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San Francisco to mandate COVID-19 testing in nursing facilities — while state mulls providing them with broad legal immunities

“A consortium of watchdog groups, including the ACLU and the Western Center on Law & Poverty, on April 28 sent its own letter to Newsom:

The proposed executive order would be extremely broad and would cover both reckless elder and dependent abuse situations as well as non COVID-related negligence in any health care setting. … With no public oversight you would be ensuring that we never truly know how many deaths this virus has caused among our elderly population.”

San Francisco to mandate COVID-19 testing in nursing facilities — while state mulls providing them with broad legal immunities

 

Analysis of Federal Coronavirus Aid, Relief, and Economic Security (CARES) Act

Today, Congress passed a $2 trillion aid package, the third piece of federal legislation to address the COVID-19 pandemic. While this aid package includes some direct payments, expanded unemployment benefits, and additional help for low-income communities and the organizations that serve them, it was passed without important benefits and considerations raised to address concerns for the poorest Americans, especially those who are living in deep poverty, people who are disabled or advanced in age, and people who are undocumented. The bill invests significantly more government aid for corporate America than it does for the people hit hardest by the crisis. We are hopeful that the fourth aid package, expected to be worked on by leaders while Congress is in recess for the next couple of weeks, will address these significant gaps.

Western Center is working hard to make sure that both the missed opportunities in the CARES Act and additional investments are considered in the next COVID bill, and we look forward to working with California’s Senators and our Congressional Delegation to make sure that happens.

FINANCIAL SECURITY

The CARES Act expands eligibility and benefits for unemployment insurance, but it does not provide assistance for states to manage the cost of rising TANF (Temporary Assistance for Needy Families) caseloads, as was done in the 2009 American Recovery and Reinvestment Act (ARRA). TANF, known as CalWORKs in California, serves the poorest families with children by providing them a basic needs grant, work training and support, homelessness prevention, and subsidized employment. It is critical that Congress and the President provide increased funding for state TANF programs in the fourth COVID package. Unlike many states, California spends the bulk of its combined federal and state welfare funds on direct cash aid and supports to families. Still, it only serves approximately 60 percent of eligible families with a benefit, and in most cases, isn’t even above half of the Federal Poverty Level (FPL). As the needs increase and caseloads rise, the state may find it difficult to maintain the program at its current level. While California could receive about $1.6 billion for Supplemental Security Income recipients, and another $3.5 billion for the CalFresh (SNAP) caseload, we will need to keep working to make sure that national TANF investments include additional resources for low-income families to weather this storm.

The stimulus plan includes one-time income for many families and individuals, including very low income households. Unfortunately, the bill does not provide funding for households where one adult does not have a Social Security number (SSN). This means many households who pay taxes and may have American citizens or Legal Permanent Residents (LPR) in their households will receive nothing, despite the fact that payroll taxes are taken from their checks. Congress must address this gross inequity in the next COVID package; it will disproportionately deny aid to low-income workers of color, many of whom are essential workers on the front line of our service sectors.

For those families who are eligible, they will receive $1,200 payments for each adult and $500 for each child under the rebate program. These payments are available to households that filed a federal tax return for 2018 or 2019 even if the household payed no taxes. This is important because households with incomes under $25,000 are not required to file tax returns since they have no federal tax liability, so many do not routinely file taxes. As a result, many low-income families may not get a check unless they file a tax return by July 15th (the new extended tax filing deadline). This could prove challenging since many Volunteer Income Tax Assistance (VITA) centers and other tax preparers are closed during shelter in place, and most of them would have finalized 2020 activities as of April 15th, the regular tax filing deadline.

Currently, the IRS has information on its website on free options for filing taxes. The IRS is required to do a public education campaign on the rebates, which should provide more information on what people need to do to get the rebates. The federal government has discretion on how to get payments to people, so what the options are for non-filers (beyond filing a regular return) is yet to be determined and might differ for different groups. California will need to explore how it can assist low income households with filing returns so they can secure the resources needed to meet their basic needs. A summary of the rebate process can be found here.

Both the IRS and the state Franchise Tax Board (FTB) have long utilized tax intercepts to collect unpaid taxes from those getting tax refunds and Earned Income Tax Credit (EITC). According to the Tax Policy Center, the IRS will not be intercepting rebate checks to collect unpaid taxes. The Center also reports that the IRS has temporarily suspended interception of EITC payments for unpaid federal taxes. Click here for more on the IRS policy changes.

And today, after receiving a request from the Debt Free Justice Coalition, Western Center, and our Legal Services Allies, the FTB has announced it will use existing authority to immediately stop tax intercepts and all other debt collection practices (including bank levies and wage garnishments) for state government debt, with the exception of child support.

The CARES Act includes $900 million to help lower income households heat and cool their homes through the existing Low Income Heating and Energy Assistance Program (LIHEAP), and another $1 Billion to Community Services Block Grant (CSBG) to help communities address the consequences of increasing unemployment and economic disruption. These are flexible funds to alleviate poverty, so there will be great variation from community to community for how these funds are used.

FOOD SECURITY

The Cares Act provides $8.8 billion for child nutrition programs in the form of additional funding for food purchases and demonstration projects to increase flexibility for schools; $15.51 billion for SNAP; $100 million for food distribution to low-income households living on Indian reservations and participating Indian Tribal Organizations; $200 million for U.S. territories that cannot access SNAP (Commonwealth of Northern Mariana Islands, Puerto Rico, and American Samoa), in addition to annual block grant funding; and $450 million for commodities and distribution of emergency food assistance through community partners, including food banks.

The CARES Act investments in food security mainly support administration of existing benefits, and does not establish new benefits. It will help fund H.R. 6201 implementation, support caseworker staff needed to keep up with increases in applications and caseload, and fund waivers and other accommodations necessary to comply with COVID-19 stay-at-home orders and the impending recession that our economy will face. This is important not only because this workforce will be needed to help low-income Californians meet their basic needs, but also because the county social worker workforce is made up primarily of women of color.

We are disappointed the bill doesn’t include a needed benefit increase and pause on the implementation of Trump Administration cuts to SNAP food stamp benefits. We are committed to working with local, state, and national partners, as well as California’s U.S. Senators and our Congressional Delegation, to make sure the expected fourth COVID bill includes these investments and others that are necessary to address acute levels of hunger caused by extended school feeding and congregate meal closures, and prolonged stay-at-home orders.

HEALTH

Through the passage of the CARES Act, private health plans must cover COVID-19 testing free of charge. The CARES Act also requires health plans to cover vaccinations at no-cost when it becomes available. For older adults and individuals with disabilities, the CARES Act enhances several Medicare benefits, including coverage of COVID-19 vaccination when it becomes available, more flexible provision of telehealth services, and a three-month supply of prescription drugs. For Medi-Cal beneficiaries who receive unemployment benefits under this act, these payments will not affect their Medi-Cal eligibility.

The CARES Act requires price transparency for COVID-19 testing but does not place a limit on testing costs which may skyrocket as the demand for testing increases and testing supplies remain low. Consumers will also face challenges to accessing affordable coverage for COVID-19 treatment. The CARES Act contains no prohibitions on surprise billing, such as additional costs patients often incur when using emergency care services, and no measures addressing the high out-of-pocket costs that many patients will have to pay for COVID-19 treatment. Even with this third emergency act, the federal government still has not authorized state Medicaid programs to cover COVID-19 treatment for those who are uninsured and undocumented.

HOUSING

The CARES Act provides for (1) a forbearance period for borrowers with Federally-backed loans who are financially impacted by COVID-19, (2) a moratorium on foreclosures of Federally-backed loans, and (3) a moratorium on evictions from public housing or housing with Federally-backed mortgages. 

Under the CARES Act, borrowers with Federally-backed mortgages may request a forbearance on the loan if they are experiencing a financial hardship during the COVID-19 emergency. The forbearance can last for 180 days and may be extended at the request of the borrower. No fees, penalties, or additional interest will accrue for borrowers during the period of forbearance. The CARES Act also provides a moratorium on foreclosures of federally-backed mortgages. Borrowers with Federally-backed multifamily mortgage loans may obtain forbearance of 30 days, which may be extended, and during the period of forbearance, are prohibited from evicting a household solely for non-payment. Importantly, the Act provides a 120-day moratorium on eviction filings for most federally subsidized rental housing, as well as for any housing that has a Federally-backed mortgage or multifamily mortgage loan if the eviction is based on non-payment.  Borrowers curious about their mortgages can look up the information through Fannie Mae, Freddie Mac, or by contacting your own mortgage company.

The CARES Act also dedicates $4 billion to the expansion of the existing Emergency Solutions Grant program intended to be used for people experiencing or who are at risk of homelessness. These funds can increase shelter capacity, allow communities to reconfigure shelter space to adhere to physical distancing guidelines, deliver medical care to people who acquire the virus or may be at higher risk, and provide short-term rental or utility assistance so that people who have lost jobs or income don’t also lose their housing.  Although the funds can be used for emergency assistance, the needs of shelters (and creating alternatives to current shelter options) are so great that there is unlikely to be sufficient funds to address all the emergency needs that come with such high rates of joblessness. It is unclear how California will use this funding.

Statement on Governor Newsom’s Executive Order to Shelter Unhoused Californians during COVID-19

The administration and state and local governments have a hard job right now, and we are grateful for their work to make sure people in California are taken care of. It is our intention to continue working alongside agencies and staff to ensure that California’s approach to the crisis is as humane, safe, and sensible as possible.

Governor Newsom’s new Executive Order, issued last night, directs $150 million to cities, counties and continuums of care to provide shelter for unhoused people in California during the COVID-19 pandemic. The funds are to be used to build emergency shelter and lease hotels and motels.

We believe leasing existing, unoccupied hotels and motels is the single fastest way to move homeless individuals into housing. While we appreciate the Governor reducing regulatory barriers to providing emergency housing, we believe that in most cases, expanding existing emergency shelters will not be an immediate solution.

We urge counties, cities, and continuums of care to be mindful not to displace existing individuals and families already living in hotels or motels. The CalWORKs Homeless Assistance Program (HAP) has long utilized motel vouchers as a way to keep families experiencing poverty housed when they are evicted or fleeing an abuser. Many other low-income families reside in motels as well. These existing pipelines of assistance must be kept available as we expand housing for individuals experiencing homelessness. It is imperative that local governments communicate closely with county human service programs, advocates, and local residents to avoid displacing vulnerable families when seeking appropriate sites.

We are also calling on the Governor to allow CalWORKs HAP motel vouchers to be used beyond 16 days in a month, and to allow vouchers to be provided in consecutive months to keep families housed during the COVID crisis.

 

JOINT STATEMENT: Families First Coronavirus Response Act passes Congress to provide significant relief during the pandemic: More action still needed

This evening, the President signed H.R. 6201, the Families First Coronavirus Response Act, which will greatly increase food security during the uncertain times presented by COVID-19 and the subsequent shelter in place protections taking hold across the country. The Senate passed the bill earlier today. The new law will provide flexibility for SNAP food stamp benefits (known as CalFresh in California) and additional anti-hunger resources like Pandemic EBT, which will prevent hunger among children during school closures. 

The law also funds additional unemployment insurance opportunities, paid sick leave, and free COVID-19 testing. We look forward to working with the Department of Social Services and County Human Services Agencies to implement the new law in California.

Specifically, the law will help Californians with low-incomes in the following ways:

  • Provides $500 in additional WIC funds and provides broad authority to USDA to grant waivers of regulatory requirements through September 30th to ensure we are able to meet the specific nutrition needs of pregnant women, new moms, and young children as WIC adopts new practices to remotely serve participant needs.
  • Provides $400M to support increased distribution of food at food banks. California’s food bank lines have doubled in the past week due to intense community need, these are vital funds for food security.
  • Establishes Pandemic EBT, which enables the state to help reduce hunger as schools close and more counties go to shelter in place. Pandemic EBT offers the quickest and easiest way to get food into the hands of those that who need it most: (1) By providing additional SNAP dollars to current SNAP recipients; and (2) By providing funds to children eligible for free and reduced-price school lunch whose families may not be currently receiving SNAP. 
  • Gives USDA authority to issue waivers to allow non-congregate meals through the Child and Adult Care Food Program.
  • Focuses strategies and additional financial resources on older adult nutrition, since older adults are one of the populations most vulnerable to COVID-19. With Governor Newsom announcing that everyone over 65 should stay home, and an increasing number of counties implementing shelter in place, it’s essential that we target services to keep this population nourished.

This is a tremendous first step in addressing the needs of people living in the United States at this time. We are hopeful that Congress and the President will continue the hard work needed to protect everyone – particularly those most vulnerable to the economic implications brought on by the pandemic. We look forward to seeing an economic stimulus package that works not just to help the economy, but most importantly, to provide relief to families and individuals across the country.

Are Medical Credit Cards a Debt Trap?

Western Center attorney and policy advocate Jen Flory joined The Doctors for a segment on the topic of high interest medical credit cards. Some dental patients face years of debt due to high interest credit cards, many of which are promoted when patients are vulnerable and in pain.

Watch here

 

Western Center Statement On Supreme Court Public Charge Ruling

Today the Supreme Court chose to allow the Trump administration to enforce its cruel and inhumane Public Charge immigration rule, even though the underlying case has not yet been decided. The decision upsets historical legal precedent in which courts preserve the status quo while litigation is pending.

As we stated in our initial statement on the rule, and in our comments to the Department of Homeland Security, this ruling will have long term detrimental effects on the health of our nation. This rule change is a cruel action aimed at immigrant communities with the unrealistic intent to create a whiter, wealthier version of the United States that does not, has not, and will never exist. The administration’s continued attacks on our country’s already inefficient and unfair immigration system weakens our nation of immigrants.

We will explore all options to protect the wellbeing and safety of our clients and communities.

For more information:

Learn more about public charge at keepyourbenefitsCA.org (English) and tusbeneficiospublicos.org (Spanish). You can also text “benefits” (for English), “libre” (for Spanish), “福利” (for Chinese) or “lợiích” (for Vietnamese) to 650-376-8006.

Visit the Protecting Immigrant Families Campaign website for fact sheets, community flyers, and more public charge details: https://protectingimmigrantfamilies.org/community-education-resources/

Contact the Health Consumer Alliance if you are worried about how your access to health care may impact your family’s immigration status: https://healthconsumer.org/

Find a trustworthy immigration attorney for individual counseling at the organizations on this list: https://www.cdss.ca.gov/Benefits-Services/More-Services/Immigration-Services/Immigration-Services-Contractors

Medi-Cal Benefits Eliminated A Decade Ago, Such As Foot Care And Eyeglasses, Are Back

“Some health activists wonder why it took the state so long to restore the benefits. “A lot of these recession-related cuts came on the backs of the poor. Yet when the economic recovery came, we didn’t see their restoration,” said Linda Nguy, a policy advocate at the Western Center on Law and Poverty. “The low-income people who needed the medical services the most were the first to see them cut and the last to have them returned.”

Read more

PRESS RELEASE: California plaintiffs win case against state for failing to provide federally-mandated In-Home Supportive Services

FOR IMMEDIATE RELEASE

State must reimburse or pay Medi-Cal recipients and conduct statewide outreach to thousands of Californians who may be eligible for in-home services

 

LOS ANGELES — Thousands of Medi-Cal beneficiaries with significant disabilities will now be able to access affordable Medi-Cal care at home, rather than going to a nursing facility. In-home care provides greater stability and health outcomes for individuals and families, and it is cost-effective for the state; but it can be prohibitively costly to pay for out-of-pocket. As a result, married people with disabilities often have to make a draconian choice: impoverish themselves and their spouses or go to a nursing facility.

“My wife and I live primarily on a fixed income of pensions and social security; we exhausted our life savings and retirement accounts paying for my care,” said plaintiff Patrick Kelley, a 68-year-old U.S. Army veteran living with spastic quadriparesis. “My wife’s ability to work was severely limited by her caregiving responsibilities to me. We spent almost all of her limited income paying for my in-home care.”

Thanks to the successful lawsuit against the state, married people with disabilities will now learn about their right to Medi-Cal eligibility so they can stay at home with their spouse, receive care, and be reimbursed through the state’s Medi-Cal program for In-Home Supportive Services (IHSS). The court ruling makes it clear that the state must fully implement a federal law, known as the expanded spousal impoverishment protection, which should have been implemented as part of the Affordable Care Act in 2014.

“This ruling will dramatically improve the quality of life for disabled Californians and their family caregivers and will prevent many Californians from falling into poverty due to the high cost of in-home care,” said Kim Selfon, IHSS Client Advocate at Bet Tzedek. “Caregivers selflessly care for their disabled spouses with courage and compassion, often to the detriment of their own finances and health. They and thousands of others will now have the support they need to continue caring for their loved ones at home.”

The two plaintiffs’ situations illustrate the diversity of the thousands of individuals that will be impacted by the outcome of this case.

“The judge’s decision is a boost to Welfare and Institutions Code section 10500, which says agencies must secure for every person the aid to which they are entitled. As California’s population ages, in-home care will become increasingly important to the future of the state,” said attorney Cori Racela of Western Center on Law & Poverty.

Plaintiff Matthew Reed is a 63-year-old man with multiple sclerosis, Bell’s Palsy, and vascular dementia from a stroke. Due to the severity of his disabilities and medical condition, Mr. Reed is eligible for Medi-Cal home services, and should have had access to care without out-of-pocket costs under spousal impoverishment protections. Instead, he was required to pay more than $1,500 per month for care, which he cannot afford.

“If the spousal impoverishment rule had been implemented as it should have, Matthew could have been found eligible for free Medi-Cal and IHSS,” said Matthew Reed’s wife, Vicki Reed. “That means my son or I could have earned IHSS wages, sparing us incalculable stress and anxiety and giving us better options for Matthew’s home care and more financial resources. I don’t want any other families to go through what we have gone through.”

The Affordable Care Act set a deadline to expand spousal impoverishment protections to home-based care starting January 1, 2014. However, the Department of Health Care Services (DHCS) failed to issue any guidance about the rule until July 2017, after Mr. Kelley and Mr. Reed brought this lawsuit.

The ruling in Patrick Kelley & Matthew Reed v. California Department of Health Care Services, et. al., was issued by a Los Angeles Superior Court judge on January 14, 2020. It concludes that DHCS must a) notify beneficiaries who could benefit from the rule, particularly those denied or discontinued from Medi-Cal because DHCS failed to implement the rule on time; b) create a process for people to be found eligible for IHSS retroactively to the date they applied for Medi-Cal; and c) allow impacted individuals to be paid for home services they were entitled to during the delay period.

“Choosing between remaining at home without needed services, impoverishing oneself and one’s spouse, or moving into a facility separate from loved ones is no choice at all,” said Claire Ramsey, Senior Staff Attorney at Justice in Aging. “This ruling means relief for many who have struggled to stay at home and in their community and receive the services they need.”

MEDIA CONTACTS:

For plaintiffs: Allison Lee: Bet Tzedek, alee[at]bettzedek.org

Courtney McKinney: Western Center on Law & Poverty, cmckinney[at]wclp.org

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About Bet Tzedek

Bet Tzedek is committed to providing free legal services to those that need them most. Bet Tzedek attorneys and advocates help people of all communities and generations secure life’s necessities. Wherever people are in crisis, Bet Tzedek’s core services and rapid response programs provide stability and hope. Founded in 1974, Bet Tzedek – Los Angeles’ House of Justice – helps over 50,000 people each year.

 

About Justice in Aging

Justice in Aging is a national organization that uses the power of law to fight senior poverty by securing access to affordable health care, economic security, and the courts for older adults with limited resources. Since 1972 we’ve focused our efforts primarily on fighting for people who have been marginalized and excluded from justice, such as women, people of color, LGBTQ individuals, and people with limited English proficiency.

About Disability Rights California

Disability Rights California (DRC) is the agency designated under federal law to protect and advocate for the rights of Californians with disabilities. The mission of DRC is to advance the rights, dignity, equal opportunities, and choices for all people with disabilities. www.disabilityrightsca.org.

About Western Center on Law & Poverty
Western Center on Law & Poverty fights for justice and system-wide change to secure housing, health care, racial justice and a strong safety net for low-income Californians. Western Center attains real-world, policy solutions for clients through litigation, legislative and policy advocacy, and technical assistance and legal support for the state’s legal aid programs. Western Center is California’s oldest and largest legal services support center.

Medi-Cal’s Very Big Decade

“Under the expansion, any adult who met the income guidelines could enroll, which represented a “radical shift” in the way the program operates, said Jen Flory, a policy advocate at the Western Center on Law & Poverty.

It transformed Medi-Cal “to more general low-income coverage,” she said.”

Medi-Cal’s Very Big Decade

Full Analysis of Governor Newsom’s proposed 2020-2021 state budget

For a PDF of this analysis, click here.

Last week, Governor Newsom unveiled his $222 billion 2020-21 budget proposal. Western Center’s summary of the proposal can be found here.

The state is in its 11th year of increasing tax revenue, and estimates a $5.6 billion budget surplus over existing obligations. The budget continues the practice of prioritizing saving state revenue for future years by increasing the Rainy Day fund to $18 billion and paying down state debts to reduce state payments in future years.

Governor Newsom is focused on addressing many long standing issues, particularly the homelessness and housing crisis. The budget proposes to allocate $1.4 billion to a variety of solutions, including $750 million in one-time funding to shore up board and care facilities, provide rental assistance to those at risk of or experiencing homelessness, and to fund adaptive re-use of existing structures to create additional housing that people experiencing homelessness can afford. The budget also includes substantial new funding for health care, including a proposal for the state to manufacture prescription medications and to expand health care to undocumented seniors.

The budget proposal does not include the third step of CalWORKs funding that would bring grants to 55 percent of the federal poverty level. Instead, the budget proposes a 3.1 percent increase for CalWORKs grants in October 2020. The budget also provides no increase in state funding for Supplemental Security Income (SSI/SSP) grants, keeping in place recession era cuts that have still not been restored.

Homelessness

The Governor’s budget proposes $750 million in one-time funds to be deposited in the new California Access to Housing and Services Fund, which the Governor recently created by executive order. The fund would be administered by the Department of Social Services, which would allocate dollars to “regional administrators” to be used to provide short- and long-term rental subsidies to people at risk of or experiencing homelessness, create additional housing units affordable to people with extremely low-incomes, and stabilize licensed board and care facilities around the state. How funds would be allocated and administered remains open to negotiation.

Housing

The budget proposes a one-time $500 million increase in the state Low-Income Housing Tax Credit program, which funds the production and rehabilitation of housing affordable primarily to households with incomes between 30% and 80% of area median income (AMI).

Financial Security

CalWORKs: CalWORKs has gone through a period of substantial investment. In 2019, the budget included funding for a 13 percent grant increase, expanded the earned income disregard to $500 a month, and stabilized CalWORKs child care for families. This budget is not as ambitious as prior years, though it does provide a 3.1 percent increase in grants beginning October 2020. This will increase grants for a family of three by about $25 a month. However, it was anticipated that CalWORKs grants would be raised to 55 percent of the federal poverty level to ensure no child lives in deep poverty. This budget proposal will not achieve that goal.

The budget does include funding to increase the CalWORKs child support pass through. Under current law, the first $50 of child support paid by the non-custodial parent goes to the CalWORKs family, but any amount over that is used to pay for the cost of welfare benefits to the state and federal government. Beginning January 2022, CalWORKs families with one child will keep the first $100 of child support, and families with two or more children will keep the first $200 of child support.

We are grateful the Governor heard parents and families in their call for a child support program that works for children. The increases to child support pass through and relief from government-owed, uncollectable debt proposed by the Governor look like a good start. We are eager to see the associated proposed trailer bill law changes so we have more details, and look forward to working with the Governor and legislature to achieve the goals of conforming with federal law and regulation, and ensuring the program works to benefit the children it purports to help.

Fines and Fees: The budget proposes to expand the traffic court ability to pay pilot program statewide. Currently, an eight county pilot program (operational in four counties) allows persons to adjudicate traffic tickets through an online portal and reduce fines by at least 50 percent for low income drivers. The budget would expand this pilot statewide over several years to all counties. The pilot has yet to be evaluated.

Additionally, the budget makes a $92 million investment in reducing criminal justice fees and their harmful, recidivistic impact on people with low-incomes and people of color, their families, and their communities. We are grateful to Budget Chair Mitchell for her leadership on this issue and look forward to working on details with her, the Governor, and other budget leaders.

SSI/SSP: The SSI/SSP caseload continues to decline, and as a result, state funding for the state supplemental program (SSP) is declining. In the 2020-21 budget the administration projects a 1.6 percent decline in SSP spending to $2.66 billion, down from $2.73 billion in the 2019-20 budget. This continues a trend of declining state spending for disabled and elderly adults. As recently as the 2016-17 budget, the state spent $2.87 billion. Rather than invest savings from caseload declines into grants, the savings are going into the General Fund for other purposes. SSI/SSP grants are critical for paying the cost of housing; this failure to invest in SSI grants will put more recipients at risk of homelessness.

Health care

Expands full-scope Medi-Cal to all income-eligible undocumented adults age 65+ (Health4AllSeniors): Building on the 2019 Budget, which made California the first in the nation to expand full-scope Medi-Cal to adults up to age 26 regardless of immigration status, the Governor’s recent proposal includes $80.5 million ($64.2 million General Fund) to expand full-scope Medi-Cal to all income-eligible undocumented adults age 65 and older. This would benefit about 27,000 older adults, to be implemented no sooner than January 1, 2021. Full implementation costs are projected to be approximately $350 million ($320 million General Fund) in 2022-23 and ongoing.

Delays 2019 Budget Act suspensions from December 31, 2021 to July 1, 2023: The 2019 Budget made important Medi-Cal investments that were to be suspended on December 31, 2021 and the proposal delays these suspensions by 18 months. This includes restoration of Medi-Cal benefits (optical, audiology, podiatry, speech therapy, and incontinence creams and washes), extension of Medi-Cal eligibility from 60 days to one year for post-partum women diagnosed with a mental health disorder, expansion of Medi-Cal screening for the overuse of opioids and illicit drugs, and Prop 56 supplemental payments to providers.

Funding for CalAIM (recently renamed to Medi-Cal Healthier California for All Initiative): The Governor’s proposal includes $695 million ($348 million General Fund) for CalAIM effective January 1, 2021 and ongoing. Despite the name change, the administration continues to advance policy changes released in October’s proposal. The proposal still terminates the Health Homes Program (HHP) despite loss of enhanced federal match rate and the Whole Person Care (WPC) program, and includes $225 million to implement the new statewide enhanced care management benefit through plans. Plans will have the option of providing housing transition services, currently provided under HHP and WPC, and other services In Lieu of Service. The Dental Transformation Initiative will end December 2020, but $112.5 million is proposed to continue and expand program elements including provider incentives for preventive services (expanded to adults); provider incentive payments for continuity of care (expanded to adults); caries risk assessment, and adding silver diamine fluoride as a covered service for children.

Termination of Dental Managed Care in Medi-Cal: The administration proposes transitioning Medi-Cal dental services from a managed care delivery system, currently mandatory in Sacramento and optional in Los Angeles, to a fee-for-service (FFS) system in January 2021. A net zero fiscal impact is estimated due to small administrative savings offset by higher dental utilization in FFS system. However, any transition will have to ensure existing consumer protections for enrollees in dental managed care, including network adequacy requirements, continuity of care protections, and a strong grievance and appeal process.

Medi-Cal Medication Assisted Treatment Benefit Changes: The administration proposes adding all FDA approved drugs (specifically buprenorphine and buprenorphine-naloxone combination) to treat opioid addiction as a Medi-Cal benefit. Currently, only methadone and naltrexone is covered for Medi-Cal enrollees needing Medication Assisted Treatment; adding two new drugs is estimated to cost $876,000.

Prescription Drug Cost Containment: The Governor proposes to continue last year’s Executive Order to carve-out the Medi-Cal managed care benefit from managed care to fee-for-service effective January 1, 2021 to include savings that are partially offset by creation of a new supplemental payment pool for non-hospital clinics for 340B pharmacy services. The Governor also proposes to establish the state’s own generic drug label to manufacture certain generic drugs, establish a single market for drug pricing within the state to combine purchasing power, and expand authority to negotiate with manufacturers internationally for Medi-Cal supplemental rebates.

Potential Public Option: With more details to come, the Health and Human Services Agency will develop options to strengthen enrollment, affordability, and choice through Covered California, including leveraging the network of existing public Medi-Cal managed care plans.

Office of Health Care Affordability: The administration proposes the establishment of the Office of Health Care Affordability in spring 2020 to increase price and quality transparency, and to reduce costs to generate savings to directly-impacted consumers.

Hearing Aids for Children: The budget proposes to create a state program to assist families with the cost of hearing aids and related services for children without health insurance coverage for households with incomes up to 600% FPL.

Behavioral Health: The administration proposes to establish the Behavioral Health Task Force Agency and strengthen enforcement of behavioral health parity laws. The Department of Managed Health Care’s enforcement will focus on timely access to treatment, network adequacy, benefit design and plan policies. The administration also supports updating the Mental Health Services Act to focus on people with mental illness experiencing homelessness, those involved in the criminal justice system, and for early youth intervention.