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

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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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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

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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.

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MOE Chart

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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

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