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California 2023-24 Legislation Session Begins
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On Monday, December 5, all new and re-elected members of the California State Assembly and Senate were sworn in, marking the start of the 2023-24 legislative session.
Assembly Speaker Anthony Rendon has appointed committee chairs. Of particular interest to stakeholders in the disability services and supports network is the Assembly Human Services Committee, where most bills affecting our disability supports are heard. This Committee will be chaired by Assemblymember Corey Jackson and Assemblymember Kate Sanchez will be the committee’s Vice Chair. Assemblymember Phil Ting returns as Chairperson of the Budget Committee while Subcommittee No. 1 on Health and Human Services will be chaired by Assemblymember Joaquin Arambula. Use this link to access a complete list of committee leadership.
This will be the first session with newly drawn State Assembly and Senate district boundaries. Every ten years, the federal government conducts a census of America’s population for a number of purposes that include adjusting the boundaries for electoral districts.
In 2008, California’s voters approved Proposition 11, which took the process of redrawing political lines out of the hands of the Legislature and placed it with an independent California Citizens Redistricting Commission. Since representation may have changed due to redistricting, all disability advocates are encouraged to visit findyourrep.legislature.ca.gov to verify the elected officials that currently represent you.
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State Budget Deficit Looms as California Legislature is Seated
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As California begins the 2023-24 legislative session, attention will be focused on the FY 2023-24 budget. Governor Gavin Newsom will release his budget proposal for the fiscal year, beginning on July 1, in early January 2023.
The budget landscape has changed significantly from a year ago when Newsom projected a $97.5 billion surplus. Recently, the Legislative Analyst’s Office (LAO) released the state budget forecast indicating that California now faces a $25 billion budget deficit, not adjusted for inflation.
Of significant concern to people with disabilities and disability service providers is that the report highlights recent disability provider rate adjustments and the effects of inflation, stating, “In the Department of Developmental Services (DDS), although the Legislature recently enacted a plan to support rate models developed in a 2019 study (and updated to 2021-22 levels), under current law, providers would only receive rate adjustments based on future legislative decisions.”
However, recently seated legislators have indicated a preference for keeping previous spending increases and dealing with the deficit in a manner that avoids budget cuts including:
- Shifting billions of dollars in expenditures to later years and re-evaluating the timing of one-time spending.
- Considering low-cost borrowing from special funds if California keeps collecting lower-than-expected tax revenue.
- Evaluating the impact of inflation on certain state expenditures. Because the Legislative Analyst’s Office estimate of a $25 billion budget deficit didn’t account for soaring inflation rates, actual state costs are likely to be higher than estimated.
Stakeholders in California’s disability services system will be closely watching the budget process, and they will be poised to engage with their elected officials if hard-fought rate increases for people with intellectual and developmental disabilities appear threatened.
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117th Congress Adjourns After Passing 2023 Appropriations Act
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On December 29, President Biden signed into law the Consolidated Appropriations Act of 2023, commonly referred to as the omnibus spending package. The $1.7 trillion spending package included several provisions of interest to people with disabilities.
Key disability provisions in the omnibus bill include:
- The ABLE Age Adjustment Act that will provide 6.2 million additional people with disabilities, including one million veterans, the opportunity to open an ABLE account and save for disability-related services and supports by extending access to people who acquired their disability between 26 and 46 years of age.
- Extending the Money Follows the Person demonstration program that supports state efforts for rebalancing their long-term services and supports system so that individuals have a choice of where they live and receive services through 2027. From the start of the program in 2008 through the end of 2020 California has received $184,243,594 to support its rebalancing effort.
- Unwinding the Medicaid continuous coverage requirement from the COVID-19 Public Health Emergency.
- Phasing out the increased FMAP (Federal Medical Assistance Percentage) for states from a 6.2% increase to a 5% increase from April 1, 2023, through June 30, 2023, then to a 2.5% increase from July 1, 2023, through September 30, 2023, and then to a 1.5% increase from October 1, 2023, through December 31, 2023. FMAP is the share of Medicaid expenditures, including disability services and supports, paid by the federal government.
Since the initial declaration of a public health emergency (PHE) due to COVID-19, states who accepted the enhanced FMAP were required to cease Medicaid redeterminations for Medicaid beneficiaries. The omnibus bill ends the continuous coverage requirement on March 31. States will then have up to 12 months to initiate, and 14 months to complete, a renewal for all individuals enrolled in Medicaid. The federal Centers for Medicare & Medicaid Services (CMS) has provided updated guidance to states on the unwinding of the continuous coverage provision.
Based on the guidance of CMS, the California Department of Health Care Services (DHCS) will update the Medi-Cal COVID-19 PHE Operational Unwinding Plan and additional plan, county, and provider guidance. In addition, the California Budget Act of 2022 appropriated $25 million to DHCS to seek a communications and advertising vendor to implement a broad and targeted education and outreach communications campaign targeted to California’s over 15 million Medi-Cal members.The goal of this campaign is to maintain eligibility by providing outreach materials that inform beneficiaries about the steps necessary to maintain coverage after the continuous coverage requirement ends.
The California DHCS has created a webpage with online resources to raise awareness of actions beneficiaries need to take, and when they need to take them, in order to maintain coverage. Beneficiaries should use this link to visit the DHCS webpage for more information.
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Justice Department Launches New Americans with Disabilities Act Website
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The United States Department of Justice (DOJ) recently announced the launch of a new and improved version of the Americans with Disabilities Act (ADA) website ADA.gov. The goal of the revamped website is to better empower people to comply with the Americans with Disabilities Act as well as understand their rights and others’ rights.
“With the new and improved version of ADA.gov that we are launching, the Civil Rights Division is taking an important step forward by providing information about the ADA in a format that is more tailored to the needs of the people seeking this information,” said Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division. “As we continue our work to increase compliance with the ADA, the department is committed to helping people with disabilities understand their rights, and to helping those who have obligations under the ADA understand their responsibilities.”
The ADA is a civil rights law that protects people with disabilities from discrimination. The ADA guarantees people with disabilities the same opportunities as everyone else to do things like go to work, engage with community resources, and enjoy stores and restaurants in their communities. In addition to information on the ADA, people can access contact information for the DOJ Civil Rights Division, file an ADA complaint with the DOJ, and sign up for ADA updates through the improved website.
Employers, state and local governments, businesses, and nonprofit organizations must adhere to the provisions of the ADA. The ADA mandates the DOJ to help people understand their rights and responsibilities under the law and one way that the Department has done this is through its website, ADA.gov.
The stated goal of the DOJ Civil Rights Division is to continually assess and improve ADA.gov. Self-advocates, families and all stakeholders are encouraged to share thoughts by filling out the user feedback form on ADA.gov. The DOJ will use stakeholder suggestions to keep making ADA.gov a vital and useful tool for people with disabilities.
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Kaiser Report Concludes Widespread Workforce Shortages Remain Biggest Challenges Facing State Medicaid Disability Services
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Kaiser Family Foundation (KFF) recently issued a report highlighting the impact of the COVID-19 pandemic on home and community-based disability supports, including the direct support professional (DSP) workforce.
The report, Ongoing Impacts of the Pandemic on Medicaid Home & Community-Based Services (HCBS) Programs: Findings from a 50-State Survey, examines the impact of the DSP workforce crisis on availability of disability services. The report concludes that “widespread workforce shortages are the biggest challenges facing state Medicaid home and community-based (HCBS) programs and those shortages were greatly amplified by the COVID-19 pandemic, which reduced the number of potential workers and increased the demand for services.”
Other key findings from KFF’s pandemic survey include:
- All responding states (49 in total) indicated they were experiencing shortages of direct care workers in 2022.
- 44 states reported a permanent closure of at least one Medicaid HCBS provider during the pandemic, up from 30 states in 2021.
- 48 states reported that they responded to the workforce crisis by increasing HCBS provider payment rates, many through the use of American Rescue Plan Act (ARPA) funding or emergency authorities authorized through the public health emergency.
- More than half of states said they plan to continue rate increases even after temporary funding and authorities expire.
- 35 states reported that their use of ARPA funds was limited to temporary measures to avoid higher ongoing costs after enhanced federal funding ended.
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Assistive Technology Reauthorization Included in the National Defense Authorization Act
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The U.S. Congress recently passed the National Defense Authorization Act (NDAA), which funds the U.S. Department of Defense, which included the 21st Century Assistive Technology Act (S. 2401 / H.R. 9028).
The bill was sponsored by Senator Casey (D-PA), Senator Collins (R-ME), Senator Cramer (R-ND), Senator Murkowski (R-AK), Representative DeSaulnier (D-CA), and Representative Sempolinksi (R-NY). Chairman Scott (D-VA), Education and Labor Committee and Chairwoman Murray (D-WA), Health, Education, Labor, and Pension Committee worked to get the bill moved through the committee and included in the NDAA.
The bill would update the Assistive Technology Act, a federal law that established and supports state Assistive Technology Programs to provide assistive technology and technical support to people with disabilities to improve or maintain their ability to participate in education, employment, transportation, and all other aspects of daily living by providing increased grants to state programs that help connect people with disabilities to various assistive technology devices.
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Advocacy Resources & Events
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MACStats: Medicaid and CHIP Data Book
The Medicaid and CHIP Payment and Access Commission (MACPAC) released the 2022 edition of the MACStats: Medicaid and CHIP Data Book, with updated data on national and state Medicaid and State Children’s Health Insurance Program (CHIP) enrollment, spending, benefits, beneficiaries’ health, service use, and access to care. As of July 2022, almost 90 million people were enrolled in Medicaid or CHIP.
From July 2021 to July 2022, enrollment in Medicaid and CHIP increased by 7.2 percent, following a 10.4 percent increase in Medicaid and CHIP enrollment from July 2020 to July 2021. While enrollment in the programs has increased since 2020, due in large part to the federal requirements that states maintain eligibility during the COVID-19 public health emergency, the growth rate has slowed. Medicaid and CHIP covered almost 30 percent of the U.S. population in 2021, with 87.8 million enrolled in Medicaid and 8.6 million in CHIP.
Enrollment increased in all states and the District of Columbia from July 2021 to July 2022.
To download a copy of the MACStats: Medicaid and CHIP Data Book click here.
Guide to the California Budget Process
The California Budget and Policy Center has published an online resource that provides a thorough explanation of our state’s budget process. To download copy of Dollars and Democracy: A Guide to the State Budget Process visit calbudgetcenter.org.
Advocacy Events
ICF/DD CalAIM Managed Care Carve-in Workgroup Meeting #4: January 20, 2023, 12:15-2:15pm.
The ICF/DD Workgroup meetings will be open to the public. Presentations and discussion are welcome from all Workgroup members and all other attendees, including members of the public, will remain in listen-only mode using this link. For any questions or comments, please email the ICF/DD Workgroup inbox at ICFDDworkgroup@dhcs.ca.gov.
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