csac institute: realignment workshop health services june 4, 2010 judith reigel, cheac executive...
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CSAC Institute:Realignment Workshop
Health Services
June 4, 2010
Judith Reigel, CHEAC Executive DirectorMargaret Szczepaniak, Assistant Director, Health Care Services
San Joaquin County
Realignment Health Account
Public Health
Indigent Health Care
(Former AB 8 and MISP/CMSP Programs)
County Health Executives Association of CA 2
History of County Health Funding Leading up to 1991
Realignment1971 – Creation of state only MIA Medi-Cal category
1978/79 – Aftermath of Prop 13: AB 8 MOE Requirement
1982/83 – Transfer of MIA’s to counties (MISP/CMSP)
1991/92 – RealignmentAB 8MISP/CMSPLocal Health ServicesSLIAG
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Health Allocations Chart
County Health Executives Association of CA 4
How are Health Realignment Funds Used? Public Health
Health and Safety Code Section 101025 “The board of supervisors of each county shall take measures as may be necessary to preserve and protect the public health in the unincorporated territory of the county, including, if indicated, the adoption of ordinances, regulations and orders not in conflict with general laws, and provide for the payment of all expenses incurred in enforcing them.”
Though mandate precedes Realignment, it is the primary funding source for county public health
Used to pull down federal matching funds (e.g. MAA/TCM)
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County Health Executives Association of CA 6
Indigent Health Care
Helps meet Welfare and Institutions Section 17000 mandate
Supports County Hospitals and clinics
Medi-Cal waiver: Non-federal share of hospital inpatient
How are Health Realignment Funds Used?
California Children’s Services (CCS) Serves children with serious illness or traumatic
injury through Medi-Cal, Healthy Families and the CCS- only program
Realignment changed state/county sharing ratio for non-Medi-Cal diagnosis/treatment/therapy from 75/25 to 50/50
Placed in Social Services Account since it is a caseload driven program
County Health Executives Association of CA 7
Local Revenue FundSales Tax
Source: ½% sales tax
Sales Tax Base Account Sales Tax Growth Account (Revenues in Excess of Base Payments)
Social Services Account Health Account Mental Health AccountCaseload Subaccount
CMSP Growth
General Growth Subaccount
Health AccountCounty Allocations
CMSP
Social Services Account Health Account Mental Health Account
Vehicle License FeeSource: 74.9% Vehicle License Fees
VLF Growth Account(Revenues in Excess of Base Payments)
Social Services Account Health Account Mental Health Account
Health AccountCounty Allocations
CMSPGeneral Growth Account
CMSP Growth
Social Services Account Health Account Mental Health Account
VLF Base Account
Revenue Sources
Account Sales Tax VLF
Health 15% 74%
Mental Health 29% 22%
Social Services 56% 4%
Percentages by Revenue Source08/09 Base Distribution
Percentages by Account08/09 Base Distribution
Account Health Mental Health Social Services
Sales Tax 25% 69% 96%
VLF 75% 31% 4%
Percentages change yearly due to Growth Distribution
Sales Tax Revenue History
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Vehicle License Fee Revenue History
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Maintenance of Effort (MOE) In order to be eligible for the receipt of Realignment Sales Tax Funds each month,
a county must:
Deposit into its health account an amount of general funds which is equal to 1/12 of the amount specified in section 17608.10 of the Welfare & Institutions code for the county.
Note: Section 17608.10 refers to old AB 8 MOE.
Deposit an amount of county general funds at least equal to the Vehicle License Fee (VLF) amount of funds transferred by the State Controller’s Office (SCO) each month.
Deposit local matching funds each month that are sufficient to permit local Health and Welfare trust fund disbursements that are equivalent to the growth of revenues in Sales Tax and VLF allocated to the county.
Constitutionally, VLF is considered county general funds; therefore, MOE’s were created to assure that VLF Health Realignment funds are actually spent on health.
County Health Executives Association of CA 12
MOE Chart
County Health Executives Association of CA 13
Benefits of Realignment to County Health Services
Stable, relatively predictable (until recently) funding source has allowed counties to plan across fiscal years
Flexibility has allowed local health departments to target resources as needed to address local community health needs
Realignment funds have been used to supplement categorical grant funding that has not kept up with need
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Challenges No Sales Tax growth since FY 05/06; no VLF growth since FY 06/07
VLF has been extremely volatile past two years
Demand for local health services has increased at same time revenues have decreased
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What Will Health Care Reform Bring? 2014: Medi-Cal expansion to childless adults to 133% FPL
(100% federally funded first 3 years)
State likely to want to recoup Health Realignment funds as early as 2014
Need to preserve public health funding
Section 17000 – Not likely to go away
County hospitals and clinics will still have uninsured to serve
Health Care Reform does not serve the undocumented
County Health Executives Association of CA 16