1. LOS ANGELES COUNTY COMMISSION ON HIV Overview of the Governor’s 2010/2011 Budget Proposal: Health and Social Service Programs Julie Cross Benefits Consultant January 14, 2009

2. 2 Overall Budget Picture Governor released initial budget proposal on January 8, 2009. Budget addresses a $19.9 billion shortfall. $6.6 billion in current year 2009-2010 $13.3 in 2010-2011 Does not include tax increases. AIDS Drug Assistance Program funding significantly better than expected. Major proposed cuts to other health and social service programs. Proposes multiple mechanisms to address funding gap: Spending Reductions Funding Shifts Federal Assistance Proposal relies heavily on the federal government providing funding and allowing operating flexibility.

3. 3 Budget Proposal: Timelines and Triggers Special Session: To address current year 2009/2010 budget shortfall. Changes to some programs March/June 2010. Budget Proposal: 2010/2011 budget year. July 1, 2010 implementation. Federal “Trigger” Cuts: The Governor’s budget proposes to “trigger” additional cuts if $6.9 million in federal financial assistance is not secured by July 2010.

4. Proposed “Base” Budget 2010/2011 Reductions proposed even if federal funding is provided.

5. 5 Office of AIDS: AIDS Drug Assistance Program (ADAP) Proposes to add $87.5 million in new General Fund support to the ADAP budget. 2009/2010 GF budget $70,849 million. Total 2010/2011 GF budget $158,311 million. Proposes to eliminate ADAP services in county jails. Eliminates $9.5 million support to county jail system. Significant % used by LA County jail system. 2010/2011: 36 jails, 2027 incarcerated individuals would have been served by ADAP. Counties are required to provide medical care to incarcerated individuals.

6. 6Medi-Cal $750 million: Unspecified limits on services, utilization controls, increase cost-sharing (co-payments, premiums). $118 million: Eliminate coverage for recent legal immigrants. Possibly effective March 2010. $104 million: Eliminate the adult day health care benefit. Possibly effective March 2010. $55 million: Delay payments to providers. $26.4 million: Increase fraud prevention activities. $28.7 million: Rescind family planning rate increase.

7. 7 In-Home Supportive Services (IHHS) IHSS provides people who are disabled or over the age of 65 with personal assistance and in-home support services so they can live safely in their homes. The program is often seen as an alternative to assisted living or nursing facilities. $950 million in cuts to IHSS: Elimination of IHSS except for persons with highest needs Reduction in state contribution to the IHSS provider’s hourly wage.

8. 8 Supplemental Security Income (SSI/SSP) $15 reduction to monthly benefit for individuals. Current benefit $845 a month for individuals. $830 a month after reduction. This will be the fourth cut in one year for SSI recipients.

9. 9 Cash Assistance Program for Immigrants (CAPI) and California Food Assistance Program (CFAP) Provides cash and food assistance to certain legal immigrants (seniors and persons with disabilities) who do not qualify for SSI due to federal limitations. Proposes to eliminate programs.

10. 10 Budget Reductions: Other Programs CalWORKs: Reduce monthly grants for CalWORKs recipients. Healthy Families: Reduce eligibility from 250% FPL to 200% FPL. Eliminate vision coverage. Increase monthly premiums. Substance Abuse Offender Treatment Program: Eliminate program. Additional one-time funding redirection to several health and human service programs.

11. Federal Funding Proposal “Triggered” cuts if $6.9 billion federal funding is not secured.

12. 12 Proposed Federal Funding Solutions: to Avoid “Triggering” Additional Cuts Increase Medi-Cal federal funding ratio from 50% to 57%. $1.8 Billion Federal Medical Assistance Percentage (FMAP). Extend Medi-Cal Federal Stimulus Provisions for Medi-Cal FMAP. $1.2 Billion American Recovery & Reinvestment Act FMAP increase set to expire 12/10. Extends AARA-enhanced FMAP through June 2011. Extension CalWORKs Federal Stimulus funding increase. $538 million Funding relief from Medicare adjustments. $1 Billion Re-payment to Medi-Cal of health costs for disabled individuals who were eligible for Medicare. Adjustments to the Medicare Part D “claw back”. Increased reimbursement for Special Education. Increased reimbursement to offset the costs of incarcerating undocumented immigrants.

13. 13 “Trigger” Cuts include: Reduce Medi-Cal eligibility to the minimum allowed under federal law: 72% FPL most adults, 133% children and pregnant women Would eliminate Medi-Cal coverage for thousands. Would increase SOC for thousands of disabled individuals. Elimination of certain Medi-Cal programs including: Breast and Cervical Cancer Treatment Program, Medically Indigent Long-Term Care Program. Eliminate Medi-Cal benefits not required by federal law (diabetes supplies, prosthetic limbs, wheelchairs, physical therapy and other benefits). Eliminate CalWORKs. Eliminate In Home Supportive Services (IHSS). Eliminate Healthy Families Program, Major Risk Insurance Program, and other health services programs, Every Woman Counts cancer screening, asthma control programs, Family PACT family planning program. Redirect Mental Health Services Act funds (Prop 63) to fund existing mental health services.

14. 14 Timelines January 8, 2010: Governor’s budget proposal released. February-May 2010: Legislature Subcommittee Hearings March/June 2010: Certain budget provisions may begin. May 2010: May Revision Governor releases revised budget based on changes to state income or expenditures. May-June 2010: Legislature Subcommittee Reports Reviewed Final Negotiations and Votes June 2010: Budget to Governor for signature/veto July 1, 2010: Budget Implementation

15. 15Discussion Questions and Answers

16. 16Reference These slides are available on the Commission website at www.hivcommission-la.info.