Title
Chief Administrative Office and Health and Human Services Agency recommending the Board:
1) Receive and file a presentation from California State Association of Counties on House Resolution (HR) 1; and
2) Approve and authorize the Chair to sign letters to the Governor, the President pro Tempore of the Senate, and the Speaker of the Assembly requesting State action to mitigate severe fiscal and operational impacts of HR 1 on county safety net programs.
FUNDING: N/A
Body
DISCUSSION / BACKGROUND
HR 1 was recently enacted at the federal level and includes substantial changes to Medicaid/Medi-Cal financing, work requirements, and eligibility processes. These changes shift costs and administrative burdens from the federal government to states and counties.
El Dorado County, along with counties statewide, anticipates significant increases in mandated service costs across public health, indigent medical care, eligibility operations, behavioral health, and hospital systems.
According to CSAC analysis, counties are anticipating $6.0 to $9.5 billion in new costs annually at full implementation of HR 1. These impacts include:
· Increased demand for indigent medical care as an estimated one million Californians lose Medi-Cal coverage.
· Substantial increases in eligibility workload due to new community engagement requirements and more frequent redeterminations.
· Reduced revenues for county-affiliated public hospital systems due to limits on state-directed payments.
· Increased demand for county behavioral health services.
Locally, El Dorado County has already projected that mandated safety net costs will exceed available state, federal, and realignment revenues in coming years. HR 1 accelerates this problem, forcing the County to potentially rely on local discretionary revenue to meet core state-mandated obligations. This comes at a time when expenditure growth already outpaces discretionary revenue growth, and departments were required to reduce discretionary r...
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