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Health Matters November 2014

November 15th, 2014

Community Health Councils - Health Matters

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In this issue:
“Disadvantaged Communities” Identified To Receive Cap-and-trade Benefits
California’s Medicaid 1115 Waiver Renewal Application Process Underway
Chemical Plants in US May Get New Rules
Green Trees for the Golden State Seeks to Increase Urban Forests
Children’s Health Insurance Program Funds Set to Expire in One Year
Governor Brown Approves New Redevelopment Tool, Vetoes Others
AB1990 - Community Food Producers Legislative Update
ACA Hearing Held By California Senate Health Committee
California High-Speed Rail Update

“Disadvantaged Communities” Identified To Receive Cap-and-trade Benefits

The California Environmental Protection Agency (CalEPA) designated the neighborhoods eligible to receive cap-and-trade funding reserved for “Disadvantaged Communities”. California is investing $832 million in cap-and-trade funds in the 2014-2015 fiscal year and at least 25% of those funds must benefit disadvantaged communities. In order to identify disadvantaged communities, the CalEPA created an environmental health screening tool known as CalEnviroScreen which identifies census tracts with the highest pollution burden and the residents most vulnerable to its effects. CalEPA recently announced communities in the top quartile of the CalEnviroScreen scores are defined as disadvantaged and eligible for targeted funds reserved for mitigating the effects of climate change for the most impacted and disadvantaged areas. A map of CalEPA’s defined disadvantaged communities is available here: http://bit.ly/1xCAYIo.

For more information, please contact Community Health Councils’ Policy Analyst, Erin at erin@chc-inc.org.

California’s Medicaid 1115 Waiver Renewal Application Process Underway

As California enters the final year of its current Medicaid 1115 Waiver, the Department of Health Care Services (DHCS) has been gearing up to apply for a renewal in 2015. A Section 1115 Medicaid Waiver authorizes states to pilot research and demonstration projects that experiment with new ways to provide and pay for health care services through Medicaid and the Children’s Health Insurance Program (CHIP). The current waiver, “Bridge to Reform”, began in 2010 and was instrumental in the successful implementation of the Affordable Care Act by laying the groundwork for the coverage expansion of Medi-Cal and pioneered innovative healthcare delivery system reforms to reduce costs and improve quality for California’s safety net.

The renewal plans to expand upon many of the lessons and strategies of the “Bridge to Reform” waiver, honing in on Medi-Cal payment and delivery reform. To date, the renewal is considering the following concepts:

• A shared savings initiative which sets a pre-determined annual per beneficiary amount for Medi-Cal. If California’s actual expenditures fall below this amount, California would be able to keep the federal funding for the amount saved.
• Incentive payment programs for groups comparable to accountable care organizations. Some incentive programs could also target the coordination of county-provided behavioral health care with the physical health care provided through Medi-Cal Managed Care.
• A global payment approach to promote coordinated and cost-effective care for the remaining uninsured.
• A Federally Qualified Health Center payment/delivery reform which would promote the provision of cost-effective and patient-centered care.
• A Delivery System Reform Incentive Program (DSRIP) “2.0” for the 21 public hospital systems in California as well as Non-Designated Public Hospitals (NDPHs) which would put more emphasis on outcomes and impact than the original DSRIP.
• Quality and cost improvements for California Children’s Services
• Medi-Cal reimbursement for housing for vulnerable populations
• Subsidies for malpractice insurance for doctors who serve safety net patients

As part of its stakeholder process, the DHCS is hosting expert stakeholder workgroups. The workgroup meetings through the end of the year are as follows:
• Workforce Nov. 20th, 2014 10:00 AM - 3:00 PM
• Safety Net Financing Dec. 9th, 2014 10:00 AM - 3:00 PM
• Workforce Dec. 11th, 2014 10:00 AM - 3:00 PM
• MCO/Provider Incentives Dec. 15th, 2014 10:00 AM - 3:00 PM
• Housing/Shelter Dec. 16th, 2014 10:00 AM - 3:00 PM
• DSIP 2.0 Dec. 19th, 2014 10:00 AM - 3:00 PM
The public call-in line is (888) 673-9807 Participant Code: 8083396

DHCS plans to submit the renewal application by February 2015.

For questions or comments, please e-mail DHCS at WaiverRenewal@dhcs.ca.gov or contact Community Health Councils’ Policy Analyst, Ine Collins at ine@chc-inc.org.

Chemical Plants in US May Get New Rules

The United States Environmental Protection Agency (EPA) is reviewing public comments on an update to regulations designed to prevent chemical accidents at facilities known to use very dangerous substances. The EPA runs a Risk Management Program that determines which technologies and procedures facilities must follow to minimize the risk of an accident. The Risk Management Plan is being reviewed since President Obama directed federal agencies to update chemical facility safety and security policies through an executive order; the executive order was prompted by an explosion at a Texas fertilizer plant in 2013 that killed 15 people and injured another 200. The options under consideration include expanding the list of substances covered under the rules, mandating buffer zones between regulated facilities and other uses, and requiring plants use safer substances when alternatives exist. An update will follow after the EPA has reviewed and responded to the public comments.

For more information, please contact Community Health Councils’ Policy Analyst, Erin at erin@chc-inc.org.

Green Trees for the Golden State Seeks to Increase Urban Forests

Green Trees for the Golden State is a grant program set forth by the California Department of Forestry and Fire Protection. The Green Trees program, along with a series of similar grants, provides funding opportunities to establish and increase the urban forest in California’s most impoverished, polluted communities.

Trees serve cities by cooling streets and sidewalks and saving energy, improving air quality, strengthening the quality of place and local economies, reducing storm water runoff, improving social connections, and creating more walkable communities.

Support for urban forest stewardship and development has grown over the last decade, but with incoming funds from the Global Warming Solutions Act of 2006, AB32, California communities can expect to see more opportunities to support urban forestry for years to come.

The goal of AB32 is to reduce greenhouse gas emissions statewide to 1990 levels by 2020. To help achieve this goal, the California Air Resources Board established a “cap-and-trade” program that limits greenhouse gas emissions from entities responsible for roughly 85 percent of the state’s greenhouse gas emissions. The policy is expected to generate billions of dollars in the coming years. The Governor has proposed to allocate those funds towards projects and programs that support a sustainable and resilient state--one of which is the urban forestry program. Specifically, the proposed funding would support local assistance grants for urban and community forestry. These grants are designed to assist environmental justice communities to create or implement projects with a focus on reducing greenhouse gas emissions. Community Health Councils, along with many local organizations, is looking for ways to tap into these funds to support urban forestry programs locally.

For more information, please contact Community Health Councils’ Policy Analyst, Heather Davis at heather@chc-inc.org.

Children’s Health Insurance Program Funds Set to Expire in One Year

In 2013, California closed its standalone Children’s Health Insurance Program (CHIP), Healthy Families, and has since funneled program dollars into coverage for children and pregnant women at higher income levels through Medi-Cal, California’s Medicaid program. The most recent CHIP funding authorization is set to expire in September 2015 although the program is authorized to operate through 2019. Community Health Councils is working with advocacy organizations such as Children Now and California Coverage and Health Initiatives to push for funding renewal through 2019 for the following reasons:
• CHIP brings a higher proportion of federal dollars into California than Medi-Cal. The federal match rate for CHIP is currently 65% and would be raised to 88% upon funding renewal while the Medi-Cal match rate is 50%.
• Although states are not allowed to drop children with Medicaid from coverage or decrease their benefit packages, if CHIP funding ends, the loss could make other Medicaid populations and public programs vulnerable targets for budget cuts.
• The national Government Accountability Office estimates as many as two million children would lose access to affordable coverage because of technicality called the “family glitch” – where the availability of potentially expensive employer-based coverage makes families ineligible for marketplace subsidies.
• Studies by The Wakely Group and the Kaiser Commission on Medicaid and the Uninsured have shown that families with CHIP coverage spend less on out-of-pocket health expenses and get more child-appropriate care than they do under marketplace qualified health plans.
• States are already developing their 2015-16 budgets and not knowing the future of CHIP hinders that process considerably.

CHC and its partners will be advocating to extend CHIP funding through 2019 in order to preserve and avoid reversing the important gains the program has achieved in its almost twenty years of existence.

For more information, please contact Community Health Councils’ Policy Analyst, Anulkah Thomas at anulkah@chc-inc.org.

Governor Brown Approves New Redevelopment Tool, Vetoes Others

In September, three years after signing a bill to close California’s local redevelopment agencies, Governor Jerry Brown vetoed a fresh proposal from state legislators to reinstate tax-increment financing (TIF) on a more limited basis. AB2280 passed the legislature this year following extensive negotiations and would have included badly needed set-asides for affordable housing development in underinvested communities that are more narrowly defined than in earlier statutes. The Governor affirmed the bill’s attempt to help disadvantaged communities in his veto message, but alluded to the state’s dubious former redevelopment law in his opposition, while offering to work with legislators in crafting a better alternative. He also vetoed bills to create new community development tax credits (AB1399) and return redevelopment bond proceeds to local governments (AB2493).

Rather than reviving past redevelopment functions, Governor Brown successfully pushed a bill through the legislature this year that expands the usefulness of infrastructure financing districts (IFD). The revamped tool includes a reduced vote requirement (from two-thirds to 55%) and a range of possible financing mechanisms such as tax increment, property assessments, benefit fees, and bonds. It is unclear how eager cities and counties will be to adopt the new IFD or for what purposes, but its intended focus is for infrastructure projects (transportation, storm water management, public utilities, environmental remediation) that reinforce development’s viability rather than financing specific development projects. City Councilmembers in Los Angeles have already introduced a motion (14-1349) to propose an IFD in support of revitalization efforts for the Los Angeles River. Housing advocates have warned that the bill contains inadequate provisions to prevent or mitigate displacement effects that often accompany new investments in low-income communities.

For more information, please see CP&DR’s review or contact Community Health Councils’ Policy Analyst, Robert Baird at robert@chc-inc.org.

AB1990 - Community Food Producers Legislative Update

Earlier this year, Assembly Bill 1990 passed both houses of the State Legislature with bipartisan support and was signed by Governor Brown. The bill was authored by Assemblyman Rich Gordon (Menlo Park) and establishes both definitions and a framework for community food producers to safely market their produce to the public. The bill will go into effect on January 1, 2015.

Under the bill, unless a local jurisdiction adopts an ordinance regulating community food production, a community food producer or gleaner may sell or provide whole uncut fruits or vegetables or unrefrigerated shell eggs, directly to the public, to a permitted restaurant, or a cottage food operation if the community food producer meets all of the following requirements:
1.Agricultural products must be grown or produced in compliance with subdivision (b) Section 113735 of the California Health and Safety Code
2.Agricultural products must be labeled with the name and address of the community food producer.
3.Signage shall be provided in lieu of a product label if the agricultural product is being sold by the community food producer on the site of production.
4.Community Food Producers must adhere to best management practices as described by the Department of Food and Agriculture
5.Egg production shall be limited to 15 dozen eggs per month.
6.A local city or county health enforcement office may require a community food producer or gleaner to register with the city or county and to provide specified contact information.

Community food producers must also follow any additional requirements imposed by an ordinance adopted by a local jurisdiction. For more information, please see California legislative information [http://bit.ly/1v8GiUv] or contact Community Health Councils’ Policy Analyst, Hector Gutierrez at hector@chc-inc.org.

ACA Hearing Held By California Senate Health Committee

On Thursday, October 30th the California State Senate Health Committee held an informational hearing on the Affordable Care Act (ACA). The session was led by committee chair State Senator Ed Hernandez and provided the Department of Health Care Services (DHCS), Covered California, and various community-based and advocacy organizations a public forum to reflect on the first year of ACA implementation in California and offer recommendations moving into the second open enrollment period.

DHCS Director Toby Douglas and Covered California Executive Director Peter Lee provided general program updates. California has enrolled 2.7 million new residents into Medi-Cal since October 1, 2013 and some 1.12 million of the 1.4 million people enrolled in Covered California paid their premiums and are eligible to renew their coverage for 2015.

The members of the Senate Health Committee, who were joined by Senator Holly Mitchell, questioned both directors about the nature of their successes as well as notable challenges including underperforming electronic eligibility and enrollment systems and unsatisfactory levels of African-American marketplace enrollment. The Committee looked to community-based organizations for additional insight on Medi-Cal expansion and the establishment of the state-based marketplace. CHC Health Coverage Policy Director Sonya Vasquez spoke on behalf of consumers and the enrollment workforce, highlighting the barriers faced by vulnerable groups like former foster youth and certain immigrants in the enrollment process and emphasizing the importance of a holistic approach to consumer assistance that includes post-enrollment support. CHC partner organizations that also participated in the hearing included Western Center on Law and Poverty, California Pan-Ethnic Health Network, Asian Americans Advancing Justice and St. Johns Well Child and Family Clinic.

The hearing background documents are available at the Senate Health Committee's website and a recording of the session can be viewed at http://www.calchannel.com/.

For more information about CHC ACA outreach, education, enrollment and advocacy work, please contact Community Health Councils’ Policy Analyst, Anulkah Thomas at anulkah@chc-inc.org.

California High-Speed Rail Update

Demolition has begun in Fresno to make way for the nation’s first high-speed rail system. The unprecedented $68 billion statewide project is expected to run electric trains at speeds over 200 miles per hour and allow passengers to complete the 520-mile trip from San Francisco to northern Los Angeles County in under three hours. The first phase is scheduled to be complete between the Bay Area and Los Angeles by 2029 with future phases extending to Sacramento and San Diego, bringing the total to over 800 miles. The rail line's first 29-mile construction segment includes the northeast fringe of Madera and extends to the southern edge of Fresno.

The recent re-election of Governor Jerry Brown strengthens the future of high-speed rail in California as this project was a priority for Brown’s administration the past two years. The Federal Railroad Administration has put up more than $3 billion in federal transportation and stimulus funds for construction in the San Joaquin Valley. The state of California is obligated to put up almost $3 billion in matching funds, which is expected to come from the sale of bonds authorized by Proposition 1A, a bond measure approved by California voters in 2008. Other funds are expected from California's cap-and-trade fund, an annual auction that generates funds from companies that are unable to reduce their greenhouse gas emissions to statewide standards. The state Legislature recently approved a $250 million allocation for high-speed rail in 2014-15 and a 25% earmark of future cap-and-trade funds each year after. The project also includes a 30% goal for small business participation including Disadvantaged Business Enterprises (DBE), Disabled Veteran Business Enterprises (DVBE) and Micro-Businesses (MB).

For more information visit the California High-Speed Rail Authority website at http://www.hsr.ca.gov.

FURTHER READING

October Issue of Health Matters

CA to Expand Coverage Options for Immigrants & Pregnant Women

Cap-and-Trade Update