Connections Newsletter (Fall 2001)

More on SB 353 - Medi-Cal Payment for RCFE

by Jason Bloome

Perhaps a brief summary is in order since it has been a while. As you may recall from our last newsletter, the bill I wrote to allow Medi-Cal to pay for assisted living homes (SB 353) was last seen floundering in the turbulent waters of the Assembly Appropriations Committee. Despite two years of effort - the letters many of you wrote in support of the bill; the venerable coalition weighted with major senior advocate groups that John Amber, West Coast Assistant Director of the American Parkinson Disease Association, and I formed; newspaper articles; radio interviews and three trips to Sacramento to lobby for the merits of SB 353, it's fate was sealed.

Not that SB 353 actually ever died (if the bill had been felled by the mortal veto pen stroke of the Governor we could have at least given it a proper burial) instead its ultimate fate was much less heroic. Citing fiscal concerns the Assembly Appropriations Committee placed SB 353 in "suspend status" - a permanent limbo land where ill-fated fiscal bills that do not carry enough favor spend the rest of their days unable to move forward. There would be no full Assembly vote for SB 353 and no ultimate decision by the Governor as to the merits of the bill. Despite it's successful voyage through the Senate Health Committee, Senate Appropriations Committee, Assembly Health and Human Services Committee, SB 353 was, for all intent and purposes, irrevocably dead in the water.

But all is not lost. Our story may still yet have a happy ending. I mentioned in the previous newsletter a bill, AB 499 (similar in nature to SB 353 but not as specific in scope), that was introduced by Dion Aroner, the Chair of the Assembly Health and Human Services Committee. Since it involved the same fiscal issues plaguing SB 353, I was not surprised when I was notified by e-mail (see below for bill subscription information) that AB 499 was also put on "suspend status" in the Assembly Appropriations Committee - so much for this year's effort to prevent low-income seniors from being unnecessarily institutionalized. What a surprise then when a few days later a curious e-mail appeared in my in-box indicating that AB 499 had successfully sailed out of the Assembly Appropriations Committee??!! Who had rescued AB 499 from limbo-land? I found out when I spoke with Scott Pfeifer, one of the staffers at the Senate Subcommittee on Aging and Long Term Care.

Turns out in Sacramento it is useful to be the powerful Dion Aroner (alas, SB 353 had no such potent savior). Using her clout, Assemblywoman Aroner convinced the right people that AB 499 should never have ended up in the Assembly Appropriations Committee in the first place! The reason? AB 499 and SB 353 were basically requests to HCFA (Health Center Financing Administration) for a "medicaid waiver" which is the entitlement to use Medical dollars for nursing home eligible seniors for non-institutional care. Multi-Service Senior Provider Services (MSSP) - is one type of medicaid waiver. To receive approval to implement a medicaid waiver a State medicaid agency must assure HCFA that, on average, it will not cost more to provide home and community-based services than providing institutional care would cost (www.hcfa.gov). In other words, since SB 353 and AB 499 would be budget neutral and involved redirecting medicaid dollars (and not new expenditures) they should never have gone to the Senate and Assembly appropriations committees.

This significant technical detail eluded the many movers and shakers promoting SB 353 and AB 499. In the halls of Sacramento only a very few veteran politicians have the political know how and muscle to remove a bill already entrenched in a committee (may those of us political neophytes humbly bow at your alters), Assemblywoman Aroner is one such person.

Once out of the appropriations limbo, AB 499 sailed through the Assembly, encountered no Senate roadblocks and in January was signed into law by the Governor.

Now for the good news and bad news. The good news: one day California will join the 41 other States that allow medicaid to pay for assisted living homes. The bad news: it will take a year to develop the medicaid waiver application for HCFA (deadline February 2002) and perhaps 3-5 years before it has any significant impact. In its research and demonstration phase AB 499 will only affect a limited number of eligible low income seniors and details as to which homes and which seniors in which counties will be eligible has yet to be determined. Will AB 499 be expanded one day to provide state-wide coverage? We can only wait and see. The need is dire though. California low-income seniors at risk of premature institutionalization do not have the luxury of unlimited time on their sides.

To read the texts of SB 353 and AB 499 go to www.sen.ca.gov and search by bill number (remember: both bills were introduced in the 1999-2000 session). At this site you can also "subscribe" to a bill for automatic e-mail notification as it progresses to various committees.