THAT HUNDRED AND 38% OF POVERTY
THEY GO FROM ZERO PREMIUM MEDI
CAL AND ZERO COPAY MEDI CAL TO
PAYING 2% OF INCOME.
AGAIN THAT'S NOT FOLKS MAKE IT
TWENTY THOUSAND DOLLARS YOU'RE
NOT MAKING A LOT OF MONEY.
THERE'S ANOTHER CLEAR FOOT 2100%
OF POVERTY PEOPLE DON'T GET VERY
MUCH HELP PAYING FOR COPAYS AND
DEDUCTIBLES THERE ARE.
A LOT OF THEM BY WHAT'S CALLED
BRONZE COVERAGE WHICH HAS A
DEDUCTIBLE.
OF ARE YOU READY FOR THIS SIX
THOUSAND THREE HUNDRED DOLLARS
AND THE ONLY THING YOU GET
BEFORE THE DEDUCTIBLE ARE THREE
DOCTOR VISITS AT SEVENTY FIVE OR
EIGHTY DOLLARS A VISIT.
THEY MAKE THAT CHOICE BECAUSE
THE PREMIUMS ARE LOWER THAN THE
STANDARD COVERAGE WHICH HAS A
TWO THOUSAND FIVE HUNDRED DOLLAR
DEDUCTIBLE.
SO WE THINK THE PEOPLE BELOW
210050% OF POVERTY NEED HELP WE
ALSO THINK THAT PEOPLE LIKE MISS
HAAS IS GOING TO SPEAK NEXT.
UP COR ABOVE 4100% OF POVERTY
NEED HELP AS WELL AND WE VERY
MUCH APPRECIATE THAT PART OF THE
GOVERNOR'S PROPOSAL -- WE ARE A
LITTLE TROUBLED THAT THERE'S A
SUNSET ON THE AFFORDABILITY HELP
BUT NOT A SUNSET ON THE PENALTY
THAT SEEMS ODD TO US.
WE UNDERSTAND SUNSETS FOR PRETTY
COMMON IN THIS TOWN. FOR NEW
PROGRAMS BUT IT DOES SEEM ODD TO
US THAT THERE WOULD BE A SUNSET
ON ONE PIECE AND NOT THE OTHER
SO.
WE HAVE BEEN IN CONVERSATION
WITH THE ADMINISTRATION
APPRECIATE -- UNDERSTANDING
BETTER THEY'RE THINKING -- AND
LOOK FOR TO CONTINUE TO WORK
WITH YOU MADAM CHAIR AND WITH
THE ADMINISTRATION IN THE OTHER
HOUSE AS WE MOVE FORWARD IN THE
BUDGET PROCESS [inaudible]
THANK YOU.
HI MY NAME IS CLARE HOSP -- I
LIVE IN OAKLAND.
AND BEFORE THE ACA I KNEW THAT I
NEEDED A JOB THEY GAVE ME HEALTH
CARE -- I HAVE MITRAL VALVE
PROLAPSE WHICH IS A HEART MURMUR
THAT DOESN'T CAUSE ME ANY
CHALLENGES AT ALL IN MY LIFE --
BUT WAS THE PRE EXISTING
CONDITION THAT DENIED INSURANCE
TO ME FROM AN INSURANCE COMPANY --
BUT NOW THAT WE HAVE COVERED
CALIFORNIA LAST YEAR I LEFT MY
JOB AS A NONPROFIT ADMIN -- AND
I STARTED MY OWN BUSINESS AND I
KNEW THAT I WOULD BE ABLE TO GET
HEALTH CARE -- MY HUSBAND IS AN
ADJUNCT PROFESSOR HE GOT A PHD
FOUND A JOB TEACHING -- BUT GETS
PAID VERY LOW AS L. ADJUNCT TO
AND DOES NOT GET ANY BENEFITS --
IF WE WERE NOT MARRIED WE WOULD
BOTH QUALIFY FOR SUBSIDIES --
INDIVIDUALLY WE A INCOME IS
WITHIN THE THRESHOLD THAT WE
WOULD GET A SUBSIDY BUT BECAUSE
WE'RE MARRIED -- INCOME JUST
EXCEEDS THAT SIXTY FIVE THOUSAND
DOLLAR CAP AND WE DON'T GET ANY
SUBSIDY AT ALL.
AND THE GRATES ARE KEEP GOING UP
EVERY YEAR -- SO I ENROLLED IN
COBRA FROM MY FORMER EMPLOYEE
EMPLOYER BECAUSE IT WAS ACTUALLY
A BETTER VALUE.
AND MY HUSBAND AND ROLE THAN
THAT BROWN'S PAYMENT PLAN THAT
BETH WAS JUST TALKING ABOUT --
AND TOGETHER WE PAY MORE THAN
NINE HUNDRED DOLLARS A MONTH AND
HEALTH INSURANCE PREMIUMS.
THAT COMES OUT TO A LITTLE OVER
TEN THOUSAND DOLLARS A YEAR --
IT'S ABOUT 15% OF OUR INCOME.
AND IT'S FOR PREMIUMS IT'S NOT
FOR ACTUAL HEALTH CARE IT'S JUST
TO PAY THE INSURANCE COMPANIES --
SO EVERY MONTH WHEN WE HAVE TO
PAY OUR BILL WE HAVE THE
CONVERSATION AGAIN OF SHOULD WE
JUST GET DIVORCED -- BECAUSE
THEN WE WOULD GET SOME SUBSIDY
AND WE WOULDN'T HAVE TO PAY SO
MUCH FOR HEALTH CARE.
WE OFTEN TALK ABOUT GOING
WITHOUT.
HEALTH INSURANCE AND EVEN IF
THERE WAS A PENALTY -- WITHOUT
IT BEING MORE FOR AFFORDABLE
THAT WOULD.
PROBABLY BE BETTER FOR US --
HEALTHCARE IS A GUY IT SHOULD BE
QUALITY IT SHOULD BE FREE -- AND
IF IT'S NOT FREE AT AT LEAST
SHOULD BE VERY AFFORDABLE -- ONE
OF THE BIGGEST CONCERNS I HAVE
ABOUT THE GOVERNOR'S PROPOSAL IS
THE VARIABLE FUNDING LEVELS FROM
YEAR TO YEAR -- AS A SELF
EMPLOYED INDIVIDUAL THE THOUGHT
THAT I COULD GET A SUBSIDY THAT
WOULD BE SIGNIFICANT ENOUGH TO
HELP ME ONE YEAR.
AND THAT THEN THE NEXT YEAR IT
COULD GO AWAY -- SEEMS LIKE.
BOTH REALLY DIFFICULT TO TO
MANAGE IN TERMS OF
PREDICTABILITY -- BUT IT ALSO
SEEMS LIKE A BIG IT WOULD JUST
BE VERY HARD TO SUDDENLY NOT BE
ABLE TO AFFORD IT -- SO I THINK
THAT THAT IS SOMETHING THAT
REALLY NEEDS TO BE ADDRESSED AND
I I REALLY WOULD LIKE IT'S NOT
SUNSET AND THREE YEARS I WOULD
LOVE TO KNOW THAT I HAVE
AFFORDABLE.
COVERAGE FOR THE LONG TERM SOME
THANK YOU VERY MUCH [inaudible]
THANK YOU.
GOOD AFTERNOON MADAM CHAIR AND
MEMBERS HAD CHEN FLORI WITH
WESTERN CENTER ON LAW AND
POVERTY -- I AGREE WITH A LOT OF
WHAT MS KAPELL SAID REGARDING --
YOU KNOW WHO STILL CAN'T AFFORD
HEALTH CARE -- YOU KNOW WE
UNDERSTAND THAT PEOPLE WHO ARE
ABOVE 4100% THEY HAVE A REAL
CLIP FOR THEIR GETTING NO HELP --
BUT IT WILL TAKE CONSIDERABLE
INVESTMENT FOR HEALTH CARE TO
TRULY BECOME AFFORDABLE -- WE DO
HAVE CONCERNS AS WESTERN CENTER
REINSTATING THE INDIVIDUAL
MANDATE WITHOUT GIVING MORE
AFFORDABILITY ASSISTANCE --
IRONICALLY THE PROPOSAL THAT
TIES THE INDIVIDUAL MANDATE TO
THE STATE FILING THRESHOLD DOES
ALLEVIATE A LOT OF OUR CONCERNS
IN THAT AREA BECAUSE A LOT OF
LOW INCOME PEOPLE WOULDN'T BE.
SUBJECT TO THE INDIVIDUAL
MANDATE BUT THEY STILL WOULDN'T
HAVE COVERAGE THAT THEY COULD
AFFORD SO WE THINK IT WOULD BE
BETTER -- YOU KNOW AS LONG AS
WE'RE DOING THIS HALL IT'S DO
THIS TOGETHER SO THAT -- YOU
KNOW SOME OF THE PEOPLE THAT --
MISS CAPELL MENTIONED THERE'S
THE GROUP BETWEEN BELOW 138% OF
THE FEDERAL POVERTY LEVEL THEY
CAN'T AFFORD TO PAY ANYTHING FOR
HEALTH CARE AND STILL PAY FOR
RENT AND FOOD -- THESE PEOPLE
BUT FOR THEIR IMMIGRATION STATUS
WOULD BE ELIGIBLE FOR MEDICARE
AL -- THEIR QUALIFIED -- THEY'RE
LAWFULLY PRESENT IMMIGRANTS WHO
JUST DON'T HAPPEN TO BE
TECHNICALLY QUALIFIED UNDER THE
MEDIC HOW RULES -- AS BETH
MENTION THERE'S A SMALL SUBSET
OF PEOPLE WHO QUALIFY WHO ARE
OVER SIXTY FIVE WHO QUALIFY FOR
NEITHER MEDI CAL NOR MEDICARE
WHO ARE ALSO SUBJECT TO THIS
RULE -- AND THEN FOR THOSE GOING
JUST ABOVE 138% THE PARTICULARLY
IF YOU CONSIDER THAT A LOT OF
THESE ARE PEOPLE WHO ARE MOVING
FROM MEDIC HAL INTO INDIVIDUAL
MARKET COVERAGE -- IT'S IT'S NOT
LIKE YOU TYPICALLY GO FROM MEDIC
HOWTHE EARNING A LOT OF MONEY
AND IN FACT A LOT OF THEM HAVE A
LOT OF UNMET NEEDS THAT THEY'VE
BEENGOING WITHOUT FOR QUITE
SOME TIME.
BECAUSE THEY HAVE BEEN LIVING
BELOW THE POVERTY LEVEL -- SO.
YOU THEY GO FROM BEING A
ELIGIBLE FOR FREE CARE TO HAVING
MONTHLY PREMIUMS AND OUT OF
POCKET COSTS AND IF THEY ENROLL
IN THE RIGHT PLAN THEY GET
CONSIDERABLY MORE ASSISTANCE BUT
MANY OF THEM SEE THAT ONE DOLLAR
PREMIUM ON THE BRONZE PLAN THEY
MIGHT BE ELIGIBLE FOR AND THEN.
THEY FIND THEMSELVES SUBJECT TO
VERY HIGH OUT OF POCKET COSTS SO.
IT'S A TOUGH CHOICE EITHER WAY
AND THEN FINALLY THERE'S THAT
OTHER CLIFF -- I THINK WHEN THE
GOVERNOR'S ADMINISTRATION IS
TALKING ABOUT THERE'S QUITE A
LOT OF HELP AVAILABLE TO PEOPLE
BELOW 210050% OF THE FEDERAL
POVERTY LEVEL.
PART OF WHAT THEY'RE REFERRING
TO IS THE COST SHARING
REDUCTIONS BUT THE DIFFERENCE IN
WHAT YOU PAY. FOR YOUR SILVER
PLAN WHETHER YOU'RE A BETWEEN AT
2100% OF THE FEDERAL POVERTY
LEVEL OR 210050% OF THE FEDERAL
POVERTY LEVEL IS NOT A LOT --
PEOPLE WHO ARE AT 210050% OVER
IT THEY WOULD ENROLL IN A SILVER
SEVENTY PLAN WITH AN ACTUARIAL
VALUE OF SEVENTY PEOPLE WHO
ENROLL AT 2100% WOULD ENROLL IN
A SILVER SEVENTY THREE PLAN WITH
AN ACTUARIAL VALUE ON AVERAGE OF
73%.
THAT DIFFERENCE IN 3% SOMETIMES
IT'S JUST FIVE DOLLARS IN A CO
PAY -- SO YOU INSTEAD OF PAYING
THIRTY FIVE DOLLARS FOR YOUR
PRIMARY CARE YOU PAY FORTY
DOLLARS FOR PEOPLE AT THESE
INCOME LEVELS THAT'S NOT REALLY
A SUBSTANTIVE DIFFERENCE AND SO
IT'S PEOPLE STARTING AT 2100%.
THAT REALLY NEED QUITE A LOT OF
EXTRA SYSTEMS -- TO A PREVIOUS
STUDY THAT ACTUALLY WAS CITED IN
THE AB EIGHTEEN TEN A REPORT OF
INDIVIDUAL MARKET ENROLLEES --
TALKING ABOUT THEIR ABILITY TO
AFFORD THEIR PREMIUMS AN OUT OF
POCKET COSTS FOUND THAT PEOPLE
EARNING BELOW 210050% REPORTED
THE EXACT SAME DIFFICULTY AND
AFFORDING PREMIUMS ARE USING
THEIR HEALTHCARE.
DESPITE ALL OF THIS EXTRA
ASSISTANCE BECAUSE THEY SIMPLY
HAVE LESS MONEY.
ON THE FLIP SIDE WHEN THEY DID
THE MODELING FOR THE UPTAKE IF
WE GIVE PEOPLE ADDITIONAL
ASSISTANCE PEOPLE AT THE LOWEST
END OF THE INCOME SCALE ARE ALSO
THE MOST PRICE SENSITIVE AND ARE
MORE LIKELY TO ENROLL EVEN WITH
SMALL AMOUNTS OF ADDITIONAL
ASSISTANCE.
SO -- WE JUST WANT TO MAKE SURE
THAT IF WE ARE GOING TO ACTUALLY
LOOK AT AFFORDABILITY THAT WE'RE
LOOKING AT IT IN TOTALITY AND
NOT JUST ON WHO'S GETTING HELP
AND WHO'S NOT GETTING HELP.
BUT IN WHO ACTUALLY NEEDS HELP
AND IT'S QUITE A LOT OF
CALIFORNIANS AND IT'S GOING TO
TAKE SOME OF TIONAL INVESTMENT
BEYOND WHAT THE INDIVIDUAL
MANDATE PENALTIES WILL GENERATE.
MADAM CHAIR IF I COULD JUST ADD
ONE OF THE GOOD THINGS ABOUT THE
GOVERNOR'S PROPOSAL.
IS THE STRUCTURE THAT THEY HAVE
PROPOSED TO CREATE WHICH IS THAT
YOU WOULD APPROPRIATE ANNUALLY
AND THEN COVERED CALIFORNIA.
WHICH HAS A HISTORY OF WORKING
VERY COLLABORATIVELY WITH THE
HEALTH PLANS.
AND WITH THE CONSUMER ADVOCATES
WOULD THEN DEVELOP WOULD THEN
LOOK AT HOW -- TO MAKE THAT
AFFORDABILITY MONEY WORK AND SO
THAT STRUCTURE OF THE FRANCHISE
TAX BOARD IMPOSES THE PENALTY
COVERED CALIFORNIA DESIGNS THE
AFFORDABILITY HELP.
THAT'S SOMETHING WE HAVE BEEN
DOING EVERY YEAR SINCE GOSH --
TWO THOUSAND TWELVE IT'S AN
ANNUAL PROCESS CALLED BENEFIT
DESIGN WORK GROUP WE DO WITH SO
WE DO WE FIGURE OUT HOW TO
DESIGN WHAT THE FEDERAL HELP
WOULD LOOK LIKE FOR CONSUMERS.
AND THIS WOULD ADD ON THE STATE
HELP AND SO THAT BASIC STRUCTURE
THAT IS PROPOSED IN THE
GOVERNOR'S TRAILER BILL MAKES A
LOT OF SENSE I THINK TO THE
ADVOCACY COMMUNITY.
AND IT'S SOMETHING WE THINK
COULD WORK WELL WE JUST WANT TO
MAKE SURE.
THAT AS THEY'RE DOING THAT THEY
HAVE THE FLEXIBILITY TO HELP
PEOPLE.
BELOW THE LOWEST INCOME THE
PEOPLE BELOW 210050% AS WELL AS
THE PEOPLE 2100526100%.
AND THEIR COURSE FEW OTHER
CHANGES WOULD LIKE IN THE
TRAILER BILLS WE INDICATED BUT
THAT THAT BASIC STRUCTURE WE
THINK IT'S VERY SOLID WARY --
APPRECIATE THE WORK OF THE
ADMINISTRATION IS PROPOSING
[inaudible]
THANK YOU.
I THINK RYAN.
YOUR LAST.
THANK YOU MADAM CHAIR RYAN WILL
SAY THAT.
THANK YOU RIGHT.
WITH THE LEGISLATIVE ANALYST'S
OFFICE -- IN EARLY FEBRUARY --
OUR OFFICE RELEASED A REPORT
WITH PRELIMINARY COMMENTS ON THE
GOVERNOR'S PROPOSAL TO IN STATE
AN INDIVIDUAL MANDATE FOR HEALTH
INSURANCE COVERAGE.
AND TO PROVIDE SUBSIDIES -- THAT
THAT REPORT WAS PRESENTED AT A
JOINT HEARING THAT THIS
COMMITTEE PARTICIPATED IN -- I'M
HAPPY TO WALK THROUGH THOSE
COMMENTS AT YOUR DIRECTION BUT
WANTED TO DEFINITELY HIGHLIGHT --
SOME ADDITIONAL THINGS THAT WE
THINK THE LEGISLATURE SHOULD PAY
ATTENTION TO NOW THAT MORE
DETAILS -- HAVE AS HAVE BEEN
DESCRIBED BY THE DEPARTMENT OF
FINANCE ARE NOW AVAILABLE ABOUT
THE PROPOSAL.
AND ONE OF THE THINGS THAT WE
WOULD ECHO IS -- SOMETHING'S
BEEN MENTIONED ALREADY ABOUT HOW
VERY CLOSELY TYING THE AMOUNT OF
SUBSIDIES TO THE AMOUNT OF
PENALTY REVENUES GENERATED COULD
RESULT.
IN SOME SWINGS IN THE AMOUNT OF
ASSISTANCE THAT'S AVAILABLE THAT
COULD CREATE SOME UNCERTAINTY
AND CONFUSION -- FOR PEOPLE THAT
ARE ELIGIBLE FOR FOR THE
SUBSIDIES.
WHEN I AM WE WOULD JUST NOTE
HOWEVER THAT-- THE STRUCTURE
THAT IT'S BEEN PROPOSES THAT THE
PENALTY REVENUES WILL GO INTO
THE GENERAL FUND AND THEN THE
COST OF THE SUBSIDIES WILL ALSO
COME OUT OF THE GENERAL FUND SO
FROM A TECHNICAL PERSPECTIVE.
THERE'S NO REASON WHY YOU HAVE
TO TIE THE AMOUNT OF ASSISTANCE --
SO CLOSELY TO THE AMOUNT OF
PENANCE PENALTY REVENUES SO.
THE LEGISLATURE COULD CHOOSE.
TO SET THOSE -- SUBSIDY LEVELS
THAT MORE CONSISTENT AMOUNT --
AT THAT THAT WOULDN'T HAVE TO
CHANGE NECESSARILY TO REFLECT.
CHANGES IN PENALTY REVENUES.
THE OTHER THING I'D LIKE TO NOTE
IS THAT -- IT'S BEEN MENTIONED
THAT THE GOVERNOR'S PROPOSAL IS
TO MODEL VERY CLOSELY ON THE
FEDERAL STRUCTURE -- AS PART OF
THAT THE ASSISTANCE WOULD BE
PROVIDED IN THE FORM OF TAX
CREDITS.
THAT IS OF COURSE AND THE WAY
THAT THE FEDERAL ADVANCE PREMIUM
TAX CREDIT WORKS HOWEVER.
IN -- SOME STATES THAT HAVE
STATE PREMIUM ASSISTANCE ON THIS
ASSISTANCE IS VERY SIMILAR TO
THE FEDERAL ADVANCE PREMIUM TAX
CREDIT EXCEPT THAT.
IT IS NOT ACTUALLY A TAX CREDIT
FOR EXAMPLE IN IN THE STATE OF
MASSACHUSETTS.
ADDITIONAL STATE ASSISTANCE IS
PROVIDED -- DIRECTLY TO
INSURANCE COMPANIES UP FRONT
MUCH LIKE THE ADVANCE FROM TAX
CREDIT WITH THE EXCEPTION THAT
THERE IS NO NEED TO RECONCILE
THE AMOUNT OF ASSISTANCE THAT
WAS ADVANCED EARLIER IN THE YEAR.
AT TAX FILING TIME.
THIS MEANS IS THAT IF A PERSON
HAS A SITUATION THAT CHANGES
DURING THE YEARS SAY THEY START
EARNING MORE OR LESS MONEY THAN
THEY DID.
WHEN THEY ORIGINALLY ESTIMATED
THEIR ASSISTANCE AMOUNT?
THEY WOULD PROSPECTIVELY HAVE A
DIFFERENT AMOUNT OF ASSISTANCE
THAT THEY WOULD RECEIVE BUT
THERE WOULD BE NO -- ATTEMPT
MADE BY THE STATE TO GO BACK AND
RECONCILE TO MAKE SURE THAT THE
ANNUAL INCOME WAS VERY CLOSELY.
TIED TO THE AMOUNT OF ASSISTANCE
RECEIVED -- IN THE CASE OF
MASSACHUSETTS IT'S OUR
UNDERSTANDING THAT THIS DESIGN
DECISION WAS MADE.
FROM A RECOGNITION THAT IT
WOULDN'T BE WORTH IT FOR THAT
STATE TO TO DO THE
RECONCILIATION THAT WAY.
THAT'S NOT NECESSARILY GOING TO
BE THE CASE FOR CALIFORNIA -- WE
UNDERSTAND THAT THE
ADMINISTRATION IS PREPARING AN
ESTIMATE OF THE COST FOR
FRANCHISE TAX BOARD TO
ADMINISTER THIS TAX CREDIT.
AND WE WOULD SUGGEST THAT THE
LEGISLATURE COULD ASK THE
ADMINISTRATION TO FURTHER
CONSIDER WHAT WOULD BE THE
IMPLICATIONS OF PURSUING THIS
ASSISTANCE NOT OF THE TAX CREDIT.
WE COULD POTENTIALLY SAVE SOME
MONEY IN TERMS OF ADMINISTRATIVE
COSS BUT ON THE OTHER HAND WHAT
WOULD BE THE IMPLICATIONS ON THE
AMOUNT OF ASSISTANCE IS PROVIDED.
AND IN THE LEGISLATURE COULD
MAKE A DECISION ABOUT THE
CORRECT COURSE OF ACTION ON THAT.
VERY GOOD THANK YOU [inaudible]
WOULD.
THANK YOU VERY MUCH MADAM CHAIR --
JUST -- COUPLE THINGS I LIKE
WE'VE OBVIOUSLY BEEN WORKING ON
THIS FOR QUITE A WHILE NOW --
AND AFTER A SELECT COMMITTEE AND
THAN THE BILLS WERE INTRODUCED --
SHORTLY AFTER THAT FEBRUARY I
BELIEVE OR MARCH I CAN'T MEMBERS
THAT MARCH OF LAST YEAR -- AND
SOME OF THE BILL'S MADE IT SOME
OF THEM DIDN'T MAKE IT -- AND WE
WERE ABLE TO MAKE A A LITTLE BIT
OF PROGRESS THIS YEAR I'M
CARRYING A BILL AB ONE SEVENTY
FOUR WHICH MIRRORS IN SOME SOME
RESPECTS THE GOVERNOR'S PROPOSAL
ON AFFORDABILITY -- AND WE ARE
STILL WORKING WITH THE NUMBERS
TO TRY TO FIGURE OUT THE BEST
YOU KNOW WHAT WHAT IS THE BEST
POSSIBLE RANGE BUT IT IS.
A SIMILAR TO TO WORK WE HAVE WE
HAD ANTICIPATED BASED ON OUR
FINDINGS -- OVER A YEAR AGO NOW.
SO I AM A COUPLE THINGS I AM I I
I I DO -- WOULD AGREE THE SAME
TO THE LA -- THAT MAYBE THERE
MIGHT BE ANOTHER OPTION OTHER
THAN A TAX CREDIT -- I DO WONDER
IF THERE'S ANOTHER WAY TO DO
THAT -- UNLESS I'M
MISUNDERSTANDING TAX CREDITS --
YOU DON'T GET THAT CREDIT UNTIL
AFTER THE FACT SO YOU'RE PAYING
UP FRONT -- AND IF IF I'M
MISUNDERSTANDING THAT -- I'D
LIKE TO KNOW THAT BUT BUT IT IF
WE'RE TALKING ABOUT
AFFORDABILITY IN PEOPLE'S
MONTHLY OUT OF POCKET EXPENSES.
NOT SURE THAT HELPS IN THE WAY
WE WOULD LIKE TO SEE IT HELP THE
SUBSIDY.
AS THE OF SOME SORT OF SUBSIDY
THAT IS.
YEP MORE CONSISTENT OR OVERTIME
MIGHT MIGHT BE I THINK A MORE
VALUABLE WAY TO DO THAT.
BECAUSE I THINK IT ONE OF THOSE
CHALLENGES PEOPLE HAVE IS
ACTUALLY WRITING THAT CHECK ON A
MONTHLY BASIS.
SO THEY'RE WAITING FOR A TEMP
FEDERAL TAX CREDIT TO COME BACK
AND IF I'M MISUNDERSTANDING THIS
PLEASE RYAN -- OR SOMEBODY HELP
ME UNDERSTAND WHAT THE VISION IS
HERE BECAUSE I'M I'M A LITTLE
UNCLEAR QUITE FRANKLY -- SUBJECT
LAND APARNA FINANCE SO THE TAX
CREDITS PROBABLY A BIT OF A
MISNOMER WHAT THE ADMINISTRATION
IS ENVISIONING WITH THE PROPOSAL
IS THAT.
ON BENEFICIARY WOULD ENROLL FOR
COVERAGE AND COVER CALIFORNIA
DURING OPEN ENROLLMENT GET THEIR
SUBSIDY AMOUNT DETERMINED.
AND WHAT THAT SUBSIDY AMOUNT IS
DETERMINED COVERED CALIFORNIA
WOULD BE PAYING THOSE HEALTH
PLANS ON A MONTHLY BASIS.
TO READ USE THOSE.
OKAY PREMIUM COSTS FOR THOSE
CONSUMERS -- AT THE END OF THE
YEAR WHEN THOSE INDIVIDUALS ARE
REPORT THEIR ACTUAL INCOMES TO
F. THREE B. THEN WE WOULD GO
BACK AND RECONCILE TO THE ACTUAL
INCOME COMPARED TO THEIR
REPORTED INCOME.
OF BETH BELL HEALTH IF MANAGER
WITH BETH CAPELL HEALTH ACCESS --
SO THE RECONCILIATION OF THE
FEDERAL TAX CREDIT WHICH IS IN
FACT IN INCOME TAX CREDIT -- IS
MAKES SOME SENSE TO US BECAUSE
FOR A LOT OF PEOPLE TO GET A LOT
OF HELP YOU KNOW THE KIDS IT CAN
BE AS MUCH AS A THOUSAND DOLLARS
A MONTH.
HOWEVER AS THE COMMITTEE
ANALYSIS SUGGEST IN THIS CASE
FOR MANY PEOPLE IT WILL BE MORE
ON THE ORDER OF TWENTY OR THIRTY
DOLLARS A MONTH.
AND SO DEPENDING ON WHETHER WE
HAVE THE ADMINISTRATION'S
REVENUE PROPOSAL OR SOMETHING
CLOSER TO WHAT THE ASSEMBLY
CONTEMPLATED BLASTER.
BUT WE WE HAVE QUESTIONS WE
DON'T THINK TECH RECONCILIATION
ON YOUR INCOME TAXES NECESSARILY
MAKE SENSE OR IS NECESSARY.
AND IT SAID MEN AS LA --
INDICATED ITS ADMINISTRATIVELY
BURDENSOME AND AND EXPENSIVE.
FOR PEOPLE ARE GETTING A LOT OF
HELP WE UNDERSTAND THE NEED TO
TRUE UP BUT WE WOULD ALSO REMIND
CHIU THAT MOST PEOPLE USE ABOUT
HALF OF THOSE WHO ARE IN COVERED%
CALIFORNIA -- THERE FOR LESS
THAN A YEAR.
AND FOR EVERYONE ELSE THERE'S AN
ANNUAL INCOME RE DETERMINATION
WHEN THEY RE ENROLL SO THERE'S
NO REASON WHY WE COULDN'T DO
WHAT MASSACHUSETTS AND VERMONT
ACTUALLY BOTH DO WHICH IS TO NOT
USE THE INCOME TAX STRUCTURE.
WHAT AND I ADMIT WE'RE LOOKING
AT THE TAX CREDIT PART OF IT IS
IN OUR BILLS WELL BUT WE'RE
STILL WE'RE STILL SOMEWHAT IN
FLUX AND IS HOW HOW WE COULD
MAKE?
US TO MAKE THIS WORK -- THIS THE
THE MANDATE AS I UNDERSTAND IT
WOULDN'T TAKE EFFECT UNTIL.
TWENTY TWENTY EIGHT BY LAW BUT
THE REVENUE WOULDN'T COME UNTIL.
TWENTY TWENTY ONE BECAUSE YOU
BECAUSE OF THE FOR THE WAY TAXES
ARE FILED.
SO THAT MEANS.
A COUPLE YEARS OF SO SIGNIFICANT
GENERAL FUND SO BACK FROM
MECHANICALLY HOW THIS WOULD WORK
YES WOULD BE A SIGNIFICANT IT
WOULD THERE BE A GENERAL FUND --
SHOULD THE JENNIFER WILL BE ON
THE HOOK FOR THE FIRST FEW YEARS
BEFORE THOSE PENALTY REVENUES --
ACTUALLY ACCRUED TO THE GENERAL
FUND BASED OFF THE THE FIRST
YEAR THE MANDATE PENALTY AND SO
I THINK.
THE REASON WHY THE
ADMINISTRATION IS PROPOSING TO
DEPOSIT PENALTY REVENUE INTO THE
GENERAL FUND AND PAY FOR THE
SUBSIDY PROGRAM OUT OF THE
GENERAL FUND.
I NATIONALLY WE HAD CONTEMPLATED
SETTING UP A SPECIAL FUND TO DO
THIS BUT BECAUSE OF THE TIMING
DELAYS WITH THE KIND OF ONE THE
REVENUE WOULD ACTUALLY -- COME
INTO THE STATE WERE HIS ONE WE'D
WANTED TO START THIS PROGRAM
THAT DATES JUST DIDN'T OUTLINE.
SO SO IS MY IS MY UNDERSTANDING
AND THAT THE THE THE GOVERNOR'S
PLAN IS THAT THE BUT IS THERE
ANY WOULD THERE BE ANY GENERAL
FUND.
EXPENDITURE -- BE ON THE
PENALTIES IN TO HELP WITH THE
WITH THE AFFORDABILITY.
RIGHT NOW THERE ISN'T DOES NOT
INTEND RIGHT NOW THE ANTENNAS
THAT TRACK IS CLOSER TO THE
PENALTY REVENUE AS POSSIBLE WITH
THE TIMING ISSUE OBVIOUSLY THE
FIRST YEAR IS GOING TO BE BASED
HEAVILY ON THOSE REVENUE.
ESTIMATES THAT WE ARE CURRENTLY
WORKING WITH THAT TO BE TO
DEVELOP RIGHT NOW WE'RE LOOKING
AT A MULTI YEAR REVENUE ESTIMATE --
BASED OFF THE PROPOSAL WE HAVE
IT MAKES SENSE TO LOOK AT THE
REVENUE WE THINK WE COLLECT IN
THE FIRST YEAR.
SECOND YEAR AND THIRD YEAR TO
KIND OF HAVE A YOU -- OVER
ARCHING REVENUE ESTIMATE TO BEST
DESIGN THAT SUBSIDY PROGRAM --
BUT YOU ARE CORRECT THERE WOULD
BE SOME TIMING ISSUES IN TERMS
OF ON THE DOLLARS WOULD COME IN
AND WHEN THE SUBSIDY PROGRAM
WITH FIRST START.
MAKING THOSE PAYMENTS.
SO OTHER THAN ADMINISTERING THIS
IT'S NOT THERE REALLY ISN'T --
THE STATE IS IS THERE TO HELP
YOU IT'S IT'S WE'RE HERE.
TO USE THE PENALTY MONEY TO PAY
FOR THIS [inaudible]
SO.
AM I MISSING SOMETHING HERE THAT.
I THINK.
AGAIN WITH THE SAUCE THE PROGRAM
GENERALLY THE ANTENNAS TO HELP
THE BROADER ISSUE AFFORDABILITY
BUT WITH THIS PROPOSAL THE
GOVERNOR HAS IDENTIFIED A
PARTICULAR FUNDING SOURCE FOR
THIS PROPOSAL AND THAT'S IT IT
IS ENTIRELY SO THERE'S NO
THERE'S NO INTENT NO INTENTION
FOR ADDITIONAL MONEY. TO HELP
WITH AFFORDABILITY IT'S JUST
GONNA BE BASED ON THE PANEL.
WHICH WON'T BE FOR AWHILE YET SO
SO HOW HOW WAS HOW WAS HOUSING
ADMINISTRATION GOING TO HOW HOW
IS THE ADMINISTRATION GOING TO
PROJECT.
HOW MUCH REVENUE WILL BE AND AND
WHAT HAPPENS IF IF IT'S?
UNDER PROJECTED ROBERT OVER
PROJECTED I'M A NO I WOULD DO WE
REALLY KNOW WE NEED WE MIGHT I
MEAN MAYBE THIS QUESTION FOR
CANCER COVER CALIFORNIA.
DO WE HAVE AN ESTIMATE OF WHAT
WHAT THE WHAT THE PANEL WELL
GUESS WHAT THE PENALTY IS GOING
TO BE.
AND WHAT KIND OF REVENUE IT
WOULD GENERATE.
AND AND SO WE ARE WORKING VERY
CLOSELY WITH THE F. T. B. AND
COVER CALIFORNIA MODEL WHAT THAT
PENALTY REVENUE WOULD LOOK LIKE
AS MENTIONED PREVIOUSLY.
WE HAVE THE IRS DATA THAT IS OUR
ACTUAL FOR WHAT CALIFORNIA'S PAY
FOR THE FEDERAL PENALTY BECAUSE
WE'RE NEARING THE FINAL FEDERAL
PENALTY SO CLOSELY THAT'S A GOOD
STARTING POINT.
HOWEVER WE DO HAVE SOME VERY
ABILITY WITH OUR DIFFERENT
FILING THRESHOLDS -- LACKING THE
MANDATE FOR A YEAR HOW WHAT
IMPACT THAT HAD ON THE NUMBER OF
PEOPLE WHO HAVE INSURANCE SO
THAT.
AMOUNT PROBABLY INCREASE
COMPARED WHAT WOULD HAVE BEEN IF
WE HAD MAINTAINED THAT PENALTY
ON GOING.
AND I THINK.
I THINK MODELING THIS WERE BEING
VERY COGNIZANT OF THE
FLUCTUATION OF VERY ABILITY
CONCERNS OUT THERE ARE.
RELATED TO CHANGING THAT SUBSIDY
AMOUNT ON AN ANNUAL BASIS.
AND SO THERE ARE MULTIPLE.
OPPORTUNITIES FOR US TO DESIGN A
SUBSIDY PROGRAM THAT.
LOOKS AT THE THREE YEAR PERIOD
OF AVAILABLE FUNDING AND TRYING
TO MODEL IT ON AN ANNUAL BASIS
IN A WAY THAT.
MAYBE LIMITS THAT VARIABILITY
YOUR TWO YEAR.
SO WHAT IS THE IS SO WE'RE WE'RE
IN THE PROCESS THE MODELING NOW
SO WE REALLY DON'T HAVE ANY IDEA
OF WHAT FOOT ROUGHLY WHAT THAT'S
GOING TO BE.
AT THIS TIME THE ONLY NUMBER I
CAN SHARE WITH YOU IS THAT FIVE
HUNDRED MILLION DOLLAR ESTIMATE
LESS 26% FOR THE CALIFORNIA
FILING THRESHOLD WERE HOPING TO
HAVE ADDITIONAL INFORMATION WE
WILL HAVE ADDITIONAL NUMBERS TO
SHARE WITH YOU I'M A REVISION.
AND THAT POTENTIALLY -- HELPS
WITH WHAT TWENTY TO THIRTY
DOLLARS A MONTH IS THAT ROUGHLY
WHAT WE'RE PROJECTING AS FAR AS
I THOUGHT I GET THAT SO MAKE
NEXT QUESTION GOING TO BE. TO
THANK YOU I JUST WANT NO I MEAN
IS IT GONNA HELPERS AGAIN OUT
TWENTY THIRTY DOLLARS A MONTH IS
THAT GOING TO HELP.
IN WORK KATY REBEL COVER
CALIFORNIA WERE ALSO PROVIDING
SUPPORT TO THE ADMINISTRATION ON
THIS I THINK THE FUNDING WILL
LOOK DIFFERENT THE AMOUNT OF
STATE SUPPORT WILL LOOK
DIFFERENT UNDER 4100% OF THE
FEDERAL POVERTY LEVEL WERE WILL
BE ADDING.
TO AN THAT FURTHER ADDING TO THE
FEDERAL CAP THAT EXISTS.
OVER 4100% WILL BE PUTTING A CAP
IN PLACE RIGHT NOW SO CONSUMERS
TODAY PAY ANY PERCENTAGE OF
THEIR INCOME THAT IT WORKS OUT
TO THE PREMIUM AS A PERCENTAGE
OF THEIR INCOME.
WILL BE PUTTING IN A CAP AND SO
THOSE CONSUMERS WILL THEN HAVE
THE BENEFIT OF A SIMILAR
STRUCTURE THAT PEOPLE DO WITH
THE FEDERAL TAX CREDIT TODAY.
THAT'S A SIGNIFICANT POINT THANK
YOU.
THAT'S REALLY IMPORTANT BUT THEN
MY FINAL QUESTION THANK YOU
MADAM CHAIR FOR I I APOLOGIZE
FROM TAKING UP TOO MUCH TIME
HERE.
SO THE THE MANDATE PENALTY IS
GOING TO GO ON IN PERPETUITY.
BUT THE PROGRAM SUNSETS IN.
TWENTY TWENTY TWO I'M SORRY I'M
I DON'T UNDERSTAND THAT.
SO I THINK WITH THESE WITH THE
SUBSIDY PROGRAM HAVING THE
SUNSET PERIOD AND TWENTY TWENTY
TWO ALLOWS TO ASSESS WHETHER OR
NOT THE PROGRAM IS ACHIEVING THE
BROADER GOALS OF AFFORDABILITY
THAT WE'VE LAID OUT.
REGARDING THE PENALTY SIDE --
YOU ARE CORRECT THAT THE PENALTY
ITSELF DOES NOT SUNSET TO TWENTY
TWENTY TWO THERE IS LANGUAGE IN
THERE THAT WOULD TIE IT.
THAT WOULD ADJUSTED
AUTOMATICALLY IF THE FEDERAL
GOVERNMENT WERE TO REINSTATE A
PENALTY AT THEIR LEVEL AND SO
THE CALIFORNIA PENALTY WOULD
DECREASE CORRESPONDINGLY.
I THINK.
OVERALL AS NOTED BY THE GOVERNOR --
ADDRESSING THESE AFFORDABILITY
CHALLENGE WILL TAKE FEDERAL
PARTNERSHIP IN FEDERAL ACTION I
THINK THAT THIS IS THE FIRST
STEP IN TRYING.
TO ADDRESS THESE AFFORDABILITY
OF AFFORDABILITY CHALLENGES WERE
WE CAN BUT IT WILL.
TAKE FOR THE CORONATION AND FOR
THE PARTNERSHIP WITH THE FEDERAL
GOVERNMENT TO TRY TO BROADEN THE
ADDRESS THE ISSUES THAT WE'VE
BEEN DISCUSSING TODAY.
SO I GUESS I GUESS WHAT I'M WHAT
I'M GETTING AT IS IS WHITE WIRE.
WITH WHY NOT HAVE LANGUAGE THAT
SAYS THAT -- THAT LEAVES A MORE
OPEN ENDED I MEAN THE LAST.
WITH THE SUNSET THAT REQUIRES
YOU GONNA HAVE TO COME BACK WITH
ANOTHER BILL AT SOME POINT IF
THE FEDERAL GOVERNMENT DOESN'T.
GET THEIR ACT TOGETHER OR OR WE
DON'T BUT WE ARE NOT ABLE TO
COURT AND AND I'M NOT SURE.
IF WE DON'T GET A COOPERATION WE
DON'T GET SOMETHING WITH THE
FEDERAL GOVERNMENT. TWENTY
TWENTY TWO IS NOT THAT FAR AWAY
AND AND SO -- IN THE MEANTIME
WE'RE GONNA CONTINUE TO COLLECT
TO THE THE THE REV THE PENALTY
REVENUE -- AYE AYE I JUST.
IS THERE A WAY TO STRUCTURE THIS
SO THAT THE LANGUAGE WOULD SAY
THAT YOU KNOW THIS IF IF THE IF
IF THEREIS NO AGREEMENT THAT
THE PROGRAM CAN CONTINUE RATHER
THAN.
HAVING TO GO BACK AND RE RE
INSTITUTE THIS THIS OVER AGAIN
AS HAS THE ADMINISTRATION
CONSIDER THAT -- I'M HAPPY TO
TAKE THOSE COMMENTS BACK AND AND
WE CAN.
WE WILL DEFINITELY CONSIDER THE
COST THERE MAKING RIGHT NOW WE
HAVE CERTAINLY
HEARD THOSE COMMENTS FROM OTHER
STAKEHOLDERS REGARDING THE
SUNSET PERIOD FOR THE SUNSET
FOR THE SUBSIDY PROGRAM SO
IN MY FINAL QUESTION -- SO
WHAT HAPPENS TO THE REST OF
THE REV PENALTY REVENUE -- IF
THE PROGRAM SUNSETS WORDS AGO
AT THIS TIME I DON'T THINK
THAT WE HAVE ANY ADDITIONAL
DETAILS TO SHARE ON THAT THAT
SPECIFIC QUESTION FROM WHAT
YOU'RE GIVEN COLLECTED BUT BUT
YOU SO THERE'S WAS GONNA GO
SOMEWHERE ALL RIGHT NOW IF IF
THE PROGRAM SUNSET AT DECEMBER
THIRTY FIRST TWENTY TWENTY
TWO AND THE MANDATE STATE AND
AFFECT POST TWENTY TWENTY TWO
YES THOSE WERE PENALTY REVENUES
WOULD BE DEPOSITED DIRECTLY
INTO THE GENERAL FUND FOR USE
FOR HEALTH CARE OR SOMETHING
ELSE THERE'S NOTHING IN THE
TRAILER BILL LANGUAGE RIGHT
NOW THAT WOULD THAT WOULD
-- DIRECT OUT FUNDING FOR A
SPECIFIC PURPOSE IT WOULD DIE
I GUESS WHICH IS ASSN MAYBE THE
MINISTRATION CONSIDER THAT THAT
FUNDING BE USED FOR ADDITIONAL
HEALTH CARE AFFORDABILITY
THANK YOU I THINK METRIC
THANK YOU THIS IS CLEARLY
SUCH MENTAL IMPORTANT TOPIC
AND I SINCERELY APPRECIATE
THE FACT THAT WE HAVE DOCTOR
WOULD -- WITH US TODAY AND
THOSE OF YOU WHO'VE BEEN
WORKING ON ON THE ISSUE --
BECAUSE THAT CONTINUITY IS
EXTREMELY IMPORTANT TO AT
THE INSTITUTIONAL KNOWLEDGE
IS EXTREMELY IMPORTANT AS WE
MOVE FORWARD ON THE SUBJECT
WE CANNOT GO BACK TO SQUARE
ONE AND TRY TO FIGURE THIS
ALL OUT WE HAVE TO BE ABLE
TO MOVE FORWARD FROM WHAT IS
ALREADY BEEN DONE AND THEN
TRY TO MAKE SOMETHING THAT
IS BETTER EVERY TIME WE TALK
ABOUT IT SO I THINK ALL OF YOU
-- I'D LIKE TO OPEN IT UP FOR
PUBLIC COMMENT AT THIS TIME
I DO WANT TO REMIND YOU ALL
THAT -- PUBLIC COME IT WILL
BE ONE MINUTE EACH WE WILL BE
TIMING IT AND YOU'LL
GET A LITTLE REMINDER
THANK YOU TURN MEMBERS LINDA
TENER WHAT'S ON BEHALF OF THE
CALIFORNIA PAN ETHNIC HEALTH
NETWORK I JUST BRIEFLY WE'D
LIKE TO LINE OUR COMMENTS
WITHOUT OF HEALTH ACT ACCESS IN
WESTERN CENTER IF YOU THAT THIS
IS AN EQUITY ISSUE TO MAKE SURE
FOLKS HOW THE CAPABILITY TO A
FOR THEIR COVERAGE THANK YOU
THANK YOU HI ALLISON HIS
FOR THE CHILDREN STRESSED
DEFENSE ON A CALIFORNIA ON
BEHALF OF THE CALIFORNIA
CHILDREN'S HEALTH COVERAGE
COALITION INCLUDING UNITED
WAYS OF CALIFORNIA AT THE
CHILDREN'S PARTNERSHIP THAT
CALIFORNIA COVERAGE AND HEALTH
INITIATIVE AND CHILDREN NOW
AND -- WE ARE SUPPORTIVE OF
MORE AFFORDABLE COVERAGE IN
CALIFORNIA BUT WE WANTED TO
FLY TO THE COMMITTEE THAT THE
-- THE LANGUAGE WE'RE TALKING
ABOUT HERE TODAY WOULD NOT HELP
CHILDREN AND SPOUSES WHO FALL
INTO THE FAMILY GLITCH -- AND
BY CONTINUING TO THESE FOLKS
ARE NOT CURRENTLY ELIGIBLE FOR
FEDERAL ASSISTANCE -- AT ALL
-- SO WE JUST WANTED TO -- AT
FOUR TO TALK ABOUT HOW WE COULD
IN A THOUGHTFUL WAY START TO
THINK ABOUT HOW WE CAN EXTEND
ASSISTANCE TO THIS POPULATION
-- AND NOT EXACERBATE THAT
CURRENT INEQUITIES SO WHERE
LOVE TO TALK MORE ABOUT THAT
THANK YOU THANK YOU RIGHT NEXT
CALIFORNIA'S DISABILITY RIGHTS
WE ALSO AGREE WITH THE SAID
BUT ONE OF OUR CONCERNS IS I
HAVE A FRIEND OF MINE WHO HAS
HEALTH CARE WHO DOESN'T HAVE
HEALTH CARE COVERAGE AND YOU
CAN NEVER FOUR DIGIT EVEN WHEN
HE DOESN'T GET ANY DEDUCTIBLES
BECAUSE HE'S KIND OF LIKE
CAUGHT IN THE MIDDLE THERE AND
SO I WOULD LIKE TO KIND OF FIND
AWAY AS YOU GUYS BEFORE WE'RE
JUST PLAN IS TO HELP THOSE WHO
ARE WORKING BUT DON'T ARE NOT
ELIGIBLE FOR SUBSIDIES SO THEY
CAUGHT IN THE GLITCH SO I WOULD
APPRECIATE ANYTHING YOU GUYS
CAN DO TO HELP THAT THANK YOU
KELLY BROOKS ON BEHALF OF
THE ASSOCIATION OF CALIFORNIA
HEALTHCARE DISTRICTS WERE IN
SUPPORT OF CREATING AN INTIMATE
IN AND THE INDIVIDUAL MANDATE
FOR CALIFORNIA -- AND WERE
SUPPORTIVE OF LEGISLATIVE AND
THE ADMINISTRATION'S PROPOSALS
TO TRY TO ADDRESS AFFORDABILITY
THANK YOU THANK YOU I'M
GOOD AFTERNOON I'M JENNIFER
ALLEY WITH THE CALIFORNIA
ASSOCIATION HEALTH PLANS AND
WE SUPPORT THE GOVERNOR'S
AGENDA TO MAKE HEALTHCARE MORE
AFFORDABLE AND ACCESSIBLE TO
CALIFORNIANS WE STAND READY
TO WORK THE GOVERNOR IN THE
ADMINISTRATION TO PROTECT
SIGNIFICANT GAINS CALIFORNIA
MADE UNDER THE AFFORDABLE
CARE ACT IN TO STABILIZE THE
MARKET PLACE -- WE STRONGLY
SUPPORT AN INDIVIDUAL MANDATE
AND PROVIDING ASSISTANCE TO
INDIVIDUALS -- PURCHASING
COVERAGE THANK YOU THANK YOU
CAPTION MARK HURLBERT WITH
SMALL BUSINESS MAJORITY AND
WE ARE APPRECIATIVE OF THIS
CONVERSATION WE STRONGLY
SUPPORT A ROBUST AND STABLE
FUNDING STREAM -- FOR -- FOLKS
WHO ARE ABOVE FOUR PERCENT
OF THE FEDERAL POVERTY LEVEL
JUST WANT TO LIFT UP THE
COMMENTS -- FROM THIS HOUSE
SHE'S NOT FOR NOR SHE CHOSE
ENTREPRENEURSHIP AND BECAUSE
OF THAT SHE'S MAKING A VERY
DIFFICULT DECISION ABOUT
HER HEALTH CARE I MEAN SHE'S
NOT ALONE SEVENTY PERCENT
OF SMALL BUSINESS OWNERS IN
CALIFORNIA STRONGLY SUPPORT
INCREASING AFFORDABILITY FOR
FOLKS WHO MAKE FOR MORE THAN
FORTY PERCENT OF THE FEDERAL
POVERTY LEVEL AND THAT'S
BECAUSE THE AVERAGE INCOME FOR
INCORPORATED SMALL BUSINESS
OWNER HERE IN CALIFORNIA IS
JUST RIGHT ABOVE THE FORTY
PERCENT CAUGHT SO WE APPRECIATE
THIS CONVERSATION WE ENCOURAGE
A STRONG STABLE FUNDING
STREAM FOR ENTREPRENEURS
AND WE FOR SHOULD THIS
DISCUSSION THANK YOU THANK YOU
MADAM CHAIR AND MEMBER BARBARA
GLAZER WITH THE CALIFORNIA
HOSPITAL ASSOCIATION WE
ARE IN SUPPORT OF THE
GOVERNOR'S AFFORDABILITY
AN INDIVIDUAL MANDATE
PROPOSALS -- AND WE LOOK
FORWARD TO WORKING WITH MONA
AB SANCHEZ ON BEHALF OF SEIU
CALIFORNIA WANTING TO ALIGN
MYSELF WITH THE COMMENTS
MADE BY WESTERN CENTER AND
HEALTH ACCESS AND REGISTER
SUPPORT FOR THE STAKEHOLDER
PROPOSAL THANK YOU THANK YOU
GOOD AFTERNOON FELIX THE WITH
BLUE SHIELD OF CALIFORNIA WE
APPRECIATE AND SUPPORT THE
ADMINISTRATION'S TRAILER BILL
LANGUAGE TO ESTABLISH A STATE
BASED INDIVIDUAL MANDATE AS
WELL AS ADDITIONAL INCOME BASED
SUBSIDIES TO HELP KEEP COVERAGE
AFFORDABLE THANK YOU THANK YOU
GOOD AFTERNOON MADAM CHAIR
MEMBERS SHAUN OFTEN WITH MOLINA
HEALTH CARE CALIFORNIA --
IN SUPPORT OF THE GOVERNOR'S
AGENDA AND THE WORK THAT THE
ADMINISTRATION LEGISLATURE
IN COVER CALIFORNIA HAVE DONE
ON MARKET PLACE STABILIZATION
LOOK FOR TO CONTINUING THAT
WORK THANK YOU THANK YOU HI
GOOD AFTERNOON BRAND OF HIM
AND SPENCER WITH THE CALIFORNIA
DENTAL ASSOCIATION JUST
WANTED TO VOICE OUR SUPPORT
OF THE GOVERNOR'S PROPOSAL
ON THE STATE LEVEL INDIVIDUAL
MANDATE AFFORDABILITY
SUBSIDIES THANK YOU THANK YOU
GOOD AFTERNOON JOANNE CAMPBELL
BEHALF LA CARE HERE TO SUPPORT
PROPOSAL WE BELIEVE THAT IT
PRESERVES AND PROTECTS THE ACA
IN THE GAINS MADE UNDER THANK
YOU THANK YOU THANK YOU MADAM
CHAIR -- TREES TO START WITH
KAISER PERMANENTE A WE ARE IN
SUPPORT OF THE ADMINISTRATION'S
INDIVIDUAL MANDATE AND SUBSIDY
PROPOSALS AS WELL AS THE
LEGISLATURE AND WE LOOK FORWARD
TO CONTINUING TO WORK WITH YOU
TO MOVE THAT FORWARD APPRECIATE
THE DISCUSSION TODAY THANK
YOU THANK YOU ANGELA WILLIAMS
CALIFORNIA BLACK HEALTH NETWORK
IN SUPPORT MANAGER ONE THANK
YOU FOR COMING TO OUR TOWN
HALLS FOR TWO YEARS IN A ROW
THERE THE DISCUSSION ABOUT
THIS BILL WAS IMPORTANT ABOUT
THIS BUDGET I WAS IMPORTANT TO
COVER ALL AFRICAN AMERICANS AT
EVERY INCOME LEVEL SO WE ARE
JUST SUPPORT WITH THANK YOU
THANK YOU FOR YOUR LEADERSHIP
IN THAT REGARD I THINK THAT
WHEN THE TOWN HALL MEETINGS
ARE BROUGHT TO THE TALONS
INTO THE CITIES TO THE PEOPLE
THEN WE ARE OBLIGATED -- TO
BE THERE AND TO LISTEN SO I
THANK YOU FOR YOUR LEADERSHIP
GOOD AFTERNOON LEN ACKERMAN
TO THE LOCAL HEALTH PLANS
OF CALIFORNIA AND WE LIKE
TO VOICE THEIR SUPPORT FOR
THE GOVERNOR'S PROPOSAL FOR
A STATE INDIVIDUAL MANDATE
AS WELL AS THE ADDITIONAL
SUBSIDIES THANK YOU THANK YOU
REBEKAH GONZALEZ NATIONALIST
ASSOCIATION OF SOCIAL WORKERS
CALIFORNIA UNLIKE MANY HERE
WE SUPPORT THE PROPOSAL BUT WE
ALSO SHARE THE CONCERN SHARED
BY WESTERN CENTER AND HEALTH
ACCESS THANK YOU THANK YOU
GOOD AFTERNOON BY THE CAMPUS
HEALTH FROM COMMITTEE HEALTH
COUNCILS I'M HERE TO EXPRESS
SUPPORT FOR THE GOVERNOR'S
PROPOSAL TO INCREASE
AFFORDABILITY AND TO IMPLEMENT
THE INDIVIDUAL MANDATE AT
THE STATE LEVEL THANKS THANKS
GOOD AFTERNOON DEEPENING
ACNE SO WITH THE CALIFORNIA
IMMIGRANT POLICY CENTER HERE TO
REGISTER SUPPORT IN THE STATE
COLOR PROPOSED ON AFFORDABILITY
THANK YOU THANK YOU
NO I BOTTOM -- REPRESENTING
CALIFORNIA RURAL LEGAL
ASSISTANCE FOUNDATION BEHALF
OF RURAL IMMIGRANT FARM
OCCURRED CAM METES WE STAND
BEHIND THE COMMENTS FROM
WESTERN CENTER AND HEALTH
ACCESS THANK YOU VERY MUCH
THANK YOU THE QUESTION EL ON
BEHALF OF MATERNAL AND CHILD
HEALTH ACCESS IN LOS ANGELES
WE'RE IN SUPPORT BUT WOULD
LIKE TO ALIGN OURSELVES WITH
THE COMMENTS OF THE WESTERN
CENTER AS WELL THANK YOU THANK
YOU ANY FURTHER COMMENTS FROM
THE COMMITTEE DOCTOR WOULD YES
I WAS ONCE A THANK YOU AND I
YOU KNOW IN SPITE OF THE MY
DRILLING DOWN ON QUESTIONS
AND COMMENTS THAT IT IS I AM
SUPPORTIVE I AM I'M SUPPORT
OF THE GOVERNOR'S PROPOSAL
-- UNFORTUNATE SPEND TOO MUCH
TIME IN THE WEEDS ON THESE
ISSUES AND AND AND I'M CONCERT
I JUST WANT TO BE SURE THAT
WE'RE WE'RE GOING TO ULTIMATELY
ACCOMPLISH WHAT IT IS WE'RE
TRYING TO DO WITH AFFORDABILITY
AND -- I WOULD LOVE TO SEE A
GREATER INVESTMENT THE GENERAL
FUND MONEY -- BEYOND THE
SUBSIDIES BECAUSE I'D BE ON
EXCUSE ME ON THE PENALTIES --
FOR GREATER AFFORDABILITY --
I THINK SPECIFICALLY AND THAT
FOUR HUNDRED TO SIX HUNDRED
PERCENT OF POVERTY LEVEL
THERE'S A THERE'S A POPULATION
OF FOLKS THAT ARE -- MORE
EVERYBODY'S HARD WORKING BUT I
THINK THERE THERE'S A THERE'S
A REAL STRUGGLE THERE AND A
LITTLE BIT TO HELP YOU MAKE A
HUGE DIFFERENCE IN AND AND SOME
PEOPLE'S LIVES AND SO SO I I
I WANT TO TAKE I HOPE YOU TAKE
THE SPIRIT OF OF I AM REALLY
JUST WANTED TO MAKE THIS WORK
AND THE BEST WAY POSSIBLE AND
SO I'M GONNA CONTINUE TO ASK
THE HARD QUESTIONS BECAUSE
I THINK THAT'S WHAT I'M HERE
TO DO SO I THANK YOU I THANK
YOU FOR GETTING IN THE WEEDS
QUITE FRANKLY BECAUSE IT'S I
AND I GO BACK TO WHAT I SAID
EARLIER IT'S YOUR WORK AND
DOCTOR RAMBLE IS WORK WITH THE
THE IF SPEAKER ANTHONY RENDON
IT IS THE COMMITMENT TO TRY TO
FIND NOT JUST TO SAY LET'S GET
HEALTH CARE FOR ALL BECAUSE I
THINK MOST OF US WOULD AGREE
THAT'S WHAT WE WANT IT'S SAYING
HOW DO WE GET THERE WE WANT TO
GET THERE HOW DO WE GET THERE
AND HOW SOON CAN WE GET THERE
AND I THINK IT IS IMPORTANT TO
GET INTO THE WEEDS AND TO TRY
TO FIGURE OUT THOSE DETAILS
AND BECAUSE OF THE NUMBER OF
HOURS ON THE NUMBER OF HEARINGS
THAT YOU AND DOCTOR ARAMBULA --
DEDICATED TO THIS I THINK YOUR
VOICE IS EXTREMELY IMPORTANT
IN THIS REGARD AND WE WE
DO RELY ON YOU TO ASK THOSE
DIFFICULT QUESTIONS BECAUSE
YOU KNOW THOSE QUESTIONS
THAT NEED TO BE ASKED I
THANK YOU VERY MUCH FOR THAT
ALL RIGHT LET'S GO
TO ISSUE NUMBER TWO
OKAY I'M SORRY WE'RE GOING
TO SKIP OVER ISSUE NUMBER
TWO TEMPORARILY I APOLOGIZE
TO THOSE OF YOU SO LET'S
GO TO ISSUE NUMBER THREE
I THINK FOR ME
OKAY SORRY
TRYING TO RAIN ON
ANYBODY'S PARADE
WE HAVE TWO PANELS
LET'S BEGIN WITH THE FIRST
PANEL IF YOU WOULD PLEASE
GOOD AFTERNOON TURN MEMBERS --
MY NAME IS DEEPENING EGNATIA
REPRESENT THE CALIFORNIA
IMMIGRANT POLICY CENTER
-- WE ARE PROUD CO SPONSOR
OF THE PROPOSAL TO EXTEND
MEDI CAL ELIGIBILITY TO ALL
ADULTS REGARDLESS OF THEIR
IMMIGRATION STATUS OUR FIRST
AND FOREMOST I WANT TO THANK
THE GOVERNOR FOR PROPOSING A
MEDICAL EXPANSION TO AGE TWENTY
FIVE I AM AND IT'S JANUARY
BUDGET CALIFORNIA IS THAT THE
POLICY IN ADVANCING BOLD PRO
IMMIGRANT POLICIES INCLUDING
THE PASSAGE OF HEALTH FOR ALL
KIDS WHICH TO DATE HAS AND
ROLLED OVER TWO HUNDRED SIXTY
EIGHT THOUSAND UNDOCUMENTED
CHILDREN AND LIFESAVING
HEALTHCARE THROUGH MEDICARE
THESE CHILDREN WILL AGE OUT
OF THE MEDICAL SYSTEM AT AGE
NINETEEN WITHOUT ANY OPTIONS
TO CONTINUE OR MAINTAIN THEIR
COVERAGE I THINK IT'S REALLY
IMPORTANT TO NOTE THAT ONE IN
SIX CALIFORNIA CHILDREN HAS AT
LEAST ONE UNDOCUMENTED PARENT
SADLY THESE PARENTS ALONG WITH
OLDER SIBLINGS AND GRANDPARENTS
CONTINUE TO BE SYSTEMATICALLY
EXCLUDED FROM ACCESSING
COMPREHENSIVE HEALTH CARE AMONG
THE MANY STORIES THE FAMILY'S
DEVASTATED BY THEIR LACK OF
HEALTH INSURANCE AS THAT OF
MARIA AND HAVE THEIR PARENTS
TO THREE CHILDREN WHO LIVE
JUST OUTSIDE OF SAN FRANCISCO
WHEN HOW THERE WAS DIAGNOSED
WITH DIABETES HE AND HIS WIFE
TRAVEL TO MEXICO FOR DOCTOR
VISITS AN INSULIN LAST YEAR
THEY CROSS THE BORDER SIMPLY
FOR INSULIN AND THEY'RE UNABLE
TO RETURN TO THEIR CHILDREN
AND COMMUNITY THIS STORY IS
WELL COUNTLESS OTHER SHOWS THE
PAINFUL REALITY THAT FAMILY
SEPARATION IS NOT JUST A RESULT
WITH OTHER
RESULT OF WALLS AND BANDS FAMILY
SEPARATION CAN ALSO RESULT FROM
DEEP INEQUITIES IN OUR
HEALTHCARE SYSTEM.
AN INVISIBLE INVISIBLE BUT
CRITICAL REASON FOR ASKING FOR
THE COMMITTEES SUPPORT -- IS
BECAUSE OF THE SUBSTANTIAL
CONTRIBUTION UNDOCUMENTED
CALIFORNIANS MAKE TO THE STATE'S
ECONOMY THROUGH THEIR WORK.
THEY CONTRIBUTE THREE POINT TWO
BILLION DOLLARS EVERY YEAR AND
STATE AND LOCAL TAXES AND MAKE
UP CLOSE TO ONE TENTH OF OUR
STATE'S WORK FORCE.
FROM AGRICULTURE CONSTRUCTION
THE MAX DOMESTIC WORKERS JUST
SERVICE WORK IMMIGRANT WORKERS
ARE HEAVILY REPRESENTED IN
INDUSTRIES THE HIGH RISK OF
INJURY ON THE JOB AND A LOW RATE
OF EMPLOYER PROVIDED BENEFITS
INCLUDING HEALTH INSURANCE.
IN THE RECENT WILDFIRES WHO
HEARD FROM MANY IMMIGRANT
WORKERS WERE EXPOSED TO THE
TOXIC WILD FIRE SMOKE -- WHICH
CAN REDUCE LUNG FUNCTION IN
CAUSE CANCER AND EVEN PREMATURE
DEATH.
IT EXPANDED MEDICAID OUT WOULD
ENSURE THAT WE PROVIDE
LIFESAVING TREATMENTS THAT
SIMPLY ALLOWED THESE FAMILIES TO
SURVIVE.
UNDOCUMENTED ADULTS CAN
CONSTITUTE THE THE SINGLE
LARGEST GROUP WITHIN
CALIFORNIA'S REMAINING UNINSURED
POPULATION AND CALIFORNIA STANDS
AS A BEACON OF HOPE AND A MOMENT
WHILE THE FEDERAL ATTACKS IN
IMMIGRANT COMMUNITIES.
REMAIN RELENTLESS AND FOR THESE
REASONS WE DO RESPECTFULLY ASK
YOUR SUPPORT OF THE STATE COLOR
PROPOSAL THANKS SO MUCH.
NEXT GOOD AFTERNOON GOOD
AFTERNOON MY NAME IS RONALD
COLMAN HERE BEHALF OF THE BEHALF
OF HEALTH ACT OF CALIFORNIA WE
THANK ASSEMBLY MEMBER REYES AND
SUBCOMMITTEE MEMBERS FOR
ALLOWING US TO PRESENT IN THE
EXPANSION TO UNDOCUMENTED
CALIFORNIANS.
HEALTH ACCESS IF THE STATE WIDE
CONSUMER ADVOCACY COALITION
COMMITTED TO QUALITY AFFORDABLE
HEALTH CARE.
WE WHOLEHEARTEDLY SUPPORT
GOVERNOR NEWSOME'S PROPOSAL
EXPAND FULL SCOPE MEDI CAL TO
ALL UNDOCUMENTED YOUNG ADULTS UP
TO AGE TWENTY FIVE WITH AN
INVESTMENT OF TWO HUNDRED
MILLION DOLLARS BUILDING ON
HEALTH FOR ALL KIDS IN COVERING
UP TO A HUNDRED AND THIRTY EIGHT
THOUSAND MORE LIVES.
UNDER THIS PROPOSAL CALIFORNIA
WOULD BE THE FIRST STATE TO
PROVIDE COVERAGE TO AN ADULT
POPULATION OF UNDOCUMENTED
IMMIGRANTS IN THEIR STATE
MEDICAID PROGRAM WE ARE THRILLED
THAT DH CS HAS ALREADY BEGUN
EFFORTS. TO MOVE IMPLEMENTATION
FORWARD OF THIS PROPOSAL
IDENTIFYING THE NEED THE VARIOUS
SUBPOPULATIONS AND THE
PROCEDURAL HURDLES FOR THEM AS
WE TRY TO OPEN ENROLLMENT AS
SOON AS POSSIBLE AFTER JULY
FIRST.
TWENTY NINETEEN WE APPRECIATE
THE GOVERNOR'S VISION AND
COMMITMENT TO ACHIEVE UNIVERSAL
HEALTHCARE AND ENCOURAGE THE
LEGISLATURE TO BUILD ON THIS
PROPOSAL WITH A TWO BILLION
DOLLAR INVESTMENT AS WE ALL KNOW
ADULT UNDOCUMENTED IMMIGRANTS
CONTINUE TO SUFFER.
FROM BEING LOCKED OUT OF ACCESS
TO CARE DUE TO THESE EXTRA.
THESE DISCRIMINATORY EXCLUSIONS.
UNDOCUMENTED ADULTS OVER AGE
TWENTY SIX ARE THE CARETAKERS
THE PARENTS THE GRANDPARENTS OF
THE KIDS AND THE YOUNG ADULTS
WHO WOULD BECOME ELIGIBLE WHAT
BUT WOULD STILL BE LOCKED OUT OF
ACCESS TO CARE.
THEMSELVES EXPANDING MEDICAID TO
ALL LOW INCOME ADULTS REGARDLESS
OF AN IMMIGRATION STATUS WOULD
EXTEND APPROXIMATELY WOULD
EXTEND ELIGIBILITY TO
APPROXIMATELY ONE POINT ONE FIVE
MILLION.
UNDOCUMENTED ADULTS BY TWENTY
TWENTY REDUCING CALIFORNIA'S
UNINSURED RATE BY AT LEAST A
QUARTER. ONE POINT ZERO FIVE
MILLION WOULDN'T ROLL
IMMEDIATELY THROUGH FROM A
RESTRICTED SCOTT MEDI CAL OFTEN
OVERLOOKED MANY UNDOCUMENTED
IMMIGRANTS ACTUALLY HAVE
EMPLOYMENT BASED JOB COVERAGE
BUT MANY LOW INCOME UNDOCUMENTED
IMMIGRANTS ARE NOT OFFERED SUCH.
90% OF LOW INCOME UNDOCUMENTED
WORKERS ARE UNINSURED COMPARED
TO JUST 10% OF THEIR LAWFULLY
PRESENT COUNTERPARTS ACCESS TO
HEALTHCARE IS EXTREMELY LIMITED
CURRENTLY THE UNDOCUMENTED
ALREADY ELIGIBLE FOR EMERGENCY
RESTRICTED GOT MEDI CAL.
CERTAINLY THAT IS ONLY FOR
EMERGENCIES ONLY STABILIZES THE
YOU IT DOES NOT TREAT YOU FOR
WHAT COULD BE A CHRONIC DISEASE
IT DOESN'T COME WITH A PRIMARY
CARE PROVIDER DOESN'T COME WITH
A MEDICAL HOME.
DOESN'T COME WITH PREVENTIVE
CARE OR ANY ACCESS O
PRESCRIPTION DRUGS DEPENDING ON
WHERE THEY LIVE.
UNDOCUMENTED IMMIGRANTS
CERTAINLY MAY HAVE ACCESS TO A
COUNTY PROGRAM BUT OFTEN IN MANY
RURAL AREAS SERVICE IS LIMITED
SOME SIMPLY GO WITHOUT CARE AND
RESORT TO HOME REMEDIES PEOPLE
WHO ARE -- UNINSURED OFTEN LIVE
SICKER A DIE YOUNGER HAVE WORSE
HEALTH OUTCOMES LACK OF HEALTH
INSURANCE ALSO MEANS THAT YOU
COULD BE ONE INJURY AWAY FROM
SERIOUS FINANCIAL CALAMITY OR
MEDICAL DEBT.
CALIFORNIA WILL LIKELY NEVER BE
ABLE TO ADEQUATELY ADDRESS THE
ISSUES OF POVERTY IF IT DOESN'T
FIND A WAY TO ADDRESS HOW
ECONOMIC SUPPORT AND PUBLIC
PROGRAMS MAKE IT TO THE
UNDOCUMENTED POPULATION AND FOR
THESE REASONS WE URGE YOU. TO
MAKE INVESTMENTS TO BUILD ON THE
GOVERNOR'S PROPOSAL TO ENSURE
THAT NO ONE IN OUR STATE SUFFERS
OR DIES FROM EASILY TREATABLE
ILLNESS SIMPLY BECAUSE OF WHERE
THEY WERE BORN THANK YOU
[inaudible]
THANK YOU.
I LET'S -- GO TO PANEL TO PLEASE.
I MADAM CHAIR MARY CAMPBELL
DEPARTMENT HEALTH CARE SERVICES
SO JUST BRIEFLY TO TO HIGHLIGHT
WHAT THE GOVERNOR IS PROPOSING --
WE ARE PROPOSING AN EXPANSION OF
A FULL SCOPE MEDICAL COVERAGE
FOR THOSE WHO ARE UP TO THE AGE
OF TWENTY SIX UP THROUGH AND
INCLUDING TWENTY FIVE AND I
WOULD ALWAYS GETS CONFUSING.
SO IF YOU'RE TWENTY FIVE YES IF
YOU'RE TWENTY SIX NO JUST TO BE
PERFECTLY CLEAR -- MET THIS IS
REALLY BUILDING ON THE PREVIOUS
EXPANSIONS THAT HAVE HAPPENED
UNDER PRIOR ADMINISTRATION AND
AGAIN I THINK AS YOU'VE HEARD
THE GOVERNOR TALK ABOUT HE
REALLY DOES SUPPORT THE CONCEPT
OF COVERAGE FOR ALL PEOPLE AND
REALLY THIS IS AN ADDITIONAL
DOWN PAYMENT ON THAT AS WE TRY.
TO WORK TOWARDS THAT GOAL WHILE
ALSO RECOGNIZING THE LIMITATIONS
THAT WE HAVE WITH STATE FUNDING --
IN TERMS OF OVERALL FUNDING WE
ARE ESTIMATING A NET COST TO THE
GENERAL FUND OF A HUNDRED NINETY
FOUR MILLION DOLLARS. FOR A FULL
YEAR OF AND ROMANCE -- IN
ESTIMATING ABOUT A HUNDRED AND
THIRTY EIGHT THOUSAND
INDIVIDUALS WHO WOULD BECOME
ENROLLED IN FULL SCOPE MEDI CAL
I WILL SAY THAT WE ARE WORKING
ON REFINEMENTS TO THESE
ESTIMATES BOTH FROM AN EFFECTIVE
DATE OF JULY.
ONE GIVE AND SORT OF THE TIMING
THAT IT'S GOING TO TAKE FOR US
TO MAKE THE SYSTEM CHANGES AS
WELL AS RECOGNIZING SOME OF THE
CONCERNS RAISED BY THE LA -- IN
TERMS OF HOW WE CAME UP WITH OUR
ESTIMATE SO WE ARE REFINING THAT
AND CERTAINLY WILL HAVE UPDATED
NUMBERS IN MAY TWO IT HOPEFULLY
ADDRESS THOSE CONCERNS THAT HAVE
BEEN RAISED [inaudible]
THANK YOU.
LARA ALLOWED DEPARTMENT OF
FINANCE IN HERE TO ANSWER ANY
QUESTIONS AS HE DID WITH THE
GOVERNOR IS A PROPOSAL -- THE
FISCAL ANY FISCAL QUESTIONS YOU
MAY HAVE.
WONDERFUL THANK YOU [inaudible]
FOR THEN JOHNSON -- YEP AND
JOHNSON WITH THE LEGISLATIVE
ANALYST'S OFFICE -- THE ONLY
THING I WOULD NOTE IS -- YET WE
DID REYES -- SOME CONCERNS
AROUND THE COST ESTIMATE BEING --
PROT LIKELY NOT BEING ABLE TO BE
IN THAT POLICY NOT BEING ABLE TO
BE IMPLEMENTED ON JULY FIRST AS
WELL AS PERHAPS AN OVER ESTIMATE
OF THE NUMBER OF INDIVIDUALS WHO
DIDN'T ROLL AND SO HAPPY TO HEAR
THAT THE ADMINISTRATION IS.
IS TAKING THOSE CONCERNS AND AND
DEVELOPING NEW ESTIMATES THERE --
WE WE WE DID PRODUCE AN ANALYSIS
OF OF THE PROPOSAL AND I I WON'T
RICK RECAPITULATE THAT HERE BUT
WE DO JUST SHARE THAT THIS DOES
PRESENT AN OPPORTUNITY
LEGISLATURE TO CONSIDER AMONG
HIS PRIORITIES IN IN THE
EXPANSION OF HEALTH CARE
COVERAGE [inaudible]
THANK YOU. TO BRING IT TO THE
COMMITTEE [inaudible]
DOCTOR WOULD.
I'D JUST LIKE TO SAY I'M
SUPPORTIVE -- IT'S I I'M I'VE
ALWAYS BEEN A FIRM BELIEVER THAT --
FINDING A WAY HAVE EVERYBODY
COVERED -- IS THE BEST POSSIBLE
WAY FOR THE SYSTEM TO WORK --
AND WE DO LESS ANYONE IS PEOPLE.
SEEKING CARE IN THE MOST
EXPENSIVE WAY POSSIBLE THROUGH
EMERGENCY ROOM SO.
AT THE PREVENTIVE CARE -- EARLY
EARLY INTERVENTION FROM CHRONIC
DISEASES THOSE ARE THINGS THAT
ARE BIG -- BIG POTENTIAL -- COST
SAVERS AND QUALITY OF LIFE --
ISSUES FOR SO MANY PEOPLE SO I I
AM I AM SUPPORTIVE -- I I WILL --
I WILL POINT OUT -- AN ONGOING
CONCERN AND THAT IS AND WILL
CONTINUE TO BE -- SOMETHING I
TALK ABOUT FOR A LONG TIME --
AND MISTER COLEMAN I APPRECIATE
YOUR COMMENTS ABOUT CHALLENGES
AND RURAL COMMUNITIES WE HAVE
CHALLENGES FOR PEOPLE ACCESSING
CARE IN LARGE URBAN AREAS AS
WELL -- THERE OFTEN COULD PLACES
IN -- LARGER URBAN AREAS WHERE
IT'S DIFFICULT TO FIND PROVIDERS --
TO CARE FOR POPULATIONS OF FOLKS
THAT ARE ACTUALLY IT'S PRETTY
ACCESSIBLE PHYSICALLY ACCESSIBLE
FOR THEM TO BE THERE -- WHICH
WHICH MEANS WHICH IS POINTS TO
THE HUGE CHALLENGES WE HAVE WITH
WORKFORCE.
WE STRUGGLED MIGHTILY WITH
PRIMARY CARE WORK FORCE IN
GENERAL AND IT'S SOMETHING WE
HAVE TO GET OUR ARMS AROUND --
SIMPLY TELLING PEOPLE YOU NOW
HAVE COVERAGE AND YOU HAVE
NOWHERE TO GO ON BECAUSE THERE
IS AN ADEQUATE CUTS OF PROVIDER
NETWORK THERE ISN'T GOING TO
HELP AND SO WE ABSOLUTELY HAVE
TO FOCUS ON THAT AS WELL.
SO I THANK YOU FOR THANK YOU FOR
THE PRESENTATION.
THANK YOU DOCTOR WOULD.
I'D LIKE TO OPEN IT UP FOR
PUBLIC COMMENT AT THIS TIME.
LINDA CHAIR WHAT'S ON BEHALF OF
THE CALIFORNIA PAN ETHNIC HEALTH
NETWORK WANT TO ALIGN OUR
COMMENTS WITH CA PC AND HELP
ACCESS THIS IS TRULY A GREAT
MATTER FOR ESPECIALLY
UNDOCUMENTED ELDERS TO
EXPERIENCE SOME OF THE WORST
HEALTH CONDITIONS THANK YOU.
THANK YOU.
MADAM CHAIR MEMBERS MONICA
MILLER EVERYTHING IN THE KIND OF
ALAMEDA MORE SUPPORTIVE OF THE
GOVERNOR'S PROPOSAL.
AND APPRECIATE HIS WILLING TO
AGAIN WE INVEST IN CALIFORNIA
THANK YOU.
HI KRISTIN GOLDEN TESTED WITH
THE CHILDREN'S PARTNERSHIP WE
STAND IN SUPPORT OF THE
GOVERNOR'S PROPOSAL BUT ALSO.
STAND IN SUPPORT WITH HEALTH
ACCESS AND SEE PIC IN --
COVERING ALL ALL ADULTS WE WANT
A HEALTHY -- PARENTS AND
GRANDPARENTS AND AUNTIES AND
UNCLES [inaudible]
TO THANK YOU.
AND THOUSAND USED WITH THE
CHILDREN'S DEFENSE FUND OF
CALIFORNIA JUST WANT TO SAY --
EXACTLY WHAT TECH KRISTIN FROM
THE CHILDREN'S PARTNERSHIP JUST
SAID SO ALWAYS HAVE STRONGLY
SUPPORTED OF OF THE GOVERNOR'S
PROPOSAL BUT ALSO -- HEALTH FOR
ALL CALIFORNIANS THANK YOU THANK
YOU.
GOOD AFTERNOON ELIZABETH
ESPINOSA HERE IN SUPPORT ON
BEHALF OF TWO GROUPS TODAY -- ON
ISSUE THREE THE ASSOCIATION OF
CALIFORNIA HEALTHCARE DISTRICT
SUPPORTS ALL PROPOSALS TO EXPAND
MEDICAID TO UNDOCUMENTED ADULTS.
AND ADDITIONALLY THE CALIFORNIA
ASSOCIATION OF PUBLIC HOSPITALS
AND HEALTH SYSTEM SUPPORTS ALL
PER ALL PROPOSALS AS WELL FOR
THE MEDICAID EXPANSION TO THE
UNDOCUMENTED POPULATION.
AND AS THE ASSOCIATION DID WITH
A LOW INCOME HEALTH -- PROGRAM
PUBLIC HOSPITALS LOOK FORWARD TO
PARTNERING WITH THE STATE -- TO
ENSURE THAT WE CAN PROVIDE THE
NECESSARY INFORMATION -- TO EASE --
TO HAVE A SMOOTH TRANSITION AND
TO MAXIMIZE ENROLLMENT STATEWIDE
THANK YOU THANK YOU.
BARBARA GLAZER WITH THE
CALIFORNIA HOSPITAL ASSOCIATION
WE ARE HERE TODAY IN SUPPORT OF
BOTH PROPOSALS THE GOVERNOR'S
PROPOSAL TO EXPAND.
FULL SCOPE MEDI CAL TWO YOUNG
UNDOCUMENTED ADULTS AS WELL AS
THE BROADER PROPOSAL -- AS
OUTLINED BEFORE YOU THANK YOU.
THANK YOU RAIN X. CALIFORNIA
DISABILITY RIGHTS AS YOU EXPAND
THESE PROGRAMS WHICH ARE VERY
MUCH IN FAVOR OF WE WANT TO MAKE
SURE THAT THEY'RE ALSO YOUR
CULTURE COMPETENCY INVOLVED IN
THAT.
AND THAT -- THERE IS REASONABLE
ACCOMMODATION FOR TRANSLATION OF
LANGUAGES IN MANY LANGUAGES
INCLUDING SIGN LANGUAGE SO AS
YOU MOVE FORWARD WITH THIS AND
YOU CAN EXPLAINS POPULATION
LET'S MAKE SURE THAT EVERYBODY
UNDERSTANDS WHAT'S HAPPENING
[inaudible]
THANK YOU.
I'M GOOD AFTERNOON JENNIFER
ALLEY WITH THE CALIFORNIA
ASSOCIATION ASSOCIATION HEALTH
PLANS AND WE DO A SUPPORT THE
EXPANSION TO AND DOCKS THANK YOU.
THANK YOU.
CAPTION MADAM CHAIR AND MEMBERS
OF THE COMMITTEE -- CENTER CERAM
SANTANA REPRESENTING CHINESE FOR
AFFIRMATIVE ACTION WHO ARE
STRONG SUPPORT OF THE
STAKEHOLDERS PROPOSAL TO EXPAND
MEDICAL TO ALL OF OUR IMMIGRANT
COMMUNITIES THANK YOU.
THANK YOU.
REBEKAH GONZALEZ NATIONAL
ASSOCIATION OF SOCIAL WORKERS
CALIFORNIA CHAPTER AND WE'RE
ALSO SUPPORTIVE OF THE FULL
EXPANSION TO ALL AND DECADE
UNDOCUMENTED ADULTS.
THANK YOU.
THANK YOU MADAM JOHN THIS IS
GONZALEZ IT QUITE A SHOWING OF
ALL YOUR SOCIAL WORKERS I THINK.
IT'S CLEAR THAT TO THE THE THE
WORK OF THE SOCIAL WORKERS IS
GOING TO BE EXTREMELY IMPORTANT
IN ALL THAT WE DO -- BECAUSE
WE'RE ALSO TALKING ABOUT MENTAL
HEALTH IN.
IN IN THIS ENTIRE PROCESS BUT
THANK YOU FOR PROVIDING YOUR
INPUT HERE THANK YOU THANK YOU.
THANK YOU MADAM CHAIR MEMBERS
MAKE CONSUMERS ON BEHALF OF
CALIFORNIA HEALTH PLUS ADVOCATES
IN THE OVER THIRTEEN HUNDRED
COMMUNITY HEALTH CENTERS AND
CLINICS IN CALIFORNIA WE ARE
ABSOLUTELY SUPPORT OF THE
GOVERNOR'S PROPOSAL ON ALSO THE
STAKEHOLDER PROPOSAL BEFORE YOU --
THAT'S BEING DISCUSSED TODAY AND
BECAUSE THE DOCTOR WOULD MENTION
THAT I ABSOLUTELY WANT TO
EMPHASIZE ONLY TALK ABOUT
COVERAGE YOU ALSO HAVE TO TALK
ABOUT ACCESS AT THE SAME TIME.
THEY CAN'T BE ADDRESSED
SEPARATELY AND SHOULD BE
ADDRESSED -- TOGETHER WE THINK
SO WE APPRECIATE YOUR HEARING
THIS ISSUE TODAY THANK YOU THANK
YOU THANK YOU FOR THAT EMPHASIS.
MY ANGER -- ACLU OF CALIFORNIA
IN SUPPORT OF THE GOVERNOR'S
PROPOSAL AND STRONG SUPPORT OF
THE STAKEHOLDER PROPOSAL TO
EXPAND THIS COVERAGE SO EVERYONE
CAN LIVE WITH DIGNITY.
THANK YOU THANK YOU.
GOOD AFTERNOON JOIN CAMPBELL ON
BEHALF OF LA CARE HERE IN
SUPPORT OF THE GOVERNOR'S
PROPOSAL AND STAKEHOLDERS
PROPOSAL THANK YOU.
THANK YOU.
THANK YOU MADAM CHAIR MEMBERS
KATHY SUNDERLAND WITH THE COUNTY
WELFARE DIRECTORS ASSOCIATION WE
DO SUPPORT THE GOVERNOR'S
PROPOSAL AS WELL AS THE
ADDITIONAL EXPANSION BEING
PROPOSED.
IT DOES -- NOTED THE ANALYSIS
THAT WE'RE WORKING WITH THE
ADMINISTRATION TO SECURE SOMEONE
TIME FUNDING FOR OUR STAFF TO BE
ABLE TO HELP MANAGE THE
TRANSITION OF THESE --
INDIVIDUALS WE DID HAVE TO DO A
LOT OF MANUAL WORK AROUND SB
SEVENTY FIVE THE CHILDREN'S
EXPANSION FROM SEVERAL YEARS AGO
WE FEEL LIKE OUR WORKERS DID AN
EXCELLENT JOB AND BE ABLE TO
MANAGE THAT.
AND GET THOSE CHILDREN ON THE
NECESSARY PROGRAMS WHEN --
ISSUES AROSE AROSE WITH THEIR
CASES AND THEY COULDN'T BE
AUTOMATICALLY TRANSITIONED SO
WE'RE ANTICIPATING SOME OF THAT
WORK AGAIN AND WORKING WITH THE
ADMINISTRATION ON THOSE NUMBERS.
AND ALSO REQUESTING SOME
ADDITIONAL FUNDING FOR THE
AUTOMATION IN OUR COUNTY
ELIGIBILITY SYSTEMS THANK YOU SO
MUCH THANK YOU.
HI LENNY KOOPMANS OF THE LOCAL
HEALTH PLANS OF CALIFORNIA HERE
IN SUPPORT OF THE GOVERNOR'S
PROPOSAL TO EXPAND COVERAGE TO
UNDOCUMENTED YOUNG ADULTS AS
WELL AS TO ALL ADULTS THANK YOU.
THANK YOU.
GOOD AFTERNOON KELLY MAC MON ON
BEHALF OF THE CALIFORNIA DENTAL
ASSOCIATION IN SUPPORT OF
EXPANSION TO MEDI CAL TO
UNDOCUMENTED.
THANK YOU.
THE BCHS BECAUSE ME LIVVIE
SANCHEZ I CHAU CALIFORNIA IN
SUPPORT OF HEALTH FOR ALL AND
THE STAKEHOLDERS EXPANSION
PROPOSAL ALSO WANT TO REGISTER
SUPPORT. FOR THE C. WTA
PROPOSALS ASKING FOR ADDITIONAL
FUNDING FOR IMPLEMENTATION THANK
YOU THANK YOU.
GOOD AFTERNOON MADAM CHAIR
NUMBERS KAREN LG UNDER THE
COUNTY MEDICAL SERVICES PROGRAM
IT'S THE GPA THAT IS A EXISTENCE
STATE STATUTE TO SERVE THE
THIRTY FIVE MOST RURAL COUNTIES
IN THE STATE.
THEY RECENTLY LAUNCHED A PROGRAM
BEGINNING IN FEBRUARY CALLED
PATH TO HELP THEIR COMMUNITY
SALUTE.
AND IT IS ACTUALLY HEALTH CARE
BENEFIT FRONT DOCUMENT A
PERSON'S UP TO THE AGE OF SIXTY
FIVE THAT INCLUDES FIVE DOLLAR
PRESCRIPTION COPAYS. ZERO
MONTHLY DEDUCTIBLE AND ZERO A CO
PAY FOR DOCTOR APPOINTMENTS AND
THAT'S THE CLINIC SYSTEM THAT
THEY HAVE DEVELOPED -- WITHIN
THOSE THIRTY FIVE COUNTIES I
WERE VERY CONCERNED THAT ON THE
PROPOSAL AND PART.
A TO FIND OF THE EXPANSION TO
TWENTY FIVE COULD IMPAIR THE SAM
S. P. FUNDING FLOW AND THEY'RE
ALREADY DOING THIS WORK PLUS.
GOING UP TO AGE SIXTY FIVE SO I
WE WOULD ASK THAT AS YOU WORK
TOWARDS CLOSING OUT THIS ITEM
THAT THE CMS P. PROGRAM IS A
PROTECTED SO THEY CAN CONTINUE
TO SERVE THAT POPULATION IN
THOSE COUNTIES THANK YOU SO MUCH.
THANK YOU THANK YOU FOR THE WORK
YOU DO THE MATH.
GOOD AFTERNOON LINDA WAY WITH
WESTERN CENTER ON LAW AND
POVERTY WE APPRECIATE THE
GOVERNOR'S PROPOSAL AS WELL AS
SUPPORT HEALTH FOR ALL ADULTS
THANK YOU.
GOOD AFTERNOON BY THE GOVERNOR
TELL WITH COMMUNITY HEALTH
COUNCILS IN STRONG SUPPORT OF
ALL PROPOSALS TO EXPAND MEDI CAL
ACCESS TO UNDOCUMENTED ADULTS
THANK YOU.
NO I BOTTOM ALL REPRESENTING
CALIFORNIA RURAL LEGAL
ASSISTANCE FOUNDATION IN SUPPORT
OF THE GOVERNMENT'S PROPOSAL. TO
EXPAND HEALTH CARE TO A YOUNG
ADULTS AND SUPPORT THE
STAKEHOLDERS PROPOSAL TO PROVIDE
EXPANDED MEDICAL COVERAGE TO ALL
REGARDLESS OF IMMIGRATION STATUS.
OUR FARM WORKER COMMUNITY SEES
MEDICARE MEDICARE ALL AS A
SUBSTANTIAL RESOURCE AND IT'S
BEEN A VERY BIG BENEFIT TO OUR
FIFTY BILLION DOLLAR
AGRICULTURAL INDUSTRY THANK YOU.
THANK YOU.
CHAIR AND MEMBERS SALLY HYUNDAI
THAT I'M HERE ON BEHALF OF NEXT
IN CALIFORNIA WE'RE VERY SUPPORT
OF THE GOVERNOR'S PROPOSAL BUT
WOULD LIKE WOULD LIKE THIS TO BE
EXPANDED TO THE ENTIRE
UNDOCUMENTED COMMUNITY THANK YOU.
THANK YOU.
ANGELA WILLIAMS CALIFORNIA BLACK
HEALTH MY WORK ON BEHALF OF THE
NEARLY THIRTY THOUSAND
UNDOCUMENTED CALIFORNIA'S OF
AFRICAN DESCENT.
WE ARE SUPPORT FOR THIS MEASURE
IS AN IMPORTANT ISSUE IN TERMS
OF SOLIDARITY BUT ALSO MAKING
SURE THAT THE ENTIRE
UNDOCUMENTED COMMUNITY IS
REPRESENTED AND COVERED BY
HEALTH INSURANCE.
THANK YOU.
MADAM CHAIR MEMBERS SERRA FLOCKS
CALIFORNIA LABOR FEDERATION IN
SUPPORT OF THE GOVERNOR'S
PROPOSAL AND HEALTH CARE FOR ALL
THANK YOU.
HELLO ABBE OVER MERS ON BEHALF
OF LATINO COALITION FOR HEALTHY
CALIFORNIA AND WE SUPPORT THE
GOVERNMENT'S PROPOSAL AS WELL AS
A PROPOSAL TO EXTEND -- HEALTH
HEALTH CARE COVERAGE TO ALL
REGARD REGARDLESS OF STATUS
THANK YOU.
CHRIS RESPONSES WHICH ARE THE
COALITION FOR HUMANE IMMIGRANT
RIGHTS CALIFORNIA'S LARGEST
IMMIGRANT RIGHTS ORGANIZATION
DIRECTLY ARE REPRESENT IMMIGRANT
FAMILIES ON WHICH TO EIGHT WERE
AN ODD SUPPORT OF THE GOVERNOR'S
PROPOSAL ON AS WELL AS THE CYCLE
PROPOSAL TO EXPAND ITS ALL
DOCUMENT AND FOLKS IN CALIFORNIA.
THANK YOU.
GET AFTERNOON MONEY AT A MINIMUM
IT WITH THE CALIFORNIA COVERAGE
AND HEALTH INITIATIVES
INITIATIVES REPRESENTING OVER
THIRTY AGENCIES ACROSS THE STATE
THAT SERVE THIS POPULATION THAT
WERE SPEAKING ABOUT.
WE'RE IN SUPPORT OF HEALTH AXES
AND SEE AYE PC'S -- COMMENTS AND
ALSO THE C. W. E. EIGHT REQUEST
FOR ADDITIONAL FUNDING AT THE
LOCAL LEVEL [inaudible]
THANK YOU.
HELLO LUCY QUESTION ALONG BEHALF
OF MATERNAL AND CHILD HEALTH
ACCESS IN STRONG SUPPORT OF BOTH
PROPOSALS.
AND I WOULD JUST LIKE TO
UNDERSCORE THAT THIS IS ALSO
ABOUT CHILDREN'S HEALTHCARE AND
MATERNAL HEALTH BECAUSE THESE
YOUNG PEOPLE NEED TO BE HEALTHY
WHEN THEY START THEIR FAMILIES
AND SO WE CAN'T REALLY BE
SERIOUS ABOUT.
EARLY CHILDHOOD DEVELOPMENT AND
QUALITY PRENATAL CARE FOR ALL
WOMEN IN CALIFORNIA UNLESS WE'RE
REALLY FOCUSED ON THE HEALTH AND
WELL BEING OF THESE YOUNG PEOPLE
THROUGHOUT THE LIFE COURSE THANK
YOU.
THANK YOU.
ON A HOUSE ABOUT WITH UNITED
WAYS OF CALIFORNIA IN SUPPORT OF
THE GOVERNOR'S PROPOSAL AS WELL
AS STRONGLY IN SUPPORT OF HEALTH
FOR ALL THANK YOU.
THANK YOU.
MICHELLE GIVENS OF THE COUNTY
HEALTH EXECUTIVES ASSOCIATION OF
CALIFORNIA HERE IN SUPPORT OF
THE GOVERNOR'S PROPOSAL TO
EXPAND COVERAGE TO UNDOCUMENTED
YOUNG ADULTS AND THROUGH TO THE
STAKEHOLDER.
IN SUPPORT OF STAKEHOLDER
PROPOSALS TO EXPAND TO ALL
UNDOCUMENTED ADULTS AND WE'LL
GET IN A LITTLE INTO OUR
CONCERNS AROUND THE FINANCING
STRUCTURE UNDER THE NEXT ITEM
THANK YOU.
YOU LOOK SEE WITH POLLUTION THE
CALIFORNIA HERE IN SUPPORT OF
BOTH THE GOVERNOR'S PROPOSAL AS
WELL AS THE STAKEHOLDER LEFT THE
PROPOSAL.
TO EXPAND FOR SCHOOL MEDI CAL TO
ALL INCOME ELIGIBLE CALIFORNIANS
REGARDLESS OF IMMIGRATION STATUS
THANK YOU.
HELLO MY NAME IS MARY ELLEN MOST
WITH HE SAID A COUPLE OF MISSILE.
OF REPRESENTING ABOUT FOUR
THOUSAND PROMOTED AS ACROSS ALL
OF CALIFORNIA AND URBAN RURAL
AREAS AND WE'RE HERE IN SUPPORT
BUT PROPOSALS.
AND REALLY HOPE THE
CONSIDERATION WILL BE GIVEN TO
THE ENTIRE FAMILY.
THANK YOU THANK YOU SO MUCH IT'S
SO GOOD TO HAVE YOU HERE.
YOUR ORGANIZATION -- BUT MESSIAH.
COMPARE ME SAFE FROM THE SENATE
COMPROMISSO THIS UNICAL FROM ME
SO -- I IT'S IT'S SUCH AN
IMPORTANT PART OF GOING INTO THE
COMMUNITY IN PROVIDING THE
SERVICE WITH A FROM WITHOUT IS
THANK YOU SO MUCH FOR YOUR
LEADERSHIP IDEA THANK YOU.
THANK YOU.
WE BRING IT BACK TO THE
COMMITTEE AGAIN. FOR THE
COMMENTS QUESTIONS VERY GOOD
WELL THANK YOU SO MUCH IT'S
CLEARLY AN IMPORTANT TOPIC AND
IT WARMS MY HEART TO HAVE
EVERYBODY WHO COMES UP.
SAY THEY AGREE WITH THIS WE NEED
TO PROVIDE.
THE HEALTH COVERAGE TO EVERYONE
REGARDLESS OF IMMIGRATION STATUS
THAT'S AS IT SHOULD BE.
THANK YOU SO MUCH.
AND I WOULD LIKE TO CALL UP --
THE PANEL ISSUE NUMBER
[inaudible]
FOUR WELCOME.
MERRY CAM TWELVE LET'S START
WITH YOU.
I WILL ACTUALLY DEFERRED TO MY
DEPARTMENT OF FINANCE COLLEAGUES
TO PRESENT THIS ITEM VERY GOOD.
CHANNING WHEN DEPARTMENT OF
FINANCE THE GOVERNOR'S BUDGET
PROPOSES A NUMBER OF CHANGES TO
NINETEEN NINETY ONE RE ALIGNMENT.
TODAY WE WILL BE WILL BE
SPEAKING SPECIFICALLY TO A. B..
EIGHTY FIVE IN TWENTY NINETEEN
TWENTY THE GOVERNOR'S BUDGET
PROPOSES TRAILER BILL LANGUAGE
TO INCREASE THE REDIRECTION
AMOUNTS OF THE COUNTY MEDICAL
SERVICES PROGRAM BOARD AND
CERTAIN OTHER.
COUNTIES INDIGENT HEALTHCARE
REALIGNMENT RABBANI.
THIS WOULD RESULT IN SIXTY THREE
MILLION DOLLARS OF GENERAL FUND
SAVINGS IN THE COW WORKS PROGRAM.
AT THE STATE TAKES ON
RESPONSIBILITY FOR PROVIDING
HEALTHCARE TO UNDOCUMENTED
ADULTS COUNTIES COST AND
RESPONSIBILITIES ON A DIGIT
HEALTHCARE ARE EXPECTED TO
DECREASE.
AS SUCH THE GOVERNOR'S PROPOSAL
WOULD NOT IMPACT THAT THIRTY
FOUR CM MUSKY COUNTIES BUT ONLY
TWO THAT'S HIM AS HE POURED.
WHICH HAS A SIGNIFICANT
OPERATING RESERVE OF OVER THREE
HUNDRED SIXTY MILLION DOLLARS.
AS FOR THE OTHER.
FIVE COUNTIES THAT ARE IMPACTED
OTHER SIXTY THREE MILLION
DOLLARS APPROXIMATELY 24% OR
FOURTEEN POINT EIGHT MILLION
DOLLARS WILL BE RE DIRECTED FROM
THOSE COUNTIES.
WE HAVE HEARD THE CONCERNS
AROUND OUR PROPOSAL AND WE'D
LIKE TO NOTE THAT WHILE THE
GOVERNOR'S PROPOSAL WOULD BE
DIRECT ADDITIONAL REALIGNMENT
REVENUES FROM COUNTIES.
OF THE REDUCTION OF COUNTIES I
EACH AS ASKED AMMO YOU COST IN
TWENTY NINETEEN TWENTY WOULD
RESULT IN TWO HUNDRED FORTY TWO
MILLION DOLLARS IN COUNTY
SAVINGS [inaudible]
THANK YOU.
NEXT COME BEN JOHNSON WITH THE
LEGISLATIVE ANALYST'S OFFICE --
WE WE ANALYZE THIS ISSUE IN A
COUPLE OF REPORTS ONE ON THE
MEDI CAL SPECIFICALLY AND ONE ON
THE GENERAL REALIGNMENT
STRUCTURE.
AND WE FIND THAT -- FOR THE A.
B. EIGHTY FIVE PROPOSAL THAT
SOME INCREASE IN THE RE
DIRECTION -- IS LIKELY
APPROPRIATE.
TO A HELP -- PAY FOR THE COST OF
THE EXPANSION BUT MORE SO TO
ACCOUNT FOR SOME OF THE COSTS
THAT THE STATE HAS TAKEN ON FOR
EXPANDING COVERAGE -- WE BELIEVE
IT'S APPROPRIATE GIVEN -- THAT
HOW HOW INDIGENT CARE CASELOADS
HAVE GONE DOWN AND ALSO FOR THE
REASON THAT -- THE CMS P. BOARD
HAS ACCUMULATED A LARGE RESERVE
THAT WOULD TAKE MANY YEARS TO
SPEND DOWN -- EVEN UNDER ITS
CURRENT BUDGET WITH THAT WITH
THE COVERAGE EXPANSION.
THAT SAID WE DO HAVE QUESTIONS
ABOUT THE SCOPE AND THE
MAGNITUDE OF THE PROPOSED
INCREASE IN THE REDIRECTION --
FIRST WE BELIEVE IT COULD HAVE
AN IMPACT ON CERTAIN COUNTIES
NOT NOT THE C. M. S. P. COUNTIES
BUT FIVE OTHER COUNTIES --
ABILITY TO MAINTAIN THEIR
EXISTING PUBLIC HEALTH
ACTIVITIES AND THEN SECOND EVEN
WITH REGARD TO THE CMS BE IT THE
THE PROPOSAL DOES CALL INTO
QUESTION ITS VIABILITY GOING
FORWARD.
AS THE C. M. S. P. BOARD --
WHICH DELIVERS ENGINE HEALTHCARE
ON BEHALF OF THE PARTICIPATING
COUNTIES WOULD RECEIVE -- NO
FUNDING -- FOR THE FORESEEABLE
FUTURE -- EVENTUALLY MAYBE THERE
WOULD BE HAVE TO BE CHANGES --
TO TO THE PROPOSED LANGUAGE OR
SO FORTH TO ALLOW IT TO HAVE
FUNDING GOING FORWARD SHOULD
THERE BE A REMAINING UNINSURED
POPULATION THAT WE WHICH I BOARD
TO SERVE SO HAPPY TO TAKE ANY
QUESTIONS [inaudible]
THANK YOU.
WHICH KEPT OVER.
PETER BE LONESOME HI.
HUNTER PETERBILT SEMIREGULAR
THIS TIME.
SORRY AND DIRECTOR OF THE
DEPARTMENT OF HEALTH SERVICES IN
SACRAMENTO COUNTY ONE OF THE
FOUR COUNTIES THAT ARE.
PARTICULARLY -- AFFECTED BY THIS
WEEK'S TOTALLY AGREE WITH THE
IDEA BEHIND THIS IN TERMS OF
INCREASING COVERAGE FOR THE
UNDOCUMENTED YOUNG FOLKS.
IN FACT WE'VE BEEN DOING THAT
AND MORE IN SACRAMENTO COUNTY
AND BECAUSE OF THIS REALIGNMENT --
BECAUSE WHAT WE CALL THE CALL
BACK -- IT REALLY IMPACTS OUR
SERVICES TO UNDOCUMENTED FOLKS
WE SERVE.
FOUR THOUSAND ADULTS ENDS WITH A
UNDOCUMENTED ADULTS ARE HEALTHY
PARTNERS PROGRAM CURRENTLY ****
COME COMPLETELY FUNDED.
RUN BY THE COUNTY OF SACRAMENTO.
AND ONLY ONE HUNDRED OF OUR FOUR
THOUSAND FOLKS ARE UNDER THE AGE
OF TWENTY FIVE OR TWENTY FIVE OR
UNDER IS ONLY TWO POINT 5% WOULD
BENEFIT FROM THIS PROPOSAL THE
GOVERNOR. NINETY SEVEN POINT 5%
OF OUR FOLKS WHO ARE
UNDOCUMENTED WOULD ACTUALLY TAKE
A HIT.
IN TERMS OF SERVICES THAT ARE
NEEDED THAT ARE BEING PROVIDED
TO THEM IN FACT WE HAVE TO CUT
ABOUT 75% OF ALL SERVICES. TO
ARE UNDOCUMENTED FOLKS WHO ARE
OLDER THAN TWENTY FIVE IN
ADDITION WE THINK THAT THE
AMOUNT OF ALLOCATED TO THE SLICE
OF THE POPULATION.
IS SOMEWHAT OVERESTIMATED
BECAUSE AS THE AS THE WHERE YOU
FROM L. L. L..
L. L. SO WHERE YOU FROM.
HELLO.
I USED TO SAID [inaudible]
SORRY.
THE THIS POPULATION IS LESS
EXPENSIVE THAN THE GENERAL
POPULATION THEY TEND NOT TO COME
IN FOR CARE.
FOR A FOR PSYCHOLOGICAL REASONS
MAINLY WHEN THEY THE THING THAT
THEIR MOST AT RISK FOR IN TERMS
OF A HIGH COST SERVICES -- BE
CARE WHICH IS COVERED BY
MEDICARE AL.
SO WE THINK ACTUALLY IN ADDITION
TO THIS BEING IN A TRIP TO THE
FOR COUNTIES THAT ARE
PARTICULARLY AFFECTED -- IN
PARTICULAR SACRAMENTO BECAUSE WE
PROVIDE THE UNDOCUMENTED CARE IN
ADDITION TO THE PUBLIC HEALTH
ASPECTS THAT ARE THAT THESE CUTS
WILL ALSO WRITTEN ENTAIL -- THAT
IT IS THERE'S A BETTER WAY
POTENTIALLY OF GETTING THE
FUNDING FOR THIS POPULATION.
AND I SHOULD JUST AT REAL
QUICKLY ON THE PUBLIC HEALTH
SIDE STANISLAUS AND HE SEES ME
US.
GLASSER STANISLAUS SANTA BARBARA
AND SACRAMENTO COUNTY WILL BE
PARTICULARLY AFFECTING THE
PUBLIC HEALTH RAINY REALM IN
ADDITION TO THIS ON DOCUMENTS
SERVICES THAT WE PROVIDE.
IN TERMS OF STD CLINICS BEING
CLOSED AND COMMUNICABLE DISEASE
INVESTIGATORS.
BEING SHUT DOWN AT PARTICULARLY
AT A TIME WHEN WE NOW HAVE
MEASLES CASES IN THE REGION AND
WE DON'T WANT TO BE SENDING
THOSE SERVICES DOWN.
SIDE RESPECTIVELY RESPECTFULLY
REQUEST THAT THIS BUDGET.
THE AMOUNT OF FOURTEEN FIFTEEN
BILLION COME FROM SOME OTHER
SOURCE [inaudible]
THANK YOU -- WELL LOOK AMONG
THREE GUESTS.
MADAM CHAIR MEMBERS WHETHER LOOK
THE MAGIC AS WITH THE DEPARTMENT
OF FINANCE -- WE ARE EVALUATING
DATA AND HAVE HAD CONVERSATIONS
WITH COUNTIES TO BETTER
UNDERSTAND THE IMPACTS OF OUR
OUR PROPOSAL THE GOVERNOR'S
PROPOSAL.
OKAY WHAT DO YOU EXPECT THAT
THAT WOULD BE DONE THE
EVALUATION OF THE DATA DATA.
IT'S AN ONGOING DIALOGUE OF
COURSE WE HAVE OUR UPDATE -- AT
ME REVISION -- BUT JUST JUST TO
PUT IT OUT THERE THAT WE HAVE
HER WE HAVE HEARD THE CONCERNS
ON ON OUR PROPOSAL.
VERY GOOD ESPECIALLY FROM THE
COUNTY'S MOST THAT WOULD BE MOST
AFFECTED.
YEAH WE MET WITH SACRAMENTO
COUNTY.
THEY'RE THE CLOSEST ONE RIGHT.
ALL RIGHT WONDERFUL -- QUESTIONS
FROM THE MEMBERS.
ALRIGHT LET'S OPEN IT UP --
MADAM CHAIR.
IT'S JUST A REAL QUICK ON THE
COUNTIES CONCERNS IS THIS THE
THE THE LIST THAT WE HAVE
CURRENTLY SANTA BARBARA --
SACRAMENTO YOLO COUNTY AS ARE
OTHER COUNTIES ALSO INCLUDED IN
THAT.
WESTERN STANISLAUS.
SO YOU'RE LOOKING AT THE IMPACT
THAT IT WILL HAVE ON COUNTIES
WERE ACTUALLY -- DOING A BROAD
LOOK AT THE FIFTY EIGHT COUNTIES
A SERRA WE JUST DOING A SAMPLE
OF THOSE ARE RAISING CONCERN SO.
DOES LIKE MY COLLEAGUE NOTED
THAT CM. THIRTY FOUR CMS BEATS
MSP COUNTIES WILL NOT BE
IMPACTED BECAUSE OF THE WAY --
THE THE BOARD -- SORT OF WHAT WE
CALL IT A CONGLOMERATION IT'S
UNDER SORT OF THE THE PORTS FOR
REVIEW -- DESPITE THE CIVIC
COUNTIES -- FOR A. B. EIGHTY
FIVE PURPOSES -- ITSELF FOR A
SIXTY FORTY A SIXTY FORTY BUT
PERCENT FORMULA ONE MEAN IN
TERMS OF THEIR REACH -- AB FIVE
A DIRECTION.
THE OTHER COUNTIES -- WE EXPECT
THAT THERE WILL BE IMPACTS -- IN
TERMS OF DECREASES TO INDIGENT
CARE BUT THOSE OTHER COUNTIES
THEIR FORMULA BASED COUNTIES AND
THE AB EIGHTY FIVE EVERY
DIRECTION HAPPENS TWO YEARS DOWN
THE ROAD SO WE EXPECT THAT THAT
THOSE COUNTIES WILL BE IMPACTED
ON THE NATURAL.
SO OUT OF THE FIFTY EIGHT HOW
MANY DO YOU THINK WILL BE IMPACT.
WELL IN NINETEEN TWENTY IT'S THE
CMS KEYBOARD AND AND FIVE FIVE
COUNTIES.
I THINK IT IS CLEAR AND TO THANK
YOU FOR YOUR TESTIMONY THAT.
THIS WOULD BE TERRIBLE FOR THOSE
COUNTIES.
AND WE DO HAVE TO FIND A WAY TO
BE ABLE.
TO IT'S TO DO WITH WHAT WE WANT
TO DO BUT TO NOT TO BECAUSE THE
HARM THAT IS BEING CAUSED.
BY THE LANGUAGE THAT WE HAVE SO
WE HAVE SOME WORK TO DO.
AND I SINCERELY APPRECIATE THE
COUNTIES THAT WILL BE MOST
AFFECTED BY THIS -- VOICING
THEIR CONCERNS SO THAT HE COULD
THEN BE TAKEN INTO CONSIDERATION
[inaudible]
THANK YOU.
ANY FURTHER QUESTIONS FROM THE
COMMITTEE [inaudible]
SEEING NONE.
I THANK YOU ALL FOR FOR YOUR
PRESENTATION.
WILL MOVE TO ISSUE NUMBER.
FIVE I'M SORRY PUBLIC COMMENT
THE MOST IMPORTANT PART OF MY
APOLOGIES.
THANK YOU MADAM CHAIR I'M FAIR
MAKE THEY TING ON BEHALF OF THE
CALIFORNIA STATE ASSOCIATION OF
COUNTIES REPRESENTING ALL FIFTY
EIGHT COUNTIES.
I THINK.
THIS IS A COMPLICATED ISSUE
OBVIOUSLY BUT IF YOU TOTAL IT UP
IT'S THIRTY NINE COUNTIES THAT
WOULD BE AFFECTED IT'S THE
ARTICLE THIRTEEN COUNTIES IN THE
C. M. S. P. COUNTIES.
AND WHILE THIS ADVERSELY
AFFECTED ADVERSELY AFFECTED THE
SAME AS PEOPLE WARD THIS.
CHANGE IN RATIO FROM SIXTY FORTY
TO SEVENTY FIVE TWENTY FIVE
WOULD AFFECT THE SAME MUST BE
BORED BUT THAT WOULD EVENTUALLY
AFFECT THE SAME SP COUNTIES AND
THE PATH TO HEALTH PROGRAM YOU
HEARD ABOUT.
ALSO ARE -- ALL THIRTY NINE
COUNTIES -- IN VARIOUS WAYS ARE
OFFERING SOME SERVICES TO
UNDOCUMENTED FOLKS AS WELL AS
CRITICAL PUBLIC HEALTH SERVICES
WHICH YOU HEARD FROM MISTER BE
LAINSON AND OTHERS.
AND SO THIS PROPOSAL THIS CHANGE
FROM SIXTY FORTY TO SEVENTY FIVE
TWENTY FIVE IS ARBITRARY.
IT'S NOT REALLY BASED ON ANY
MATH THAT WE'VE BEEN ABLE TO
DETERMINE -- WE DO REALIZE THAT
WITH THE EXPANSION -- BUT THERE
COULD BE SOME SAVINGS ON THE
COUNTY SIDE BUT AGAIN -- MANY
COUNTIES ARE OFFERING SERVICES
TO THESE FOLKS AND SO -- WE LOOK
FOR TO CONTINUE IN THE
CONVERSATIONS WITH DEPARTMENT OF
FINANCE AND OTHERS TO FIGURE OUT
A WAY.
TO DO THIS AND THEN LASTLY WE
WANT TO SAY THAT -- WILL TWO
THINGS SORRY -- THIS IS SEPARATE
FROM THE HSS PROPOSAL THAT WAS
MENTIONED BY THE FIRST SPEAKER --
THIS IS A MET IN THE HEALTH
REALM AND DOES ISN'T IS SEPARATE
FROM AYE HSS PROPOSAL.
ANY COUNTY SAVINGS ON I JUST
PROPOSAL SIDE COUNTY STILL DO
CONTRIBUTE THEIR REALIGNMENT TIE
IT TO ASSESS SO IT'S NOT
NECESSARILY A SAVINGS PER SE.
AND THEY'RE DIFFERENT POTS OF
MONEY SO EVEN IF YOU DID SAVE
SOMEONE I'D JUST ASIDE WHICH
WILL NEVER HAPPEN YOU WILL NEVER
SAVE -- YOU CAN'T USE IT FOR THE
SORTS OF SERVICES OVER HERE SO
IT'S VERY COMPLICATED -- BUT WE
LOOK FORWARD TO WORKING WITH THE
ADMINISTRATION OTHERS WE
APPRECIATE YOUR COMMENTS.
THANK YOU.
MICHELLE GIVENS OF THE COUNTY
HEALTH EXECUTIVES ASSOCIATION OF
CALIFORNIA WE REPRESENT LOCAL
HEALTH DEPARTMENTS THROUGHOUT
THE STATE AND I THINK IT'S JUST
IMPORTANT TO WALK BACK IN REAL
RECOGNIZE HOW NINETEEN NINETY
ONE HEALTH REALIGNMENT IS USED
SO IT'S BOTH INDIGENT CARE
SERVICES AND THE PROVISION OF
THOSE BUT IT'S ALSO. FOR THE
PROVISION OF PUBLIC HEALTH
SERVICES WHICH IS AT PROVIDED TO
EVERYONE REGARDLESS OF YOUR
CITIZENSHIP STATUS AND I SAY
THAT BECAUSE WHEN COUNTIES OPTED
FOR THE SIXTY FORTY OUR
UNDERSTANDING WAS THAT 40% UNDER
THIS DEAL OF AB EIGHTY FIVE IS
THAT THAT 40% WOULD BE RETAINED
FOR PUBLIC.
HEALTH SERVICES AND FOR ANYTHING
ELSE THAT THE COUNTIES CHOSE TO
DO BUT IT WAS NOT GOING TO BE
SWEPT EVERY TIME THERE WOULD BE --
EXPANSION OF MEDIC HOW IN SOME
SORT AND I THINK IT'S IMPORTANT
TO JUST RECALL THAT UNDER THE AB
EIGHTY FIVE CONSTRUCT THERE'S A
FORMULA AND WITHIN THAT FORMULA
THE JURISDICTIONS THAT OPTED TO
USE THAT.
THERE IS A IS A PROTECTION THERE
IT'S A MECHANISM TO MAKE SURE
THAT THEY DON'T -- SWEEP MORE
THAN THEIR HISTORICAL MADAM OF
MONEY THAT WAS USED FOR INDIGENT
SERVICES SO THERE'S AMOUNT OF
MONEY OUR PERCENTAGE IT'S ALWAYS
RETAIN FOR PUBLIC HEALTH.
THESE FIVE JURISDICTIONS THAT
WERE NAMES AND JUST PREVIOUSLY
DON'T HAVE THAT PROTECTION AND
BECAUSE OF THAT THE MONEY THAT
WOULD BE A VOTED IN TAKEN BACK
AND WOULD DEFINITELY HARM THEIR
PUBLIC HEALTH SERVICES THANK YOU.
THANK YOU.
THANK YOU CAN'T DO BURKE WITH
THE HEALTH OFFICER'S ASSOCIATION
OF CALIFORNIA HERE TO ECHO THE
CONCERNS OF OUR COLLEAGUES AT C.
SACK AND SHE ACT.
AND TO SAY THAT WE DO SUPPORT
EXPANSION OF MEDICARE ALL TO
UNDOCUMENTED IMMIGRANTS
IMMIGRANTS BUT IT'S VITAL THAT
WE DO SO WITHOUT HARMING PUBLIC
HEALTH INFRASTRUCTURE AT THE
LOCAL LEVEL THINK YES THANK YOU.
GOOD AFTERNOON AGAIN KAREN
LAYING ON BEHALF OF THE PLASTER
AND STANISLAUS COUNTY BOARDSOF
SUPERVISORS BOTH WITH STRONG
CONCERNS.
THE JACKSON'S OF AB EIGHTY FIVE
I CHANGE FROM SIXTY FORTY TO
SEVENTY FIVE TWENTY FIVE THE
PROGRAM SPECIFICALLY THAT ARE.
THEY WOULD HAVE TO BE KIND AND
PLASTER AND STANISLAUS AFFECT.
REALLY IMPORTANT PUBLIC HEALTH
PROGRAMS THAT DON'T HAVE
ANYTHING TO DO WITH HEALTH CARE
THEY'VE ALSO DONE --
MATHEMATICAL ANALYSIS ON WHAT
THEY THINK THEY MIGHT SAVE FOR
SAYS WHAT ARE THE STATE MIGHT
SAVE WITH THE EXPANSION AND THE
NUMBERS JUST DON'T ADD UP SO WE
WOULD ASK THAT THE COMMITTEE
CONTINUE TO PUSH ON DURING THE
ANALYSES OF WHAT THEIR REAL
SAVINGS ARE.
NOT ON THE UP AGAIN OF THE
FAMOUS P. COUNTIES YES THERE IS
A RESERVE A LOT OF THAT RESERVE
IS A ONE TIME PAYMENT FROM THE
FEDERAL GOVERNMENT BECAUSE CMS
P. SPENT THEMSELVES ALMOST
INSOLVENT. TO DO EARLY
IMPLEMENTATION OF THE AFFORDABLE
CARE ACT SO YES THERE'S A
RESERVE WE'RE TALKING TO THE
ADMINISTRATION ABOUT IT BUT I IF
YOU START OUT THE BOARD.
THE BOARD'S DOING THE WORK OF
THIRTY FIVE COUNTIES THAT'S IT'S
WHY WAS DESIGNED THAT WAY TO
FISH AT SO WE HAVE CONCERNS WITH
THE READER ACTION THEY ARE
IMPLEMENTING AND AN EXPANSION OF
HEALTH CARE SERVICES TO
UNDOCUMENTED PERSONS NOW AND SO
WE HAVE TO TAKE ALL THAT A
CONSIDERATION.
WHEN YOU COME BACK AFTER THE
REVISION THANK YOU [inaudible]
Q..
MADAM CHAIR CLIFF BURKE HERE
BEHALF OF SANTA BARBARA COUNTY I
JUST WANT TO ECHO THE CONCERNS
YOU'VE HEARD -- THE GOVERNOR'S
PROPOSAL WOULD HAVE A
SUBSTANTIAL IMPACT ON COUNTY
PUBLIC HEALTH SERVICES ALL THE
MONEY THAT WOULD BE CUT
CURRENTLY GOES TO PUBLIC HEALTH
AND SANTA BARBARA COUNTY WE'VE
CALCULATED THE NUMBERS THE MEDI
CAL EXPANSION SAVE THIS LIKE
SEVENTY THOUSAND DOLLARS.
AND THE CUT IN THE REALIGNMENT
FUNDS WILL COST US TWO POINTONE
MILLION DOLLARS COMING OUT OF
PUBLIC HEALTH.
SO I MEAN NOT EVEN CLOSE.
REALLY DEVASTATING IMPACT ON
PUBLIC HEALTH [inaudible]
THANK YOU.
RAIN X. CALIFORNIA'S DISABILITY
RIGHTS FOR THOSE WHO DON'T HAVE
MEDI CAL OR MEDICARE SERVICES
RIGHT NOW COUNTIES ARE THE LAST
DITCH EFFORT FOR THEM TO GET
SERVICES IT REALLY AS A PRIMARY
CARE CLINIC IS WHERE THEY GO.
AND IF DAVID DUKE DO THIS CALL
BACK PRIMARY CARE CLINICS WOULD
GET HURT ESPECIALLY MENTAL
HEALTH AND YOU KNOW MENTAL
HEALTH IS ALWAYS BEEN SHORT.
SHORT SHAFT ALL THE TIME SO.
I I BELIEVE YOU CAN HAVE TO FIND
A WAY DIFFERENT REVENUES THAT
WOULD BE NICE OKAY THANK YOU.
GOOD AFTERNOON RONALD COMMON
HERE BEHALF OF HEALTH ACCESS
CALIFORNIA WELL SOME COUNTIES
PROVIDE LITTLE OR NO ASSISTANCE
TO THE UNDOCUMENTED CERTAINLY
THERE ARE COUNTIES THAT DO
PROVIDE A MEDICAL HOME OR SOME
TYPE OF ACCESS TO UNDOCUMENTED
POPULATIONS.
CERTAINLY WE SEE THAT IN
SACRAMENTO AND YOLO COUNTY
SPECIFICALLY -- ADDITIONALLY WE
WE VERY MUCH APPRECIATE THE SAME
AS P. PATHWAY TO HELP PROGRAM
THAT DOES PROVIDE SERVICES FOR
ABOUT TWENTY THOUSAND
UNDOCUMENTED INDIVIDUALS WE
CERTAINLY WANT TO MAKE SURE THAT
COUNTIES ARE IN THE POSITION OF
BEING ABLE TO CONTINUE TO SERVE
THE REMAINING UNINSURED
INCLUDING THE UNDOCUMENTED IF
THEY'RE DOING.
SO TODAY AND ALSO BE ABLE TO
SERVE THE PUBLIC HEALTH PROGRAMS
WE DEFINITELY DON'T WANT TO PULL
THE RUG OUT OF SOME UNDOCUMENTED
COMMITTEE MEMBERS THAT ARE ABLE
TO GET SERVICES -- AT AT THE
COUNTY LEVEL EVEN IF IT IS JUST
A PATCHWORK OF COUNTIES TO DO
THIS EXPANSION AND WHATEVER'S
LEFT LEGISLATURE -- TO FIND
GENERAL FUND -- DOLLARS TO DO SO
THANK YOU.
THANK YOU [inaudible]
ALL RIGHT.
WE'RE DONE WITH PUBLIC COMMENT
NOW WE CAN MOVE ON TO ISSUE
NUMBER
FIVE GOOD LET'S BEGIN
WITH YOU.
THANK YOU MADAM CHAIR AND
MEMBERS I'M I'M HERE TODAY TO
PRESENT THE BUDGET PROPOSAL TO
RAISE THE INCOME LIMIT AT THE
AGED AND DISABLED MEDI CAL
PROGRAM TO A HUNDRED AND 38% OF
THE FEDERAL FEDERAL POVERTY
LEVEL.
CREATING PARITY BETWEEN SENIORS
AND THE DISABLED MEDICARE
BENEFICIARIES AND OTHER MEDICARE
BENEFICIARIES.
SINCE THE PASSAGE OF THE ACA
MOST ADULTS CAN NOW QUALIFY FOR
MEDI CAL IF THEY HAVE AN INCOME
BELOW 110038% OF THE FEDERAL
POVERTY LEVEL.
THE ACA HOWEVER DID NOT CHANGE
THE INCOME LEVEL FOR THE MEDI
CAL AGED AND DISABLED PROGRAM
WHICH IS EQUIVALENT TO A HUNDRED
AND 22% OF THE FEDERAL PART OF
THE FEDERAL POVERTY LEVEL.
THIS MEANS THAT A SIXTY FOUR
YEAR OLD ADULT WITH FREE MEDI
CAL CAN LOSE IT.
THE DAY THEY TURN SIXTY FIVE
YEARS OLD.
THE SENIOR WITH AN INCOME OF
EVEN ONE DOLLAR OVER THE 122% OF
FEDERAL POVERTY LEVEL THRESHOLD
IS ONLY ELIGIBLE FOR MEDICARE.
WITH EXPENSIVE SHERIFF COST THE
ONLY WAY FOR SENIORS WITH
INCOMES ABOVE A HUNDRED AND 22%
OF THE FEDERAL POVERTY LEVEL TO
ACCESS MEDI CAL BENEFITS IS TO
PAY HUNDREDS OF DOLLARS.
IN A MONTHLY MEDI CAL SHARE CROC
COST OF OVER SIX HUNDRED AND
FIFTY DOLLARS PER MONTH WHICH
MANY SENIORS SIMPLY CANNOT
AFFORD TO PAY.
THIS CREATES A SIGNIFICANT BERRY
FOR SENIORS TO EXCESS AFFORDABLE
HEALTH CARE.
RATED THE AGED RAISING THE AGED
AND DISABLED INCOME LIMIT TO A
HUNDRED AND 38% OF THE FAR
FEDERAL POVERTY LEVEL IS THE
MOST APPROPRIATE.
AND COST EFFECTIVE WAY TO ENSURE
LOW INCOME SENIORS HAVE ECOBILL
EQUITABLE ACCESS TO AFFORDABLE
HEALTHCARE.
THIS BUDGET PROPOSAL WOULD
ENSURE THAT THE VULNERABLE
POPULATION OF LOW INCOME SENIORS
ARE TREATED FAIRLY.
AND COULD HAVE ACCESS TO
AFFORDABLE MEDICAL CARE WITHOUT
THE SENIOR PENALTY.
HERE WITH ME TODAY IS -- LINDA
WAY WITH THE WESTERN CENTER FOR
LAW AND POVERTY.
THANK YOU.
GOOD AFTERNOON CHAIR MEMBERS
LINDA WAY WITH WESTERN CENTER ON
LAW AND POVERTY THANK YOU FOR
CONSIDERING THIS PROPOSAL.
IT IS UNFAIR THAT SENIORS AND
PERSONS WITH DISABILITIES ARE
SUBJECT TO A LOWER INCOME
ELIGIBILITY THRESHOLD OF ABOUT A
HUNDRED SIXTY DOLLARS LOWER A
MONTH TO QUALIFY FOR FREE MEDI
CAL IF A SENIOR PERSON.
WITH DISABILITY HAS AN INCOME OF
MORE THAN TWELVE HUNDRED AND
FORTY TWO DOLLARS A MONTH HERE
SHE CAN ONLY GET FREE MEDIC.
CAN GET MEDICARE WITH A SHARE OF
THE COST I SHARE CAST IS THE
AMOUNT AN INDIVIDUAL MUST PAY
FOR THEIR HEALTHCARE BEFORE MEDI
CAL KICKS IN.
A PERSON'S SHARE COST IF THEIR
MONTHLY INCOME MINUS SIX HUNDRED
DOLLARS THIS IS BASED ON THE
ANTIQUATED IDEA THAT PEOPLE CAN
LIVE OFF OF SIX HUNDRED DOLLARS
A MONTH.
THIS MAY MADE SENSE IN NINETEEN
EIGHTY NINE WHEN THAT THRESHOLD
WITH THAT BUT CERTAINLY DOESN'T
MAKE SENSE NOW.
EVERY YEAR THERE AGING DISABLED
INCOME LIMIT LOSES GROUND BUT IS
ESPECIALLY HARD FELT THIS YEAR I
LEGAL AID ADVOCATES REPORT AN
INCREASE IN THE NUMBER OF
CLIENTS WHO ARE NO LONGER
ELIGIBLE FOR FREE MEDI CAL.
SIMPLY BECAUSE OF A COST OF
LIVING ADJUSTMENT IN THEIR
SOCIAL SECURITY.
THE AVERAGE COST OF LIVING
ADJUSTMENT INCREASE FOR SOCIAL
SECURITY IS THIRTY NINE DOLLARS
FOR THIS YEAR TEN DOLLARS HIGHER
THAN THE AGING DISABLED INCOME
INCREASE FROM LAST YEAR.
MANY OF THESE RETIREES WOULD
HAPPILY GIVE UP THAT EXTRA
THIRTY NINE DOLLARS IN INCOME
RATHER THAN PAY A SEVEN HUNDRED
DOLLAR SHERIFF COST.
FORCE BETWEEN PAYING FOR RENT
AND FOOD OR THEIR MEDI CAL SHARE
OF COSTS MANY FOREGO NEEDED
MEDICAL SERVICES PROMPTING THEM
TO MOVE INTO A SKIRT SKILLED
NURSING FACILITY AT A HIGH COST
TO THE STATE.
AND EVEN HIGHER PERSONAL COSTS
TO THEIR INDEPENDENCE AND WELL
BEING.
WE URGE THE SECOND SUBCOMMITTEE
TO BRING SOME MUCH NEEDED PARITY.
THANK YOU [inaudible]
THANK YOU.
MERRY.
MERRY CAM ALL THE PART OF HEALTH
CARE SERVICES SO JUST FROM --
TECHNICAL OPERATION STANDPOINT
CERTAINLY IF THE PROPOSAL IS
SOMETHING THAT THE STATE COULD
SEEK WITH THE FEDERAL GOVERNMENT
THERE ARE FISCAL ISSUES THAT
I'LL DEFER TO MY DEPARTMENT
FINANCE COLLEAGUE.
JUST A COUPLE THINGS TO NOTE ONE
WE WOULD OBVIOUSLY NEED FEDERAL
APPROVAL TO DO THIS EXPANSION
AND THE OTHER BEING THAT --
BECAUSE AS THIS COMMITTEE WEALTH
KNOW WHO'S AS DO THE PEOPLE
SITTING AT THIS TABLE MEDI CAL
BEING AS COMPLICATED AS IT IS.
IT'S NOT EXACTLY PARITY BECAUSE
OF THE DIFFERENT INCOME
DISREGARD SO I THINK WE WOULD
WANT TO UNDERSTAND -- OF WHAT IS
THE END GOAL IN TERMS OF IS IT
PEOPLE WHO AT THE END AFTER
THEIR INCOME DISREGARDS ARE IT'S
PARITY SO I THINK THERE'S SOME
TECHNICAL ISSUES WE WOULD NEED
TO WORK THROUGH SO THAT WE COULD
PRESENT THOSE. TO SEE A MASS TO
THE DEGREE THIS WAS SOMETHING
THAT.
THE LEGISLATURE AND THE GOVERNOR
ENDED UP INCLUDING THE FINAL
BUDGET BUT I'LL DEFER THE FISCAL
ISSUES TO LARA.
LORI L. AT DEPARTMENT OF FINANCE
WE DON'T HAVE AN UPDATED THE
FISCAL ESTIMATE AT THIS TIME BUT
WE WANTED TO KNOW.
THAT -- FOR THIS PROPOSAL LAST
YEAR THE COSTS WERE
APPROXIMATELY THIRTY FIVE
MILLION GENERAL FUND IN THE
FIRST YEAR OF IMPLEMENTATION
RISING TO JUST OVER TWO HUNDRED
MILLION -- AT FULL
IMPLEMENTATION AND THE
ADMINISTRATION'S WORKING ON
REVISING HAS -- SPOKEN WITH
STAKEHOLDER TO STAKEHOLDERS AND
TAKING INTO ACCOUNT THEIR
FEEDBACK AND WILL BE REVISING
THE ESTIMATE BUT WE JUST WANTED
TO NOTE OUR CONCERNS GIVEN THIS
WOULD CREE ADDITIONAL COSTS NOT
INCLUDED IN THE GOVERNOR'S
BUDGET [inaudible]
THANK YOU. ONE OF THE COMMENTS
FROM A AN ADVOCATE.
SAID TO ME THAT THIS ABSOLUTELY
LOOKS LIKE.
OUT RIGHT AGE DISCRIMINATION.
AND IS SOMETHING THAT WE SHOULD
LOOK AT THAT WE SHOULD CONSIDER
WHEN WE'RE LOOKING AT THE
110023%.
VERSUS THE 110038% ESPECIALLY
BECAUSE OF THE OTHER OTHER
ELIGIBILITY ISSUES.
VERY GOOD ANY COMMENTS QUESTIONS.
I'M SORRY.
I SUPPOSE WE SHOULD BE ASKING
THAT TO WE HEAR FROM YOU RIGHT.
I APOLOGIZE.
RON WE'LL SEE THANK YOU MANAGER
AROUND WITH THE WITH THE LA --
DON'T HAVE A LOT TO ADD HERE
JUST WANTED TO MENTION THAT --
WE REVIEWED THE FISCAL ESTIMATES
OF THE DEPARTMENT OF FINANCE
MENTION FROM LAST YEAR -- AND
FOUND THEM TO BE LARGELY
REASONABLE THERE WERE SOME
CONCERNS THAT WERE RAISED ABOUT
A COUPLE OF ASSUMPTIONS THAT I
UNDERSTAND THE DEPARTMENT IS.
IS LOOKING AT AND SO WE LOOK
FORWARD TO TO SEEING AN UPDATED
ESTIMATE TO TO REVIEW THAT AND
CAN PROVIDE FEEDBACK TO THE
LEGISLATURE AT THAT TIME
WONDERFUL THANK YOU SO MUCH.
THANK YOU.
I JUST RESPECTFULLY ASK FOR
CONSIDERATION WHEN THE TIME
COMES THANK YOU THANK YOU SO
MUCH DOCTOR WOULD AND AS A
VOTING MEMBER HERE I'M SURE THAT.
IT'LL BE GIVEN DUE CONSIDERATION.
NOW LET'S OPEN IT UP TO PUBLIC
COMMENT.
GOOD AFTERNOON RONALD COMING
HERE BEHALF OF HEALTH TEXAS
CALIFORNIA WHERE IN STRONG
SUPPORT OF THE PROPOSAL WE DO
NOT SEE ANY POLICY RATIONALE
HERE AND KNOW THAT SENIORS AND
DISABLED POPULATIONS ARE PAYING.
HUNDREDS OF DOLLARS A MONTH AND
THIS IS SOMETHING THAT CAN
EASILY BE SOLVED THANK YOU.
THANK YOU.
LINDA CHAIR WITH TO THE
CALIFORNIA PAN ETHNIC HEALTH
NETWORK WHICH IS ECHO THE
COMMENTS OF HEALTH ACCESS AND
WESTERN CENTER.
JENNIFER I'M GONNA DISABILITY
RIGHTS CALIFORNIA AND WE'RE IN
SUPPORT OF THE PROPOSAL.
THANK YOU.
REBECCA GONZALEZ NSW CALIFORNIA
WE ALSO SUPPORT GETTING RID OF
THE SENIOR PENALTY THANK YOU.
THANK YOU BRING HICKS
CALIFORNIA'S DISABILITY RIGHT
YEAH WE'RE WITH YA [inaudible]
THANK YOU.
TALK ABOUT IT WITH US YEAH YOU
CALIFORNIA WE ALSO SUPPORT THE
STAKEHOLDER PROPOSAL THANK YOU
THANK YOU.
GOOD AFTERNOON JENNIFER ALLEY
WITH CALIFORNIA ASSOCIATION
HEALTH PLANS WE ALSO SUPPORT THE
PROPOSAL.
THANK YOU.
FELIX TO POLLUTION THE
CALIFORNIA ALSO IN SUPPORT.
THANK YOU.
KATHY SETTLING WITH COUNTY
WELFARE DIRECTORS ASSOCIATION IN
SUPPORT.
THANK YOU.
ELIZABETH ESPINOSA ON BEHALF OF
THE ASSOCIATION OF CALIFORNIA
HEALTHCARE DISTRICTS AS WELL AS
ABOUT THE CALIFORNIA ASSOCIATION
OF PUBLIC HOSPITALS AND HEALTH
SYSTEMS IN SUPPORT.
THANK YOU.
NO I BOTTOM ALL REPRESENTING
CALIFORNIA RURAL LEGAL
ASSISTANCE FOUNDATION IN SUPPORT
[inaudible]
THANK YOU.
SEAN OFTEN WITH MOLINA HEALTH
CARE CALIFORNIANS SUPPORT.
THANK YOU.
GOOD AFTERNOON KELLY MAC MILLAN
WITH CALIFORNIA DENTAL
ASSOCIATION AND SUPPORT.
THANK YOU.
I THINK UP A TELL WITH COMMUNITY
HEALTH COUNCILS IN SUPPORT.
THANK YOU.
WHEN A COULD MISS THE LOCAL
HEALTH PLANS OF CALIFORNIANS
SUPPORT THANK YOU THANK YOU?
LUCY QUESTION ON BEHALF OF
MATERNAL AND CHILD HEALTH ACCESS
IN STRONG SUPPORT OF THE WESTERN
CENTER PROPOSAL AND I JUST
WANTED TO REMIND FOLKS THAT WE
HAVE MANY MULTI GENERATIONAL
FAMILIES.
SO THIS AFFECTS FAMILIES WITH
CHILDREN THE HOME AS WELL NOT
JUST SENIORS AND YOU KNOW PEOPLE
WITH DISABILITIES BUT A BROAD
RANGE OF COMMUNITIES THANK YOU.
THANK YOU.
HEAVY ARMOR IS ON BEHALF OF
LATINO CUSHION FOR HEALTHY
CALIFORNIA IN SUPPORT.
THANK YOU SO MUCH.
WELL THANK YOU -- PANELISTS --
WE'RE GOING.
TO MOVE TO ISSUE NUMBER SIX IT'S
TIME
.
OKAY.
LINDA HOW DO YOU PRONOUNCE YOUR
LAST NAME. TEN THEIR WITS.
OKAY DINNER WEEKS VERY GOOD.
WELL LET'S BEGIN WITH YOU LINDA.
THANK YOU CHAIR AND MEMBERS --
LINDA TO NARROW ITS ON BEHALF OF
THE CALIFORNIA PAN ETHNIC HEALTH
NETWORK WE ARE YOU STATEWIDE
HEALTH ADVOCACY ORGANIZATION
THAT WORKS TO ENSURE THAT ALL
CALIFORNIANS HAVE ACCESS TO HELP
THE LIVELIHOODS. TO HELP QUALITY
HEALTHCARE AND EQUITABLE
CONDITIONS WE THANK YOU FOR THE
OPPORTUNITY TO PRESENT OUR
PROPOSAL TO FIND HEALTH COVERAGE
OUTREACH ENROLLMENT AND
NAVIGATION ASSISTANCE AND HARD
TO REACH COMMUNITIES.
ARE ASK IS FOR FIFTEEN MILLION
DOLLARS EACH YEAR FOR TWO YEARS
WHICH WOULD DRIVE DOWN A FEDERAL
MATCH FOR A TOTAL OF SIXTY
MILLION DOLLARS TO GO TOWARDS
THIS CRUCIAL WORK.
THE FUNDING STRUCTURE FOR THIS
PROGRAM WOULD MIMIC THE AB AT TO
PROCESS WHICH WAS ADOPTED IN TWO
THOUSAND THIRTEEN WHICH
DISPERSED FUNDS COUNTIES BASED
ON POPULATION.
EIGHT COUNTIES THEN MADE GRANTS
AVAILABLE TO COMMUNITY BASED
ORGANIZATIONS THAT DO OUTREACH
WORK TO HELP FACILITATE
HEALTHCARE COVERAGE AND
NAVIGATION ASSISTANCE.
UNFORTUNATELY THIS FUNDING
EXPIRED IN JUNE OF TWENTY
EIGHTEEN AND SO DID THAT MORE
ROBUST OUTREACH WORK.
ACCORDING TO A RECENT UC
BERKELEY LABOR CENTER BLOG WE
KNOW APPROXIMATELY FIVE HUNDRED
THOUSAND PEOPLE WHO WERE
ELIGIBLE FOR MEDI CAL DID NOT
ENROLLING COVERAGE IN.
TWENTY SIXTEEN SEVENTEEN THIS IS
DUE IN PART TO ON AWARENESS THAT
OPEN ENROLLMENT IS YEAR ROUND OR
THAT COVERAGE IS PREMIUM FREE.
WE ALSO HAVE SEEN A CHILLING
EFFECT SWEEPING THE STATE AS
WELL AS A RESULT OF THE TRUMP
ADMINISTRATION'S ANTI IMMIGRANT
RHETORIC WHICH IS HINDERED
PEOPLE FROM USING PUBLIC
ASSISTANCE.
WE FEEL THAT THE TIME IS RIGHT
TO INVEST IN OUR COMMUNITY
WORKERS WHO ARE TRAINED AND
EQUIPPED TO ENSURE THAT
POPULATIONS FACING SOME OF THE
GREATEST ADVERSITY GET THE
INFORMATION AND ASSISTANCE THEY
NEED TO GET AND STAY COVERED.
DOES YOUR COUPLE OF EXAMPLES OF
WHAT THIS FUNDING MEANS I'D LIKE
TO BRIEFLY SHARE TWO STORIES ON
BEHALF OF MATERNAL AND CHILD
HEALTH ACCESS ABOUT TWO OF THEIR
CLIENTS.
MISTER MARTINEZ IS A SEVENTY TWO
YEAR OLD MAN IN SEVERE PAIN IN
SEVERE PAIN AND BOUND TO A
WALKER AS A RESULT OF A BRUTAL
ASSAULT SIX YEARS AGO.
HE HAD RESTRICTED SCOPE COVERAGE
UNDER MEDICARE.
HE CAME TO US IN PAIN WITH
LITTLE HOPE OF EVER WALKING
AGAIN.
THERE ARE THOROUGH SCREENING WE
DISCOVERED THAT HE HAD BEEN
ELIGIBLE FOR FULL SCOPE MEDI CAL
ALL ALONG.
DUE TO HIS VICTIM.
DUE TO HIS VICTIM OF CRIME YOU
VISA STATUS.
WE WORKED ON FIXING HIS MEDI CAL
AND WITHIN DAYS HE WAS GRANTED
FULL SCOPE COVERAGE.
HE CAME TO US AND THANK DOES
JUST TWO MONTHS LATER WALKING
UNASSISTED FOR THE FIRST TIME IN
SIX YEARS.
HE HAD BEEN ABLE TO RECEIVE
SPINAL SURGERY AND THERAPY WHICH
ENABLED HIM TO WALK.
THE SECOND CLIENT MISSED
HERNANDEZ IS A SINGLE MOTHER OF
FOUR US CITIZEN CHILDREN THE
YOUNGEST WITH CEREBRAL PALSY.
IN THE PROCESS OF ADJUSTING HER
IMMIGRATION STATUS SHE WAS
ADVISED BY A NORTH AUDIO OR A
FAKE IMMIGRATION ATTORNEY TO
TERMINATE ANY AND ALL PUBLIC
BENEFITS TO AVOID THE RISK A
PUBLIC CHARGE.
SHE HAD FOLLOWED HIS ADVICE AND
TERMINATED ALL OVER CHILDREN'S
BENEFITS INCLUDING HER SICK
CHILD SSI BENEFITS.
AS A RESULT OF THIS SHE FELL
DEEPER INTO FINANCIAL TROUBLES
TOOK ON A SECOND JOB AS AN UBER
DRIVER.
YET STRUGGLE TO PAY RENT AND
FEED HER CHILDREN.
SHE SUFFERED A NERVOUS BREAKDOWN
AND LANDED IN THE HOSPITAL.
SHE CAME TO US STRESSED IN TEARS
AND A MEDICAL THAT.
WE COMFORTED HER AND GOT HER THE
MEDI CAL BENEFITS BACK ON AND
RETROACTIVELY GOT HER HOSPITAL
BILLS COVERED.
WE REFERRED HER TO OUR CALPERS
SPECIALISTS WHO ALSO GOT HER HER
NUTRITIONAL BENEFITS BACK.
AND THEN TO AN SS I LIAISON TO
HELP HER REAPPLY FOR HER CHILD'S
LOST AS A SIDE BENEFITS.
SO THOSE ARE JUST A COUPLE OF
EXAMPLES OF HOW CRUCIAL THIS
OUTREACH WORK AS THE
TROUBLESHOOTING AND NAVIGATION
SUPPORT WE PROVIDE IS UNIQUE
IT'S LIKE NO OTHER.
AND ENSURES THAT PEOPLE WHO ARE
NOT ONLY.
ARE NOT ONLY INVOLVED IN
COVERAGE BUT ARE ABLE TO UTILIZE
THEIR BENEFITS AND ACCESS THEIR
SPECIALTY CARE.
SO FOR THESE REASONS WE
RESPECTFULLY REQUEST YOUR
SUPPORT TO FIND COMMUNITY BASED
OUT REGION ENROLLMENT EFFORTS IN
THE STATE BUDGET AND I'D BE
HAPPY TO ANSWER ANY QUESTIONS
[inaudible]
THANK YOU.
MY DEAR FROM METAMORA.
GOOD AFTERNOON EVERYONE.
YES -- I MANY AT A MINIMUM ORDER
WITH THE CALIFORNIA COVER XIN
HEALTH INITIATIVES -- CCH HIGH
ON DOES THE ACRONYM FOR THE
ORGANIZATION IS A NONPROFIT
STATEWIDE ASSOCIATION OF ALL
WERE -- FORTY AGENCY SERVING IN
MOST COUNTIES IN CALIFORNIA.
C. C. H. I. IS WORKING ON AN
ONGOING BASIS TO SUPPORT THE
ENROLLMENT OUT REACH AND IN.
OPERATION ROOM AND UTILIZATION
AND RETENTION WORK CASE
MANAGEMENT AS WE CALL IT OUT FOR
THE MEDIC CAL COLOR CAL COVER
KILL FORGET POPULATIONS --
ACROSS THE STATE -- WE'VE BEEN
AROUND ALMOST -- TWENTY YEARS
ARE CVO SO WITH OR WITHOUT
FUNDING DO THIS TYPE WORK --
MOST LIKE -- THE EXAMPLES THAT
LINDA PROVIDED -- THESE ARE THIS
IS THE WORK THAT WE DO IN THAT
WE'VE BEEN DOING -- WE USED TO
RENT THE HELL TICKETS PROGRAMS --
THAT WERE -- IN PLACE BEFORE THE
ACA -- AND WITH THE TRANSITION
OF THE SB SEVENTY FIVE
POPULATION -- ARTSY BILLS
CONTINUE TO BE AROUND BECAUSE
ARE WELL KNOWN IN THE COMMUNITY --
AND WITH THE AGAIN WHAT THE
EIGHT ACA -- IMPLEMENTATION THEY
THAT POPULATION.
TO SO -- WE C. C. H. I. IS THE
SUPPORT AT SEA BANDS -- PROPOSAL --
IT AS WE SEE IT AS A
COMPLEMENTARY PROPOSAL THAT
WE'RE PUTTING -- FOR THE AMOUNTS
ARE THE SAME YOU HAVE THEM --
WITH YOU -- C. C. H. I. IN
ADDITION TO ITS MEMBERSHIP WE WE
PARTNER WITH CENTER IN FIFTY
GRASSROOTS CULTURALLY AND
LINGUISTICALLY COMPETENT CV ELSE
THAT ARE.
TRUSTED MESSENGERS AND THE
COMMUNITY THAT HAVE BEEN AROUND --
TO SUPPORT WITH THE CURRENTLY
WHAT THE PUBLIC CHURCH -- SOCIAL
MEDIA AND SORT OF THREAT -- FOR
INDIVIDUALS THAT ARE
UNDOCUMENTED IN THIS -- COUNTRY
AND IN CALIFORNIA FOR THAT
MATTER.
AND THERE INDIVIDUALS THAT --I
WAS IN A SISTER MYSELF -- IN THE
PAST AND WE WERE.
WHERE THE TRUST MESSENGERS ASKED
ME SIEU ON A COMPROMISE THAT
THIS THIS PROPOSAL THAT WE'RE
PUTTING FOR ITS IN PARTNERSHIP
WITH?
THE SENATE COMPROMISSO -- THE
NINETY PLUS OPERABLE THOUGHT IS
AND MANY MANY AS SISTERS ACROSS
THE STATE THAT DO THIS WORK --
BECAUSE THEY THEY CARE FOR HER
COMMUNITIES AND ARE PART OF
THEIR COMMUNITIES -- THE PRIMARY
FOCUS -- OF THIS -- WILL BE TO
BE READY THAT WERE READY TO TO
SUPPORT THE MEDI CAL EXPANSION
THAT THE GOVERNOR IS PUTTING
FORWARD -- FOR THE MEDICAL
POPULATION -- THE YOUNG THE
YOUNG ADULTS -- THE SERVICES
THAT ARE PROVIDED AGAIN ARE
CULTURALLY AND LINGUISTICALLY
APPROPRIATE STAFF AND
ORGANIZATIONS WHO LIVE AND WORK
IN THE COMMUNITIES THEY SERVE.
THIS REQUEST IS TO BUILD UPON OF
RECENT PAST RECESSES OF THE
ENROLLMENT -- IN SUPPORT THE
PROPOSED EXPANSION OF MEDICAL
COVERAGE AND DEFENSE AGAINST
EFFORTS BY THE FEDERAL
GOVERNMENT AS A REFERENCE TO
THAT IS PUBLIC CHURCH.
IN -- YEAH OR HER WORK IS HERE
TO SUPPORT THE VERY MUCH NEEDED
OP OUTREACH AND EDUCATION THAT
IS NEEDED BEFORE THAT INDIVIDUAL
CHOOSES TO SUBMIT THAT
APPLICATION THROUGH THE COUNTY
SYSTEMS OR THE CAL HERE SYSTEM
THROUGH COVER CALIFORNIA.
THE WORK OF THE A SISTER IS
THERE TO HELP THEM NAVIGATE THE
BERIA'S -- SYSTEMS THAT WE HAVE
IN PLACE FOR OUR INDIVIDUALS
THAT ARE ELIGIBLE FOR MEDICARE
WILL COVER CALIFORNIA AND BY
THAT I MEAN.
THE CAL HERE'S THE CALL SALAS
SYSTEMS AND IMCLONE APPLICATION
PROCESS AND IN PERSON PROCESS.
THAT OBVIOUS CUMBERSOME -- IN IT
IT WORKS DIFFERENTLY IN
DIFFERENT AREAS COUNTIES --
ACROSS THE STATE [inaudible]
THANK YOU.
CAMPBELL THE PART OF HEALTH CARE
SERVICES -- I WAS NOT A PART OF
THE GOVERNOR'S PROPOSAL SO ASIDE
FROM THE FISCAL -- THAT'S
ALREADY BEEN MENTIONED I THINK
WE WOULD JUST WANT TO MAKE SURE
THAT WERE HAVING IF TO THE
DEGREE THIS WAS INCLUDING THE
FINAL BUDGET THERE ARE LESSONS
LEARNED FROM THE LAST TIME.
THAT WE HAD THIS TYPE OF PROGRAM
I THINK THERE WERE SOME
ADMINISTRATIVE COMPLEXITIES AS
WELL AS I'D I DON'T THINK IN THE
END WE GOT AS MANY PEOPLE TO
RETAIN COVERAGE AND I THINK
THAT'S LAID OUT IN THE AGENDA
PRETTY WELL THAT WE WOULD HAVE
HOPED.
IN TERMS OF THE NUMBERS AT THE
END OF THE DAY AND SO CERTAINLY
TO THE DEGREE THIS IS SOMETHING
THAT IS INCLUDED IN THE FINAL.
BUDGET WITH BETWEEN HE
LEGISLATURE AND THE GOVERNOR WE
WOULD WANT TO MAKE SURE WORK
WERE LEARNING FOR WHAT WE DID
LAST TIME AND SEE IF WE COULD --
IMPROVE ON THOSE RESULTS IF IF
THIS IS SOMETHING THAT'S GOING
TO CONTINUE [inaudible]
THANK YOU.
QUESTIONS COMMENTS FROM THE
COMMITTEE.
I I DO WANT TO ASK -- C. C. H.
I.. TO PLEASE EXPLAIN HOW YOUR
PROPOSAL IS DIFFERENT.
FROM OR SUPERIOR TO THE C. P. H.
AND PROPOSAL.
THANK YOU -- ASSEMBLY MEMBER
RIGHT YES -- WE AS MERRY NOTED --
BECAUSE OF THOSE COMPLICITY SO --
THAT TOOK PLACE -- WERE
REQUESTING THAT THAT IF IN FACT
WE DO HAVE A MEDI CAL EXPANSION
OR FUNDING AVAILABLE FOR CB ELSE.
THAT EQUALS THREE THIRD PARTY
ENTITY THAT CAN HELP GET THOSE
FUNDED OUT TO THE CV ELVES ARE
WORKING WITH COMMUNITY MEMBERS
DIRECTLY.
THAT WILL BE THE MAIN --
DIFFERENCE THAT WE SEE.
IT DOES AND DOES YOUR PROPOSAL --
INVOLVE KEEPING A PORTION OF THE
FUNDS -- IF SO FOR WHAT PURPOSE
FOR MINISTRATIONS TRADE.
MORE THAN ANYTHING PARTNERSHIP
ADMINISTRATIVELY SO THAT WE CAN
KEEP TRACK AND BUT BILLS THAT WE
HAVE.
WHILE THE THIRD PARTY OR THE
SORT OF COOL BE A MINISTRY IN
THAT -- YOU KNOW I WILL THINK
IT'S IT WILL BE UP TO THE THE
PROCESS THAT WE HAVE HERE -- BUT
IT WILL BE FOR IT AND MINISTRY
BILLS ONCE AND GETTING BILLS OUT
AS QUICKLY AS POSSIBLE -- IS
THERE A PERCENTAGE THAT IS
EXPECTED TO BE -- UTILIZE FOR
ADMINISTRATIVE PURPOSES -- FROM
THE THIRTY THOUSAND THIRTY
MILLION. THIRTY THIRTY BILLION --
I YOU KNOW -- I DON'T HAVE THE
PERCENTAGES IN FRONT OF ME BUT I
BELIEVE -- THE CONVERSATION HAS
BEEN IN THE 5% 210% AT THE MOST.
ANY WILL BE MIRROR -- WITH OTHER
FUNDING -- AND SORT OF OPEN FOR
RECOMMENDATIONS ON THAT.
AND YOU KNOW THE DEPARTMENT
HEALTHCARE SERVICES CAN SPEAK TO
THAT -- TOO I DON'T KNOW IN
TERMS OF WHEN THOSE MONIES WERE
ALLOCATED FOR THE A. B. EIGHTY
TWO HOW MUCH WAS IT THAT THE
STATE KEPT.
FOR YOU NOTICE READING THOSE
FUNDING.
GET IN IT THEN ANOTHER QUESTION
IS HOW DOES.
THIS METHOD.
INCREASE EFFICIENCY WITH HEALTH
MANAGERS.
AND BY EXTENSION INCREASING
ACCESS TO MEDICAL [inaudible]
HELP MANAGERS.
THOSE WHO ARE GOING TOWARD THE
NAVIGATORS THE NAVIGATORS CAN
YOU REPEAT THAT AGAIN I'M SORRY
HOW HOW IS THAT YOUR PROPOSAL --
BETTER IN MAKING SURE THAT --
THAT THE NAVIGATORS CAN GET TO
THE PATIENTS OR THE CONSUMERS --
BETTER CARE ESPECIALLY THROUGH
ACCESS FOR MEDI CAL.
YES SO -- IN.
YOU KNOW WERE C. C. H. I. HAS
BEEN AROUND FOR ALMOST TWENTY
YEARS OR SO OFFICIALLY
UNOFFICIALLY -- BUT YOU KNOW THE
AS SISTERS THAT WORK WITH THE
FAMILIES DIRECTLY OUR TRADE
INDIVIDUALS THAT DO THE WORK ON
THE GROUND -- IN TERMS OF
GETTING THE MONEY DIRECTLY TO
THEM THEY WILL IT WILL GO TO THE
CBO. TO STAFF THEM AND TO
SUPPORT THEM -- STEP MANY OF
THIS A SISTERS ARE FUNDED BY
VARIOUS STREAMS SO THEY'RE LIKE
CASE MANAGERS OUT THERE WITHIN
THE FAMILY SUPPORT -- FAMILY
RESOURCE CENTERS THE CV ELSE --
THAT ARE PROVIDING OTHER
SERVICES SUCH AS CAL FRESH --
WHICH SERVICES AND AND SO ON
LIKE ALL THE THE SOCIAL
DETERMINANTS OF HEALTH AND THOSE
PROGRAMS THAT.
ARE ARE THERE FOR FAMILIES -- SO
MANY TIMES THE HELL THAT CIS IS
SISTERS ARE CARRYING MULTIPLE
HATS SO IN THIS CASE IT WILL
SUPPORT THAT THEY BECOME FULL
TIME EMPLOYEES AND AND THAT THEY
CAN HELP THEM NAPA HELP THAT
FAMILIES NAVIGATE THE HEALTH
INSURANCE -- PROCESS THE END.
THE THE ISSUES THAT WERE
DESCRIBED EARLIER THE C. P. H.
AND R. THEIR SHOES THAT CAN BE
RESOLVED.
THROUGH THIS PROCESS OR DO YOU
THINK THERE THEY ARE ISSUES THAT
CANNOT BE OVERCOME AND THAT'S
WHY YOU'RE RECOMMENDING IT
COMPLETELY -- DIFFERENT
NAVIGATOR.
NOT NAVIGATOR -- OR ST --
STRAIGHT DISTRIBUTION OF FUNDS
OR WHAT DO YOU MEAN IN OTHER
WORDS IT WAS WITH THE C. P. HM.
AND IF THE PROPOSAL NOW IS TO
HAVE SU CHI DO IT.
BECAUSE THERE WERE ISSUES WITH
C. PAN.
ARE THE ISSUES WE SEE PAN SO
GREAT THAT THEY CANNOT BE
OVERCOME OR CAN -- CAN NEW
PROCESSES BE IMPLEMENTED TO
REMEDY WHATEVER PROBLEMS THERE
WERE THROUGH THE INITIAL --
THROUGH THE SB MANAGERIAL YES --
I THINK IN SOME COUNTIES THE SB
EIGHTY TWO PROCESS WAS VERY
SUCCESSFUL LOS ANGELES ORANGE
COUNTY -- AND OTHERS -- IT WAS
VERY SUCCESSFUL TO FOR COUNTIES
TO A MAN THERE CUT CONTRACT THAT
THEY HAD FOR OTHER SERVICES --
AND THEY WERE ABLE TO DISTRIBUTE
THOSE FUNDINGS IMMEDIATELY TO CV
ELSE OR ON THEIR SCHEDULE RIGHT.
BUT ANOTHER COUNTY SUCH AS SOME
BUT ON THE OTHER RIVERSIDE AND
OTHERS SAN DIEGO YOLO COUNTY AND
OTHERS -- IT WAS NOT AS
SUCCESSFUL AND AND THAT'S WHY
WE'RE RECOMMENDING IT AND WE DO
SUPPORT THE THE CURRENT PROPOSAL
BY SEA PEN.
AND MATERNAL TELEHEALTH ACCESS
AND COMMUNITY -- HEALTH COUNCILS
BUT WE BEAT TRUTHFULLY BELIEVE
THAT -- EITHER A MERGER OR A WE
SEE IT AS A COMPLEMENTARY
PROCESS -- BUT WE DEFINITELY
BELIEVE THAT SEE FEELS WILL BE.
ACROSS THE STATE WILL BE SERVED
BY BY GETTING ESPECIALLY IF WE
HAVE A MEDI CAL EXPANSION --
JULY FIRST TWO THOUSAND AND
NINETEEN THAT SEE FEELS WILL
WILL BE.
SIR QUICKLY -- IT ACROSS THE
STATE RURAL COMMUNITIES INCLUDED --
WITH THIS PROCESS THAT WE'RE
PUTTING.
FOR THANK YOU.
I'D LIKE TO OPEN IT UP FOR
PUBLIC COMMENT AT THIS TIME.
GOOD AFTERNOON THANK YOU CHAIR
MEMBERS -- MYSELF AGAIN WITH
COMMUNITY HEALTH INITIATIVE KERN
COUNTY AS A CBO THAT ASSIST
FAMILIES WITH THE ENROLLMENT
PROCESS -- WERE VERY IN SUPPORT
OF THE PROPOSAL -- WE ASSIST
FAMILIES WITH THE ENROLLMENT
PROCESS AND EVERYTHING THAT
COMES AFTER THAT -- WE WORK --
CLOSELY WITH A GUN CONTRACTORS
WITH FROM WHAT THOUGHT AS THAT
THEY GO TO THOSE HARD TO REACH
AREAS OF THE WORK THAT WE DO CAN
BE DONE.
BECAUSE OF THEM BECAUSE THEY GO --
TO THAT THE MY LIST AND THEY GO
TO THE SUPERMARKET AND THOSE ARE
THE HARD TO REACH AREAS AND FOR
THAT REASON WEARING VERY SUPPORT
OF AB.
THE PROPOSAL TO BE -- TO ALLOW
CBO'S -- TO ASSIST FAMILIES
CONTINUE THE WORK THAT WE
ALREADY DO -- DELIVERING THE
CORRECT INFORMATION -- WITH THE
CURRENT ADMINISTRATION THAT WE
HAVE AT THE FEDERAL LEVEL
BECAUSE OUR IMMIGRANT
COMMUNITIES IN KERN COUNTY ARE
VERY AFRAID.
I THANK YOU.
THANK YOU.
HI MY NAME IS BETTY I'M NOT FROM
KERN COUNTY TO AND I'M WORKING
WITH THE A CHAI I SUPPORT THESE --
BUDGETS PROPOSAL BECAUSE CYCLES
IN THAT THAT MIGHT CONSIDER THAT
MY JOB IS VERY IMPORTANT AS A
PROMOTE THOUGHT A VERY USEFUL --
BECAUSE WHEN I AM I'M GOING OUT
TO REACH PEOPLE AND I DON'T CARE
ANY PLACE IS JUST THAT BODY IT
VISA THERE THAT MY NEIGHBORHOODS
MY MY FAMILY'S EVERYBODY I AM
LOOKING THEIR OF THEIR MORMON.
THE EVERY TIME TO TO PROVIDE
INFORMATION TO PROVIDE EDUCATION
BECAUSE THEY KNOW ME I AM PART
OF THE COMMUNITY AND THEY KNOW
ME THEY KNOW WHAT I AM DOING.
IN THE END THEY UNDERSTAND THAT
I CAN HELP THEM EVEN IF YOU TRY
RECEIVE THE SUPPORT.
IT WOULD BE VERY GRATEFUL
BECAUSE WHICH THEY CAN
INCORPORATE MORE PROMOTE TORRES
MORE BABIES THAT THEY CAN HELP
YOU WITH ACCESS TO HEALTH.
THANK YOU THANK YOU.
GOOD AFTERNOON LINDA WAY WITH
WESTERN CENTER ON LAW AND
POVERTY HERE TEST SUPPORT SEE
PAN A PATERNITY CHILD.
HEALTH ACCESS IS A PROPOSAL
THANK YOU THANK YOU.
HI ON A HOUSE ABOUT WITH UNITED
WAYS OF CALIFORNIA -- WE ARE
SUPPORTIVE OF BOTH THE
STAKEHOLDER PROPOSALS WE WOULD
LIKE TO SEE THEM MERGED INTO ONE
AND AS WE SIT SEE THEM AS PART
OF A SPECTRUM OF THE KINDS OF
OUR REGION AROMA AND RETENTION
UTILIZATION SERVICES.
CALIFORNIA SO STRONGLY NEEDS
ESPECIALLY WITH THE POTENTIAL OF
EXPANDING MEDIC CAL -- TO YOUNG
ADULTS AND AND AND HOPEFULLY TO
HEALTH FOR ALL -- AND WE ALSO AS
INDIVIDUALS AND ORGANIZATIONS
THAT ARE -- VERY COMMUNITY BASED --
SEE THE INCREDIBLE VALUE OF FROM
THE TARAS AS WELL AS OTHER
NAVIGATORS -- WHO REALLY HAVE
THE I'M TRUST OF THEIR
COMMUNITIES -- AND SO WE JUST
WANTED TO PUT AN EMPHASIS ON
THAT PROPOSAL AS IT YOU KNOW
VERY VALUABLE TO TO OUR
COMMUNITIES AND ENSURING THAT
THEY UNDERSTAND NOT ONLY WHAT
THEY'RE ELIGIBLE FOR BUT HOW TO
NAVIGATE A COMPLEX MEDICAL
SYSTEM THANK YOU SO MUCH.
THANK YOU.
HELLO I WAS INDUCED -- ON BEHALF
THE CHILDREN'S DEFENSE ON A
CALIFORNIA ONE OF REPEAT WHAT --
MY COLLEAGUE FROM UNITED WAYS
JUST SAID SO WE'RE IN SUPPORT OF
BOTH PROPOSALS AND HOPE THEY ARE
MERGED TOGETHER WE ARE STRONGLY
SUPPORTIVE OF ADDITIONAL FUNDING
SO THAT EVERY PERSON IN
CALIFORNIA WHO IS ELIGIBLE.
FOR COVERAGE GETS ENROLLED IN
THE BEST COVERAGE AT THAT IS
MOST SUITABLE FOR THEM THANK YOU.
THANK YOU.
ABIGAIL REMAINS WITH THAT THE NO
COLLISION FOR HEALTHY CALIFORNIA
HERE SUPPORTING T. PENSA
PROPOSAL AND HOPING THAT --
COLLABORATION CONTINUE TO TO
HAPPEN THANK YOU.
THANK YOU.
GOOD AFTERNOON DIPPING ACNE SO
WHAT THE CALIFORNIA IMMIGRANT
POLICY CENTER -- IN SUPPORT OF
THE CALIFORNIA PAN AT THE CULT
NETWORKS -- PROPOSAL I THINK
IT'S PARTICULARLY IMPORTANT TO
US AS HAS BEEN EVIDENCED BY OUR
DECADES OF EXPERIENCE WORKING IN
IMMIGRANT -- IT'S EXTREMELY
IMPORTANT TO HAVE PEOPLE WHO ARE
KNOWLEDGEABLE WHO SPEAK THE SAME
LANGUAGE I'M IN THESE
COMMUNITIES ESPECIALLY WITH THAT
THEY'RE A PUBLIC CHARGE -- AND
AS WE TALK ABOUT THE EXPANSION
OF HEALTH CARE TO UNDOCUMENTED
INDIVIDUALS WE KNOW THE L. TAKE
A PARTICULAR INVESTMENT TO REACH
I'M THESE COMMUNITIES WHO ARE
CURRENTLY LIVING IN FEAR BECAUSE
OF THE FEDERAL ADMINISTRATION
AND ALL OF THEIR TACTICS SO WE
ARE STRONGLY IN SUPPORT.
THANK YOU THANK YOU.
REBEKAH GONZALEZ AND A S. W.
CALIFORNIA WE ARE SUPPORTIVE OF
FUNDING NAVIGATORS -- WE DON'T
HAVE A POSITION ON BETWEEN THE
COMPETING PROPOSALS BUT HOPE WE
CAN COME TO A SOLUTION THANK YOU.
THANK YOU.
HERE AMERICANS FROM THE SENATE
COMPROMISSO OR WE ARE IN SUPPORT
OF THE PROPOSAL SOME FROM CCA
CHAI WE WOULD LIKE TO SEE THOSE
FUNDING.
TO HELP US TO INCORPORATE MORE
PROMOTED AT THIS TIME TO THE WHO
ARE WELL TRUSTED MEMBERS WITH
THEIR OWN COMMUNITY TO ASSIST
INDIVIDUALS AND FAMILIES TO
NAVIGATE THE SYSTEM. TO CONTINUE
BEING A ROLE I RECEIVE SERVICES
AS WELL [inaudible]
THANK YOU.
MY TO GET THE REST OF THE MONTH
SO WITH COMMUNITY HEALTH
INITIATIVE NAPA COUNTY I WE ARE
IN FAVOR FOR THE REQUEST FOR
FUNDS TO SUPPORT STRAINING CBO'S
ALREADY ON THE FRONT LINES.
OF ENROLLING LOW INCOME AND
VULNERABLE POPULATIONS INTO
HEALTH CARE COVERAGE THANK YOU
THANK YOU.
HI MY NAME IS JAMAICA AND I'M
FROM ROOTS COMMUNITY HEALTH
CENTER AND DEEP EAST OAKLAND AND
SAN JOSE.
HEALTH NAVIGATORS OUR COMMUNITY
ROOTED STAFF WHO ARE PART OF THE
HEALTHCARE TEAM.
PROVIDERS HEAVILY RELY ON THE
GATT NAVIGATORS TO HELP
COORDINATE CARE AT ROUTE
NAVIGATORS ARE THE LARGEST
EMPLOYEE CLASS NAVIGATOR
SPECIFIC TO REITS HAVE LIVED
EXPERIENCE WHICH LANDS TO
CLIENTS BEING ABLE TO TRUST IN
THEIR PROVIDERS AS WELL AS THE
HEALTHCARE SYSTEM.
THIS LIVE EXPERIENCE AIDED AND
ROOTS NAVIGATOR SUCCESSFULLY
BEING ABLE TO OUTREACH AND ROLL
OVER SIX HUNDRED CLIENTS PER
YEAR INTO MEDI CAL IN THE
PREVIOUS AB AT TO FUNDING AWARD.
OUR OUTREACH MEANT THAT OUR
NAVIGATORS WERE ABLE TO DOOR
KNOCK EDUCATE AND ENGAGE MEMBERS
OF THE COMMUNITY SO THAT THEY
KNOW OF THEIR ELIGIBILITY AND
THEY'RE MEDI CAL BENEFITS.
THESE CLIENTS ARE FROM THE MOST
MARGINALIZED COMMUNITIES SUCH AS
RE ENTRY PERSONS OF COLOR AND
IMMIGRANTS ALL OF THIS WORK
STARTS WITH THE HELP NAVIGATOR
BEING AN INTERCALATED TO WHOLE
HEALTH CARE.
DEDICATED FUNDING IS CRITICAL TO
ENSURINGFOCUS ON THE MOST
VULNERABLE AND MOST MARGINALIZED
OUT REACH SHOULD BE ONGOING.
THE NEED DOES NOT END THANK YOU
THANK YOU.
THANK YOU MADAM TURN MEMBERS
KATHY SAID KNOWING THAT THE
COUNTY WELFARE DIRECTORS
ASSOCIATION HERE TO SUPPORT THE
C. PEN PROPOSAL.
THANK YOU.
VICTORIA'S STEVEN CONSULTANT FOR
THE INLAND EMPIRE COVERAGE IN
HEALTH INITIATIVE ALSO KNOWN AS
THE I. E. CHAI.
WE SEE THESE PROPOSES IS NOT
COMPETITIVE BUT COMPLEMENTARY
AND WE BELIEVE THAT THEY SHOULD
BOTH BE SUPPORTED BECAUSE
READING MORE THAN ONCE METHOD OF
STREAMING FUNDING.
IT WERE THE C. PEN AND AB AT TO
SYSTEM WORKS WELL IN SOME
COUNTIES IT DOES NOT WORK WELL
IN ALL COUNTIES.
AND THE I. EIGHT IS AT SAM READY
TO RIVERSIDE COUNTY IS EXAMPLE
WORSE NOT WORK WELL IN THE PAST
AND SO ON ALTERNATIVES SUCH AS
THE C. C. H. I. PROPOSAL.
OF USING THROUGH IS THE FUNDING
OF THROUGH CBO'S AND THE THIRD
PARTY WOULD BE EFFECTIVE AND SO
WE WERE SUPPORT BOTH FUNDING.
BUT WE WANT THEM TO HAVE AN
OPTION SO THAT BUT THE FUNDING
CAN BE EFFECTIVELY THE STREAMED
INTO EACH REGION.
L. I. IN A WAY THAT WE CAN
BENEFIT ALL EVERYBODY WHO NEEDS
TO SUPPORT THE DIE EACH AYE IT'S
BEEN DOING THIS FOR A NUMBER OF
YEARS ALONG WITH THE STATE CHAI.
AND WE KNOW WHAT CAN BE DONE IN
OUR COMMUNITIES AND I THINK EACH
COMMUNITY NEEDS COUNTY NEEDS
THOSE OPTIONS SO THANK YOU.
THANK YOU AND I'M GLAD THE I. E.
IS REPRESENTATIVE.
CYNTHIA PRESSURE REPRESENTING
AMPLE HEALTH COMMUNITY HEALTH
CENTER SERVING SIX NORTHERN
CALIFORNIA COUNTIES.
SEE TO SEE CA TRIES REQUEST IS
BUILT ON RECENT PAST EXCESSES ON
THE ENROLLMENT FRONT AND
SUPPORTS THE PROPOSED EXPANSION
OF MEDICARE COVERAGE.
CCH EYES PROCESS WILL BENEFIT
OUR COMMUNITIES ESPECIALLY THE
UNDERSERVED THANK YOU
[inaudible]
THANK YOU.
HI MICHELLE COVER LETTER WITH A
CA YOU CALIFORNIANS STRONG
SUPPORT OF THE C. PEN PROPOSAL
WHICH ALSO WOULD CONNECT
INDIVIDUALS TO COMMUNITY BASED
ORGANIZATIONS TO DO NAVIGATION.
JUST TIED IN WITH THE LARGER
COUNTY AND ELIGIBILITY AND
ENROLLMENT SYSTEM THANK YOU.
THANK YOU.
HI KRISTIN GOLDEN TEST WITH THE
CHILDREN'S PARTNERSHIP IN
SUPPORT OF THE C. PEN OUT REACH
PROPOSAL IN A LARGE DIVERSE
STATE LIKE CALIFORNIA REQUIRES A
VARIETY OF APPROACHES AND HOW TO
REACH FAMILIES FROM.
PROMO TORAS TO COMMUNITY HEALTH
WORKERS -- TO ENROLLMENT AS
SISTERS AND SO WE WERE SUPPORT A
AND INVESTMENTS THAT WOULD
SUPPORT THESE VARIETY TYPE OF
WRITING -- TYPES OF APPROACHES
THANKS THANK YOU.
AFTERNOON MADAM CHAIR AND
MEMBERS SHAUN HOFFMAN WITH
MOLINA HEALTH CARE OF CALIFORNIA
WE DON'T HAVE A POSITION ON THAT
PARTICULAR FUNDING DISTRIBUTION
MECHANISMS BUT WE DO SUPPORT THE
INVESTMENT OF ADDITIONAL
RESOURCES FOR THE HEALTH
NAVIGATORS.
THANK YOU.
HI RENEE COULD MISS THE LOCAL
HEALTH PLANS OF CALIFORNIA IN
SUPPORT OF STEEP AND PROPOSAL
THANK YOU.
NO I BOTTOM ALL REPRESENTING
CALIFORNIA RURAL LEGAL
ASSISTANCE AND THE HAVING OUR
SAY COALITION.
IN SUPPORT OF THE SEAT AND
PROPOSAL AND THEN ON BEHALF ITS
YEARLY FOUNDATION LOOK TO SEE
HOW THE OTHER PROPOSAL CAN.
BEST BE I USED TO STUDY AND THEN
ALSO IMPLEMENT TODAVíA AN
EFFECTIVE WAY TO MAKE SURE THAT
OUR COMMUNITIES HAVE THE OUR
GENERAL IT'S NEEDED SO THAT THE
GET THEM INTO THE HEALTH CARE
THEY NEED THANK YOU.
THANK YOU.
MADAM CHAIR AND MEMBERS OF THE
COMMITTEE MY NAME IS GREGORY
MATHIS AND I'M WITH THE
COMMITTEE HEALTH INITIATIVE OF
ORANGE COUNTY -- KNOWN AS CHECK
CHECK CHECK IS ONE OF THE CHAI'S
THAT RECEIVED THE A. B. --
EIGHTY TWO FUNDING.
THE FUNDS WERE AWARDED TO US BY
THE ORANGE COUNTY SOCIAL
SERVICES AGENCY.
AND CHIAKI HAS THE WHAT A GREAT
WORKING RELATIONSHIP WITH THE
COUNTY OF ORANGE HOWEVER NOT ALL
THE THE CHINESE HAVE THAT --
SAME TYPE OF RELATIONSHIP THIS
IS WHY WE ENCOURAGE THIS
PROPOSAL FOR THIS -- JOINT
FINDING BETWEEN THE COUNTY AND
AND CHINESE.
THE SONS WILL GO A LONG WAYS TO
SUPPORT THE PARTNERSHIP THAT
ALLOWS FOR THE HELP NAVIGATORS
TO SUPPORT THOSE THAT ARE
UNDERSERVED AND COMMUNITY.
THANK YOU.
ANGELA WILLIAMS CALIFORNIA BLACK
HEALTH NUMBER COULD STRONG
SUPPORT OF C. PINS PROPOSAL --
ONE THING JUST TO MENTION IN OUR
TOWN ALL OVER THE LAST TWO YEARS
NAVIGATORS ONE OF THE TOP ISSUES.
PARTICULARLY RELEASED ON ROMAN
IN THE LONG RUN THE NUMBERS FOR
AFRICAN AMERICANS IN THE AFRICAN
IMMIGRANTPOPULATION.
BUT ALSO -- MANY OF THE
PARTICIPANTS FOCUSED ON
NAVIGATION BETWEEN AMONG AND
WITH IN THE SYSTEM -- AND REALLY
WANTED SOME SENSE.
OF EITHER A PROGRAM OR TRAINING --
THOUGH FOCUS ON A VERY
PERNICIOUS ASPECT OR VERSION OF
IMPLICIT BIAS ANTI BLACK RACISM.
OF COURSE WE URGE YOUR SUPPORT
FOR THE CITY PAN VERSION -- IN
TERMS OF THE PROPOSAL AND FOCUS
ON ANTI BLACK RACISM AND ALSO
NAVIGATORS.
OF COURSE FOR ENROLLMENT BUT
WITHIN THE SYSTEM ITSELF THANK.
THANK YOU.
GOOD AFTERNOON BY THE KAPITEL
WITH COMMITTEE HEALTH COUNCILS
WE'VE BEEN IN ENROLLMENT
ENTITIES SINCE NINETEEN NINETY
SEVEN I CANNOT STRESS THE
IMPORTANCE OF THIS WORK WE
CANNOT DISCOUNT THIS WORK
ANYMORE.
I MY BIGGEST TAKEAWAY FOR YOU
ALL IS TO UNDERSTAND THAT THE
AND ROLLERS ARE BRIDGING THE GAP
BETWEEN VULNERABLE COMMUNITIES
AND A COMPLEX HEALTHCARE SYSTEM.
WE NEED TO START PRIORITIZING
THEM AS THEY ARE CRUCIAL TO OUR
HEALTHCARE WORKFORCE AND
ENABLING HEALTH YOUR LIVES IN
THE STATE OF CALIFORNIA THANK
YOU.
THANK YOU.
GOOD AFTERNOON ERIC HARRIS WITH
MARCH OF DIMES HERE IN SUPPORT
OF THE SUPER PROPOSAL THANK YOU.
THANK YOU.
HI GOOD AFTERNOON NOT IN A
COMMUNITY FROM YOU FOR IS MY
LAST COMPANY WE ARE SUPPORTING
THESE PROPOSED SIDE WE ARE FINAL
TCO TIES.
PRONE. TO DOES SAND.
ELEVEN AND WE ARE PART OF THE
COMMUNITY WE NOTED THE NEEDS OF
THE COMMUNITY WE KNOW IT
IMPORTANCE THAT IS NOT ON IT
ENROLLMENT IRRITATION.
IS YOU FORMED A COMMUNITY WE
NEED THAT BUDGET TO CONTINUE
WORKING WITH THE COMMUNITIES
THANK YOU THANK YOU.
GOOD AFTERNOON JEANETTE BECAUSE
MINE I'M WITH DIGNITY HEALTH CHI
AND IT'S REALLY IMPORTANT THAT
REACH OUT. TO THE RURAL
COMMUNITIES WHICH THE PROMOTE
BUT I DOES THE TRUST IS IN THE
COMMUNITIES AND I THINK IT'S
VERY IMPORTANT THAT WE RETAIN
THAT.
INFORMATION AND THAT WE GIVE OUT
THE INFORMATION TO THE COMMUNITY
SO THAT WE CAN GET THOSE NUMBERS
AND THE COMMUNITY TRUST US THANK
YOU.
THANK YOU.
WITHOUT THE NORM MY NAME IS
MARIA MARTINEZ.
HA I PROPOSE SO I SUPPORT HIS
PROPOSED THINK [inaudible]
THANK YOU.
HI GOOD AFTERNOON MY NAME IS
VERONICA FLORES I SUPPORT THIS
PROPOSAL BECAUSE I LIKE I MEMBER
OF CH I. I SUPPORT THIS PROPOSAL
LIKE THAT PROMOTE THE LIKE UPPER
MADONNA.
I SUPPORTED THESE PROPOSED LIKE
THAT ANY MEMBER OF THE COMMUNITY
I KNOW THAT MANY PEOPLE IS
WAITING INFORMATION.
IT UP FOR DID REASON I SUPPORT
THIS PROPOSAL THANK YOU THANK
YOU.
RIGHT NEXT CALIFORNIA DISABILITY
RIGHTS WE HAVE NO -- WE CAN NEW
TRUMBULL FOR FOSSILS WE SAY
WHATEVER HELPS PEOPLE GET
COVERED THAT'S WHAT WE NEED TO
DO AND WE PROBABLY NEED TO REACH
OUT AND EXPAND MORE REASONABLE
ACCOMMODATION.
PROGRAMS TO MAKE SURE IF YOU
HAVE LOW NUMBERS MAYBE NOT
EVERYBODY CAN UNDERSTAND WHAT'S
HAPPENING AND WHAT'S GOING ON SO
MAYBE -- MORE SIGN LANGUAGE
INTERPRETERS ANOTHER CUT OTHER
LANGUAGES MAYBE PERHAPS MORE
MATERIALS IN OTHER LANGUAGES FOR
FOR FOR THOSE WITH DISABILITIES
THAT MAY BE SOMETHING YOU GUYS
MIGHT WANNA LOOK INTO IF YOU'RE
TRYING TO ROLL MORE PEOPLE INTO
THE SYSTEM [inaudible]
THANK YOU.
RONALD COMING HERE ON BEHALF OF
HEALTH ACCESS CALIFORNIA WE
STRONGLY SUPPORT THE PROPOSAL BY
SEE PAN MATERNAL CHILD HEALTH
ACCESS AND ALSO COMMUNITY HEALTH
COUNCILS THANK YOU.
THANK YOU.
WITHOUT THE GNOMON CHAIR
INCOMPETENT MY NAME IS HALEY
MORALIS I'M DOOR WITH H. CHI AND
I THOUGHT FROM WHAT THE WHAT I
SUPPORT THESE ON THE TOOL --
PROPOSAL THANK YOU.
THANK YOU.
MARIA CRUZ RCH I PROMOTE THE
RECORD COUNTY.
IN AS A PROMOTER OR NOT WE
SUPPORT THESE BOTH ON THANKS
THANK YOU.
HELLO MY NAME IS LUCY QUESTION
ELLA I'M HERE ON BEHALF OF
MATERNAL AND CHILD HEALTH AXIS
TODAY IN VERY STRONG SUPPORT OF
THE C. PEN PROPOSAL.
I'M ELATED TO HEAR SUCH STRONG
CONSENSUS ABOUT THE ESSENTIAL
FUNDAMENTAL IMPORTANCE OF THIS
WORK.
UNDER BOTH PROPOSALS THE
COMMUNITY WORKERS WHO DO THIS
CRITICAL SERVICE.
IT'S THE SAME THERE'S NO
DIFFERENCE BETWEEN A COMMUNITY
BASED ORGANIZATION IF YOU WANT
TO CALL IT THAT WAY OR A CLINIC
CONSORTIUM IF YOU WANT TO THINK
OF IT THAT WAY OR PROMOTE THE
WATER.
UNDER BOTH PROPOSALS ALL OF
THESE TYPES OF WAYS OF
DELIVERING SERVICE IN THE
COMMUNITY WOULD BE COVERED.
THE FUNDAMENTAL DIFFERENCE
BETWEEN THE TWO PROPOSALS AND
WITH ALL DUE RESPECT I DO NOT
SEE THEM AS COMPLEMENTARY THEY
ARE DIFFERENT.
THE KEY DIFFERENCE IS THAT UNDER
THE C. PEN PROPOSAL THERE'S A
BUILT IN STRUCTURE OF
TRANSPARENCY AND ACCOUNTABILITY.
UNDER THE OTHER PROPOSAL THERE'S
A SUGGESTION THAT IN INTERESTED
AND TO TEA RECEIVE THE FUNDS AND
MAKE THE DISTRIBUTION.
AND I HAVE A FUNDAMENTAL PROBLEM
WITH THAT I HOPE THE MEMBERS CAN
ALSO SEE THAT FOR TRANSPARENCY
AND ACCOUNTABILITY WE CAN'T BE
GRANTING THE FUNDS TO ONE OF THE
INTERESTED ORGANIZATIONS.
I ALSO WANTED TO ADDRESS ONE OF
THE COMMENTS BY THE DEPARTMENT
UNDER THE A. B..
EIGHTY TO PROCESS THAT WE HAD IN
CALIFORNIA WHERE THESE FUNDS
WERE DISTRIBUTED.
A MY UNDERSTANDING OF THE MAIN
COMPLEXITY FOR THE DEPARTMENT
WAS THAT IT INITIALLY STARTED
WITH TWO TYPES OF PROGRAMS ONE
WAS GRANTS FOR COMMUNITY BASED
ORGANIZATIONS THAT WERE
ADMINISTERED THROUGH THE
COUNTIES.
AND HAD REPORTING FROM THE
COUNTIES THE OTHER WAS DIRECT
THE INVOICING BY INDIVIDUAL
COMMUNITY WORKERS WHO WERE
PROVIDING ASSISTANCE. TO THE
DEPARTMENT OF HEALTH CARE
SERVICES IN SACRAMENTO AND NOT
STILL APART RAPIDLY BECAUSE IT
WAS JUST BEYOND THE CAPACITY.
OF THE DEPARTMENT TO DEAL WITH
SO I AM EAGER TO LEARN FROM THE
DEPARTMENT.
IF THERE WERE OTHER COMPLEXITIES
THAT IT'S REFERRING TO WE WOULD
VERY MUCH APPRECIATE KNOWING
THAT.
OUR MAIN GOAL IS TO MAKE SURE
THAT THE COMMUNITY IS SIR THAT
EVERYONE OF THE ORGANIZATIONS
WHO'VE SPOKEN HERE TODAY GETS
GOOD TECHNICAL ASSISTANCE FROM
THEIR ASSOCIATION.
ABOUT THE FUNDING OPPORTUNITY
AND GETS TO WORK WITH THEIR
COUNTY TO GET THE MONEY OUT THE
DOOR IN THE RIGHT WAY -- WE
WOULD VERY MUCH LIKE TO SEE IN
THE TRAILER BILL WITH THIS
MEASURE WHICH WE REALLY HOPE
WILL BE INCORPORATED INTO THE
STATE BUDGET WE WOULD LIKE TO
SEE A STRENGTHENING.
OF THE CORE STRUCTURE THAT WE
HAD IN PLACE WITH A. B. EIGHTY
TWO SO FOR EXAMPLE WE HAVE BEEN
ASKING FOR A LONG TIME. TO HAVE
A STAKEHOLDER PROCESS
INCORPORATED SO THE DEPARTMENT
CAN HEAR FROM THE COMMUNITIES
ABOUT WHAT THEY NEED TO FEEL
MORE SECURE ABOUT THE PROGRAM
WE'D ALSO LIKE MUCH MORE
TECHNICAL ASSISTANCE FROM THEIR
ASSOCIATIONS SO THEY KNOW ABOUT
THE FUNDING OPPORTUNITY AND THE
DEADLINES.
ON ANOTHER ISSUE HERE IS THE
LEGISLATION IN THE PAST GAVE
SMALL COUNTIES THE OP THE
OPPORTUNITY THE OPTION TO GROUP
TOGETHER.
AND GO THROUGH THE COUNTY
MEDICAL SERVICES PROGRAM MORE
THE SAME S. P. PROGRAM BOARD AND
GET THEIR FUNDING ADMINISTERED
THAT WAY FOR EFFICIENCY AND MANY
GROUPS JUST DIDN'T REALIZE THAT
THEY WERE ACTUALLY GETTING
FUNDED.
BUT IT WAS COMING THROUGH THE
SAME AS PEOPLE ARE SO IN
CONCLUSION I URGE MEMBERS TO
THINK ABOUT TRANSPARENCY
ACCOUNTABILITY THE FUNDS REALLY
SHOULDN'T GO TO AN INTERESTED
PARTY THEY SHOULD BE
ADMINISTERED BY THE STATE
THROUGH THE COUNTIES FOR
EVERYBODY'S BENEFIT.
THANK YOU [inaudible]
THANK YOU.
AND QUESTIONS FROM THE COMMITTEE
[inaudible]
NUMBER [inaudible]
VERY GOOD.
LET'S MOVE THANK YOU PANELISTS --
LET'S MOVE NOW TO ISSUE NUMBER
.
SEVEN OKAY LET'S BEGIN WITH
KRISTEN GOLDEN TESTER.
I ASSEMBLY -- I'M CHRIS
SINGLETON TESTER AND I WANT TO
THANK YOU MADAM CHAIR AND
MEMBERS OF THE COMMITTEE FOR
ALLOWING US TO PRESENT OUR
PROVIDE COVERAGE ENROLLMENT
PROPOSAL.
AND THIS IS -- WE'RE REQUESTING
THAT THE LEGISLATURE INCLUDE IN
THEIR BUDGET THE CREATION OF A
WICK TO MEDI CAL EXPRESS LANE
PATHWAY THIS IS ON BEHALF OF THE
CALIFORNIA CHILDREN'S COVERAGE
PROPOSAL WHICH INCLUDES THE
CHILDREN'S PARTNERSHIP CHILDREN
NOW.
UNITED WAYS OF CALIFORNIA AND C.
C. H. I. AS WELL AS ON MARCH OF
DIMES -- SO WE ESTIMATE THAT
THIS WILL BE ABOUT -- FIVE
MILLION DOLLARS GENERAL FUND IN
THE BUDGET YEAR.
RIGHT NOW THERE'S UP ABOUT HALF
OF THE TWO HUNDRED AND SEVENTY
THAT SEVENTY FIVE THOUSAND
UNINSURED KIDS AND CHILDREN AND
CALIFORNIA.
ARE ELIGIBLE FOR MEDICARE ALL
RIGHT NOW SO REALLY THE WORK IN
ON BEHALF OF COVERAGE FOR
CHILDREN INVOLVES MAXIMIZING
ENROLLMENT GOING TO THE PLACES
WHERE THEY ARE -- ONE SMART
STRATEGY THAT WE'VE COME ACROSS
IS GOING TO OTHER PROGRAMS IN
THE STATE WHERE ARE THESE
CHILDREN ARE FINDING WHICH ONES
ARE NOT ENROLLED IN MEDICAID OUT
AND ROLLED ENROLLING LARGE
NUMBERS OF THEM THERE -- FOR
EXAMPLE THE WICK PROGRAM WHICH
IS A NUTRITIONAL PROGRAM FOR
PREGNANT MOTHERS INFANTS AND
CHILDREN -- HAS RIGHT NOW ABOUT
NINETY THOUSAND OR AND THE MOST
RECENT DATA WE GOT WAS EIGHTY
FOUR THOUSAND CHILDREN THAT ARE
RIGHT NOW ON WAY BACK THAT ARE
NOT ROLLED IN MEDI CAL.
BUT BECAUSE OF THE ELIGIBILITY
RULES EVERYONE OF THEM SHOULD BE
ENROLLED SIMILARLY THERE'S ABOUT
ELEVEN THOUSAND PREGNANT WOMEN
ON THE WICK PROGRAM THAT ARE NOT
ENROLLED.
IN MEDICAID I'LL AND AGAIN
THEY'RE ALL ELIGIBLE.
SO -- THAT'S KIND OF CONCERNING
AS YOU CAN IMAGINE BECAUSE THE
STATE WE KNOW -- THE NAMES AND
CONTACT INFORMATION OF ALL OF
THESE THOUSANDS TENS OF
THOUSANDS OF CHILDREN THAT ARE
ELIGIBLE BUT NOT ENROLLED BUT
THE GOOD NEWS IS THERE'S A
REALLY SMART STRATEGY THAT WE
COULD UTILIZE TO ENROLL THEM
QUICKLY.
USING THE INFORMATION THAT'S
ALREADY BEEN COLLECTED FROM WORK
THIS IS CALLED A OF FEDERAL
MEDICAID LAW -- CALLED EXPRESS
LANE ELIGIBILITY HOW THAT WORKS
IS THAT -- THE WICK INFORMATION
CAN BE USED AS FINDINGS FOR MEDI
CAL SO MEDI CAL DOESN'T NEED TO
RE ASK THESE QUESTIONS AS A NEED
TO RECALCULATE IN COMICS THAT
ARE A WE CAN USE THAT
INFORMATION ALREADY COLLECTED
FROM WAY BACK. TO START A
MEDICAID APPLICATION AND EXPRESS
AND ROLL THEM.
JUST QUICKLY ON THE BUDGET
NUMBERS WE ESTIMATED FIVE
MILLION -- ON THE ASSUMPTION
THAT ARE A LOT OF THE FIRST YEAR
WOULD BE ASSOCIATED WITH SYSTEM
MODIFICATIONS OF WHICH THERE'S A
NINETY TEN MATCH IN MEDICAID
THIS IS A MEDICAID.
ENROLLMENT SYSTEM SO MEDICAID
WOULD COVER ALL OF THOSE COSTS --
OTHER NINETY TEN MATCH -- AND
THEN IN WHEN IT'S IMPLEMENTED
LET'S SAY IT WAS IMPLEMENTED IN
THE FINAL QUARTER OF THE BUDGET
YEAR THAT WOULD BE COVERAGE FOR
THOSE CHILDREN THAT OTHERWISE
WERE NOT ENROLLED OF COURSE ALL
OF THEM ARE ELIGIBLE THEY JUST
HAVEN'T BEEN ROLLED.
AND THEN IN THE NEXT YEAR THE
COSTS ASSOCIATED WITH IT WOULD
BE THOSE ASSOCIATED WITH THE
COVERAGE OF THOSE CHILDREN.
NOW AGAIN -- THIS IS A
COMMITMENT THAT THE STATE HAS
ALREADY MADE ON THIS BEHALF SO
WE'VE REALLY ALREADY INVESTED IN
COVERING CHILDREN THIS IS JUST A
MATTER OF FOR FILLING THAT
PROMISE AND CLEARLY THE
GOVERNOR'S INTENT IS TO MAKE
SURE THAT -- THESE CHILDREN IN
PARTICULAR ARE GETTING EARLY
ACCESS TO CARE WHEN THEY'RE
INFANTS AND SO GOING TO WHERE
THEY ARE MAKES A LOT OF SENSE
THANK YOU VERY MUCH.
THANK YOU.
AMERICAN ALL THE PART OF HEALTH
CARE SERVICES -- YOU KNOW
OBVIOUSLY WILL DEFER TO MY
DEPARTMENT FINANCE COLLEAGUES ON
ANY FISCAL ESTIMATES THAT THE
ADMINISTRATION WOULD HAVE --
FROM AN OPERATIONAL STANDPOINT
THERE WOULD BE SYSTEM CHANGES
AND THINGS THAT WOULD NEED TO BE
MADE -- GIVEN THAT THE DATA
STREAMS RIGHT NOW ARE NOT
ACTUALLY CONNECTED BUT CERTAINLY
THOSE ARE THINGS THAT COULD BE
WORKS THROUGH WHETHER THOSE
COSTS ADMINISTRATIVELY WE HAVE
NOT COSTS ABOUT THAT AMOUNT SO I
CAN'T SPEAK TO THAT EXACT COST
BUT THEN.
DEFERRED TO MISSILE FOR ANY
OTHER FISCAL.
LORI L. AT DEPARTMENT OF FINANCE
BASED ON THIS PROPOSAL LAST YEAR
THE ESTIMATED GENERAL FUND COSTS
FOR THE FIRST YEAR OF
IMPLEMENTATION WERE BETWEEN. TEN
TO TWENTY MILLION GENERAL FUND --
INCREASING TO UP TO TWO HUNDRED
AND FIFTY MILLION GENERAL FUND
THAT FULL IMPLEMENTATION AND IN
ADDITION TO THESE FISCAL
CONCERNS ALL THE FOR TO MY
COUNTERPART FOR THE DEPARTMENT
OF PUBLIC HEALTH TO SPEAK.
TO SOME IMPLEMENTATION
CONSIDERATIONS [inaudible]
THANK YOU.
WE ARE ALMOST APARTMENT A
FINANCE SO FOR THE SIMILAR
PROPOSAL IN TWO THOUSAND
EIGHTEEN THAT OUR PUBLIC HEALTH
HAD ESTIMATED APPROXIMATELY.
SIX HUNDRED THOUSAND GENERAL
FUND TO MAKE SOME CHANGES TO AN
EXISTING WICK PROGRAM.
EXISTING WICKS SYSTEM AT
APPROXIMATELY ONE MILLION
GENERAL FUND TO MAKE CHANGES TO
A NEW WORK SYSTEM WE NOTE THAT --
BECAUSE OF THE TIMING OF THIS
PROPOSAL THAT WOULD ONLY MEAN
NEED TO BEING CHANGES MADE TO
THE NEW SYSTEM NOT THE EXISTING.
SYSTEM AS WAS LAST YEAR -- WE DO
WANT TO NOTE SOME TIMING
CHALLENGES ON AS A LEGISLATURE
ABOUT WITH THIS PROPOSAL -- WE
WOULD ASK THAT YOU CONSIDER
INAPPROPRIATE IMPLEMENTATION
TIMELINE.
THE CURRENT PROPOSAL REQUIRES AN
IMPLEMENTATION TIMELINE OF APRIL
TWENTY TWENTY WHICH WE NEED MEAN
THAT WE WOULD NEED TO MAKE
SYSTEM MODIFICATIONS IN THE
BUDGET YEAR THAT COULD
POTENTIALLY JEOPARDIZE PUBLIC
HEALTH'S FEDERALLY MANDATED
IMPLEMENTATION SCHEDULE FOR THEN
YOU WAKE SYSTEM.
IF THE SYSTEM FAILS TO ME IT'S
IMPLEMENTATION DEADLINE THE US
DEPARTMENT OF AGRICULTURE COULD
IMPOSE SIGNIFICANT PENALTIES ON
THE STATE.
OF THE TIMELINE SHOULD ALSO
CONSIDER THE NEED FOR YOU AS THE
A APPROVAL OF THE MODIFICATIONS
OF THE NEW WORK SYSTEM.
AND FOR PUBLIC HEALTH TO AMENDED
ITS EXISTING VENDOR CONTRACT WE
NOTE THAT THE FEDERAL GOVERNMENT.
MAY REQUIRE INFORMATION
RECIPROCITY BETWEEN THE MEDICAL
SYSTEM IN THE WAKE SYSTEM. TO
INCREASE WHICH PENETRATION FOR
ELIGIBLE BUT NOT AND ROLLED
PARTICIPANTS OF THE CURRENT
PROPOSAL DOES NOT INCLUDE
INFORMATION RECIPROCITY
[inaudible]
THANK YOU.
CAN I RESPOND SOME OF I'M SORRY
COULD I RESPOND TO SOME OF THE
FISHER CAM -- ON ON THE THE
ESTIMATES -- THAT ONE I THINK IN
THAT -- PART OF FINANCE ESTIMATE
FROM LAST YEAR THE THE NOW THIS
IS FROM DEPARTMENT OF FINANCE
SAID THAT THAT WAS AN OVER
ESTIMATE.
AND IT EITHER KIND OF SHOWS IF
YOU LOOK AT THE NUMBERS OF
ENROLLMENT THAT THAT'S BASED ON
IT SHOWS THAT WE'RE EITHER
WILDLY SUCCESSFUL IN AND ROLLING
MORE CHILDREN THAT WE ESTIMATE
ARE.
IN FACT UNINSURED OR WE'VE
IDENTIFIED AND OR WE'VE
IDENTIFIED A BIGGER PROBLEM THAT
MORE CHILDREN ARE UNINSURED AND
NOT ENROLLED AT NEED TO BE
ENROLLED SO IT.
I'M NOT SURE WHICH ONE IT IS BUT
I IF THERE IS A BIGGER PROBLEM
AND THERE'S THAT MANY UNINSURED.
THEN WE HAVE A BIGGER PROBLEM
AND THIS IS A VERY SUCCESSFUL
PROGRAM MORE SUCCESSFUL THAN WE
THOUGHT -- ON THE ON THE WEAK
SIDE WE ARE -- TALKING WITH THE
DEPARTMENT ABOUT THE TIME LINE
AND ON THIS IS ALSO A BILL AB--
FIVE TWENTY SIX PETRA NORRIS AND
SO ON THE AUTHOR IS TALKING WITH
THE DEPARTMENT ABOUT WHAT WOULD
BE US THE TIME LINE THAT WOULD
BE FEASIBLE BASED ON THEIR THEIR
ROLL OUT OF THEIR EXISTING
SYSTEM CHANGES [inaudible]
THANK YOU.
I BEN JOHNSON [inaudible]
VERY GOOD.
DID YOU WANT TO ADD SOMETHING
OKAY.
ALL RIGHT TO QUESTIONS FROM THE
COMMITTEE.
ALL RIGHT LET'S HEAR PUBLIC
COMMENT THEM.
HELLO THOUSAND IS FOR THE
CHILDREN'S DEFENSE FUND OF
CALIFORNIA AND STRONG SUPPORT
WERE ACTUALLY ALMA A CO SPONSOR
OF LEGISLATION AND WE THINK IT
IS -- TERRIFIC WAY TO IDENTIFY
CHILDREN WHO ARE ALREADY
ELIGIBLE -- BUT AN INSURED AND
THIS IS GOING TO HELP -- ALL THE
CHILDREN THAT WE CAN REACH AND
THEIR AND THEIR FAMILIES THANK
YOU.
THANK YOU.
ON A HASSLE BUT WITH UNITED WAYS
OF CALIFORNIA I WOULD ECHO THE
COMMENTS OF MY COLLEAGUES -- AT
THE CHILDREN'S DEFENSE FUND --
AS WELL AS THE CHILDREN'S
PARTNERSHIP THANK YOU THANK YOU.
GALEANO CHILDREN NOW ALSO WANTED
TO SHOW STRONG SUPPORT OF THIS
TIME PROPOSAL AND WANTED TO ECHO
THE COMMENTS THAT WERE SAID
EARLIER THANK YOU.
THIS.
BACK AGAINST ALL OF SANTA S. W.
CALIFORNIA ALSO IN SUPPORT OF
THIS PROPOSAL.
THANK YOU.
OUR GUESTS ON BEHALF THE MARCH
OF DIMES STRONG SUPPORTER AND
I'M CO SPONSORING THE PROPOSAL
WE BELIEVE DAHLE WOMEN'S HAVE
STRONG ACCESS TO THE HEALTHCARE
IN CALIFORNIA THANK YOU.
THANK YOU.
JENNIFER I WITH THE CALIFORNIA
ASSOCIATION HEALTH PLANS ALSO IN
SUPPORT [inaudible]
Q..
UNDER TURNER WITH WITH THE
CALIFORNIA OF HANNAH THANK
HEALTH NETWORK ALSO IN SUPPORT.
THANK YOU.
SHAWN HOFFMAN WITH MOLINA HEALTH
CARE OF CALIFORNIA ALSO IN
SUPPORT.
THANK YOU.
RONALD KOEMAN HERE WE HAVE OF
HEALTH TEXAS CALIFORNIA ALSO
HERE IN SUPPORT THANK YOU.
THANK YOU.
LINDA WAY WITH WESTERN CENTER ON
LAW AND POVERTY ALSO HERE IN
SUPPORT.
THANK YOU.
RAIN X. CALIFORNIA DISABILITY
RIGHTS IN STRONG SUPPORT.
THANK YOU.
THANK YOU SO MUCH FOR FOR THE
THE PRESENTATION -- YOU'RE RIGHT
THESE ARE ALL THINGS THAT WE
ABSOLUTELY MUST LOOK AT IF IF
WE'RE GOING.
TO PROVIDE THE SERVICE THAT WE
THINK WE'RE GOING.
TO I THANK YOU SO MUCH -- AND
NOW I'D LIKE TO GO BACK TO ISSUE
NUMBER -- TWO AND ASK THE
PANELISTS. TO COME FORWARD
PLEASE.
THE MEDI CAL ASSETS TESTS
OVERSIGHT [inaudible]
JIM LAURIE.
GOOD AFTERNOON CHAIRS MEMBERS --
GENTLER THE WESTERN CENTER ON
LAW AND POVERTY -- THE
AFFORDABLE CARE ACT RADICALLY
TRANSFORMED OR MEDI CAL PROGRAM
FOR MOST OF MEDI CAL POPULATION.
IN ADDITION TO ADDING ADULTS
UNDER AGE SIXTY FIVE WITH NO
PREVIOUS LINK TO THE PROGRAM WE
ALSO IMPLEMENTED TO SYNC UP A
SIMPLIFIED INCOME COUNTING ROLE
BASED ON HOW AN INDIVIDUAL FILES
TAXES.
AND ELIMINATED THE ASSETS TEST
OR THE AMOUNT OF PROPERTY AND
OTHER RESOURCES YOU MAY HAVE AND
STILL BE ELIGIBLE FOR THE
PROGRAM.
HOWEVER ADULTS OVER AGE SIXTY
FIVE IN MANY PERSONS WITH
DISABILITIES ARE STILL SUBJECT
TO THE OLD PROGRAM RULES.
RULES THAT ARE BASED ON SSI
ELIGIBILITY RULES.
BY SIMPLIFYING THE INCOME
DETERMINATION AND ELIMINATING
THE ASSETS TEST COUNTIES ARE
ABLE TO ADMINISTRATIVELY VERIFY
ELIGIBILITY IT RE DETERMINATION
FOR MANY RECIPIENTS UNDER THE
NEW RULES BUT VERY FEW UNDER THE
OLD RULES. FOR EXAMPLE IN
SEPTEMBER THE MOST RECENT MONTH
FOR WHICH WE HAVE DATA.
LA COUNTY ADMINISTRATIVELY
VERIFIED AT RENEWAL ALMOST A
HUNDRED THOUSAND CASES USING THE
NEW RULES BUT NO CASES OF
INDIVIDUALS IN THE PROGRAM
SERVING ADULTS OVER AGE SIXTY
FIVE AND PERSONS WITH
DISABILITIES.
PRECISELY THOSE WERE MORE LIKELY
TO LIVE ON A FIXED INCOME
CREATION WE COULD DO A LOT MORE
TO ALIGN THESE TWO SIDES OF THE
MEDICARE PROGRAM [inaudible]
HOWEVER.
ABSENT THAT COOPERATION.
THERE ARE STILL THINGS THAT
CALIFORNIA CAN DO AS AUTHORIZED
BY FEDERAL STATUTE ONE OF THEM
AS YOU HEARD EARLIER IS RAISING
THE INCOME TEST FOR OUR AT
PEOPLE ON THE A AND D. PROGRAM.
ANOTHER WOULD BE ELIMINATING A
RAISING THE ASSETS LIMIT.
AS WELL AS SIMPLIFYING THE RULES
USED TO DETERMINE ASSETS.
FEDERAL LAW REQUIRES THAT STATES
HAVE AN ASSET LIMIT THAT IT'S NO
MORE RESTRICTIVE THAN THE LIMIT
FOR SSI.
FEDERAL GUIDANCE FROM CMS HAS
CLARIFIED THAT THE NO MORE
RESTRICTIVE TEST INCLUDES
ELIMINATING ASSETS
CONSIDERATIONS FOR SUMMER ALL OF
THE PROGRAM'S COMPLETELY.
WHAT CALIFORNIA HAS ADDED SOME
EXCLUSIONS TO ITS ASSET LIMIT?
AT THE OVERALL CAP JUST LIKE THE
OVERALL.
FEDERAL ASSET CAP FOR FED FOR
SSI HAS REMOVED MADE AT TWO
THOUSAND DOLLARS FOR AN
INDIVIDUAL OR THREE THOUSAND
DOLLARS FOR A COUPLE SINCE.
NINETEEN EIGHTY NINE THE CURRENT
ASSET LIMIT PREVENT SENIORS AND
PERSONS WITH DISABILITIES FROM
HAVING ADEQUATE RESOURCES OR
WHETHER CRISIS SUCH AS AN
EVICTION A LEAKING ROOF OR MAJOR
VEHICLE REPAIR.
THE INEQUITIES BETWEEN THE TWO
SIDES OF THE MEDICARE PROGRAM
ARE HIGHLIGHTED AS MANY PEOPLE
ARE NOW AGING INTO THIS PART OF
THE MEDICARE PROGRAM. ONE OF OUR
PARTNERS REPORTED HELPING A
WOMAN WHO LOST HER MEDI CAL WHEN
SHE TURNED SIXTY FIVE BECAUSE
SHE HAD AMASSED A SMALL AMOUNT
OF SAVINGS TO PAY FOR TERMINALLY
ILL HUSBANDS FUNERAL THAT SHE
WAS UNWILLING TO GIVE UP.
SURE REMAIN OFF MEDI CAL UNTIL
SHE ACTUALLY SPENDS THAT MONEY.
OTHER PART ANOTHER PARTNER
REPORTS HELPING AN ELDERLY
INDIVIDUAL WHO WAS EVICTED TO
OBTAIN A RELOCATION FEE TO FIND
A NEW APARTMENT.
BUT BECAUSE HE WAS NOT ABLE TO
IMMEDIATELY FIND A NEW PLACE HE
HAD TO SPEND DOWN THE RELOCATION
MONEY IN ORDER TO KEEP IS MEDI
CAL.
BECAUSE THE COST OF HEALTH CARE
SO HIGH AND LOW INCOME SENIORS
AND PERSONS WITH DISABILITIES
HAVE SO FEW ASSETS TO BEGIN WITH
WHEN FACED WITH A MEDIC WITH THE
OUTDATED MEDI CAL ASSET RULES.
PEOPLE SIMPLY SPEND DOWN THEIR
ASSETS OFTEN ON HEALTH CARE
UNTIL THEY'RE ELIGIBLE FOR
MEDICARE.
THIS PUTS THEM AT RISK OF
FURTHER INSTABILITY ARE
HOMELESSNESS WHEN FINANCIAL
CRISES HAPPEN.
FURTHERMORE THESE RULES ALSO
DISPROPORTIONATELY PUNISHED
SENIORS OF COLOR BECAUSE THEY
ARE MORE LIKELY TO HAVE CASH
STATE SAVINGS INSTEAD OF AN
EXEMPT HOME. FOR EXAMPLE A LOW
INCOME SENIOR WHO OWNS OUT RIGHT
AN EXPENSIVE HOME IN THE BAY
AREA CAN QUALIFY FOR MEDI CAL.
BUT A RENTER WITH THE SAME
INCOME WOULD NOT GET MEDI CAL IF
THEY HAD TWO THOUSAND AND ONE
DOLLARS IN THE BANK.
SYDNEY SIGNIFICANTLY RAISING THE
MEDI CAL ASSET LIMIT WILL
INCREASE FINANCIAL STABILITY SO
SENIORS CAN SAVE FOR CRISIS AND
DECREASE RACIAL INEQUALITY SAID
SENIORS OF COLOR ARE PUNISHED
FOR RACIAL DISPARITIES IN
HOMEOWNERSHIP.
ACCORDING TO A TWO HUNDRED AND
TWO HUNDRED TWO THOUSAND FIFTEEN
STUDY BY THE BY THE KAISER
FAMILY FOUNDATION. TWELVE STATES
PLUS WASHINGTON DC RAISE THEIR
ASSETS TEST AND SOME DID SO
SIGNIFICANTLY IN SUMMER ALL OF
THEIR MEDICAID PROGRAM SERVING
SENIORS AND PERSONS WITH
DISABILITIES.
ARIZONA ELIMINATE AS ITS ASSETS
TEST COMPLETELY TO SIMPLIFY
ELIGIBILITY DETERMINATIONS AFTER
FINDING ADMINISTRATIVE SAVINGS
LARGELY OFFSET BY ANY INCREASE
ENROLLMENT.
WE BELIEVE THE FOLLOWING THREE
CHANGES WOULD DRASTICALLY
DECREASE THE NEGATIVE EFFECTS OF
THE MEDICARE ASSETS TEST.
FIRST WE SHOULD INCREASE THE
OVERALL CAP ON ASSET SO PEOPLE
CAN SAVE MONEY FOR EMERGENCIES
AND INDEX IT SO IT GOES UP EVERY
YEAR.
SECOND SIMPLIFY THE EXISTING
ASSETS EXCLUSIONS TO DECREASE
THE ADMINISTRATIVE BURDEN OF
RENEWING MEDI CAL EVERY YEAR.
MANY PEOPLE SUBJECT TO THE
ASSETS TEST HAVE TO GET
CONSIDERABLE HELP INTERPRETING
FINANCIAL DOCUMENTS OR OBTAIN
ASSESSMENTS ON LOW VALUE
PROPERTIES IN ORDER TO KEEP
THEIR MEDI CAL.
WE THINK LARGER CATEGORIES OF
ASSETS CAN BE EXCLUDED ENTIRELY.
AND THIRD ELIMINATE THE ACID
TEST ASK.
ASSETS TEST FOR THE MEDICARE
SAVINGS PROGRAM.
THESE ARE PROGRAMS OR MEDI CAL
JUST PAYS FOR THE MEDICARE COSTS
RATHER THAN AND ROLLING THE
INDIVIDUAL AND MEDIC HOUSE.
SEVEN STATES PLUS DC HAVE GONE
THIS ROUTE FOR SUMMER ALL OF
THEIR MEDICAL SAVINGS PROGRAMS.
BECAUSE THE STATE IS NOT ON THE
HOOK FOR SOME OF THE MOST COSTLY
EXPENSES ASSOCIATED WITH END OF
LIFE CARE FOR THESE PROGRAMS.
IT COULD BE AN IMPORTANT TESTING
GROUND FOR A COST BENEFIT
ANALYSIS AS WHETHER AN ASSET
TEST CONTINUES TO MAKE SENSE AT
ALL.
WE SHOULD NOT AS A STATE
SIMULTANEOUSLY PROMOTE THE VALUE
OF SAVINGS WHILE PUNISHING THOSE
WHO ATTEMPT TO SAVE BY TAKING
AWAY THE ONLY HEALTH CARE THEY
CAN AFFORD [inaudible]
Q. [inaudible]
THANK YOU.
CALIFORNIA HEALTHCARE SERVICES
SO OBVIOUSLY NOT A PART OF THE
GOVERNOR'S PROPOSALS NO SPECIFIC --
POSITION ON IT I WOULD SAY FROM
AN IMPLEMENTATION STANDPOINT WE
CERTAINLY AGREE THAT THERE ARE
FEDERAL AVENUES THAT WOULD
PERMIT SOME OF THESE CHANGES
WHETHER TO THIS DEGREE YOUR HOW
MUCH I THINK.
THE DEPARTMENT HAS NOT HAVE
THOSE CONVERSATIONS WITH THE EN
MASSE -- THERE IS I WOULD SAY
SOME SUBJECTIVITY ON THE CMS
SIDE AS TO WHAT THEY COULD
APPROVE AND SO WE WOULD HAVE TO
WORK THROUGH THOSE AND AGAIN WE
HAVE NOT HAD ANY OF THOSE
CONVERSATIONS BUT IN ADDITION
THAT OBVIOUSLY THERE WOULD BE
FISCAL COST FROM HAVING
ADDITIONAL.
PEOPLE ON THE PROGRAM THAT WE
HAVE NOT HAD A FISCAL ANNOUNCES
OF THAT DONE AT THIS POINT.
QUESTIONS COME.
TO THIS IS JUST GOING BY WHAT
WHAT WAS THE ORIGINAL LOGIC WITH
THAT.
ASSET TESTING YOUR OPINION.
AT THAT TIME ALL PUBLIC PROGRAMS
HAD AN ACID TEST -- MORE
RECENTLY WE GOT RID OF THE ACID
TEST FOR MOST OF THE MEDICARE
PROGRAM -- IN ADDITION FOR OUR
FOOD STAMPS PROGRAM CAO FRESH WE
FUNCTIONALLY HAVE GOTTEN RID OF
THE ASSETS TEST FOR ANYONE BELOW
2100% OF THE FEDERAL POVERTY
LEVEL -- THE LOGIC AT THAT TIME
THOUGH WAS JUST MUCH MORE
PUNITIVE ON WHO WAS ELIGIBLE FOR
PUBLIC ASSISTANCE AND THE IDEA
WAS THAT YOU NEVER WANTED
ANYBODY WITH ANY SORT OF MEANS
GETTING FOR THAT PUBLIC
ASSISTANCE.
WHEREAS NOW WE'VE MOVED TO
LOOKING AT PUBLIC ASSISTANCE AS
A WAY TO HELPING FAMILIES
STABILIZE AT TO HELPING PEOPLE
ACTUALLY SUSTAIN THEMSELVES.
I I ALWAYS SAID IF WE KIND OF
SAID WE HAD AN ASSET TESTING FOR
PEOPLE WHO WANTED TO PUT MONEY
INTO A FIVE TWENTY NINE THE
COUNTER PEOPLE WANT TO SAVE
MONEY TO AN IRA I MEAN.
YOU WOULD NEVER HAVE ANYBODY
DOING THOSE THINGS BECAUSE IT'S
SO SO DRACONIAN TO NOT ONLY HAVE
THE TO DO AN ACID TEST BUT ALSO
ALL THE PAPERWORK YOU HAVE TO
FILL OUT SO.
ON THIS SAME SORT OF LONG
OVERDUE IN TERMS OF WHAT YOU'RE
WHAT YOU'RE TALKING ABOUT IN
ORDER TO STREAMLINE STREAMLINE
IT I THINK THERE ARE --
REASONABLE CONCERNS ABOUT THE
FISCAL FISCAL SITUATION BUT
HAVING SAYS GIVING THAT YOU KNOW
THAT THE EXTRAORDINARY HIGH
LEVELS OF POVERTY IN OUR STATE.
KNOWING THAT THERE ARE PEOPLE
THAT IF THEY'RE NOT ON THAT
ACCOUNT MAYBE THEY'RE DOING
OTHER THINGS LIKE GOING INTO THE
EMERGENCY ROOM OR THEY'RE NOT.
THEY'RE NOT OUT COOLEY TAKING
CARE OF THEMSELVES WE HAVE TO
PICK UP THE COST SOMEWHERE ELSE
IT SEEMS LIKE.
ON WALL THAT MIGHT.
BE AN INCREASE IN COST OF
MEDICAL AYE IT'S PROBABLY BETTER
FOR THE OVERALL HEALTH.
HEALTH OF THE STATE.
MY ONE QUESTION WAS DO YOU DO
YOU FEEL LIKE THE PROPOSAL AND
MISS CAREERS BUILD THE TEN
THOUSAND FIVE DOLLARS IT'S
REALLY HIGH ENOUGH GIVEN THE
HUGE COST OF LIVING.
IN THE STATE YOU KNOW LIKE TEN
pYOU KNOW I MEAN A GOOD CHUNK OF
THAT COULD EVEN BE FIRST AND
LAST MONTH'S RENT DEPENDING ON
WHERE YOU WORKED WHICH PART OF
THE STATE YOU'RE RENTING IT.
WE WOULD LIKE TO LEMONADE
ENTIRELY.
IF I'M HONEST -- WITH WHICH YOU
CAN'T DO BUT THE QUESTIONS ARE
JUST CURIOUS WHY YOU CHOSE THIS
TWO NUMBERS WELL EITHER.
TAKING IN CONSIDERATION WITH THE
OTHER PIECES OF THE PROPOSAL
THAT ARE EXCLUDING BROAD
CATEGORIES RETIRE EARLY -- SO
FOR EXAMPLE YOU BROUGHT UP
RETIREMENT RIGHT NOW RETIREMENT
IS OFTEN EXCLUDED BUT IT DEPENDS
IF YOU'RE TAKING THE
DISBURSEMENTS AND A LOT OF OUR
LOW INCOME CONSUMERS ARE
HESITANT TO TAKE DISBURSEMENTS
WHEN THEY HAVE A VERY TINY.
RETIREMENT BUCKET TO BEGIN WITH
SO WE PROPOSE EXCLUDING ENTIRELY
AND THERE ARE OTHER THINGS LIKE
LIFE INSURANCE POLICIESWE
PROPOSE ENTIRELY -- BUT WE WOULD
NOT BE OPPOSED TO ANY PROPOSAL
THAT RAISES IT EVEN FURTHER.
GREAT THANK YOU I MAKE IT JUST
IT JUST SEEMS LIKE IF WE
ACTUALLY -- WANT BETTER PUBLIC
HEALTH WE WANT PEOPLE TO BE
INSURED AND AND THIS SEEMS TO
HAVE COUNTER INTUITIVE TO KEEP
THEM.
KEEP THEM OFF MEDI CAL AND I
DON'T KNOW IF YOU HAVE ANY
COMMENTS FOR THE YOU KNOW I MEAN
I AGAIN I THINK -- OBVIOUSLY AT
THE END THE DAY AT THE DECISION
THAT WOULD NEED TO BE MADE AS
PART OF THE BUDGET I THINK WHERE
I JUST COME IN AT THE CAUTION IS.
HOW WHAT THE A MESSAGE RESPONSE
WOULD BE ON WHAT'S REASONABLE
AND HOW DO WE DEMONSTRATE WHAT'S
APPROPRIATE AND SO THAT'S JUST
WHERE WE HAVE NOT HAD THAT
CONVERSATION SO I?
I CAN'T SPEAK TO WHETHER CMOS
WOULD BE FINE WITH THIS OR
SOMETHING HIGHER SOMETHING LOWER
I THINK YOU KNOW THEY'RE
PROBABLY ONLY A COUPLE FEET THAT
HAVE.
AROUND THESE TYPES OF LEVELS --
NEW YORK BEING ONE OF THEM --
THAT IS SLIGHTLY HIGHER THAN
THAT WHAT'S PROPOSED IN THE BILL
BUT IT MOST STATES ARE AROUND
OUR LEVEL SO IT'S JUST THAT
CONVERSATION WITH THE FEDERAL
GOVERNMENT AND WHAT SUBJECTIVITY
THEY HAVE AN APPROVING SOMETHING
LIKE THAT.
IN IN THEIR ONLY RESTRICTIONS AT
THAT WE HAVE A LIMIT THEY DID
THEY DO THEY HAVE SAID AFTER
PROVE OUR LIMIT AB SURVEY DO SO
ANY CHANGE IN OUR PROPOSED ASSET
LIMITS IN ANY EXEMPTIONS ARE ALL
REQUIRED TO GO THROUGH A FEDERAL
APPROVAL PROCESS.
THAT WAS BEFORE.
ALWAYS FIND.
OKAY.
I I I THINK THAT WE WHATEVER WE
COULD DO TO I THINK SUPPORT YOUR
EFFORTS IT WOULD BE GOOD -- TO
GET FROM FINANCE SOME ESTIMATES
OF COSTS EVEN WITH THIS AYE AYE
SOMEONE TO GO TO THIS BILL YOU
START TO GET SOME.
THAT'S NO COST BUT WOULD BE GOOD
SO THAT WE CAN REALLY UNDERSTAND
THAT OF SARS FINANCE COMING UP.
MY GOD GOOD.
NOT GONNA SPEAK FOR FINANCE.
YES.
THANK YOU -- BUT I'M CHAIR
MEMBERS SO GIVEN YOU KNOW OUR
LIMITED RESOURCES AND MAYOR
VISION A WORKLOAD WERE HAPPY TO
WORK WITH YOUR STAFF ON A
PARTICIPATION APPROACH ON ON
TECHNICAL ASSISTANCE.
THANK YOU.
ON THE ESTIMATES I MEAN WE DON'T
HAVE AN ESTIMATE TO PUT ON THE
TABLE EITHER BUT OUR AREAS OF
WORKING WITH CLIENTS WHEN WE
TELL THEM THEY CAN HAVE MEDI CAL
OR THEY CAN HAVE -- AMOUNT OF
ASSETS OVER THE LIMIT.
THEY GET RID OF THOSE ASSETS AND
GO ON MEDI CAL -- IT'S JUST
NORMAL LOW INCOME PEOPLE CAN
AFFORD HEALTHCARE YEAH AND AGAIN
THAT WHICH IS WHICH IS LIKE A
HORRIBLE DECISION.
BECAUSE IT MEANS THAT THEY ARE
PUTTING.
THEIR FAMILIES AT MUCH GREATER
RISK RIGHT IT'S NOT THAT'S NOT
THE BEHAVIOR WERE.
WE WALKED RIGHT WE'RE NOT SAYING
DON'T DON'T HAVE A CAR WHEN I
THINK DON'T PICTURE CARD DON'T
DON'T.
DON'T WHATEVER RIGHT IT JUST
THAT THAT DOES MAKE A SENSE.
OKAY.
THANK YOU VERY MUCH.
BUT IT WOULD BE GOOD FOR
FINANCED OF IF YOU COULD.
HELP US THINK THROUGH WHAT WHAT
A WHAT A NUMBER OF MIGHT BE THAT
BE GREAT.
THANK YOU MISTER FRAZIER JUST
ONE QUESTION WHEN YOU TALK ABOUT
THE FEDERAL PROCESS FOR APPROVAL
HOW LONG IS THAT [inaudible]
SORRY.
LAUGHED OUT LOUD.
IT CAN VERY SO JUST SO YOU
UNDERSTAND OUR PROCESS SO ONCE
WE SUBMIT A PROPOSED STATE PLAN
AMENDMENT TO CMS THEY HAVE
NINETY DAYS. TO RESPOND WITH
EITHER ADDITIONAL QUESTIONS
WHICH I IN MY EXPERIENCE 95% OF
THE TIME THEY HAVE QUESTIONS --
ONCE THEY SEND THOSE QUESTIONS
THE CLOCK STOPS.
AND WE HAVE TO RESPOND TO THEM --
ONCE WE ARE ABLE TO SUBMIT THAT
THE AGAIN HAVE NINETY DAYS SO IT
WE HAVE STATE PLANS THAT CAN BE
APPROVED IN THE NINETY DAY TIME
PERIOD AND WE HAVE STATE PLANE
AMENDMENTS.
DATING BACK.
TO TWENTY SEVENTEEN SO I SO
SOMEWHERE BETWEEN THREE MONTHS
AND THREE YEARS.
SO GOOD ESTIMATE FOR IT.
IT REALLY HAS TO DO WITH SORT OF
THE FEDERAL PROCESS AND HOW --
BOTH WHAT WHAT ARE THE EFFORTS
REQUIRED ON OUR SIDE BUT REALLY
SORT OF WHAT'S THE EFFORT ON THE
FEDERAL SIDE AND IF THEY HAVE A
LOT OF CONCERNS OR ISSUES
TYPICALLY THE DOING ADDITIONAL
QUESTIONS IS A IS A METHOD FOR
DELAYING THE IMPLEMENTATION.
DO YOU GENERALLY SEE THE
QUESTIONS A COME BACK OR A
MATTER OF JUST TRYING TO BE
RELEVANT OR ARE THEY ACTUALLY
AFFECT FACTUAL QUESTIONS FOR ME
OR THEY JUST WANT TO PROLONG.
THE BUREAUCRACY BECAUSE I MEAN
THIS IS THIS IS AFFECTING
PEOPLE'S LIVES.
BUT AGAIN I WOULD SAY IT VARIES
I THINK IT REALLY DEPENDS ON THE
ISSUE -- AND HAVING NOT
PERSONALLY GONE THROUGH A STATE
PLAN PROCESS WITH RESPECT TO
ASSETS UP MYSELF I CAN'T SPEAK
TO WHAT THE FEDERAL GOVERNMENT'S
VIEWPOINT IS OR WHETHER.
THE PROCESS WOULD BE COMPLICATED
OR NOT I THINK IT IT REALLY IS
IT IS A YOU KNOW AS WITH
ANYTHING IF YOU CAN DELAY A
PROCESS BECAUSE YOU DON'T LIKE
THE THE OUTCOME THAT IS A YOU
KNOW A TACTIC THAT SOMETIMES IS
TAKEN SOMETIMES IT'S JUST THAT
IT'S COMPLICATED -- AND EVEN ON
THE FEDERAL SIDE REGARDLESS OF
THE PROGRAM STAFF JUST LIKE HERE
YOU KNOW WHEN OUR STATE OUR
DEPARTMENT HEALTH CARE SERVICES
STAFF -- THAN THERE ARE THEY
ALWAYS HAVE TO GO THROUGH THEIR
LEGAL COUNSEL AND THERE AND
BUDGET IMPACT AND STUFF LIKE
THAT THAT I THINK CAN DELAY THE
PROCESS JUST BECAUSE OF DEPENDS
ON WHAT LAYER OF LIKE APPROVAL
HAS TO GO THROUGH WHETHER IT'S
SORT OF MORE.
STANDARD OR UP THROUGH THE
HIGHER LEVEL SO IT IT'S REALLY
HARD TO SAY JUST BECAUSE IT IS
IT IS SOMETHING WE HAVE AT LEAST
I HAVE NOT DONE.
IN MY EXPERIENCE IN THE LAST
EIGHT YEARS AND SO I JUST I
CAN'T SAY WHETHER IT WOULD BE
SOMETHING EASIER HARDER IN
BETWEEN.
ALL I CAN SAY IS APPRECIATE YOUR
PATIENCE.
THANK YOU.
SO DEPARTMENT FINANCE THEN
YOU'LL BE WORKING WITH -- CHAIR
TING STAFF TO MAKE SURE THAT WE
GET THAT INFORMATION.
YES I'LL BE WORKING WITH THEM.
MISS MARGOLIS ON THAT.
VERY GOOD THANK YOU.
ALL RIGHT PUBLIC COMMENT --
MADAM CHAIR AND MISTER CHAIR I
WOULD JUST NOTE THAT WHEN THE
ASSET TEST WAS PUT IN PLACE
GEORGE DEUKMEJIAN WAS GOVERNOR --
WHICH TELLS YOU HOW LONG IT'S
BEEN IN PLACE AND ON CHANGED AND
I CAN'T QUITE PULL UP ON MY CELL
PHONE OUT HOW MUCH INFLATION
WE'VE HADN'T HEALTHCARE IN THOSE
YEARS.
BUT IT'S BEEN A LOT HUNDREDS OF
PERCENT AND SO WE STRONGLY
SUPPORT THIS PROPOSAL AND
PARTICULARLY THE REQUIREMENT
THAT IT AUTOMATICALLY ESCALATE
OVER TIME THANK YOU [inaudible]
THANK YOU.
RAINY X. CALIFORNIA DISABILITY
RIGHTS THIS.
AND MYSELF THIS ACTUALLY AFFECTS
ME BECAUSE WHAT HAPPENS IS EVERY
TIME WE DO A MEDICARE RENEWAL WE
HAVE TO FILL OUT THE FORM.
AND EVERY TIME TO FILL OUT THAT
FORM YOU HAVE TO MENTION EVERY
BIT OF CASH CHECK MONEY ANYTHING
YOU GET SO WHEN THEY FILL A NEW
GUY TO MAKE SURE YOU DON'T HAVE
TWO THOUSAND DOLLARS IN THE BANK
TO BEGIN WITH.
BUT YOU CAN HAVE A CERTAIN
AMOUNT OF ASSETS EITHER SO
PEOPLE CAN'T BE GIVING YOU MONEY.
BECAUSE YOU HAVE TO ROUTE
DECLARE IT YOU CAN'T BE WINNING
MONEY YOU HAVE TO DECLARE IT.
AND THEN WHAT HAPPENS IS IF YOU
GO OVER THE AMOUNT YOU'LL GET A
LETTER FROM.
CMS THIS IS NOW YOUR SHARE OF
COSTS HIS DEATH.
AND THAT IS THERE SHE'S RIGHT
MORE PEOPLE ARE MORE LIKELY TO
EITHER A QUIT THEIR JOB.
OR SELL OUT THEIR ASSETS OR GIVE
EVERYTHING AWAY JUST SO THEY CAN
HAVE MEDICAL COVERAGE AND AS
BETH CAPELL.
HEALTHCARE COSTS HAVE GONE UP
AND AM NOT PASTE UP DID WITH THE
HOW MUCH YOUR ACID TEST IS SO AS
A PERSON WHO KNOWS THIS.
AND I HAVE TO FILL THAT FORM
EVER QUARTERLY.
I CAN TELL YOU WE NEED DESKS.
THANK YOU.
KURT CHILD DISABILITY RIGHTS
CALIFORNIA WHERE IN STRONG
SUPPORT THANK YOU.
ON A HASSELBLAD WITH UNITED WAYS
WERE IN STRONG SUPPORT -- AND
YOU KNOW I THINK ONE OF THE
THINGS THAT WE REALLY THINK
ABOUT IN OUR WORK IN COMMUNITIES
IS THE ABILITY TO TO ACTUALLY
BUILD ASSETS INTO T AND
HEALTH COVERAGE IN CARE -- WITH
FINANCIAL STABILITY -- AND ENDED
INDEPENDENCE -- AS WE BELIEVE
THIS PROPOSAL HELPS GET AT THAT
AND TAKES CARE OF SOME --
UNNECESSARY COMPLICATIONS THANK
YOU THANK YOU.
REBECCA GONZALEZ NE SW
CALIFORNIA ALSO IN STRONG
SUPPORT THANK YOU.
ELIZABETH HAS BEEN -- SOME
BEHALF OF THE COUNTY WELFARE
DIRECTORS OF CALIFORNIA IN
SUPPORT SEASON COUNTY WELFARE
DIRECTORS ASSOCIATION SUPPORT
THANK YOU THANK YOU.
HI MICHELLE CABINET I WITH SCA
YOU CALIFORNIANS STRONG SUPPORT.
THANK YOU.
HI SEAN OFTEN WITH MOLINA HEALTH
CARE OF CALIFORNIANS SUPPORT.
THANK YOU.
HI KELLY MAC MILLAN MY BEHALF
THE CALIFORNIA DENTAL
ASSOCIATION IN STRONG SUPPORT.
THANK YOU AND I WANT TO THANK
OUR PANELISTS -- THIS IT IS LONG
OVERDUE.
OF I'D LIKE TO NOW WELCOME THE
TWO PANELS FOR ISSUE NUMBER.
EIGHT THE FINAL ISSUE.
ALL RIGHT LET'S DO PANEL.
ONE LET'S BEGIN WITH JENNIFER
CAM.
HELLO GOOD EVENING -- SO.
I THINK YOUR AGENDA DOES THAT
REALLY -- NICE JOB OF LAYING OUT
THE GOVERNOR'S EXECUTIVE ORDER
BUT JUST FOR KIND OF A QUICK
OVERVIEW THERE ARE THREE AND
STREAMS OF WORK THAT ARE BEING
DONE PURSUANT TO THE GOVERNOR'S
EXECUTIVE ORDER -- THE FIRST --
IS UNDER WAY WITH THE DEPARTMENT
OF GENERAL SERVICES AROUND THE
BOOK PURCHASE SEEN -- AND FOR
FOLKS THAT ARE NOT AS FAMILIAR
WITH.
HOW WE AND DDS ARE VERY
DIFFERENT -- I LIKE TO EXPLAIN
IT IN SIMPLE TERMS AND THAT TGS
PURCHASES DRUGS FOR
INSTITUTIONALIZED POPULATIONS
AND SO IF YOU ARE A JAIL A
COUNTY JAIL OR DEPARTMENT OF
CORRECTIONS OR DEPARTMENT OF
STATE HOSPITALS OR ONE OF THOSE
STATE DEVELOPMENTAL CENTERS --
YOU WORK WITH THE GS TO PURCHASE
A CERTAIN KIND OF DRUG IN A
CERTAIN AMOUNT THEY GO THEY
NEGOTIATE THE CONTRACT BUT THEY
DELIVER THE DRUG TO THAT
INSTITUTIONAL FACILITY AND IT'S
DISTRIBUTED TO PATIENTS
ACCORDINGLY -- AS A PAYER --SO
IN TERMS OF HOW MEDI CAL
OPERATES WE DON'T PURCHASE DRUGS --
AS A AS A HARD AS YOU KNOW KIND
OF COST IS WHAT WE DO IS WE HAVE
AGREEMENTS WITH MANUFACTURERS --
A PATIENT WILL GET A SCRIPT FROM
A PHYSICIAN THEY WILL GO TO A
PHARMACY THE PHARMACY WILL FILL
THE PRESCRIPTION WE REIMBURSE
THE PHARMACY BOTH THE
ACQUISITION COST IN THE
DISPENSING FEE -- WE HAVE TWO
KINDS OF REBATES THAT WE
NEGOTIATE -- ONE IS A FEDERALLY
MANDATED REBATE FOR ALL DRUGS
BOTH FEE FOR SERVICE AND MEDI
CAL MANAGED CARE.
AND THEN WE AS A STATE HAVE
NEGOTIATED SUPPLEMENTAL REBATE
SINCE NINETEEN NINETY FOUR WITH
MANUFACTURERS IN FEE FOR SERVICE
AND SO ANY DRUG THAT IS SOLD --
IN A CALIFORNIA PHARMACY -- AND
WE HAVEN'T SUPPLEMENTAL REBATE
IN PLACE WE GET IT AN ADDITIONAL
AMOUNT OF FUNDING ABOVE AND
BEYOND WHAT THE MANDATED FEDERAL
REQUIREMENTS ARE -- I THINK ONE
OF THE MOST CHALLENGING ASPECTS
OF HAVING A PRESCRIPTION DRUG
DISCUSSIONS IS THE THE WAY THE
PRICING WORKS -- EACH PURCHASER
HAS DIFFERENT APRES SAYS THAT
THEY CAN NEGOTIATE -- A LOT OF
THOSE ARE -- OBVIOUSLY
CONFIDENTIAL AND THEN -- AS YOUR
AGENDA NOTES WE GET SIGNIFICANT --
MANDATORY REBATES -- AND SOME
SUPPLEMENTAL REBATES -- FOR THE
PROGRAM THAT WE HAVE.
WHEN THE GOVERNOR I SIGNED THE%
EXECUTIVE ORDER -- WE HAVE TO
SEPARATE WORK STREAMS ON TOP OF
WHAT THE WORK IS THAT TGS IS
CURRENTLY DOING ONE OF WHICH IS
AN INITIAL FIRST STEP TO CARVE
OUT -- THE PHARMACY BENEFIT FROM
OUR MEDICAL MANAGED CARE PLANS
AND RETURN IT AS A FEE FOR
SERVICE BENEFIT.
THE SECOND WORKSTREAM WAS TO
LOOK ACROSS NOT ONLY OUR PROGRAM
BUT ACROSS ALL PURCHASERS ALL
PEERS IN CALIFORNIA.
ALL PROGRAMS UNDERSTANDING THAT
THERE ARE A VARIETY OF WAYS THAT
WE AS A STATE CAN USE OUR
ECONOMIC LEVERAGE SO TO SPEAK TO
DRIVE LOWER DRUG PRICES I THINK --
WE WOULD NOT WANT TO SAY THAT
JUST GETTING -- SAVINGS AND
MEDIC COW IS ENOUGH -- FROM THE
STANDPOINT THAT WE ARE A VERY
KIND OF UNIQUE PURCHASER BECAUSE
OF OUR FEDERAL AND STATE
PROTECTIONS AROUND REBATES AND
MEDICAID BEST PRICE.
SO THE GOVERNOR'S EXECUTIVE
ORDER IS REALLY CHALLENGING US
TO WORK ACROSS THE DIFFERENT
DEPARTMENTS -- TO COME UP WITH
RECOMMENDATIONS TO LOWER DRUG
PRICES NOT ONLY FOR OUR PROGRAM
BUT FOR OTHER PURCHASERS
INCLUDING INDIVIDUAL CONSUMERS
AND THE STATE AND SO THAT IS A
SEPARATE -- AND DISTINCT PART OF
THE EXECUTIVE ORDER THAT WERE
ALSO WORKING ON FOR PURPOSES OF
THE AGENDA AND THE QUESTIONS --
FOR THE CAR ABOUT -- OF THE
PHARMACY BENEFIT FROM THE
MEDICAL MANAGED CARE PLANS --
THE REASONS FOR THIS ARE --
THERE ARE SEVERAL REASONS FOR
THIS THE FIRST IS -- WE HAVE --
REALLY -- STRONG INTENTION OF
STANDARDIZING THE MEDICAL
BENEFIT ACROSS THE MANAGED CARE
MARKET SO WE HAVE -- WAIVERS
THAT ARE COMING DUE AND TWENTY
TWENTY A LOT OF THE THINGS THAT
WE AS A STATE PROGRAM WOULD LIKE
TO DO AS IT TURNED AS IT --
TALKS ABOUT WHOLE PERSON CARE
AND DIFFERENT KINDS OF
INITIATIVES IT REALLY REQUIRES
US TO STANDARDIZE THE BENEFIT --
IN A WAY THAT WE CAN START TO DO
MORE REGIONALI STRAIGHT AND
SIMPLIFY SOME OF OUR RATE
SETTING.
BY PULLING OUT THE PHARMACY
BENEFIT AND STANDARDIZING NOT
ACROSS THE MARKET THAT ACHIEVE
CERTAINLY THAT GOAL -- AS IT
PERTAINS DIRECTLY TO THE
GOVERNOR'S EXECUTIVE ORDER -- WE
ONLY RECEIVE SUPPLEMENTAL
REBATES ON THE FEE FOR SERVICE
POPULATION TODAY WHICH HAS
DRAMATICALLY SHRUNK -- IN SOME
CASES -- DOWN TO VERY SMALL
POPULATIONS -- ELIGIBLE FOR FULL
SCOPE BENEFITS A LOT OF OUR FEE
FOR SERVICE POPULATION ARE THOSE
THAT ARE ON RESTRICTED SCOPE --
MEDI CAL WITH ONLY ACCESS TO
EMERGENCY SERVICES -- THE OTHER
POPULATION THE OTHER LARGEST
POPULATION FEE FOR SERVICE ARE
DUAL ELIGIBLES -- I FEEL REALLY
OLD WHEN I TALK ABOUT -- LOOKING
BACK ON TWO THOUSAND SIX WHEN WE
SAW THE IMPLEMENTATION OF THE
MEDICARE PART D. BENEFIT AND ON
A SINGLE DAY APPROXIMATELY A
MILLION DUAL ELIGIBLES HAD THEIR
COVERAGE CHANGE FROM OUR
PHARMACY BENEFIT AS A STATE
MEDICAID PROGRAM.
OVER TO THE MEDICARE PART D.
BENEFIT IN WHICH A LOT OF BEEN
FISHERIES HAD NO UNDERSTANDING
OF HOW WHICH PLAN THEY WERE IN
ROLLED AND HOW DID THEIR DRUG
PLAN WORK.
AND SO.
I'M A LOT OF OUR RESIDUAL FEE
FOR SERVICE POPULATION IS REALLY
NOT GENERATING THE SAME KINDS OF
SUPPLEMENTAL REBATES THAT IT
ONCE DID AND I THINK -- PART OF
THE GOVERNOR'S EXECUTIVE ORDER
IS CERTAINLY -- IN THE SHORT
TERM INTERESTED IN RETURNING
THAT THIRTEEN MILLION MEMBER
POPULATION INTO FEE FOR SERVICE
SO THAT WE CAN BE -- KIND OF
GENERATING AND RECEIVING THE
FULL LEVERAGE OF THOSE
SUPPLEMENTAL REBATES THAT WE
OTHERWISE DON'T HAVE TODAY.
AND THEN LASTLY I THINK THAT
WHEN WE LOOK AT DRUG PRICES ALL
TOGETHER WE ARE DEPARTMENT THAT
SPENDS APPROXIMATELY TWELVE
BILLION DOLLARS.
IN PHARMACEUTICAL COSTS A YEAR --
COMBINED ACROSS MANAGED CARE AND
FEE FOR SERVICE AND CERTAINLY TO
THE EXTENT THAT WE CAN --
EXTRICATE ADDITIONAL SAVINGS IN
THAT AREA IT OBVIOUSLY HAS -- IF
THOSE ARE BIG DOLLARS AND SO ANY
SPUR CENTERS THAT WE CAN SAVE A
CERTAINLY -- SIGNIFICANT FROM
BOTH A SHORT TERM IN A LONG TERM
GOAL GOING FORWARD SO WITH THAT
I'M HAPPY TO ANSWER QUESTIONS
BUT THOSE ARE THOSE THE EFFORTS
THAT WERE UNDER WAY WITH THE
GOVERNOR'S EXECUTIVE ORDER.
THANK YOU.
THANK YOU VERY HAS A LITTLE.
AND YOU WANT TO PRESENT
[inaudible]
ALRIGHT.
HI JENNY HANDLES ELIGIBILITY
I'LL I'LL TAKE.
ALL RIGHT [inaudible]
IS -- JENNY -- WELL ABOVE THE
COVER FOR DAILY YEAH HUNDRED
GUESS YOU LET SOMEONE TAKE AS
WITH THE DEPARTMENT OF FINANCE
SO WE DO KNOW THAT THE PROPOSAL
DOESN'T HAVE A FISCAL IMACT IN --
NINETEEN TWENTY DAMAGE AT THAT
MINISTRATION IS WORKING ON
EVALUATING THE FISCAL IMPACT
WHICH WILL -- HAVE OCCUR AT A
LATER TIME IN -- TWENTY TWENTY
ONE TWENTY TWO AND ALSO THAT
MINISTRATION IS EVALUATING THE
ADMINISTRATIVE CHANGES THAT WILL
BE REQUIRED -- AS PART OF UP AS
PART OF THE TRANSITION --
STRICTER CAN'T DESCRIBE.
VERY GOOD THANK YOU.
BEN JOHNSON WITH LEGISLATIVE
ANALYST'S OFFICE WE LAST WEEK WE
RELEASED A REPORT ANALYZING THE
CARVE OUT OF PHARMACY SERVICES
WITHIN MEDI CAL AND WE FOUND
THAT -- THE CAR ABOUT WOULD
LIKELY RESULT IN SAVINGS FOR THE
STATE BUT OF AN UNKNOWN
MAGNITUDE -- THE SAVINGS -- WE
THINK OF LEND ITSELF LEND
THEMSELVES TO THE LEGISLATURE
SERIOUSLY CONSIDERING THIS
ACTION AND AND I'LL DISCUSS SOME
OF THE MEANS FOR OVERSIGHT HERE
AND IN JUST ONE MINUTE -- BUT A
SIGNIFICANT OF THE PORTION OF
THE SAVINGS WE THINK COULD COME
FROM THAT THREE FORTY BE --
ELIGIBLE ENTITIES SUCH AS
HOSPITALS AND CLINICS AND SO
FORTH THAT ARE ELIGIBLE FOR
THOSE FEDERAL DRUG DISCOUNTS.
AND THAT SOME OF THE SAVINGS
COULD ALSO COME FROM THE
SUPPLEMENTAL REBATES AND OTHER
SORT OF REDUCE COST UNDER THE
CARVE OUT -- SUCH AS REDUCE
COSTS IN MANAGED CARE -- WE DO
FIND THOUGH THAT THE CAR ABOUT
WOULD ALSO HAVE SIGNIFICANT
IMPACTS ON A MAJOR MEDICAL
STAKEHOLDERS -- FROM FIRM A
BENEFICIARY PERSPECTIVE WE
BELIEVE THAT THE CARVE OUT WOULD
SERVE TO STANDARDIZE THE BENEFIT --
CURRENTLY -- IF -- MEMBERS WHICH
IS MANAGED CARE PLANS FOR
EXAMPLE -- THEY MIGHT HAVE A
LIST OF DRUGS AT DIFFERENT LIST
OF DRUGS THAT ARE READILY
AVAILABLE TO THEM AND AND WHILE
I BELIEVE THERE ARE SOME
PROTECTIONS IN PLACE FOR THEM
THERE COULD BE SOME AND
ADMINISTRATIVE BURDENS THAT THEY
WOULD.
HAVE TO GO THROUGH -- THAT SAID --
WE DO RAISE SOME QUESTIONS AND
CONCERNS IN THE REPORT ABOUT.
WHAT THE IMPACT WOULD BE ON THE
CARE COORDINATION ACTIVITIES
THAT THAT PLANTS HAVE SUCH AS
THEIR DISEASE MANAGEMENT
PROGRAMS -- FOR PARTICULARLY
HIGH NEED POPULATIONS AND SO
FORTH THEY DO TRACK --
MEDICATION ADHERENCE AND SO --
WE WOULD WE DO WE DO REYES CELLS
CONCERNS AN ASTON MINISTRATION
TO COME UP WITH A PLAN -- TO
INSURE SOME OF THOSE ACTIVITIES
CAN CONTINUE OR EVEN BE IMPROVED
ALSO NON CONSUMER STAKEHOLDERS
WOULD LIKELY BE EFFECTIVE
AFFECTED BY THE BY THE BY THE
EXECUTIVE ORDER MANAGED CARE
PLANS FOR WHAT FOR EXAMPLE WOULD
RECEIVE SIGNIFICANTLY LESS
FUNDING GOING FORWARD -- THOUGH
A SIGNIFICANT PORTION OF THIS
REDUCTION IN FUNDING WOULD
REFLECT THEIR REDUCE
RESPONSIBILITIES RELATED TO
PAYING FOR THE PRESCRIPTION
DRUGS UTILIZED BY THEIR MEMBERS.
AND THEN -- PROVIDERS THAT
PARTICIPATING THREE FORTY B. AND
OTHERS COULD NOT RECEIVE LASSEN
EARNINGS ON UNDER THE FEE FOR
SERVICE APPROACH.
THE ADMINISTRATION ASSERTS THE
NO STATUTORY CHANGES ARE NEEDED --
TO AFFECT THIS CARVE OUT AND GET
SAYING THAT CURRENT LAW PERMITS
THE DIRECTOR OF DEPARTMENT OF
HEALTH CARE HEALTH CARE SERVICES --
WIDE LATITUDE IN DETERMINING
WHICH SERVICES ARE DELIVERED
THROUGH MANAGED CARE OR
DELIVERED THROUGH FEE FOR
SERVICE.
WE WE DON'T QUESTION -- THE
AUTHORITY TO DO SO NEVER THE
LESS WE DO BELIEVE THAT THE
LEGISLATURE HAS AUTHORITY IN AN
IMPORTANT ROLE TO PROVIDE INPUT
INTO HOW PHARMACY SERVICES ARE
DELIVERED GOING FORWARD -- WE
BELIEVE THE DEPARTMENT IS GOING
TO REQUIRE SIGNIFICANT NEW
RESOURCES -- THE STATE
OPERATIONS LEVEL -- TO AT
IMPLEMENT THIS CARVE OUT FOR
EXAMPLE THE DEPARTMENT IS LIKELY
GOING TO NEED EITHER IN HOUSE OR
CONTRACT STAFF -- TO COMPLETE
TREATMENT AUTHORIZATION REQUESTS
FOR DRUGS THAT -- ARE ARE NOT ON
THE STATE'S PREFERRED DRUG LIST
AND THEY'RE ALSO COULD BE SOME.
IT SYSTEMS IMPROVEMENTS AND SO
FORTH -- TO INSURE BETTER
COMMUNICATION BETWEEN THE STATE
AND MANAGED CARE PLANS -- AROUND
DRUG UTILIZATION INFORMATION.
SO GIVEN THE THE NEED FOR THE
DEPARTMENTS NEW RESEARCH SO
RESOURCES TO IMPLEMENT THE CARVE
OUT THE LEGISLATURE HAS A CLEAR
OPPORTUNITY THIRDS APPROVAL OR
REJECTION OF THESE RESOURCES --
TO PROVIDE INPUT INTO BOTH
WHETHER AND HOW THE THE THE
BENEFIT IS DELIVERED AND MEDI
CAL -- THE DEPARTMENT HASN'T
COME AT THIS TIME -- WITH THE
RESOURCE REQUEST BUT WE WOULD
EXPECT ONE TO COME IN THE FUTURE.
FINALLY JUST NOTE THAT MANY
IMPORTANT DETAILS ON THE
PROJECTED IMPACT AS WELL AS THE
IMPLEMENTATION PLAN OF THE CARVE
OUT HAVE YET TO BE -- RELEASED
AND GIVEN THAT WE DO RECOMMEND
THAT THE LEGISLATURE WITHHOLD
APPROVAL OF THE OF ANY FUTURE
RESOURCE REQUEST BY THE
ADMINISTRATION UNTIL THIS KEY
INFORMATION IS PROVIDED -- THIS
KEY INFORMATION -- IN OUR IN OUR
ANALYSIS IS AT ONE A ROBUST
FISCAL ANALYSIS WHICH I OUR
UNDERSTANDING IS ONE IS EXPECTED
TO COME IN MAY -- THIS YEAR'S
MAYOR AROUND THE TIME OF THIS
YEAR'S MAY REVISION THOUGH IT IS --
FOR FOR AN OUT YEAR -- WE WOULD
ALSO -- HOPE TO SEE A PLANNED
UPGRADE THE STATE'S IT
INFRASTRUCTURE TO ALLOW THE
GREATER -- TRANSFER OF DRUG
UTILIZATION AND TO MANAGED CARE
PLANS TO ALLOW -- CARE
COORDINATION ACTIVITIES TO
CONTINUE -- GUIDANCE AIMED AT
MAINTAINING OR IMPROVING
BENEFICIARY CARE UNDER THE CARVE
OUT SUCH AS ANY CONTINUITY OF
CARE PROTECTIONS I THINK SOME
STAKEHOLDERS ARE GOING TO BRING
UP LATER.
AS WELL AS AN ANALYSIS OF
FEASIBLE ALTERNATIVES TO THE
GOVERNOR'S APPROACH -- THERE ARE
WE DO LAY OUT A FEW --
ALTERNATIVE APPROACHES SOME OF
WHICH HAVE RECEIVED
CONSIDERATION -- PREVIOUS IN
PREVIOUS YEARS AND THEY ALL COME
WITH DIFFERENT TRADE OFFS I VIS
A VIS EACH OTHER AND VIS A VIS --
THE GOVERNOR'S APPROACH AND SO
WOULD -- WANT -- THIS THIS --
ACTION TO BE CONSIDERED -- IN
LIGHT OF THOSE ALTERNATIVES SO
HAPPY TO TAKE ANY QUESTIONS.
THANK YOU SO MUCH.
QUESTIONS FROM THE COMMITTEE.
ALL RIGHT LET'S OPEN IT.
TOO OF PUBLIC COMMENT -- EXCUSE
ME LET'S GO TO PANEL TO AND THEN
WE'LL TAKE PUBLIC COMMENT AFTER
PANEL [inaudible]
TO THANK YOU.
WE OFFERED YOU CAN ALL STAY BUT
I THINK THIS WILL SQUEEZE
[inaudible]
THANK YOU.
BEGIN WITH THAT [inaudible]
DOCTOR CON.
GOOD AFTERNOON MADAM CHAIR -- I
APPRECIATE THE OPPORTUNITY TO
MAKE COMMENT THIS AFTERNOON --
MY NAME IS SEYED KHANDAN THE
CHIEF MEDICAL OFFICER FOR MOLINA
HEALTH CARE OF CALIFORNIA --
CARE COORDINATION IS REALLY
PARAMOUNT TO FUNCTIONS THAT
HEALTH PLANS PERFORM IN FACT I
WOULD SAY THAT.
IT RISES TO THE TOP VERY QUICKLY
IN TERMS OF ACTIVITIES THAT
HEALTH PLANS TO IN TERMS OF
BRINGING VALUE.
TO PATIENTS AND MEMBERS -- A LOT
OF THE CARE COORDINATION
ACTIVITIES RELY HEAVILY ON DATA
AND ON REAL TIME DATA AND ONE OF
THOSE KEY COMPONENTS IS REAL
TIME PHARMACY DATA.
NOT ALL CARE COORDINATION
ACTIVITIES REQUIRE REAL TIME BUT
MANY OF THEM DO AND I I THINK
GIVING A COUPLE OF EXAMPLES
QUICK EXAMPLES MAY HELP
ILLUSTRATE -- SOME OF THE
DEPENDENCE ON THIS TYPE OF DATA.
AND HOW -- FAIRLY NIMBLE
ADJUSTMENTS TO MEDICATIONS ARE
RECOMMENDED BY THE HEALTH PLAN
TO THE PRESCRIBER. ONE EXAMPLE
IS IN THE TREATMENT OF I ASTHMA
CHILDHOOD ASTHMA WHICH IS VERY
PREVALENT IN THE MEDI CAL --
ADOLESCENT IN YOUTH POPULATION --
VERY QUICKLY IT'S TREATED BY TWO
INHALERS THERE'S THERE IS LONG
ACTING AND SHORT ACTING INHALERS.
THE LONG ACTING IS THE
CONTROLLER AND BY -- FIVE
MONITORING THE USAGE OF TWO
DIFFERENT TYPES OF MEDICATIONS
THAT PLAN.
CAN I UNDERSTAND WHETHER A CHILD
OR WHETHER A PATIENT IS BEING
COMPLIANT IS ACTUALLY TAKING THE
MEDICATION FILLING THE
MEDICATION NUMBER ONE BUT THEN
ACTUALLY TAKING IT.
AND THEN PROVIDING THAT FEEDBACK
TO THE PROVIDER OR IN SOME CASES
ACTUALLY MAKING INTERVENTION
THEMSELVES TO REACH OUT TO THE
MEMBER.
AND MAKE RECOMMENDATIONS THAT
HEY YOU'RE TAKING THE WRONG
MEDICATION THE WRONG WAY IT'S A
FAIRLY SIMPLE -- CHRONIC ILLNESS
TO TO CONTROL THAT DOES RELY ON
REAL TIME PHARMACY DATA BECAUSE
FREQUENTLY MEMBERS WILL FILL
THEIR THEIR MEDICATIONS MORE
THAN ONCE A MONTH PARTICULARLY
FOR CONTROLLER TYPE OF
MEDICATION.
THE OTHER EXAMPLE IS ONE IN
WHICH INTERVENTION CAN BE DONE
WITH REGARD -- TO EITHER COMPLEX
DISEASE DOT COMPLEX MEDICATION
REGIMENS OR WITH REGARD TO
DANGEROUS MEDICATION REGIMEN SO
THAT WAS THE CASE BOB VERY
RECENTLY THAT I WAS INVOLVED IN
REVIEWING.
OF A PATIENT WHO WAS GETTING A
PROCEDURE DONE FOR LOW BACK PAIN.
AND IN PART OF THE REVIEW
PROCESS IT'S OUR PROTOCOL TO
REVIEW ALL THE MEDICATIONS THAT
WERE FILLED -- FOR THAT MEMBER
IN THIS PARTICULAR MEMBER
HAPPENED TO BE TAKING AN OPIOID
AND BENZODIAZEPINE WHICH IS A A
GENERALLY SPEAKING A CONTRACT --
CATION THAT THEN PROMPTS US TO
REACH OUT TO THE DIFFERENT
PRESCRIBERS BECAUSE THEY WERE
NOT PRESCRIBED BY THE SAME
PRESCRIBER IN THIS CASE.
AND UNDERSTAND WHY THEY WERE
PRESCRIBED AND THEN MAKE
INTERVENTIONS IS APPROPRIATE --
TO MINIMIZE THE RISKS OF THE
REAL ISSUE WHAT THE REAL CONCERN
THAT THE HEALTH PLANS HAVE IS.
TIMELY ACCESS TO REAL THIS TIME
PHARMACY DATA AND UTILIZING THAT
INFORMATION. TO HELP.
COURSE CORRECT AND MAKE
RECOMMENDATIONS TO PATIENTS
REGARDING THEIR CARE
[inaudible]
THANK YOU [inaudible]
THANK YOU -- JONATHAN.
I AM IN PLACE OF JONATHAN MY
NAME IS AB PATTERSON I AM --
WITH CALIFORNIA HELPLESS
ADVOCATES YET TO STEP OUT -- SO
I'VE EXCUSE ME AS I TAKE SOME OF
HIS COMMENTS AS WELL AS SOME
ANOTHER ONE OF OUR HEALTH
CENTERS COMMENTS AND ALL READ
THEM ON HIS BEHALF -- SO THANK
YOU FOR THE OPPORTUNITY TO SHARE
OUR PERSPECTIVE ON THE
GOVERNOR'S EXECUTIVE ORDER TO
CREATE A SINGLE PURCHASER SYSTEM
FOR PHARMACEUTICALS IN
CALIFORNIA.
THE COST OF DRUGS ONE OF THE
FASTEST RISING CROSS COSTS IN
HEALTHCARE TODAY.
HEALTH CENTERS AND OTHER SAFETY
NET PROVIDERS REMAIN COMMITTED
TO FINDING MORE WAYS TO LOWER
THE COST OF PRESCRIPTION DRUGS.
AS THESE IN.
AND TO THE AS THESE IMPORTANT
CONVERSATIONS CONTINUE WE ASK
THAT THE ADMINISTRATION AND THE
LEGISLATURE KEEP IN MIND.
THE POTENTIAL IMPACT ON
CALIFORNIA'S COMMUNITY HEALTH
CENTERS IN SAFETY NET HOSPITALS
THAT PARTICIPATE IN THE THREE
FORTY B. DRUG PRICING PROGRAM
FOR LOW INCOME RESIDENTS.
I'M GONNA SHARE A LITTLE BIT --
A FROM WELL SPACE AS WELL AS
WELL AS ONE COMMUNITY HEALTH --
BUT OUR COMMENTS ARE REALLY
REFLECTIVE ON BEHALF OF
COMMUNITY HEALTH CENTERS
THIRTEEN HUNDRED PROVIDING CARE
SEVEN MILLION PEOPLE IN
CALIFORNIA ONE IN -- SIX AS WELL
AS OUR PARTNERS AT THE HOSPITAL
SYSTEMS IN URBAN AND RURAL
CALIFORNIA -- SO WHILE SPACE
THEY USE THEIR THREE FORTY B.
DRUG -- ONE COMMUNITY HEALTH
THREE FORTY B. DRUG DISCOUNT
PROGRAM SUPPORTS THE FOLLOWING
SERVICES.
IN HOUSE PHARMACY -- WHICH IS
STAFF TO WORK WITH INDIVIDUAL
PATIENTS TO GUARANTEE ADHERENCE
OFTEN COMPLEX MEDICATION
REGIMENS -- THE DOCTOR CON JUST
MENTIONED AND PROVIDE FREE
SHIPPING AND DELIVERY.
IT ALSO FUNDS.
INDIGENT MEDICAL AND DENTAL CARE
SUPPORT TO THE UNINSURED
PATIENTS FOR PRIMARY MEDICAL
DENTAL MENTAL HEALTH CARE
CLINICAL PHARMACY OUT REACH CASE
MANAGEMENT MENTAL HEALTH.
SUBSTANCE ABUSE TREATMENT
NUTRITION AND HEALTH EDUCATION
SERVICES ALL -- AIM TO INTEGRATE
CARE FOR BETTER PROVEN -- HEALTH
OUTCOMES AND MOST OF THESE WOULD
ALL HAVE TO BE SCALED BACK OR
COMPLETELY ELIMINATED OF THIS
PROPOSAL GOES THROUGH AND THREE
FORTY BE SAVINGS ARE ELIMINATED --
AT THE STATEWIDE LEVEL THREE
FORTY B. CONGRESS CREATED THE
THREE FORTY B. PROGRAM IN
NINETEEN NINETY TWO TO ENABLE
THE SAFETY NET HOSPITALS AND
COMMUNITY HEALTH CENTERS TO
SCRAP TO STRETCH.
SCARCE FEDERAL RESOURCES AS FAR
AS POSSIBLE REACHING MORE
ELIGIBLE PATIENTS AND PROVIDING
MORE COMPREHENSIVE SERVICES.
IN CALIFORNIA HUNDREDS OF HEALTH
CENTERS AND A HUNDRED AND EIGHTY
HOSPITAL'S PARTICIPATE AND RELY
ON THE THREE FORTY B. DRUG
DISCOUNT PROGRAM.
IN ORDER TO QUALIFY AN
ORGANIZATION MUST BE CONSIDERED
A COVERED ENTITY FEDERALLY
QUALIFIED HEALTH CENTERS -- ARE
ELIGIBLE AS WELL AS HOSPITALS
THAT ARE EITHER NONPROFIT OR
PUBLICLY OWNED AND SERVE A
DISPROPORTIONATE SHARE OF THE
MEDICARE AND MEDICAID PATIENTS.
THE ADMINISTRATION ARGUES THAT
THE PROPOSAL LOWER THE COST OF
DRUGS AND BRING MORE MONEY TO
THE STATE.
AND WE'RE SUPPORTIVE OF THE GOAL
TO LOWER THE COST OF DRUGS WE
WANT TO POINT OUT THOUGH THAT
AND THREE FORTY BE A HELP.
WE WANT TO POINT OUT THOUGH THAT
THREE THOUGHT FORTY BE HEALTH
CENTER PATIENTS OF WHICH THERE
ARE SEVEN MILLION ARE ALREADY
RECEIVING LOW TO NO COST DRUGS.
AND THE SAVINGS ACCRUED FROM
THREE FORTY B. R. 1100% INVESTED
BACK INTO THE PATIENT CARE AND
SERVICES.
SHOULD THE STATE ELIMINATE OUR
ABILITY TO PARTICIPATE AND THREE
FORTY BE MANAGED CARE AND
REQUIRE THAT DRUGS BE PURCHASED
IF YOU FOR SERVICE ACTUAL
ACQUISITION.
WE ESTIMATE THAT AT LEAST A
HUNDRED MILLION SAVINGS AND I
CAN SAY THAT CONFIDENTLY AND
HAVING HEARD BACK FROM 50% OF
THE HEALTH CENTERS.
AND IT'S ALREADY NINETY MILLION.
THAT WILL BE A LOSS TO HEALTH
CENTERS ALONE ACROSS THE STATE
RESULTING IN A REDUCTION OF
STAFF SERVICES AND HOURS OF
OPERATION.
LAST YEAR WHEN WE WERE TALKING
ABOUT THE SOME OF THE RURAL
HEALTH CENTER SO THAT THEY WOULD
HAVE TO CLOSE SOME OF THEIR
SITES AT THREE FORTY ONE AWAY.
WE WANT TO PARTNER WITH THE
STATE AS THIS PROPOSALS DEVELOP
TO ENSURE CALIFORNIA'S CRITICAL
SAFETY NET HOSPITALS AND
COMMUNITY HEALTH CENTERS WILL BE
ABLE TO CONTINUE TO DELIVER
ESSENTIAL SERVICES THAT THEY DO
TODAY.
THANK YOU FOR PROVIDING A SPACE
FOR THIS IMPORTANT CONVERSATION
AND WE LOOK FORWARD TO WORKING
TOGETHER IN THE FUTURE
[inaudible]
THANK YOU.
THAT I FELT.
BETH BILL WITH HEALTHAXIS
CALIFORNIA HERE IN SUPPORT OF
THE GOVERNOR'S PROPOSAL AND I
WANT TO BE CLEAR THAT ARE WORKS
OR NOT AIM.
TO OUR FRIENDS IN THE COMMUNITY
CLINICS OR THEIR THEIR GOOD WORK.
OF INSTEAD WHAT WE'D LIKE TO
TALK ABOUT IS HOW EFFECTIVE
CALIFORNIA WAS IT MAXIMIZING
DRUG SAVINGS WHEN THE MEDI CAL
PROGRAM.
NEGOTIATED SUPPLEMENTAL REBATES
WE WERE ONE OF THE FIRST STATES
IN THE NATION TO DO THAT.
OVER THE YEARS WE SAVED BILLIONS
AND BILLIONS NOT MILLIONS
BILLIONS AND BILLIONS OF DOLLARS.
BY HAVING A SUPPLEMENTAL DRUG
REBATE THAT WAS NEGOTIATED ON
TOP OF THE MANDATORY REBATE
FEDERAL LAW REQUIRES THAT THE
MEDICAID PROGRAM GET THE BEST
PRICE.
AS WE TRANSITION TO PEOPLE INTO
MANAGED CARE WE GAVE UP THOSE
SUPPLEMENTAL REBATES ON THE
SCIRI.
THAT THE MANAGED CARE PLANS
WOULD DO A BETTER JOB
NEGOTIATING WE SPENT A LOT OF
TIME LOOKING AT WHAT MANAGED
CARE PLANS DO IN NEGOTIATING
DRUG PRICES IN THE COMMERCIAL
SPACE AS A RESULT OF SB.
SEVENTEEN OTHER PIECES OF
LEGISLATION.
AND BY AND LARGE WERE NOT VERY
IMPRESSED -- WE THINK THAT THE
STATE OF CALIFORNIA SHE HAD A
MUCH BETTER TRACK RECORD IN PART
DRIVEN BY THE NEEDS OF OUR STATE
BUDGET.
IN ORDER TO BE THE MOST
EFFICIENT WE COULD BE IN TERMS
OF NEGOTIATING SUPPLEMENTAL
REBATES.
I WANT TO BE CLEAR THAT STATE
AND FEDERAL LAW REQUIRES THAT
THE MEDI CAL PROGRAM GIVE PEOPLE
ACCESS TO MEDICALLY NECESSARY
DRUGS WHAT WE'RE TALKING ABOUT
IS A PREFERRED DRUG LIST.
LITERALLY.
THE MEDIC CAL PROGRAM NEGOTIATED
WITH DRUG MANUFACTURERS IN ORDER
TO GET ADDITIONAL REBATES IN
ADDITION TO THE 23% MANDATORY
REBATE AND THEY ALL.
ABOUT DOUBLE THAT AMOUNT THAT'S
A LOT OF SAVINGS THAT GOT HANDED
OFF TO THE MANAGED CARE PLANS IN
THEORY IT'S REFLECTED IN THEIR
RATES.
WE CAN'T TELL WHAT'S ON THE MEDI
CAL SIDE BUT ON THE COMMERCIAL
SIDE WE KNOW NOW.
THEY MOST THEM.
DON'T BARGAIN HARD AT LEAST AS
BEST WE CAN TELL.
WE HAVE A NUMBER OF SUGGESTIONS
FOR THE ADMINISTRATION AND HAVE
BEEN IN CONVERSATION WITH THEM
ON HOW THEY CAN BE EVEN MORE
EFFECTIVE THAN THEY WERE IN THE
PAST WE SUGGEST FOR EXAMPLE.
THAT THEY THINK ABOUT A
FORMULARY THAT'S BY CONDITIONS
SO IF YOU HAVE ASTHMA THAT THEY
NEGOTIATE A COUPLE OF THE
INAPPROPRIATE FORMULAR A FOR THE
ASTHMA DRUGS IF YOU HAVE HIGH
BLOOD PRESSURE.
THEY HAVEN'T ACOSTA ENOUGH
GENERICS IN EACH CATEGORY TO
TREAT HIGH BLOOD PRESSURE BUT
NOT EVERY DRUG.
AND THAT THEY NEGOTIATE BUT
CONDITION WE'VE ALSO SUGGESTED
THAT SOMETHING THAT THE HEALTH
PLANS THEMSELVES ARE REQUIRED BY
FEDERAL LAW TO HAVE A EIGHT
WHAT'S CALLED A PAEAN TO
COMMITTEE OF PHARMACEUTICAL IN
THERAPEUTICS COMMITTEE WOULD BE
GOOD FOR THE DEPARTMENT TO HAVE
SOMETHING LIKE THAT TO HELP THEM
WITH.
THESE CLINICAL DISCUSSIONS.
AND CERTAINLY PRESCRIBING
INFORMATION IS SOME OF THE MOST
REAL TIME INFORMATION THAT WE
HAVEN'T HEALTH CARE IT SHOULD BE
AVAILABLE IN REAL TIME IT'S ALL
IT'S ALMOST ALL OUR TRONIC AND
HAS BEEN FOR A LONG TIME SO.
THAT MAKES SENSE TO US AS WELL.
WE ALSO WANT TO MAKE SURE THAT
IS PEOPLE ARE GIVEN ACCESS TO
MEDICALLY NECESSARY DRUGS THAT
THERE'S A PROCESS THAT INVOLVES
CLINICIANS IN MAKING THAT
DECISION. FOR MANAGED CARE WE
HAVE THE INDEPENDENT MEDICAL
REVIEW PROCESS IT'S A LITTLE
DIFFERENT FOR MEDI CAL WE WOULD
HOPE THAT IS THIS IS DEVELOPED
THERE WE COULD HAVE SOMETHING
THAT INVOLVES CLINICIANS WITH
THE RELEVANT EXPERTISE.
SOMEBODY WHO KNOWS SALES MUST
SOMEBODY WHO KNOWS LUPUS
WHATEVER THE CONDITION IS THAT
WE HAVE THE EXPERTISE THAT'S
NECESSARY.
SO YOUR ANALYSIS OF NOTES A
NUMBER OF OTHERS WERE WE MADE
SUGGESTIONS -- BUT THE HOURS
LATE AND WE WILL.
LEAVE HE WE WERE SURE YOU'VE
DONE YOUR READING SO WE WERE
HAPPY TO ANSWER ANY QUESTIONS.
THANK YOU SO MUCH AND ALL OF THE
COMMENTS -- WERE VERY IMPORTANT
I THINK ALL OF THOSE ARE GOOD
SUGGESTIONS [inaudible]
QUESTIONS COMMENTS [inaudible]
DOCTOR WOULD.
HI I'M JUST YOU KNOW I'VE I'VE
HEARD I'VE HEARD FROM.
MANY MANY CLINICS IN MY DISTRICT
ABOUT SIX THEIR CONCERN HERE --
AND SO.
ARE THERE MEETINGS HAPPENING
WITH.
I DIED AT TO TRY TO RESOLVE.
RESOLVE THE CONCERNS.
YES SO WE HAVE MET WITH THE
CLINICS THE HOSPITALS THE PLANS --
I THINK IN SOME CASES IT'S BEEN
ASKING QUESTIONS YOU KNOW FOR
CLARITY AROUND WHAT THE
GOVERNOR'S EXECUTIVE ORDER IS
AND HOW WE'RE PROCEEDING -- I
THINK WE HAVE CHALLENGED THE
PLANS IN THE HOSPITALS AND THE
CLINICS -- TO YOU KNOW IF
THERE'S A PROPOSAL OR A COUNTER
PROPOSAL -- THAT MEETS THE
GOVERNOR'S OBJECTIVES AROUND
PRICE SCENE AND GREATER
TRANSPARENCY AROUND THE THREE
FORTY B. -- REVENUES THAT WE
WOULD BE OPEN TO SEEN THAT AND
SO I THINK IN SOME CASES THERE'S
AN ONGOING DIALOGUE AS IT
PERTAINS TO THE DATA ISSUE WITH
THE HEALTH PLANS -- WE'VE HAD
BOTH GROUP DISCUSSIONS WITH THE
PLANS AS WELL AS WE HAVE BEEN IN
CONTACT WITH A COUPLE.
OF OUR MANAGED CARE PARTNERS
THAT WE RELY PRETTY HEAVILY ON
FOR TECHNICAL FEEDBACK SOMETIMES
I THINK THAT WE HAVE HEARD LOUD
AND CLEAR THAT DATA.
AND REAL TIME DATA IS IS THE
IDEAL AND WE AGREE AND SO I
THINK WE INTERNALLY YOU'RE
LOOKING AT OUR SYSTEMS THAT ARE
CAPACITY IN CAPE CAPABILITY TO
DO THAT SO.
I THINK YOU KNOW WE ARE OPEN TO
A DISCUSSION AS LONG AS IT IS
HITTING SOME OF THE OBJECTIVES
THAT WE NEED IN TERMS OF THE
STATE'S PROPOSAL AROUND.
GREATER SAVINGS GREATER LEVERAGE --
TO ACHIEVE SUPPLEMENTAL REBATES
TO THE EXTENT THAT DRUGS REMAIN
IN THE MANAGED CARE PROGRAM WE
LOSE ALL OF THE SUPPLEMENTAL
REBATE DISCUSSION SO THERE IS.
AN ATTENUATED -- NEED TO KIND OF
UNDERSTAND WHAT OTHER PEOPLE ARE
THINKING FOR CONSIDERATION THERE.
WELL I GUESS MY CONCERN IS AND
THE I'VE HEARD THIS SENSE ALMOST.
INSTANTLY SINCE THE INTRODUCTION
OF THE THE GOVERNOR'S PLAN AND
AND I AM CONCERNED IS IS.
YOU KNOW.
I'M NOT AND I'M NOT IN THE BEST
POSITION TO JUDGE ARE THERE IS
THE POTENTIAL.
FOR CLINICS TO CLOSE BECAUSE OF
THIS CHANGE IN POLICY.
THAT WOULD NOT BE ACCEPTABLE --
AND SO I'M I'M I LOOK FORWARD TO
HEARING THE RESOLUTION OF THESE
DISCUSSIONS BECAUSE AT A TIME
WHEN YOU KNOW WE WE DESPERATELY
NEED -- CLINICS AND TO BE ABLE
TO PROVIDE CARE AT THE THOUGHT
THAT WE MIGHT LOSE SOME OF THEM
BECAUSE OF A CHANGE IN POLICY.
I'D I'D I NEED TO UNDERSTAND
THAT BETTER SO I WILL I WILL
LOOK FORWARD -- TO RESPONSE AT
SOME POINT AND I WOULD SAY THAT
YOU KNOW WE HAVE A LONG HISTORY --
OF SUPPORTING AND BUILDING THE
SAFETY NET GREAT YOU KNOW WE WE
NEGOTIATE ENTIRE MEDICAID
WAIVERS TO BRING IN ADDITIONAL
YOU KNOW BILLIONS OF DOLLARS TO
SUPPORT -- OUR SAFETY NET AND SO
IT'S NOT OUR INTEREST NOR OUR
INTENTION TO HARM THAT WE FULLY
ACKNOWLEDGE THAT THE CLINICS
PROVIDE THE BACKBONE OF OUR
PRIMARY CARE SYSTEM IN THE
MEDICAID PROGRAM.
I THINK WHAT WE HAVE ALWAYS --
SAID IS THAT IN THIS KIND OF AND
IT HAS BEEN A LITTLE BIT OF A
PAINFUL DISCUSSION IN TERMS OF
THE REVENUES ASSOCIATED WITH THE
THREE FORTY B. PROGRAM.
IS COME TO US AND SHOW US WHAT --
THE CLINICS BOTH.
I RECEIVE THE REVENUE FOR AND
WHAT YOU USE IT FOR AND TO THE
EXTENT THAT THE STATE
COLLECTIVELY SEES.
THAT IN A IN A MORE TRANSPARENT
WAY IT'S A POLICY DISCUSSION
ABOUT HOW THE STATE WANTS TO
PRIORITIZE THOSE FUNDS AND AND
THE TYPES OF SAFETY NET
INITIATIVES AND PROGRAMS THAT WE
WANT TO COLLECTIVELY SUPPORT AND
SO.
I THINK THAT'S THE DISCUSSION
THAT WE'RE WILLING TO HAVE AND
SO WOULD CERTAINLY BE HAPPY TO
TO WORK WITH YOU AS WELL AS
OTHERS ON THAT.
AND I TEND TO TALK ABOUT CLINICS --
COMMUNITY HEALTH CENTERS -- THAT
WE ARE WE HAVE BEEN WORKING ON A
TRANSPARENCY PROPOSAL SINCE LAST
YEAR -- TO AND KNOWING THAT
THAT'S BEEN A TOUGH.
PLACE TO TALK ABOUT AND WORKING
ON IT SINCE EVERYBODY DOES A
LITTLE BIT DIFFERENTLY THE NOTES
I HAVE HERE SHOW TO HEALTH
CENTERS DOING A LITTLE BIT
DIFFERENTLY -- BUT WE WANT TO BE
TRANSPARENT AND THE SAVINGS
MEANS SO MUCH TO US AND ARE ABLE
TO SUPPORT.
THINGS LIKE SOCIAL DETERMINANTS
OF HEALTH THINGS LIKE CARE
COORDINATION ALL THE THINGS -- I
THINK THE PROBABLY THE MOST
EXCITING THINGS ABOUT HEALTHCARE
ARE IN THE THREE FORTY B.
PROGRAM AND SO WE DON'T WANT
THEM TO GO AWAY AT ALL AND IF WE
CAN BE MORE TRANSPARENT AND
DELIBERATE AND CLEAR BACK TO THE
STATE ABOUT WHAT WE'RE DOING.
WE'RE MORE THAN WILLING TO DO
THAT.
THANK YOU I I WANT TO SAY THAT I
REALLY APPRECIATE THAT THE
GOVERNOR CAME IN AND HE KNEW
THAT THERE'S A PROBLEM.
DRUG PRICES ARE TOO HIGH AND WE
KEEP HEARING.
ESPECIALLY WITH FAMILIES AND
WITH OUR SENIORS THAT THEY HAVE
TO DECIDE OR DO I FEEL THE
PRESCRIPTION OR DO I PUT FOOD ON
THE TABLE.
A SITE I REALLY APPRECIATE THAT
HE SAW HOW SERIOUS IT WAS AND
THAT SOMETHING NEEDS TO BE DONE
ABOUT IT.
I TOO HAVE BEEN HEARING FROM MY
COMMUNITY HEALTH CENTERS -- THEY
ARE SOUL IMPORTANT IN OUR
COMMUNITY.
AND WE WE HAVE TO BE SURE THAT
THAT DOESN'T BECOME THE
UNINTENDED CONSEQUENCE.
BECAUSE THAT WOULD BE
DEVASTATING TO THE COMMUNITIES --
THE TRANSPARENCY IS EXTREMELY
IMPORTANT SO IF IF THE
ADMINISTRATION IS SAYING WE WANT
TO EVALUATE.
BUT DON'T GIVE A SANTA DON'T
ONLY INFORMATION GIVE US HARD
FACTS -- THEN THE VALUATION CAN
BE PROPERLY MADE -- AS OPPOSED
TO YES WE'RE GOING TO CLOSE DOWN.
SHOW ME THE NUMBERS SHOW ME
EXACTLY WHY YOU WOULD BE CLOSING
DOWN -- IF IF WE WERE TO
IMPLEMENT THIS -- HOW IMPORTANT
IS A THREE FORTY PROGRAM HOW
MUCH MONEY IS COMING IN?
AND I THINK THAT.
AS OPPOSED TO DOING IT
ANECDOTALLY IF WE HAVE TOTAL
TRANSPARENCY THE INFORMATION IS
PROVIDED.
THEN THE SOMETHING THE
ADMINISTRATION COULD SAY -- THAT
MAKES SENSE NOW I UNDERSTAND WHY
YOU SAY YOU MAY CLOSE DOWN BUT
IF THE CLINICS ARE SAYING.
WE MAY HAVE TO CLOSE DOWN
BECAUSE IT WAS SUCH AN IMPORTANT
PART THE REBATE TO SUCH AN
IMPORTANT PART -- I CAN SEE THE
PUSH BACK I CAN UNDERSTAND THE
PUSH BACK SO I WOULD HOPE LIKE
DOCTOR WOULD DO THAT.
THE CONVERSATIONS WOULD CONTINUE.
BECAUSE WHAT THE GOVERNOR DID
WAS VERY BOLD AND THE WE HAVE TO
WE HAVE TO GET FULL CREDIT. FOR
FOR HIS COURAGE TO TO DO THAT.
WE ALSO WANT TO BE SURE.
AND HE WOULD BE JUST AS
CONCERNED ABOUT COMMUNITY HEALTH
CENTERS.
WE HAVE TO BE SURE THAT ARE A
COMMUNITY CENTERS COMMUNITY
HEALTH CENTERS DO NOT CLOSE DOWN.
SO THE INFORMATION I THINK HAS
TO BE PROVIDED FOR FOR FOR FOR
FOR FULLY VALUATION [inaudible]
ANYTHING FURTHER.
NO I I AGREE I THINK -- WE ALL
SHARE THE VISION OF THE GOVERNOR
THE GOVERNOR'S VISION OF FINDING
A WAY TO REDUCE DRUG PRICES I
MEAN THAT'S SOMETHING OF
TEMPERATE AND THAT'S THE DAY I
GOT HERE AND YES -- AND WILL
CONTINUE TO WORK ON THAT BECAUSE
IT YOU KNOW AT AS DRUG PRICES
CONTINUE TO RISE.
AT THE HIGH AT FASTER THAN ANY
OTHER SECTOR OF HEALTH CARE --
WE HAVE TO FIND A WAY TO GET OUR
ARMS AROUND THIS AND SO I I
APPLAUD THE GOVERNOR'S EFFORTS
IN AND THEY JUST.
MY CONCERN IS IS IS NOT WANTING
TO HAVE AN UNINTENDED
CONSEQUENCE AND AND LOSE
PROVIDERS BECAUSE OF BECAUSE OF
THAT.
SO I'M CONFIDENT THAT THERE WILL
BE.
EFFORTS TO MAKE SURE IT DIDN'T
HAPPEN WILL YOU WILL YOU GIVE ME
ONE ANECDOTE WILL YOU ALLOW ME
ONE ENACTED.
YES OKAY.
SO -- WE HAVE I ASK QUESTIONS OF
MY DEPARTMENT BECAUSE I REALLY
LIKE DATA AND I ASKED A QUESTION
OF MY DATA ANALYTICS PEOPLE A
FEW YEARS AGO AND SAID WHAT.
WHAT IS THE MOST EXPENSIVE
PERSON IN MY PROGRAM RIGHT I
KNOW HOW MUCH ONE PERSON THERE'S
GOT TO BE ONE PERSON THAT HAS?
HAS RECEIVED A LOT.
AND WE HAVE ONE PERSON THAT HAS
RECEIVED IN THE IN THAT YEAR --
TWENTY ONE MILLION DOLLARS THEY
WERE THEY COST US TWENTY ONE
MILLION DOLLARS I HAVE FIVE
PEOPLE THAT OF COST OVERTEN
MILLION DOLLARS.
AND YOU CAN HAVE THESE
THEORETICAL CONVERSATIONS AROUND
YOU KNOW HOW MUCH IS HEALTH CARE
COST IN IS IT TOO MUCH AND ARE
YOU DOING A BETTER JOB YOU KNOW
WHY DON'T PEOPLE TAKE MORE
RESPONSIBILITY FOR THEIR COSTS
YOU KNOW WHATEVER.
AND WHEN SOMEONE SAYS THAT I
IMMEDIATELY PUSHED BACK AND SAY
BUT IF WHAT IF THAT TWENTY ONE
MILLION DOLLAR PERSON WITH YOUR
CHILD.
AND THEY SAY OH MMHM AND THEN
THEY USUALLY QUIETLY WALKWAY AND
DON'T ASK ME MORE QUESTIONS.
WE HAVE DRUGS THAT HOURS WITHIN
BEING APPROVED BY THE FDA.
WE HAVE A REQUEST FROM PROVIDERS
TO AUTHORIZE THAT FOR CHILDREN
IN SOME CASES WE HAVE DRUGS
RELATING TO MUSCULAR DYSTROPHY
TRADITIONS.
THAT ARE HALF A MILLION DOLLARS
A YEAR -- WHICH WITHIN HOURS WE
HAVE REQUEST FOR AUTHORIZATION I
MEAN WE DO SOME REALLY AMAZING
AND INCREDIBLE THINGS I THINK WE
RECOGNIZE HOW IMPORTANT -- THE
AVAILABILITY AND ACCESS TO
PRESCRIPTION DRUGS IS.
THERE'S NO ONE ELSE THAT CAN
SUPPORT A TWENTY ONE MILLION
DOLLAR INDIVIDUAL OTHER THAN THE
STATE OF CALIFORNIA AND THE
PROGRAM THAT WE RUN -- THAT IS
NOT POSSIBLE AND AS AN EMPLOYER
BASED COVERAGE ON IT WOULD
CRIPPLE SOMEONE WITH AN
INDIVIDUAL POLICY AND SO I THINK
WE'RE EXTREMELY MINDFUL OF THE
IMPORTANCE OF THE BENEFIT.
BUT ALSO WANTING TO MAKE SURE
THAT WE ARE USING ALL OF THE
POWER OF OUR DEPARTMENT AND THE
FACT THAT WE'RE THE FIFTH
LARGEST ECONOMY IN THE STATE.
ARE IN THE IN THE IN THE WORLD
TO THINK ABOUT HOW WE NEGOTIATE
BETTER PRICING AND SO I THINK
YOU HEAR A COMMITMENT FROM US
WHICH IS.
WE VALUE THE BENEFIT WE SEE THE
IMPORTANCE FOR INDIVIDUALS BUT
WE ALSO ARE KEENLY AWARE OF THE
FACT THAT WE ARE MOVING TO
MARKET SHARE.
AND SO THAT IS THE PARTNERSHIP
THAT WE WANT TO WORK ON WITH
BOTH THE LEGISLATURE AND OTHERS
AS WE KIND OF MOVE FORWARD ON
THIS EXECUTIVE ORDER.
WONDERFUL THANK YOU KNOW
UNINTENDED CONSEQUENCES I NEED
MY COMMUNITY HEALTH CENTERS.
TAKE CARE OF EVERYBODY I THANK
YOU ALL SO VERY MUCH -- I'D LIKE
TO OPEN IT UP.
FOR A PUBLIC COMMENT NOW.
LINDA WAY WITH WESTERN CENTER ON
LAW AND POVERTY WERE NEUTRAL ON
THE GOVERNOR'S PROPOSAL BUT DO
SEE IT AS AN OPPORTUNITY TO
IMPROVE.
FEE FOR SERVICE CARVE OUT SYSTEM
AB PARTICULARLY WE'D LIKE TO SEE
ANY CAR ABOUT RECOGNIZE THE
PRIOR AUTHORIZATION PROCESS
INTERNALLY HAS UNDERGONE AND
PROVIDE CONTINUITY OF CARE --
ELIMINATE THE SIX DRUGS OFF CAP --
IT ENSURE TIMELY ACCESS SIMILAR
TO WHAT'S REQUIRED IN STATUTE
FOR MEDI CAL MANAGED CARE PLANS.
AS WELL AS I DO PROCESS RIGHTS
AND ACCESS TO AN INDEPENDENT
MEDICAL REVIEW OR SOME EXTERNAL
A PROCESS SIMILAR TO THAT -- IN
ADDITION -- RECOGNIZING THE THE
THE WORK -- MOVING FORWARD ON
THIS ISSUE A STAKEHOLDER PROCESS
AS WELL THANK YOU.
THANK YOU.
GOOD EVENING JENNIFER ALLEY WITH
CALIFORNIA ASSOCIATION OF HEALTH
PLANS AND WE REALLY DO APPLY THE
GOVERNOR'S EFFORTS TO ADDRESS
THE RISING COSTS OF PRESCRIPTION
MEDICATION.
I'M SKYROCKETING DRUG PRICES
BEEN A MAJOR ISSUE THAT IMPACT
THE OVERALL COST TO HEALTH CARE --
OUR MEMBER HEALTH PLANS WHATEVER
YOU HAVE QUESTIONS REGARDING THE
EXECUTIVE ORDER AND HOW IT WILL
IMPACT THE HEALTH PLANS ABILITY
TO MANAGE AND COORDINATE CARE
FOR MEDI CAL BENEFICIARIES --
WE'VE YOU THE PHARMACY BENEFIT
THERE'S MORE THAN JUST
PURCHASING DRUGS -- HEALTH PLANS
UTILIZE PRESCRIPTION DATA TO
MANAGE OF THE AN OR AN
UNRELEASED CHRONIC CONDITIONS
AND MONITOR REFILLS FOR SPECIFIC
MEDICATIONS -- IS UNCLEAR -- HOW
THE SERVICES WILL BE IMPACTED BY
THE CAR ABOUT AND HOW IT WILL
ULTIMATELY LOWER THE COST OF
CARE DRUG PRICES THANK YOU?
THANK YOU.
GOOD EVENING MADAM CHAIR AND
MEMBERS ELIZABETH ESPINOSA HERE
THIS EVENING ON BEHALF OF THE
CALIFORNIA ASSOCIATION OF PUBLIC
HOSPITALS AND HEALTH SYSTEMS --
LIKE OTHERS WHO SPOKE BEFORE ME
WE ARE IN SUPPORT OF THE
GOVERNOR'S EFFORT TO REDUCE OF
PHARMACY COSTS AS AS I THINK --
WE ALL SHARE AS AN OBJECTIVE BUT
DO YOU WANT TO KNOW SOME IMPACTS
THAT ARE MEMBERS I WOULD
EXPERIENCE -- AS A RESULT OF THE
GOVERNOR'S PROPOSAL AS YOU'RE
WELL AWARE ALL PUBLIC HEALTH
CARE SYSTEMS ARE ELIGIBLE THREE
FORTY BE PROVIDERS.
AND WOULD BE AFFECTED INDEED BY
THE MOVE A PHARMACY TO MEDI CAL --
FEE FOR SERVICE OUR MEMBERS USE
THESE DRUG DISCOUNTS TO PROVIDE
BETTER ACCESS TO DRUGS FOR ALL
OF OUR PATIENTS.
PUBLIC HOSPITALS ALSO ADMINISTER
CRITICAL CRITICAL PROGRAMS THAT
PATIENTS MAY NOT FIND ELSEWHERE
INCLUDING HABSI TREATMENT
HEMOPHILIACS SERVICES HIV AND
SPECIALTY SERVICES. FOR OTHER
FORMER VULNERABLE PATIENTS SO AT
AS YOU'VE HEARD FROM OTHERS
BEFORE US WHO SPOKE BEFORE ME WE
DO LOOK FOR TO CONTINUE THE
CONVERSATION WITH THE
LEGISLATURE ADMINISTRATION TO
ENSURE THAT WE CAN CONTINUE TO
PROVIDE THESE SERVICES -- IT TO
MITIGATE ANY POTENTIAL IMPACTS
OF THE THREE FORTY PROPOSAL
THANK YOU.
GOOD EVENING I CHAIR AND MEMBERS
MITCHELL GOT IT I WITH SCA YOU
CALIFORNIA WE LIKE THE
GOVERNOR'S EXECUTIVE ORDER
BECAUSE WE THINK IT FORCES
INDIVIDUAL STAKEHOLDERS TO
REALLY STRETCH THE LIKELIHOOD OF
GENERATING.
SIGNIFICANT SAVINGS FOR THE
STATE OF CALIFORNIA WHICH WE CAN
THEN REINVEST TO WHERE THERE ARE
LEGITIMATE AT EXTRA SERVICES
BEING PROVIDED BY THE SAFETY NET
TO BACK FILL AND HOLD THEM
HARMLESS WE THINK WE CAN DO BOTH
THINGS.
AND WE AGREE THAT HEALTH PLANS
DO NEED TIMELY ACCESS. TO THE
DATA BUT WE ALSO NEED A PROCESS
AT THE STATE LEVEL TO ENSURE
THAT WHAT WE ARE PROVIDING THE
MOST EFFECTIVE DRUGS TO MEDI CAL
BENEFICIARIES AND SO WOULD LIKE
TO ALIGN OURSELVES WITH HEALTH
ACCESSES COMMENTS AND URGE YOU
TO CONSIDER MOVING FORWARD WITH
THIS PROPOSAL.
THANK YOU THANK YOU.
GOOD EVENING BARBARA GLAZER WITH
THE CALIFORNIA HOSPITAL
ASSOCIATION WE DO SUPPORT THE
GOVERNOR'S PROPOSAL TO LOWER
DRUG COSTS I THINK WE ALL
SUPPORT THAT.
BUT WE ARE CONCERNED ABOUT THE
IMPACT TO ON SOME OF OUR
HOSPITALS OF THETHREE FORTY P.
PROGRAM AND AND WHAT THAT WOULD
MEAN.
APPROXIMATELY HUNDRED EIGHTY
HOSPITAL'S PARTICIPATE IN THIS
PROGRAM OUT OF ABOUT.
FOUR HUNDRED IN THE IMPACT WOULD
VERY DEPENDING ON A PARTICULAR
HOSPITAL AND THEIR RELATIONSHIP
WITH THEIR PHARMACIES WE DO WE
ARE CONCERNED ABOUT A RURAL
HOSPITALS BECAUSE A NUMBER OF A
NUMBER OF THEM I THINK WOULD BE
IMPACTED GREATLY BY THIS.
SO WE APPRECIATE ALL THAT YOU
HAVE DISCUSSED AND THAT YOU WILL
BE LOOKING AT THE TOTAL IMPACT
ON OUR PROVIDERS -- AND WE ARE
HAPPY TO WORK WITH YOU I ALSO
WANT TO MENTION THAT -- AT THE
FEDERAL LEVEL THE AMERICAN
HOSPITAL ASSOCIATION JUST THIS
YEAR.
HAS STARTED A VOLUNTARY PROGRAM
THAT HOSPITALS CAN ENTER WHERE
THEY WILL REPORT.
WHAT THE EIGHT WHAT THEY USE
THEIR THREE FORTY BE SAVING
SUPPORT SIDE BE GLAD TO GET YOU
MORE INFORMATION ON THAT BECAUSE
THAT IS A -- TRANSIT YOU KNOW A
WAY THAT WE CAN BE TRANSPARENT
ABOUT WHAT THE SAVINGS MEAN
PRIOR HOSPITALS [inaudible]
THANK YOU.
GOOD EVENING LEN ACKERMAN TO THE
LOCAL HEALTH PLANS OF CALIFORNIA.
AND WE TWO WOULD LIKE TO APPLAUD
THE GOVERNOR FOR HIS
UNWILLINGNESS TO ADDRESS THIS
ISSUE RIGHT OUT OF THE GATE OF
AND THE NEW ADMINISTRATION.
AND COMING INTO OFFICE WE DO
ALSO HAVE CONCERNS ABOUT THE
PROPOSED CARVE OUT -- PHARMACY
SERVICES ARE CENTRAL TO PATIENT
CARE.
AND WE'RE CONCERNED THAT --
FULLY CARVING THEM OUT OF
MANAGED CARE I'M COULD
POTENTIALLY JEOPARDIZE CARE
COORDINATION AND CARE MANAGEMENT --
AND WE DO THINK THESE -- THESE
ARE CRITICAL FOR HEALTH PLANS TO
MAINTAIN -- OVERSEEING IN THE
PROGRAM AND SO WE ALSO DO THINK
THAT ALTERNATIVES EXIST AND
WOULD LOOK FORWARD TO HAVING A
CONVERSATION WITH THE
ADMINISTRATION AND LEGISLATURE.
ABOUT HOW TO BOTH LOWER THE COST
OF PRESCRIPTION DRUGS.
AS WELL AS ENSURE THAT --
CLINICAL OUTCOMES CAN CONTINUE
TO RAIN REMAIN AS HIGH AS THEY
ARE ON THROUGH THE COORDINATION
OF CARE THAT OUR PLANS DELIVER
THANK YOU.
MANAGER MEMBERS RAND MARTIN ON
BEHALF OF THE AIDS HEALTHCARE
FOUNDATION FOR THOSE THAT DON'T
KNOW HF IS THE LARGEST PROVIDER
OF CARE AND TREATMENT OF PEOPLE
WITH HIV IN THE WORLD -- BASED
HERE IN CALIFORNIA SO WE WERE A
LARGE POPULATION OF GREAT
INTEREST IN POLICY HERE -- 100%
SUPPORT THE GOVERNOR'S EXECUTIVE
ORDER IN TERMS OF LOWERING DRUG
PRICES WE ARE VERY CONCERNED --
THOUGH WITH THE POTENTIAL IMPACT
ON THE THREE FORTY B. PROGRAM HF
PRIDES ITSELF ON BEING THERE FOR
PEOPLE REGARDLESS OF THE ABILITY
TO PAY.
A LOT OF THE PEOPLE THAT WE
SERVE ARE INDIGENT UNDOCUMENTED
ESPECIALLY IN LOS ANGELES COUNTY --
AND SO THREE FORTY B. IS VERY
IMPORTANT TO KEEPING OUR PROMISE
OF PROVIDING THAT CARE
REGARDLESS OF ABILITY -- TO TO
PAY SO AS WE MOVE FORWARD I'M
SURE LOOK FORWARD TO WORKING
WITH YOU AND CERTAINLY WITH THE
DEPARTMENT I'M IN TRYING TO FIND
A SOLUTION THAT DOES NOT PULL
THE RUG OUT FROM UNDER THREE
FORTY B..
THANK YOU.
THANK YOU MADAM CHAIR AND
MEMBERS ALL BE QUICK CONFIRM IF
THEY TING WITH THE CALIFORNIA
STATE ASSOCIATION OF COUNTIES --
WE DO HAVE CONCERNS ABOUT
IMPACTS OF THE THREE FORTY B.
PROGRAM OUR PUBLIC HOSPITALS AND
COUNTY PUBLIC HEALTH CLINICS
COULD BE AFFECTED.
BY ANY RAPID CHANGE SO WE
SUPPORT THE GOVERNOR'S PROPOSAL
WE SUPPORT THE STAKEHOLDER
PROCESS AND OVERALL WE SUPPORT
MORE TRANSPARENCY IN DRUG
PRICING AND PURCHASING THANK YOU
[inaudible]
THANK YOU.
THANK YOU TO ALL THE PANELISTS --
I SINCERELY APPRECIATE.
YOUR STAYING FOR THE LONG OUR
THANK YOU DOCTOR WOULD.
THANK YOU VERY MUCH ANDREA AND
THEN THE HAVE A GOOD EVENING
THIS CONCLUDES THIS SUB ONE
HEARING