California's Children

CBP: Realignment: health care "savings" w/pay for county social services

May 17, 2013: The nonprofit, Sacramento-based California Budget Project has released its breakdown of the May Revise announced by Governor Brown on Tuesday. Among the issues highlighted by CBP are programs affected by shifts in Brown's position on county/state realignment of social programs [emphases ours]:

...[The '13-'14 proposed budget] drops the Governor’s county-based approach and commits to a state-led Medi-Cal expansion. Newly eligible Californians would enroll in Medi-Cal and receive the same benefits available to other Medi-Cal enrollees. Health advocates, counties, and the nonpartisan Legislative Analyst’s Office have strongly supported the state-based approach.  

[The May Revise] maintains – and provides new details about – [Brown's] proposal to link the Medi-Cal expansion to a major realignment of responsibilities for human services from the state to the counties.

The Governor proposes that counties “assume greater financial responsibility” for CalWORKs, CalWORKs child care, and operation of the CalFresh food assistance program, thereby generating substantial state savings.

Under the Governor’s proposal, these new county costs would be funded with county savings attributable to health care reform. The state would determine county savings by comparing counties’ available health care revenues to their costs for providing health care to the remaining uninsured. Savings would be “redirected” to the human services programs, with this shift beginning in 2013-14 as the state implements the Medi-Cal expansion.

The Administration suggests that the redirected dollars – that is, funding shifted from counties’ health care infrastructure – could total $300 million in 2013-14, rising to $1.3 billion by 2015-16. On a May 14 briefing call, Administration officials indicated that the proposal would amount to a “fiscal transfer” for all programs during 2013-14, after which counties would have increased flexibility with respect to CalWORKs and related child care programs. County flexibility would be balanced with beneficiary protections, and “the state would continue to provide funding for above-average costs that result from economic downturns or policy changes outside counties’ control,” according to the Administration...

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Medi-Cal expansion & May Revise: 3rd option now on the table

House ag comm passes farm bill with $20.5 bil in food stamp cuts

UPDATE, May 16, 2013: The House of Representatives Agriculture Committee approved a $940 billion farm bill late last night in a 36-10 bipartisan vote. Erik Wasson, reporting for The Hill:

...Overall, the farm bill crafted by [committee chair Frank] Lucas (R-OK) and ranking member Collin Peterson (D-Minn.) cuts $20.5 billion from food stamps... No major changes were made in committee to the nutrition...programs [e.g., Women, Infants & Children (WIC)]. The food stamp cuts saw the most sustained attack during the markup. Liberal Democrats attempted to reverse the food stamp cuts in the farm bill but their main amendment... was defeated by a vote of 17 to 27. ...[Opposition said] the cuts are needed because the Obama administration has engaged in a “concerted effort to increase the dependency class” during a heated debate that ultimately involved dueling citations from the Bible on how to treat the hungry...The food stamp cuts in the House farm bill are $16 billion more than are included in the Senate Agriculture Committee bill, which has $4 billion in cuts...

UPDATE, May 15, 2013:The Senate Committee on Agriculture approved a farm bill yesterday (details below the jump); the House Committee on Ag will vote on its version today. California Food Policy Advocates says that, if enacted, both of the farm bill proposals would have a significantly negative impact on California households by "slashing monthly benefits or by eliminating benefits altogether."

LAUSD board unanimously says "yes" to classroom breakfasts

 UPDATE, May 15, 2013: The Los Angeles Unified School District board voted unanimously at its meeting yesterday to keep breakfast in the classroom -- a political wrangle between the teachers' union and the service employees' union that district superintendent had told the board to solve, specifically and intentionally, and not as part of a larger packaged of programs. 

 Speaking to the press, board member Steve Zimmer said, “We know we cannot turn away and pretend for a moment longer that [hunger] is someone else’s problem. This is not instead of education. This is education.”

Medi-Cal expansion & May Revise: 3rd option now on the table

10:00 a.m. Follow the announcement of the May Revise live on the California Channel and on Facebook.

May 14, 2013:  The May Revise of the California state budget for '13-'14 to be unveiled this morning by Governor Brown is expected to "focus and intensify" the debate over how to expand Medi-Cal, according to a story in California Healthline in which editor David Gorn highlights the compromise proposal now on the table from Health Access California that "proposes a time frame and percentages for the state and counties to share $1.4 billion in savings when Medi-Cal coverage is expanded through the Affordable Care Act next year. State and county officials have been wrangling behind closed doors about how the windfall should be divided.

 "These negotiations are at a logjam," said Anthony Wright, at right, executive director of Health Access California. "For us to move forward with Medi-Cal expansion, the governor wants to restate the relationship between the counties and the state. But the two proposals in the budget have not been seen as viable...The conversation about Medi-Cal expansion should not just be a closed-door debate with counties over realignment...This can't be just a money conversation between the state and the counties...The people with the most at stake here are California families. And their interests need to be represented in this conversation. This proposal allows counties to keep resources, but they don't get a blank check."

The Legislative Analyst's Office has agreed to review and comment on the new plan, putting pressure on the state to present its own answers soon. 

Toby Douglas, above left, director of the state Department of Health Care Services that administers Medi-Cal, was reluctant to entertain the Health Access proposal.

The Medi-Cal expansion decision, Douglas said, "has to be all the components of either option, and not another option. It needs to be affordable and sustainable, and it has to include those two components....The focus of the administration and the governor is a commitment to the optional expansion, and working on one of two different option...The goal is to create an approach that's affordable and sustainable. And to preserve the safety net. Those are the principles."

Assembly member Holly Mitchell (D-Los Angeles) did her best to get an answer on the details of the two roughly outlined choices for optional Medi-Cal expansion -- a state- or county-based approach -- at a budget subcommittee hearing last week.

Douglas did not reveal much...

"My concern is, if the administration continues to fixate on the two [options] proposed in the budget, it's pretty clear to me that the Legislature's not going to go down that road," [Assemblymember Holly] Mitchell said. "If that's where we're stuck...we're spinning our wheels and frankly wasting a lot of time now, going back and forth in the debate over which of the two options, when this body has begun to send a pretty clear message that those options, as articulated in the budget, are not viable. So ... where does that leave us?"

Douglas laughed a little at that. "I hear you loud and clear," he said. "We want to work with the Legislature. The options include both a state-administered and county-administered option, as well as including the changing role of the state and counties. So both pieces -- the delivery system, as well as the changing role -- need to be part [of the conversation]." ...

 

Preschool rich kids: mental/neuro disabilities doubled since 2001

May 6, 2013: "The changing landscape of child disability" in the U.S. was noted at a conference over the weekend where researchers announced that while the number of disabled children has risen 16.3% over the past decade (to 6 million children) -- and while children living in poverty still experience the highest rates of disability -- the highest growth in disabilities were experienced only by children living in households with incomes 300-400%+ above the federal poverty level.

Concurrently, disabilities in neurodevelopmental and mental health conditions -- as opposed to physical disabilities --  were found by researchers (from National Health Interview Survey datasets) to be on the rise, nearly doubling (18.7 cases per 1,000 ten years ago to 35.6 cases/1,000 in 2010, the most recent year for which data is available).

Reporting at this weekend's Pediatric Academic Societies annual meeting in Washington D.C., Amy J. Houtrow, M.D., at left, chief of the Div. of Pediatric Rehabilitation Medicine at Children's Hospital of Pittsburgh, said this rise, which is most prevalent in the 0-6 age group, "...is concerning and warrants further study and further research...to determine etiology of these changing trends." 

“There’s a very large increase in the percentage of children under the age of 5 [that] are now considered disabled and this is particularly concerning because we have a strong understanding of the value and importance of that developmental time period,” Houtrow said.

However, physical disability from physical conditions declined.

Researchers also found that children living in poverty experienced the highest rates of disability, 92.7 cases per 1,000 in 2001 to 2002 and 101.4 cases per 1,000 in 2009 to 2010. However, only children living in households with incomes 300% to 399% and 400% or above the federal poverty level experienced statistically significant disability rates over the study period (28% and 23.9%, respectively).

“We are talking about children who live in households where their parents have a college education,” Houtrow said. “We are talking about households where their income is above 300% of the Federal Poverty Level and that is very different from what we would have expected based on what we know about sociodemographic disparities.”