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Policy Updates for City/Local, State, and Federal.

Policy Updates: City/Local

1. SFCCC Delegation Meets with the Mayor’s Deputy Chief of Staff and Director of Governmental Affairs Regarding Health Care Issues that Impact The City and Clinics

The delegation of six SFCCC Board members met with the Mayor’s senior staff leaders on April 8 to coordinate regarding a variety of issues ranging from suggestions for “Healthy San Francisco” enhancement to City wide planning for Health Information Exchange among all providers; a low-cost pharmacy plan for the safety net; the SFGH rebuild and proposed bond issue; and proposed State Medi-Cal cuts and the Mayor’s lawsuit.

SFCCC is following up on actions recommended. The group agreed to meet quarterly.

2. “Healthy San Francisco” Enrollments Top 18,000; SFCCC Clinics are the Medical Homes for 39% of Enrollees

Enrollments in “Healthy San Francisco” (HSF) – the City’s program to provide health care access to (ultimately) 82,000 uninsured residents – were at 18,285 San Franciscans as of the most recent City report. The program continues to grow steadily as residents between 100%-300% of the Federal Poverty Level began signing up in January. So far, only a small number of enrollees – 70 – have been disenrolled due to failure to pay participation fees (required of enrollees above 100% FPL).

Of the enrollees, 39% have chosen an SFCCC partner clinic as their “medical home.” SFCCC continues to work with the Department of Public Health (DPH) to assure that any enrollee can sign up for any medical home option at any site – i.e., “any door is the right door” to enrollment in the enrollee’s medical home of choice.

The DPH/ SFCCC/ San Francisco Health Plan HSF coordinating committee continues to meet on a regular basis to coordinate both policy matters and necessary program adjustments. Efforts are proceeding to streamline the enrollment and re-enrollment processes.

For additional information about SFCCC health centers’ participation in “Healthy San Francisco,” please contact Allen Meyer (ameyer@sfccc.org/ 415 355-2226).

3. Health Commission Passes Budget Resolution for 2008-2009 DPH Budget; Board of Supervisors (BOS) Begins Budget Review and Hearings in June

On April 15, the San Francisco Health Commission reluctantly approved a proposed DPH budget for 2008-2009 after identifying an additional $ 12.8 million in General Fund cuts requested by the Mayor. The proposed City budget will now be submitted to the BOS by the Mayor on June 2 and the BOS will review and hold public hearings on it by Department June 16- 26.

SFCC will monitor the budget as it moves through the process and inform the SFCCC Board of additional significant potential impacts on clinics and client populations as they become known. As issues are identified, SFCCC will coordinate appropriate testimony at BOS hearings.

4. SFCCC’s 26th Anniversary Gala Honors Assemblyman Mark Leno – A Staunch and Long-Time Supporter of Community Clinics

On March 27, SFCCC celebrated its 26th anniversary with 200 friends and supporters at the Concord-Argonaut Club in San Francisco. Assemblyman Mark Leno was honored for his support of San Francisco community clinics – both as a San Francisco Supervisor and in his current capacity as a State Assemblyman, leader of the Assembly appropriations committee and member of the Assembly/ Senate budget reconciliation conference committee. Assemblyman Leno addressed the group regarding the State budget crisis and proposals for resolving it.

5. SFCCC’s Assessment of Clinics’ Impacts on San Franciscans Health Care Access and the City’s Economy Is Proceeding

SFCCC is collecting data from member clinics on a broad range of clinic impacts on the City and its districts – economic and financial as well as health care access indicators. Key data is due from clinics on April 29. Staff will combine it with State health planning and other local data to create a picture of the clinics’ imprint on the City’s health care access and economic vitality. Impacts by supervisorial district will also be identified.

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Policy Updates: State

1. SFCCC to Survey Member Clinics Re Impacts of the State Medi-Cal Check Write Delays and the Anticipated Delays in the Approval of the State Budget

Again, courtesy of CPCA, below is a summary of the recently-enacted Medi-Cal check write delay policy:

Recently enacted State healthcare cuts (responding to the current year and projected State budget crises) include a 10% Medi-Cal provider rate cut (FQHCs and Family PACT are exempt) and the adoption of the Governor's proposed Medi-Cal check-write delay and cash management proposals.

The “permanent deferral of Medi-Cal Check-write” means that this delay is not a one-time deferral but will continue for all outgoing budget years. The check-write delay would delay the second to last Medi-Cal check-write in June. Currently, DHCS holds your last check-write…which this year would be the June 26th check…under this proposal they would hold June 19th’s as well, and both checks would be paid to the health center in July. Again, this would be an ongoing delay.

The cash management proposal would hold all 4 check-writes for the month of August and those would be paid in September. This would be a one-time deferral of payment. All in all, this would be a total of 5 weeks of delayed payments.

In addition to the Medi-Cal check write delays, the approval of the State budget could be delayed six months or more (see below).

CPCA recently surveyed clinics on the projected impacts on clinic fiscal operations. SFCCC will also survey our members for additional information.

2. Governor’s May Revise Expected to Report Increasing Budget Shortfall/ Approval of the Budget Could Be Delayed Beyond September

The State budget situation appears to be getting worse with State revenues apparently still declining $200-300 million per month and senior State officials projecting that the budget may not be approved until January- February 2009 (instead of by the required July deadline). The Governor’s “May Revise” budget proposal is expected to paint a bleaker picture than his January budget submission.

3. SFCCC to Testify at May 7 Hearing on Assemblywoman’s Fiona Ma’s Legislation (AB 158) to Extend Medi-Cal Benefits to People with Chronic Hepatitis B

Currently, individuals with chronic hepatitis B are not eligible for Medi-Cal until they become disabled. Without early treatment, thousands of individuals are at risk of liver cancer and liver disease. AB 158 directs the Department of Health Care Services to apply for a federal waiver to expand Medi-Cal eligibility for individuals with chronic hepatitis B.

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Policy Updates: Federal

1. SFCCC President/CEO John Gressman Inducted into the National Association of Community Health Centers (NACHC) Advocacy Hall of Fame at the March NACHC Policy and Issues Forum in Washington, D.C.

At the March 13 ceremony, John was cited for his tireless efforts in D.C. on behalf of clinics for more than a decade. John was acknowledged for playing a leadership role for NACHC in establishing and maintaining productive relationships with key Congressional leaders. He has also worked effectively with HRSA and Bureau of Primary Health Care administrators by anticipating the impacts of proposed policies on health centers and making sure recommendations get to the right people at the right time.

2. Congratulations to New Congresswoman Jackie Speier!

Congresswoman Speier was elected to the seat in the House of Representatives representing South San Francisco and San Mateo County formerly held by Congressman Tom Lantos who recently passed away. SFCCC offers its congratulations to Congresswoman Speier and we look forward to working with her in her new role. She was a strong supporter of clinics during her tenure in the California legislature

Please call or email Dick Hodgson at 415 355-2230/ rhodgson@sfccc.org if you have questions or need additional information on any of these topics.

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