More on SB 353 (medi-cal waiver bill)

by Jason Bloome

As you may have heard in the news, August 30th was the last day for all bills to be heard in the state Senate and Assembly. On this day, as for the few proceeding, the normally placid halls of the State Capitol are filled with the din of earnest voices and frenetic footsteps as hundreds of lobbyists and staffers make pleas, compromises and employ other tools in the art politique with members of congress in last ditch efforts to advance their own particular causes.

The fate of hundreds of bills precariously hang in the balance but only a lucky few will garner the necessary votes to pass both houses and the pertinent committees to end up on the desk of the Governor. Within 30 days, he will either pass or veto these bills.

SB 353, which would allow MediCal to pay for assisted living homes, is one bill that I am particularly concerned about. As you may recall from previous newsletters, John Amber, West Coast Assistant Director of the American Parkinsons Disease Association and I have been working to pass this bill for the past two years. The reason for SB 353 in California is obvious: low income seniors with custodial care needs currently residing in skilled nursing homes should not be there when lower level assisted living settings exist. Forcing a senior into a nursing home just because he/she is poor is cruel, unethical and costs the state millions of unnecessary medicaid dollars. Currently, 40 states allow medicaid to pay for assisted living homes. SB 353 is a request for the Department of Health to apply for a medicaid waiver which must be approved by the Health Center Financing Administration, a federal agency.

My last newsletter detailed the passage of SB 353 through the Senate and the various subcommittess (Appropriations and Health). We decided at that time to pull the bill from being heard in the Assembly Appropriations Committee once we found out the Department of Health opposed the bill. Why? Because they believed MSSP already paid for assisted living homes (which it does not). By making SB 353 a two-year bill we had more time to purge whatever bad information DHS or the Department of Finance had about SB 353 and then worked to move the bill forward through the Assembly. Over the next few months we sent all the pertinent parties: the Department of Health, the Department of Finance, the Department of Aging and the Assembly Appropriations Committee information they would need to properly evaluate the bill, especially in regards to it's financial merits.

Because it was authored by a Republican, we knew passage of SB 353 would be difficult (Democrats control the Senate, Assembly and Governorship). (Having a Republican author the bill was not of our doing; SB 353 already existed in 1999 before John and I stepped aboard to help. This year, I was asked to redraft the bill and subsequently Connections has become the primary sponsor). We quickly learned the extent of partisan bickering ever present in Sacramento and scrambled to neutralize the Republican parentage of the bill by having three powerful Assembly members, Sheila Kuehl, Kevin Shelley and Antonia Villariagosa, co-author the bill. We also lined up as much support behind the bill as possible and formed the Coalition Group for SB 353 which included among many other agencies: AARP, the Alzheimer Association, the American Parkinsons Association, the Counties Welfare Director's Association, the Grey Panthers, the California Congress of Seniors, the California Little Hoover Commission and the United Nurses Association.

Which brings us up to the recent past. On August 23, SB 353 was scheduled for a hearing in the Assembly Appropriations Committee and I flew up to Sacramento to lobby on behalf of the bill. The night before, I had read a fair, impartial analysis of the bill done by the Department of Finance. The 3-page analysis included, among many items, the following: Medicaid waivers must be cost neutral (that the state can not pay any more than what it would have cost if the resident was placed in a nursing home), and that additional costs to the state (to the extent seniors who otherwise would have remained in their homes move into assisted living homes because of the bill) would be offset by: 1) transitioning IHSS recipients with custodial care needs to assisted living rather than skilled nursing settings and 2) by keeping seniors in assisted living homes instead of transitioning them to nursing when they run out of money. According to the Department of Finance assessment, assuming 1,000 beneficiaries transfer to assisted living care who otherwise would have moved to a skilled nursing facility, the state would save $16.4 million dollars annually.

After the comprehensive analysis done by the Department of Finance, I could not have been more shocked when I read an hour before the hearing the paltry two-paragraph analysis done by the Assembly Appropriations Committee. Now, how would you vote as a member of this committee if you saw an analysis that said

"major unknown Medi-cal costs (for 1000 participants about $8.1 million) which would be offset by unknown savings to the extent persons are able to live in lower level placements"

and nothing else?

No mention that the Medicaid waiver must be cost neutral, that nursing homes are more expensive than assisted living homes and that hundreds of seniors end up in nursing homes unnecessarily each month. Unfortunately, the damage was already done.

At 9:30 a.m., I sat in front of the Assembly Appropriations Committee to testify on behalf of the bill. Senator Johannessen made a 30 second introduction of the bill, Carol Migden, Chair of the Committee, gave me 20 seconds to talk about the bill and asked the Department of Finance representative seated next to me for his opinion. He said, other than for administrative costs, SB 353 would be cost neutral to the State. And that was that. Two minutes in front of the committee and we were done. Two hundred more bills were to be heard that day.

For the rest of the day, I shuttled back and forth between the offices of Sheila Kuehl (where the staffer, Jennifer Richards, and I talked about politics and puffer fish), Kevin Shelley (Majority Leader), Brian Hertzberg (Speaker of the Assembly) and Bill Campbell (Vice-Chair of the Assembly Appropriations Committee) office. At this last office, Sharon Bishop, the staffer, informed me that, as a Republican, the Vice-Chair had no power whatsoever with the committee and that my best hope would be to have Senator Johannessen personally call Carol Migden.

I went back to Senator Johannessen's office where Bill Cardosa, the staffer, told me having the Senator call Carol Migden would be impossible. Why? Because the Senator that morning had destroyed any political clout he may have had with Carol Migden by going over her head to pass a bill through her committee that she was dead set against.* Bill suggested going back to Jennifer Richards to ask if Sheila Kuehl could make the call. Jennifer said she would have Sheila do this. It was 5:00 p.m.; time to call it a day. The next day, SB 353 was killed in the Assembly Appropriations Committee.

But all is not lost. A similar bill to SB 353, AB 499 (which was introduced in the Assembly by a Democrat) looks like it may pass out of the Senate and possibly go to the Governor's desk. If that bill fails, the push for a Medicaid waiver for assisted living homes starts all over again next year. This time we'll do it right, with a Democratic author and perhaps a few visits to elected officials by lobbyists from the Alzheimer's Association, the American Parkinsons Association, the Little Hoover Commission, etc. to help with more of the ground battle. Perhaps we'll even get a coterie of rabble rousing AARP seniors marching down the halls of the Capitol to help with this most worthwhile fight.