Transcript Fiscal Exposure For Counties Under Realignment


Estimates of the influx of newly-covered
individuals in California by 2014:
◦ range from 1.5 to 2 million new Medi-Cal beneficiaries
◦ over 3 million others subsidized by the California
Health Benefit Exchange.
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Estimated 147,000 to 195,000 of the new MediCal enrollees will need substance use disorder
services.*
Estimated 155,000 to 400,000 of the new MediCal enrollees will need mental health services.*
* Note: these figures are estimates.
DRUG MEDI-CAL
Section 1902 of the SSA has the basic Medicaid
requirements. With few exceptions, the following
rules must hold for the Drug Medi-Cal program
administration:
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Comparability of Services
◦ Services to be comparable for eligible individuals –
equal in amount, scope, duration for all
beneficiaries in a covered group; services to
categorically needy can not be less in amount,
scope, duration than those provided to medically
needy groups.
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Statewideness:
◦ Benefits offered to any individual must be available
throughout the state.
Choice of Providers:
◦ An individual may obtain Drug Medi-Cal services
from any institution, agency, pharmacy, person, or
organization that is qualified to perform the
services (i.e. D/MC-certified).
◦ In California, if a certified D/MC provider is not
given a contract by a specified county, that provider
is guaranteed a direct contract with the state. DHCS
can access the county’s realignment funds in the BH
subaccount to finance the direct contract.
 Allows Dept. of Health Care Services to notify the Controller,
DOF and a county that said county is failing to perform a
federal Medicaid program (applies to Drug Medi-Cal and
specialty mental health services) to the extent federal
Medicaid funds are at risk. The Controller then deposits the
county’s revenues for the program in question into the
County Intervention Support Services Subaccount.
 This section is intended to cover a case in which a county
refuses to perform Drug Medi-Cal or is performing
inadequately (beneficiaries are not receiving entitled services).
How is this “inadequacy” determined?
 DHCS will have access to those funds in the County
Intervention Support Services Subaccount.
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Minor Consent:
o Though billed under Drug Medi-Cal for SUD
services, Minor Consent is not part of the federal
entitlement, and there is no federal match.
o
Counties are not required to provide or contract for
Minor Consent services. However, in the 2011
Realignment, the State used historical DMC
expenditures, which included Minor Consent
expenditures, to determine county realignment
allocations. So counties are encouraged to
continue these services to youth who need them.
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The realignment superstructure statutes state that a
county that seeks to implement significant
reductions or elimination of optional or discretionary
services must do so in an open setting with board of
supervisor approval.
Under Title 42-CFR federal confidentiality rules, the
SUD program and/or county cannot disclose that the
minor is receiving Minor Consent services for alcohol
or drug treatment.
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Beginning this year, the state is transferring Healthy
Families youth to the Medi-Cal program. The
expectation is that many more youth will receive SUD
treatment under this shift than had accessed
treatment under the Healthy Families program.
In the 2011 Realignment, the State did not take into
account either historical SUD expenditures for
Healthy Families youth, nor projected expenditures
for serving these youth in Drug Medi-Cal, when
determining county realignment allocations.
Maintenance of Effort:
 The purpose of the Substance Abuse
Prevention and Treatment Block Grant MOE is
to ensure Federal SAPTBG funds are used to
supplement, not supplant state funding.

The SAPTBG MOE has implications for the
county’s Behavioral Health realignment
subaccount, as it limits somewhat the
county’s flexibility with regard to the use of
those subaccount funds.
Substance Abuse Prevention & Treatment Block Grant MOE
In order to maintain federal Block Grant funding for
substance use disorder prevention and treatment, the
state is required to maintain state expenditures for SUD at
a level that is no less than the average of the 2 preceding
fiscal years’ expenditures.
Per the Code of Federal Regulations, the SAPTBG must be
the funding of last resort for authorized services.
Consequences of Not Meeting the MOE Requirement
There will be a dollar-for-dollar reduction to the state’s
Block Grant award if it is determined by SAMHSA that the
state did not materially comply with the MOE requirement.
Implications for Counties:
Under Realignment, counties will now be responsible to meet the
state’s MOE obligation. Realignment funds for substance use disorder
services in the Behavioral Health subaccount will be counted as state
funds only for the purpose of the MOE.
 Each county will be responsible to meet its portion of the state’s
MOE obligation for any given fiscal year, which means that it must
expend realignment funds for authorized SUD services in an amount
at least equivalent to the average expenditures for the previous 2
fiscal years. The state will notify each county of its MOE obligation
when it sends out the preliminary allocation letters each year.
 If a county underspends its realignment allocation in any given fiscal
year, and fails to meet its MOE obligation, it risks losing an
equivalent amount of federal Block Grant funding.
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Requires ADP to notify each county regarding its
estimated amount of federally required MOE
statewide expenditure levels on authorized
activities.
ADP may reduce federal funding allocations, on a
dollar for dollar basis, to a county that has reduced
expenditures in a way that could result in a
decrease in SAPTBG funding.
The State Fiscal Year 2012-13 total MOE is
approximately $204 million.
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