Board of Supes 1/07: 2014 Officers; Indigent Health Care Services

The Board of Supervisors met briefly on this first Tuesday of the new year.  The first order of business was to elect officers for 2014.  Supervisor Les Baugh was elected Chairman and Supervisor Leonard Moty elected Vice Chairman, both unanimously.  Supervisor Baugh was elected to the Board in 2006.  He served on the Anderson City Council for four terms.  He currently serves as Pastor of the Anderson Community Church and as  Mercy Hospital Advisory Board Member.

The Board took action to adjust the county’s budget for health care services to low income or indigent people in the county.  For more than 100 years, counties have been required in the law to provide health care services to uninsured low income, indigent adults who are not otherwise eligible for other publicly-funded health programs.   This is the same law that requires counties to provide a General Assistance program (see the report on the December 17, 2013 meeting).  Over the years, as county capacity to raise taxes has been limited and in order to assure some consistency in services statewide, the California state budget has provided funds to support county indigent health care services and has required counties to maintain a certain level of funding (maintenance of effort).

35 primarily rural counties fulfill the obligation for indigent health care services through the County Medical Services Program (CMSP).  Counties fund CMSP primarily through revenues from the 1991 Health and Welfare Realignment program.  This Realignment provides sales tax and Vehicle License Fee funds to counties for health, mental health and welfare programs.  Most of the individuals requiring CMSP health services will, starting in January 2014, be provided health care through the Affordable Care Act.  Shasta County expects that a caseload of roughly 5,000 individuals will drop to 500.  As a result, the 2013-14 state budget required that counties return to the state funds previously provided to pay for indigent health care.  The amount of funds Shasta County is required to return, nearly $5.4 million, is the same as the amount it received under this portion of Realignment and that it was required to provide prior to implementation of the Affordable Care Act. In other words, the county return of these funds to the state is a wash in the county budget. The balance of the indigent health care caseload, approximately 500 individuals, are adults between 139% and 200% of poverty who are required to purchase health care under the Affordable Care Act but do not do so during the open enrollment period.  They will be provided care until Affordable Care Act services can be arranged.  In addition, the county will provide only. emergency care to undocumented and documented aliens up to 200% of poverty. The remaining amount of funds that the county has been required to spend on indigent health care, its maintenance of effort in the program, is expected to provide for this residual population.

The Health and Human Service Agency provided a warning that while the county appears to be held harmless for indigent health costs, the state took other action with respect to 1991 health Realignment funds.  The state awarded Cost of Living Adjustments for CalWORKS welfare grants, and provided that funding for this purpose will come from annual growth funds in the sales tax and Vehicle License Fee fund sources.  Because Realignment funding sources grow according to the economic drivers of sales tax and license fee revenues, it is not yet clear how the state’s action will affect counties.  Shasta County Health and Human Services have sufficient revenues to provide for budgeted items at this time, and will include a reserve for some future periods when the growth in cost exceeds the remaining growth in Realignment revenues.  The Agency will be able to provide the Board with information about this issue in the future.

Little is more complicated than this kind of State/county mix of responsibilities and funding sources.  If you want to know more, just ask and I’ll try to be more clear!

Catherine Camp is currently retired. During her career, she worked as a policy and budget analyst for the California Assembly and California Senate, in health and human services fields. She worked as a policy analyst and advocate for California’s public mental health system. Early in her career, she worked in the Community Action and Head Start programs in Shasta County.

is currently retired. She served as a Consultant to the California Senate Budget Committee in 2001-02, reviewing Social Services, Employment Development, Aging, Community Services, Alcohol and Drug Programs, Rehabilitation and Child Support budgets. From 1989-2000, Catherine was Executive Director for the California Mental Health Directors Association. During that period, Catherine staffed the county mental health system's restructuring of public mental health through Realignment of community and long term care programs from the state to the county, transfer of the management of specialty mental health Medi-Cal services to those counties that agreed to provide them, development of risk mechanisms for consortia of small counties, and advocacy and policy analysis for the operation of public mental health programs throughout the state. Her prior experience includes Executive Director to the California-Nevada Community Action Association, Principal Consultant to the Assembly Human Services Policy Committee, and Director of Community Action and Head Start programs in Shasta County.
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