Title
Receive a report on the implementation of the Affordable Care Act (ACA) in Monterey County, and provide direction to staff.
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors receive a report on the implementation of the Affordable Care Act (ACA) in Monterey County, and provide direction to staff.
SUMMARY:
Based upon the direction of the County Administrative Officer, in recognition of the magnitude of the issues the County is faced with regarding successful implementation of the ACA, an ACA Implementation Team has been created. The ACA Implementation Team is comprised of staff from the CAO Office, NMC, Health and Social Service departments, and the County's state and federal legislative advocates. The Team has met regularly over the past several months and has relayed the County's concerns and challenges regarding the implementation to our state representatives in Sacramento.
The issues surrounding ACA implementation are rapidly evolving - with many issues still to be resolved. The purpose of this report is to update the Board on the status of the implementation in Monterey County, and the challenges and uncertainties the County is faced with. Attached to this report is a list of Monterey County's many concerns regarding successful ACA implementation (Attachment #1) and a report on legislative implementation efforts from JEA & Associates, the County's state legislative advocate (Attachment #2).
Oral reports will be provided as part of this item from:
- Nick Chiulos, CAO Office (Intergovernmental & Legislative Affairs)
- John Arriaga & Laurie Johnson, JEA & Associates
- Harry Weis, NMC
- Ray Bullick / Wayne Clark - Health and Behavioral Health
- Elliott Robinson, Social Services
As the ACA implementation process moves forward additional updates will be provided to the Board. Budget issues related to the implementation will be addressed in the FY 2013-14 budget development process.
Additionally, ACA Team members and JEA & Associates been working with the California State Association of Counties (CSAC) on ACA implementation issues, and have participated in the CSAC Health Working Group and CSAC CAO Health Reform Implementation Working Group.
DISCUSSION:
The Affordable Care Act (ACA) is the most sweeping health care reform legislation since Medicare was created in 1965. Monterey County has a long standing commitment to ensuring health care access for all of its residents. Support for the successful implementation of health care reform is one of the top priorities included in the County's 2013-14 Legislative Program. As such, we are closely following the ongoing discussions in Washington D.C. and Sacramento relative to the implementation of the Affordable Care Act (ACA) in California.
On February 26, 2013, the Board took a support position on the state-based option for the proposed Medi-Cal expansion as outlined in the Governor's 2013-14 proposed budget.
As allowed under the ACA, the Administration proposed to expand Medi-Cal to adults with incomes under 138% of the Federal Poverty Level (FPL) who are not currently Medicaid eligible. In Monterey County, it is estimated that approximately 27,000 people will qualify for the expanded Medi-Cal Coverage. The Governor's budget document presents two options to expand Medi-Cal to these adults - a state-based approach and a county-based approach
The California State Association of Counties (CSAC) has prepared an analysis of the expansion options, Thinking Through the State and County Options for Medi-Cal Expansion (Attachment #3). The CSAC Board of Directors, at a special meeting on March 28, 2013, approved a set of Medi-Cal optional expansion principles (Attachment #4). Supervisor Armenta is the County's representative on the CSAC Board of Directors.
Regardless of whether the state or county option is implemented, counties will continue to be responsible for providing public health services and health services to indigent adults without private or public health care insurance coverage. It is critical for the health and welfare of all residents that counties retain sufficient realignment funds to deliver public health and remaining indigent services. This is especially important in Monterey County where 13.5% of our population is undocumented and we have the largest percentage of working poor. Based on recent reports, Monterey County has the highest percentage of persons who do not qualify for either Medicaid or subsidized health insurance due to documentation status.
Additionally, the County has relayed its position to our state legislators that no reduction in health realignment funding should occur in the first three years of program expansion. This is important in order to allow the County to rebuild its public health infrastructure and quantify its residual responsibilities for indigent health care.
OTHER AGENCY INVOLVEMENT:
The County Administrative Office - Intergovernmental and Legislative Affairs Division prepared this report. Information was provided, without review by the CAO office, by NMC, Health/Behavioral Health Departments, Department of Social and Employment Services, California State Association of Counties (CSAC), and JEA & Associates - the County's state legislative advocate.
FINANCING:
Receipt of this report does not have any financial implications. Financing related to implementation of the ACA will be handled through the County's FY 2013-14 budget process.
Prepared by: Approved by:
Annette D'Adamo Nicholas E. Chiulos
Management Analyst III Assistant County Administrative Officer
March 26, 2013
Attachments:
1) Monterey County's Concerns Regarding Successful Affordable Care Act (ACA) Implementation
2) JEA & Associates - Legislative Update
3) Thinking Through the State and County Options for Medi-Cal Expansion
4) CSAC Medi-Cal Optional Expansion Principles
Cc: Harry Weis (NMC), Carol Adams (NMC), Daniel Leon (NMC), Ray Bullick (Health), Elsa Jimenez (Health), Wayne Clark (Behavioral Health), Elliott Robinson (DSES), Dewayne Woods (ACAO-Budget), Rod Walker (CAO-Budget), John Arriaga and Laurie Johnson (JEA & Associates), Brent Heberlee (Nossaman LLP)