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California Governor Criticized for Proposal to Eliminate Health Benefit for Some Disabled Immigrants

SACRAMENTO, Calif. (AP) — California Gov. Gavin Newsom vowed he would not fix the state’s budget deficit by taking away health insurance from low-income adults living in the country without legal permission, calling the state’s policy “something I believe in.”

But Newsom would eliminate an important health benefit for some low-income immigrants with disabilities, angering his allies who are now accusing the second-term governor of breaking his word.

California was one of the first states to give free health insurance to all low-income adults regardless of their immigration status. The multibillion-dollar project, completed in January, made more than 1 million people eligible for California’s Medicaid program, including many people who had never before had health insurance.

Now, just five months later and with California facing an estimated $45 billion deficit, Newsom wants the state to stop paying for caregivers to come to the homes of some disabled people — who are living in the country without legal permission — to help them with cooking, cleaning and other tasks so they can stay out of nursing homes. Everyone else would keep that benefit.

The Newsom administration says this would save about $94 million and impact fewer than 3,000 people out of the more than 15 million who are enrolled in the state’s Medicaid program, known as Medi-Cal. But eliminating the benefit would also keep thousands more from becoming eligible in the future.

Neswom’s proposal “is a betrayal,” said David Kane, an attorney with the Western Center on Law and Poverty. Ronald Coleman Baeza, managing policy director for California Pan-Ethnic Health Network, called it “indefensible” and compared the proposal to a notorious ballot proposition from the 1990s that sought to bar immigrants from accessing government assistance programs.

“I think it could move us back in the sense of treating undocumented as different,” said state Sen. Maria Elena Durazo, a Democrat from Los Angeles who has pushed for the Medicaid expansion for years.

Newsom’s proposal for immigrants would impact a benefit known as in-home supportive services that’s becoming more expensive for the state to provide. The average hourly wage for caregivers has gone up 6% since 2014. And starting this year, with some emergency federal funding provided during the pandemic expired, there have been cost increases of about $200 million.

Once people qualify for the program, they get to hire their own caregiver. It’s often a relative, meaning the program often acts as financial assistance for families.

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California could boot thousands of immigrants from program that aids elderly and disabled

In Bell Gardens, Raquel Martinez said she has relied for nearly three years on a program that pays an assistant to help her make it safely to her frequent appointments at the MLK Medical Campus.

Martinez, 65, is blind and has cancer. If she did not have the help of her support worker, Martinez said, she would struggle to navigate the elevators and find the right office. Her assistant also helps her with groceries and other daily tasks such as housekeeping, she said, tending to her 21 hours a week.

“I was in need of a lot of help,” Martinez said in Spanish.

As budget cuts squeeze the state, California could yank such assistance from elderly, blind or otherwise disabled immigrants who have relied on the state’s In-Home Supportive Services program.

IHSS pays assistants who help people with daily tasks such as bathing, laundry or cooking; provide needed care such as injections under the direction of a medical professional; and accompany them to and from doctor’s appointments. It aims to help people remain safely in their own homes, rather than having to move into nursing facilities or suffer without needed care.

Gov. Gavin Newsom has proposed cutting immigrants in the country illegally from the IHSS program, estimating it would save California nearly $95 million as the state stares down a $44.9-billion budget deficit.

The proposed cut has outraged groups that advocate for immigrants and disabled people, which argued it would be a shortsighted move that would jeopardize Californians who need day-to-day support, put them at increased risk of deportation and ultimately drive up costs for the state.

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Millions of Californians in Jeopardy of Losing Medi-Cal Coverage

Millions of Californians in Jeopardy of Losing Medi-Cal Coverage 

The Protecting Medi-Cal Coverage for Californians Act (AB 2956), aimed at helping millions of low-income Californians keep their Medi-Cal coverage, held back from progressing through the Legislature 

(Sacramento, CA) May 20, 2024 – The Protecting Medi-Cal Coverage for Californians Act (AB 2956) introduced by Assemblymember Tasha Boerner (D-Encinitas) has died in Assembly Appropriations. The bill, aimed at protecting the most vulnerable by allowing adults enrolled in Medi-Cal to keep their coverage for a full 12 months and by making the federal Medi-Cal renewal flexibilities permanent, was intended to decrease the number of wrongful Medi-Cal disenrollments Californians are currently experiencing.

As of April 2023, California restarted the process of reviewing and renewing Medi-Cal eligibility for the first time since Medi-Cal renewals were paused in March 2020, referred to as Medi-Cal “unwinding.” Over 1.6 million Californians have lost their Medi-Cal coverage in the first 10 months of this unwinding period – the overwhelming majority being people of color, with about half of all disenrolled people being Latines. The overwhelming majority (80%) of Medi-Cal disenrollments have been for procedural or ‘paperwork’ reasons, meaning they have been disenrolled by no fault of their own, even when they were likely still eligible.

Most notably, California had adopted several federal flexibilities to streamline the renewal process and reduce the number of wrongful disenrollments. In other words, without these flexibilities, far more eligible Medi-Cal enrollees would have lost their coverage. AB 2956 would continue those flexibilities that otherwise would expire. The federal agency has extended those flexibilities through June 2025. But without AB 2956, it is unclear that California will extend these flexibilities beyond December 2024.

Advocates have been sounding the alarm that the unwinding process would come down on the backs of poor Californians, particularly communities of color. Although the state is approaching the end of this process, redeterminations are an annual procedure for the Medi-Cal program – meaning that unless protections are put in place, these wrongful disenrollments will continue and be far worse without continuing existing flexibilities. AB 2956 was one last effort to put protections in place. However, today the Legislature held this bill on suspense in the Assembly Appropriations Committee. Coupled with the proposed cuts in the state budget to enrollment navigators, California leaves millions more at risk of wrongfully losing coverage, potentially increasing poverty and negative health outcomes in the state.

“I am disappointed that AB 2956, a bill that would have helped many Californians retain health coverage, did not get the necessary approval to move forward. I remain committed to ensuring that those eligible for Medi-Cal are not routinely disenrolled due to bureaucratic red tape. It is unconscionable to think that over a million people each year are not able to get the care that they need due to something as simple as missing a single piece of paper,” stated Assemblymember Tasha Boerner. 

The bill is co-sponsored by the Western Center for Law and Poverty (WCLP)The Children’s Partnership (TCP), and The Latino Coalition for a Healthy California (LCHC),

“Since Medi-Cal redeterminations began nearly a year ago, 1.6 million low-income Californians, including well over 300,000 children, have lost Medi-Cal coverage, all through no fault of their own. The vast majority of disenrollments are the result of procedural reasons, not eligibility – placing children at risk of losing coverage due to barriers like submitted renewal forms not being received and long call wait times to get questions answered. Even relatively short gaps in Medi-Cal coverage can mean the difference between getting the timely early developmental intervention that growing children and their families need to lead healthy lives and falling dangerously behind in healthy childhood development. Putting families’ coverage in jeopardy, especially our BIPOC communities that are more likely to rely on Medi-Cal for coverage, exacerbates existing racial disparities and undermines Californians’ investments in coverage for all.” – Mayra E. Alvarez, President, The Children’s Partnership

“This important legislation was an intentional fight for justice. The health of Latines is in a fragile state: our community is still facing acute cases of COVID-19, long-COVID and the socio-economic repercussions of the pandemic. This means that now more than ever, Medi-Cal coverage is essential to our well-being. Unfortunately, in the wake of post-pandemic public health emergency flexibilities, Medi-Cal redetermination disenrollments have disproportionately affected Latinos. In 2023, of those who were disenrolled, 49.5% were Latino – that’s 613,280 Latine community members who lost life-saving coverage. We find ourselves at a unique nexus of time. California has led the nation in expanding access to Medi-Cal for ALL, regardless of immigration status. And these disenrollments are an antithesis to the decades of hard work we, as a state, have put in. To truly reach health equity for all Californians, we have to ensure that there are intentional processes that take into account the realities that our communities are facing. The loss of AB 2956  will unfortunately have a dire impact on the health and economy of our state.” – Dr. Seciah Aquino, Executive Director, Latino Coalition for a Healthy California

“We are deeply disappointed that AB 2956 is not moving forward. The failure to permanently extend temporary, innovative fixes that eliminate burdensome administrative barriers means California is turning back the clock and resuscitating a bureaucratic process that stripped health coverage from thousands of people every month.” – Linda Nguy, Associate Director of Policy Advocacy, Western Center for Law and Poverty

“Failing to move forward with AB 2956 is a failure to better protect the most underserved Californians. The restart of the renewals process in the state has provided an incredible opportunity to improve our Medi-Cal eligibility and enrollment systems at a crucial time when millions of residents’ coverage has not been renewed for several years since the start of the Public Health Emergency. Preventing further efforts to enact stronger and improved policies amidst the current momentum on improving Medi-Cal eligibility processes is a huge missed opportunity to mitigate loss of coverage and prevent deeper inequities among underserved communities in California.” – Skyler M. Rosellini, Assistant Director of California Policy, National Health Law Program

CONTACT: 

Robert Nunez

Latino Coalition for a Healthy California

[email protected]

(805) 815-7730

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Assemblymember Tasha Boerner represents the 77th District, which encompasses Carlsbad, Encinitas, Solana Beach, Del Mar, and the coastal communities of La Jolla south to Downtown and Coronado. You can learn more about Assemblymember Boerner at a77.asmdc.org.

Latino Coalition for a Healthy California (LCHC)— is the leading statewide policy organization with a specific emphasis on Latine health. For over 30 years, LCHC has worked on transforming systems to achieve Latinx health justice. We pride ourselves in translating community solutions into equitable policy and lasting systemic change.

The Children’s Partnership is a California advocacy organization advancing child health equity through research, policy, and community engagement. For 30 years, TCP has championed policies that help create a California where all children have the resources and opportunities they need to be healthy and thrive.

Through the lens of economic and racial justice, Western Center on Law & Poverty  litigates, educates, and advocates in courts, cities, counties, the State Capital, and the public arena to secure just housing, health care, economy, and legal systems for  Californians with low incomes.

Newsom’s proposed spending cuts spur backlash from affected California groups

Just minutes after Gov. Gavin Newsom unveiled a revised state budget with billions of dollars in spending reductions on Friday, advocates for affected programs began showering reporters with statements of dismay.

The gist of the complaints was that after Newsom and the Legislature had devoted attention and money to expanded health care coverage, prekindergarten education, income supports for the poor, undocumented immigrant assistance, homelessness, climate change and a myriad other left-of-center causes, the new budget would punish their recipients.

Building the California Dream Alliance, a consortium of nearly 60 groups, was among those disappointed with Newsom’s budget, issuing a compendium of comments from its members, including the Western Center on Law and Poverty.

“Although we appreciate the governor maintaining previous expansions and grants, his approach balances the budget on the backs of low-income Californians through over $3 billion in cuts,” Linda Nguy, an associate director of the organization, said. “Instead of considering additional revenue solutions, the governor proposes to cut in-home supportive services for people who were previously excluded from Medi-Cal due to their immigration status, deeper CalWORKs cuts, and continued cuts to housing and homelessness prevention programs.”

Analysis Of Governor Newsom’s May Revision of California’s 2024-2025 Budget

May 10, 2024

The Governor released his May Revision on May 10, estimating that the budget shortfall for the 2024-25 fiscal year grew by approximately $7 billion from the January Proposal to approximately $44.9 billion. This differs from the Legislative Analyst’s Office earlier estimate of $73 billion, with differences attributed to higher revenue projections and different Proposition 98 calculations. After accounting for the early action budget package that included $17.3 billion of solutions, the remaining budget problem is approximately $27.6 billion.

Western Center on Law and Poverty appreciates that the Governor maintains some of the previous expansions and grants proposed in the January budget. However, we oppose the Governor’s approach to address the current budget shortfall through cuts to critical safety net programs. This approach balances the budget on the backs of low-income Californians through over $3 billion in cuts. Instead of considering additional revenue solutions, the Governor proposes to cut In-Home Supportive Services for people who were previously excluded from Medi-Cal due to their immigration status, deeper CalWORKs cuts, and continued housing cuts. We look forward to working with the Governor and Legislature on a final budget that reflects our values and protects vulnerable Californians.

HEALTH CARE

Cuts In-Home Supportive Services for Undocumented Individuals — Despite historic investments in Medi-Cal expansions, the May Revision proposes treating people who were previously excluded due to their immigration status differently. Specifically, the May Revision cut IHSS services for those who were previously excluded at a reduction of $94.7 million. IHSS allows seniors and people with disabilities to safely stay in their home.

Managed Care Organization (MCO) Tax — Sweeps $6.7 billion over multiple years from the Medi-Cal provider rate increases, Medi-Cal workforce funding, and equity payments planned for January 2025 and proposes amendment to include Medicare health plan revenue resulting in an additional $9.7 billion in total MCO Tax funds over multiple years. The related November ballot initiative raises uncertainty. If the measure passes, billions of dollars could be diverted, resulting in budget deficit that may result in future cuts to safety net programs.

Cuts Acupuncture as Medi-Cal Benefit — Eliminates acupuncture as a Medi-Cal benefit starting January 2025 at reduction of $5.4 million this budget year and $13 million ongoing.

Healthcare Workforce Reduction— Eliminates about $900 million various healthcare workforce initiatives including community health workers, nursing, social work, Song-Brown residencies, Health Professions Career Opportunity Program, and California Medicine Scholars Program as well as eliminates $189.4 million Mental Health Services Fund for programs proposed to be delayed to 2025-26 at Governor’s Budget.

Children and Youth Behavioral Health Initiative Reduction— Reduces $72.3 million onetime in 2023-24, $348.6 million in 2024-25, and $5 million in 2025-26 for school-linked health partnerships and grants, behavioral health services and supports platform, public education campaign, and youth suicide reporting and crisis response pilot.

Eliminates Behavioral Health Continuum Infrastructure Program and Reduces Bridge Housing Program— Eliminates $450.7 million from the last round of the Behavioral Health Continuum Infrastructure Program and reduces funding for the Behavioral Health Bridge Housing Program.

Eliminates Public Health Funding—Eliminates $52.5 million in 2023-24 and $300 million ongoing for state and local public health.

2022 Health Trigger Investments not Included: • Share of Cost Reform so that seniors and people with disabilities can afford to access needed Medi-Cal services • Continuous Medi-Cal Coverage for Children Aged 0 through 4.

HOUSING

One of the highest priorities for California lawmakers and residents is the housing and homelessness crisis, which requires more investment in affordable housing and homelessness prevention programs. We are concerned about the proposed cuts to these crucial programs, especially as Californians are grappling with housing insecurity and the continued legal attacks on our unhoused neighbors.

The May Revision proposes a total $1.76 billion in continued cuts to the following program (with additional cuts to January Proposal noted):

• Adaptive Reuse Program – additional $127.5 million cut

• Foreclosure Intervention Housing Preservation Program – additional $236.5 million cut

• Multifamily Housing Program – additional $75 million cut

• Infill Infrastructure Grant Program – additional $35 million cut

• Homeless Housing Assistance Program (HHAP) – additional $260 million cut

• Veteran Housing and Homeless Prevention Program – additional $26.3 million cut

The May Revision will include funding of $500 million to the state LIHTC (Low Income Housing Tax Credits) program.

PUBLIC BENEFITS AND ACCESS TO JUSTICE CalWORKs

While the May Revision does not propose to cut CalWORKs grants, the proposal continues the deep cuts proposed in January, including:

• The elimination of the Family Stabilization Program (FSP), which provides housing assistance, mental health, substance use and domestic violence services. This is a core program within CalWORKs that keeps people housed, safe, and well.

• The elimination of the Subsidized Employment Program, which provides additional job opportunities to participants to provide job experience and a path to unsubsidized employment.

• The draining of the safety net reserve, which was created to protect human services programs against cuts. The use of these funds results in a double cut to the CalWORKs program.

Additional cuts to CalWORKs include:

• The reduction of $47.1 million for the CalWORKs home visiting program ongoing, which is a cut of 45%. This highly effective program, which pairs professionals with new parents, prepares families for new infant household members and provides early supports to ensure a successful transition to new and increased parenting responsibilities. This cut could result in new referrals to child welfare services.

• The permanent elimination of the CalWORKs Mental Health and Substance Abuse Services program which is a cut of $126.6 million. These are critical services that stabilize a family and can also prevent referrals to child welfare services.

SSI/SSP

The Governor’s proposed budget did not propose a cut to SSI/SSP grants, but additional investments are still needed for this program which provides grants to seniors and people living with disabilities. The grant for individuals is currently 94% of the 2024 Federal Poverty Level (FPL). We hope to work with the administration in future budget years to strengthen these programs to bring the individual grant to at least 100% of the poverty line and to reinstate the annual cost of living increase. We would also request a revival of the special circumstances program to assist SSI recipients with unexpected expenses.

Child Support

Despite 2022 budget trigger language, the May Revision did not include a provision to fund full pass-through of child support payments to currently assisted CalWORKs families. Based upon current revenue, this trigger was not pulled and there is a need to renew this language in the 2024-25 budget.

Child Care Slots

The May Revision pauses the promised expansion of child care slots and keeps them at the current level. By pausing this expansion, the state will reduce support for California’s working families by $489 million in 2024-25 and $951 million in 2025-26.

In-Home Supportive Services for Undocumented Individuals

As previously mentioned, the May Revision cut IHSS services for people who were previously excluded from Medi-Cal due to their immigration status at a reduction of $94.7 million. IHSS allows seniors and people with disabilities to safely stay in their home.

California Food Assistance Program Expansion

• The May Revision delays the promised expansion of the California Food Assistance Program (CFAP) for two years, pushing benefits back to the 2027-28 budget year. CFAP is the state-funded CalFresh counterpart that serves some immigrants who are excluded from CalFresh due to their immigration status.

• This delay prevents California from fulfilling the promise to expand food benefits to undocumented older adults, therefore perpetuating poverty, food insecurity, and again inflicting harm specifically on California’s low-income immigrant communities.

Download the full analysis here: WCLP Analysis of 2024-25 May Revision

While Valley Children’s Executives Earn Millions, Community Benefits Lag

March 22, 2024

As news comes out about Valley Children’s Hospital’s high rate of executive pay, an examination of public records reveals the hospital’s community benefit fund lags other children’s hospitals.

The IRS and hospitals have an understanding. In 2020, an estimated $28 billion in taxes were exempted from nonprofit hospitals, according to Kaiser Family Foundation.

Instead of paying millions of dollars in taxes, state and federal governments require nonprofit hospitals to keep a community benefit fund.

The government knows that hospitals take major losses from patients who can’t pay for their services. Hospitals also provide other services pro bono such as education courses and research.

That can cover anything from health education to scholarships to research grants. Most traditional hospitals send a lion’s share of their community benefits to cover hospital bills for those who can’t pay — called charity care and unreimbursed care.

Valley Children Had a 2% Community Benefit Fund in 2022

In 2022, Valley Children’s entire community benefit fund came in just under $17 million, according to its report filed with the California Department of Health Care Access and Information. That was only 2% of the hospital’s expenses.

That same year, Children’s Hospital Los Angeles spent $440 million on its community benefit fund, or 31% of its expenses. Children’s Hospital Orange County’s $143 million community benefit made up 18% of its expenses.

Rady Children’s Hospital in San Diego spent $85.6 million on its 2022 community benefit fund, or 8.8% of expenses.

For comparison purposes, in 2021, Valley Children’s administrative pay exceeded $20 million and CEO Todd Suntrapak made $5.1 million. That same year, Valley Children’s community benefit fell more in line with other hospitals — its $80 million CBF making up 10.32% of expenses.

But in 2020 the CBF was $12.6 million, or 1.83% of expenses.

Vintage Foster, president of AMF Media Group, a third-party representative for Valley Children’s, said the hospital’s benefit fund was in line with other hospitals.

Foster provided community benefit numbers showing the net community benefit was 13.87% of expenses in fiscal 2021 and 9.88% in fiscal 2020. However, those figures didn’t line up with IRS 990 reports or the hospital’s reported community benefit fund.

Questions to Valley Children’s and Foster to clarify these discrepancies were not answered.

Affordable Care Act Doesn’t Cover Everyone: Western Center for Poverty and Law

A majority of hospital community benefits typically go toward unpaid medical debts.

Of the $269 million community benefit fund from Fresno-based Community Health Systems in 2022, $213 million covered what government-funded insurance didn’t, according to the medical group’s report. The hospital system that year also provided $15 million in charity care.

Children’s hospitals operate differently.

“For Children’s Hospitals, Charity Care trend lower than other hospitals because the percentage of children without health insurance is significantly less than it is for adults,” Foster said.

In contrast, unpaid Medi-Cal costs for Valley Children’s in fiscal year 2022 totaled $85.4 million. Revenue from the California Department of Health Care Service covered the entirety of that cost that year. Charity care totaled $181,952.

But even with the Affordable Care Act, some patients don’t have adequate insurance, said David Kane, an attorney with the Western Center for Poverty and Law.

Western Center and its partners often find patients who should have qualified for charity care.

A Look at Valley Children’s 2022 Community Benefits

Valley Children’s Hospital reported nearly $17 million in community benefit money in fiscal year 2022. (Valley Children’s)
Valley Children’s Hospital reported nearly $17 million in community benefit money in fiscal year 2022. (Valley Children’s)

California law requires access to discounted or even complete coverage for patients making up to 400% of the federal poverty level. In California, that is $4,530 a month for a single person or $9,250 a month for a family of four.

In 2016, St. Agnes requested the amount of required charity care be lessened as more people received insurance and therefore didn’t need the assistance.

Then-Attorney General Xavier Becerra didn’t buy that argument, saying California hospitals’ reported unpaid debt showed an unfilled need in the community. St. Agnes was required to pay out to nonprofits to make up the difference.

Becerra’s office used the hospital-reported “bad debt” as evidence that even federally mandated insurance wasn’t enough to provide for the needs of the community.

In fiscal 2021, Valley Children’s reported $3.7 million in unpaid medical debt, issuing only $181,952 in charity care, or 5% of unpaid medical debt.

Rady Children’s Hospital reported $17.6 million in unpaid debt on its IRS Form 990. But the charity care it reported topped $3.2 million, or 18%.

Of the four California children’s hospitals examined by GV Wire, Valley Children’s was second in charity care.

In 2021, Children’s Hospital of Orange County reported only $52,716 in charity care and $28.8 million in bad debt.

Children’s Hospital of Los Angeles reported $175,661 in charity care and $36.3 million in bad debt.

Hospitals Don’t Receive Much Oversight Into Charity Care: Kaiser Family Foundation

State and federal governments give nonprofit hospitals a lot of leniency for how they spend the money they would otherwise pay to the IRS. But not total leniency.

Kaiser Family Foundation in 2022 reported that “it is possible that some nonprofit hospitals may not expect significant oversight of their charity care practices from government regulators.”

When patients receive their medical bills, hospitals are supposed to inform patients of applications for charity care, said Kane, the attorney with Western Center Poverty and Law. Kane did not speak about Valley Children’s specifically.

He says charity care programs break down because hospitals aren’t incentivized to inform people of their options.

“It’s not because they don’t have the funding available to provide assistance to people who need it. It’s simply because they haven’t implemented the rules properly to screen people, evaluate them, tell them about, those sorts of things,” Kane said.

And hospitals will actively pursue debt collection on patients who may qualify for charity care. Questions about how many Valley Children’s bills have been sold to debt collection agencies went unanswered by the hospital.

A court search in Fresno and Madera counties for two known local medical debt collection agencies did not show legal action on medical bills originating from Valley Children’s.

“There is still a problem with some hospitals not providing this assistance to people who still need it today,” Kane said.

How Does Valley Children’s Spend Its Community Benefit?

Valley Children’s Community Health Needs Assessment identified access to health care and economic insecurity as two of the greatest barriers to healthy living for the community it serves.

Valley Children’s put $11.2 million toward education and research and $5.4 million toward health education, community health improvement, and other non-billing expenditures.

Valley Children’s spokesperson Zara Arboleda said the money for education supports significant training and education to more than 900 physician residents, medical students, and other health profession students —including nurses, pharmacists, social workers, physical therapists, speech therapists, and others.

The hospital also provides education to community-based providers including private practice physicians and school nurses.

“A significant portion of those funds are needed to have the personnel in place to teach future workforce members and to conduct research,” Arboleda said.

Valley Children’s staff and doctors provide education.

Using cumulative IRS 990 data from 2019 to 2021, Valley Children’s spent the least amount on benefits compared to Rady Children’s and the L.A. and Orange County children’s hospitals.

The $38.9 million spent on benefits such as community health improvement services, education for health professionals, and research only accounted for 1.82% of Valley Children’s expenses for those three years.

Valley Children’s did spend the most of the four hospitals in one area — donations to eligible nonprofits. The two biggest donations were $2.8 million to Valley Children’s Medical Group and $1 million to Valley Children’s Healthcare in 2021.

New eligibility rules mean nearly 2 million on Medi-Cal can now save for a rainy day.

FEB. 14, 2024 3 AM PT

Millions of Medi-Cal beneficiaries can now save for a rainy day, keep an inheritance, or hold on to a modest nest egg without losing coverage, thanks to an eligibility change phased in over the past year and a half.

The change also has opened the door for thousands who previously did not qualify for Medi-Cal, the health insurance program for low-income residents that covers over one-third of California’s population.

Until Jan. 1, 3 million Medi-Cal beneficiaries — mainly those who are aged, blind, disabled, in long-term care or in the federal Supplemental Security Income program — faced limits on the value of financial accounts and personal property they could hold and still qualify for coverage. Now, nearly 2 million of them will no longer face these restrictions, putting them on par with the roughly 12 million other Medi-Cal beneficiaries who don’t have asset limits.

They still must be below Medi-Cal’s income threshold, which for most enrollees is currently $1,677 a month for a single adult and $3,450 for a family of four. However, the change will eliminate a lot of paperwork for applicants and the county workers who verify their eligibility.

For a long time, this group of Medi-Cal beneficiaries could have no more than $2,000 in the bank — $3,000 for a married couple — though the home they lived in, as well as one car and certain types of other personal property, were exempt.

“If you had $5,000 in assets, you would have to spend $3,000 on something to prove that you were beneath the limit to qualify,” said Tiffany Huyenh-Cho, a senior attorney at the advocacy group Justice in Aging. “We had people who prepaid rent, spent money on car repairs, bought a new couch or appliances — things to reduce their assets in order to get to the $2,000 limit.”

Now, Huyenh-Cho adds, “you don’t have to remain in deep poverty. You can save for an emergency; you can save for retirement or for a security deposit if you want to move.”

And those who have hoped to leave a little something for their children when they die can now do so, even if they need expensive long-term care.

The first phase of the rule change was implemented in July 2022, when the threshold was raised dramatically to $130,000 for an individual and $195,000 for a two-person household. That was a nonfactor for the vast majority of those concerned; after all, most people with incomes low enough to qualify for Medi-Cal would not have that much saved. For this reason, the total elimination of the so-called asset test ushered in this year is expected to help fewer people financially than the first change did.

Still, there are some people with more than $130,000 in the bank whose savings would have been wiped out in shockingly short order had they needed long-term care in a nursing facility or at home. Now, they can qualify to have Medi-Cal pick up that cost.

Dr. Joanne Shinozaki, a resident of Granada Hills, hired private full-time caregiving last year for her mother, Fujiko, who has dementia. But it cost nearly $11,000 a month, which Shinozaki quickly realized would burn fast through the roughly $200,000 in savings her father had left when he died early last year. Reluctantly, she put her mom in a memory care home, which was less expensive. But after a 10% increase in January, it is now costing $9,000 a month, although that includes food and utilities.

Fujiko Shinozaki, who has dementia, at a memory care home in Agoura Hills.
Fujiko Shinozaki, who has dementia, is currently in a memory care home in Agoura Hills. Thanks to a change in eligibility rules that took effect Jan. 1, she may now qualify for Medi-Cal despite a nest egg her husband left when he died last year.
(Joanne Shinozaki)

Because of the money Shinozaki’s dad left, her mom did not qualify for Medi-Cal under the old rules. Now that money no longer counts against her.

Shinozaki, a veterinarian who quit her job to coordinate her mother’s care, needs to return to work soon. She has applied for Medi-Cal for her mom and is waiting for it to be approved.

“It would mean being able to bring her back to the house where she’s lived since 1988, if she’s well enough to come home,” Shinozaki says. To do that, she will need to get her mom access to caregivers via Medi-Cal’s In-Home Supportive Services program.

Indeed, another benefit of the change in eligibility rules is that it supports the caregiver economy, says Kim Selfon, a Medi-Cal and IHSS policy specialist at Bet Tzedek Legal Services, which provides free legal assistance to people in Los Angeles County.

Advocates who work with Medi-Cal enrollees and applicants say they often have to explain the difference between assets and income.

“I think a lot of people are confused,” says Stephanie Fajuri, program director at the Center for Health Care Rights, an L.A.-based nonprofit that helps people navigate Medi-Cal and Medicare. “They say, ‘What do you mean? I could be making $1 million a year?’ And we say, ‘No, that’s income.’”

So, let’s be clear: Under the new rules, yes, you can have a second house. But if you are renting it out, that’s income — and given today’s rental prices, it will probably disqualify you from full Medi-Cal benefits. You can also keep an investment account regardless of the balance, but distributions from it as well as any interest, dividends and capital gains it generates are also income.

Again, most beneficiaries are unlikely to have a large pool of assets and still have income low enough to qualify for Medi-Cal. But if you suddenly inherit a modest sum — or even a large one — now you can keep it, though it may briefly affect your coverage.

Unfortunately, the 1.1 million Medi-Cal beneficiaries receiving Supplemental Security Income are still subject to an asset test, because different rules apply to them.

CARE Court or Scare Court? The California CARE Court system allows for involuntary mental health treatment.

It is estimated that more than 170,000 individuals are homeless in California and that one in four of them has a serious mental illness. This is due to a lack of affordable housing and the state’s failure to provide necessary mental health care. Governor Newsom is hoping to change these statistics with his 14-billion-dollar investment in a system that will bring mental health into the courtroom. Judges will be able to order people to get help and counties to provide it under the Community Assistance Recovery and Empowerment (CARE) Court initiative. Newsom believes that the new civil court design will help thousands of people get off the streets and begin to live their lives with the mental health support they need.

Indeed, the CARE Court philosophy seems like a no-brainer. What is there to dispute about finally providing overdue clinical services to this widely ignored and vulnerable population? For starters, the CARE Court program is mandated for those who fall under its purview. Disability rights groups argue the CARE Court system violates the fundamental rights of individuals being forced into involuntary treatment. Further, the efficacy of mandated treatment is questionable.

What Is CARE Court?

Newsom has implemented CARE Court to address people with mental health and substance use disorders. This new court protocol is evidence-based and predicated on the ideology that people can stabilize, begin healing, and exit homelessness in less restrictive, community-based care settings. The CARE Court is designed to aid people who have become homeless, incarcerated, or worse due to mental illness by getting them into treatment, including therapy, medications, and housing. Specifically, Newsom proclaims the CARE Court system steps in and connects a person struggling with mental health and often co-occurring substance abuse with a court-ordered care plan for up to 12 months, which can be renewed for an additional year. Each treatment plan is managed by a care team in the community and is individualized with supportive services that are supposed to be culturally and linguistically competent.

How Does CARE Court Work?

The first step is a petition to the court by a family member, behavioral health provider, first responder, or other approved party to provide care and prevent institutionalization of an individual. Those who are exiting a short-term involuntary hospital hold or an arrest may be particularly good candidates for CARE Court. However, it is not available for every individual experiencing homelessness or mental illness. CARE Court only applies to those people on the schizophrenia spectrum and other psychotic disorders who may also have substance use issues and who lack medical decision-making capacity. Mental illnesses such as anxietydepression, and posttraumatic stress disorder are not included, and the participant must be 18 years or older. The civil court then orders a clinical assessment after a reasonable likelihood of meeting the CARE Court criteria is held. The court appoints a public defender and a CARE supporter to represent the individual to ensure their rights are being protected.

The court reviews the clinical evaluation, and if the person meets the criteria, the development of a CARE plan is ordered, which will include therapy, medications, and housing as part of its objective. As housing is an important component of this system, persons under a CARE Court plan will have access to clinically enhanced interim or bridge housing, licensed adult and senior care settings, and other supportive housing options. The CARE plan is then reviewed and adopted by the court with both the individual and county behavioral health as parties to the court order for up to 24 months. If an individual refuses to participate in their CARE Court-ordered plan, including stabilization medications, they may be subject to an additional court hearing and can be referred by the court for a conservatorship.

Civil Rights Groups Against CARE Court

Not everyone is praising Newsom’s CARE Court system. Helen Tran, senior attorney at the Western Center on Law and Poverty stated: “The CARE Act unnecessarily involves our court systems to force medical care and social services on people.” Additionally, Disability Rights California and The Public Interest Law Project have challenged the constitutionality of the CARE Courts program-mandated treatment agenda. Specifically, they argue that the CARE Court violates constitutional guarantees of due process and equal protection while burdening fundamental rights to privacy, autonomy, and liberty. Moreover, enabling the state to force severely mentally ill individuals into court-ordered treatment and housing programs is unconscionable. Disability activists contend that the CARE Court is a coercive, involuntary system period. Further, there are consequences for not following through with a CARE plan including that the court will refer the person for a conservatorship, which equates to the loss of controlling their own medical care, finances, and housing preferences. Finally, they indicate that there is no proven research that mandated treatment works.

Efficacy of Involuntary Treatment

The CARE Court system is predicated on self-determination for the individual involved. However, at its core, the CARE Act was devised to essentially force people into a court-mandated design of treatment. Taking people off the streets and requiring them to subject themselves to treatment or face conservatorship does not scream self-determination. Moreover, there is evidence that forced treatment doesn’t work. According to Corrado Barbui, the efficacy of mental health treatment when coercive is vastly reduced. Barbui contends that shared decision-making interventions and integrated care to reduce forced treatment in mental health services should be considered in the development of policy and clinical practice. Moreover, Christopher Maylea argues that social workers should reject the compulsion for involuntary treatment as the research does not support this paradigm. Instead, he states that inclusive participatory mental health approaches offer the individual the greatest chance for change.

Conclusion

Advocates of the CARE Court argue that this model of intervention will help thousands of mentally disabled persons. The CARE Court’s inception is brand new, and time will reveal if involuntary treatment offers hope for California’s most vulnerable population. While it was created as a “CARE” Court, its focus on mandated treatment scares many.

References

1. Barbui, C. 2021. Efficacy of interventions to reduce coercive treatment in mental health services: umbrella review of randomised evidence. The British Journal of Psychiatry, 218(4) 185–195.

2. Maylea, C. 2017. A rejection of involuntary treatment in mental health social work. Ethics and Social Welfare, 11(4) 336–352.

Western Center’s 2024 Legislative Agenda

Western Center’s 2024 Legislative Agenda

February 28, 2024
Following is a list of bills to help secure housing, healthcare, and a strong safety net for low-income Californians that will be sponsored or co-sponsored by Western Center on Law & Poverty during the 2024 legislative session.

Healthcare

AB 2297 (Friedman): Medical Debt Protection
This bill would modernize the Hospital Fair Pricing Act by prohibiting the use of home liens to collect unpaid medical bills from financially eligible patients, clarifying hospitals must review financial assistance eligibility at any time, clarifying Medi-Cal and Medicare cost sharing amounts can be deducted under financial assistance policies, defining charity care as free care, and other changes.
(Co-sponsored with Bet Tzedek)
AB 2297 Fact Sheet

AB 2319 (Wilson, Weber): Reducing Black Maternal Mortality through Implicit Bias Training
This bill would reduce the disproportionate maternal mortality rate of Black women and other pregnant persons of color by ensuring successful implementation of the California Dignity in Pregnancy and Childbirth Act of 2019 (SB 464 (Mitchell)) by clarifying which facilities are mandated to administer anti-bias trainings, confers enforcement powers to CDPH and the Attorney General, establishes administrative penalties for noncompliant facilities and requires compliance data to be posted online.
(Co-sponsored with Attorney General Rob Bonta, Black Women for Wellness Action Project, Reproductive Freedom for All California, California Nurse-Midwives Association and the California Black Women’s Collective)
AB 2319 Fact Sheet

AB 2753 (Ortega): Rehabilitative and Habilitative Services: Durable Medical Equipment and Services
This bill would clarify that durable medical equipment is a covered essential health benefit in California-regulated health plans and policies when prescribed by a doctor for rehabilitative or habilitative purposes. The bill would also remove limitations such as annual caps on durable medical equipment coverage.
(Co-sponsored with National Health Law Program)
AB 2753 Fact Sheet

AB 2956 (Boerner): Protecting Medi-Cal Coverage for Californians
This bill would allow people to keep their Medi-Cal coverage for a full 12 months, regardless of changes in their income and would direct California to seek federal approval, when necessary, to make permanent the federal Medi-Cal flexibilities to reduce and remedy procedural terminations, simplify income verification requirements, increase automatic Medi-Cal renewals, and improve program outreach and customer service. (Co-sponsored with The Children’s Partnership and Latino Coalition for a Healthy California)
AB 2956 Fact Sheet

AB 3170 (Ortega): Drug Testing of Pregnant People
This bill will be amended to indicate that any drug or alcohol test or screen performed by the staff or contractor of a health care institution on a pregnant or perinatal person or newborn, or any information on drug or alcohol use in the pregnant or perinatal person or newborn’s medical records, shall not be admitted in any criminal or civil proceeding, including juvenile dependency proceedings, over the objection of the person who was tested.

SB 1289 (Roth): County Call Center Oversight and Reporting
This bill would remedy the barriers at county call centers by directing the promulgation of regulations that set basic standards for things like wait times and requiring DHCS to publish online call center data from all 58 counties.
(Co-sponsored with Coalition of California Welfare Rights Organizations)

Housing

AB 653 (Reyes): Increasing Voucher Utilization
This bill would create a competitive grant program for public housing authorities (PHAs) to fund housing navigation services, landlord incentives, and deposit resources to increase lease-up success rates for tenants with Housing Choice Vouchers. This bill would require PHAs to annually report their success rate and require those with a success rate below 60% to adopt certain policies to increase housing choice and work with HCD to analyze and improve their policies.
(Co-sponsored with Housing California, Corporation for Supportive Housing, United Ways of California, and the National Housing Law Project).

AB 846 (Bonta): Low-income housing Credit.
This bill would establish anti-price gouging protections for rent in properties funded by the low-income housing tax credit (LIHTC) program.
(Co-sponsored with the California Rural Legal Assistance Foundation and Public Advocates)

AB 2304 (Lee): Masking Limited Civil Unlawful Detainer Cases
This bill will close the gaps in the state eviction masking laws and ensure that all tenants are protected as originally intended.
(Co-sponsored with the California Rural Legal Assistance Foundation).

AB 2347 (Kalra): Protecting Tenant Due Process Rights
This bill would preserve the due process rights of tenants by preventing evictions when a tenant has not been properly served.
(Co-sponsored with the California Rural Legal Assistance Foundation).

ACA 10 (Haney): Housing is a Human Right
ACA 10 will recognize that every Californian has the fundamental human right to adequate housing on an equitable and non-discriminatory basis. Should the measure pass in the legislature, California voters will have the opportunity to vote to add this right to the state’s constitution, creating an obligation on the part of state and local governments to take meaningful action to fully realize the right.
(Co-sponsored with Alliance of Californians for Community Empowerment (ACCE) Action, End Poverty in California (EPIC), Housing Now, ACLU California Action, Abundant Housing LA, National Homelessness Law Center, and PowerCA Action)

Public Benefits and Access to Justice

AB 274 (Bryan): CalWORKs: CalFresh: Eligibility: Income Exclusions
This bill would exempt any grant, award, scholarship, loan, or fellowship benefit provided to any assistance unit member for educational purposes from consideration as income or resources for purposes of determining CalWORKs eligibility or grant amounts. The bill would also require the State Department of Social Services to exercise a federal option to exclude, for purposes of calculating a household’s income under CalFresh, any type of income that the department excludes when determining eligibility or benefits for CalWORKs.

AB 1815 (Weber): Discrimination: Hairstyles: Amateur Sports Organizations
This bill expands upon the CROWN act by prohibiting an amateur sports club or organization from discriminating against any person based on race, inclusive of traits historically associated with race, including, but not limited to, hair texture and protective hairstyles in the operation, conduct, or administration of a youth or amateur sports competition, training, camp, or club.
AB 1815 Fact Sheet

AB 3170 (Ortega): Drug Testing of Pregnant People
This bill will be amended to indicate that any drug or alcohol test or screen performed by the staff or contractor of a health care institution on a pregnant or perinatal person or newborn, or any information on drug or alcohol use in the pregnant or perinatal person or newborn’s medical records, shall not be admitted in any criminal or civil proceeding, including juvenile dependency proceedings, over the objection of the person who was tested.

SB 1107 (Durazo): Public Social Services: County Departments: Mail Programs
This bill would require a county human services agency that administers public benefits to develop and implement a program to ensure that, at a minimum, homeless residents of a county can pick up and receive government-related mail addressed to the resident at a place designated by the agency.

Contact our Sacramento Advocates: For more information about Western Center on Law & Poverty and our advocacy priorities, go to www.wclp.org.

Brandon Greene, Director of Policy Advocacy
[email protected]
916-282-5112

Health
Linda Nguy
[email protected]
916-282-5117

Sandra O. Poole
[email protected]
916-282-5141

Housing
Cynthia Castillo
[email protected]
916-282-5103

Tina Rosales
[email protected]
916-282-5118

Public Benefits and Access to Justice
Christopher Sanchez
[email protected]
916-282-5104

Rebecca Gonzales
[email protected]
916-282-5119

LA County Care Court aims to help those on streets with mental illness

Thursday, November 30, 2023

LOS ANGELES (KABC) — Los Angeles County has about 75,000 people living on the streets. Officials estimate about 10% suffer schizophrenia or other disorders.

“There are too many people with severe mental illness who are living on the streets,” LA County Supervisor Janice Hahn says. “We’ve all seen them and so far, we’ve been unable to reach them.”

Los Angeles County officials on Thursday announced a new program called Care Court to help people receive treatment and services.

“We are really committed to helping people get the support they need to improve their mental health and well-being. We are here to change the trajectory of people’s lives,” says Dr. Lisa Wong from the Los Angeles County Department of Mental Health.

With this program a family member or someone else can file a petition asking to determine if someone qualifies.

A judge can then order a care plan for the person.

Samantha Jessner, presiding judge for the Superior Court of Los Angeles County, says “This new tool provides an alternative to the way in which most individuals enter our county’s mental health system, which is usually through the criminal justice system.”

“Initially, LA County wasn’t going to have this program until next year. But we are ground zero for this problem. And so, we moved our start date up an entire year,” adds Hahn.

Not everyone likes this program. The Western Center on Law & Poverty sued to stop the Care law, saying it forces treatment on people.

In an article it claimed, “The law paves the way to eventually institutionalize people who are unhoused and have schizophrenia and other psychotic disorders.”

Ricardo García, the Los Angeles County public defender says, “To those who are concerned that Care court will lead to forced treatments or detention, I want to emphasize participation in Care Court is absolutely voluntary.”

The program officially begins Friday and until then authorities say they’re not sure how many people would qualify for Care Court.