COUNTY OF SAN MATEO

Inter-Departmental Correspondence

COUNTY MANAGER'S OFFICE

DATE:

August 24, 2001

BOARD MEETING DATE:

September 11, 2001

TO:

Honorable Board of Supervisors

FROM:

John L. Maltbie, County Manager

SUBJECT:

County Manager's Report #

1.

Summary of 2001 Legislative Action

Attached for your review is a summary of action taken by the Board on state and federal legislation in 2001, including a current status report for each bill.

2.

Pending Legislation: Request for Action

HR 504 (Green): Community Access to Health Care Act of 2001

The Community Access Program (CAP) is a federal demonstration program established in FY 2000 to provide funding to support local efforts to comprehensively address the health care needs of the uninsured on a regional basis. It has been estimated that over 44 million people living in the United States are uninsured. When these individuals seek health care they often utilize services provided by a patchwork of unrelated agencies, including public hospitals, community/rural health centers, faith-based organizations, and a host of other safety net providers. Studies have found that patients derive improved health benefits and that the health care safety net system operates more efficiently when collaboration occurs among these disparate providers. CAP seeks to expand access to health care for the uninsured by increasing the effectiveness and capacity of the country's health care safety net at the community level. According to former Secretary of Health and Human Services, Donna E. Shalala, "This grant program's goal is to assure that more uninsured people receive needed care, that the care received is of higher quality, and that the uninsured are served by providers who participate in accountable health systems."

Last year, San Mateo County's Health Services Agency/Division of Hospital and Clinics submitted a proposal for CAP funding. Community partners joining in the proposal include: Central Labor Council; El Concilio; South County Community Health Center; and the Health Plan of San Mateo. In March 2001, Health Services was notified that it would receive $897,773 for the current grant year. Health Services intends to use this funding for the following purposes: increase the availability of chronic disease management services to minority populations; provide work place safety and health education to low-income union workers; improve utilization and case management of the medically indigent adult population; integrate the South County Community Health Center in East Palo Alto into the wider system of health care; and maximize enrollment in the Medi-Cal and Healthy Families programs.

Although Health Resources Services Administration (HRSA) is accepting applications for a second year of funding, future grants are questionable, as the $125 million intended for CAP has been slated for elimination in this year's budget. On August 1, 2001, the House Subcommittee on Health held a hearing on "Authorizing Safety Net Public Health Programs." At this hearing several persons testified as to the importance of restoring CAP funding, including Congressman John D. Dingell, who noted that CAP "is quite popular among safety net providers and should be restored, if not increased."

HR 504 (Green) was introduced earlier this year to establish the Community Access to Health Care Act of 2001. This Act would amend Part D of title III of the Public Health Services Act (42 U.S.C. 254b et seq.) thereby expanding the existing CAP grant program. If enacted, this bill would authorize annual appropriations of $250 million in fiscal years 2002 through 2006. These funds would enable public or nonprofit private entities, such as FQHCs, 340B hospitals, and public health departments, to establish or strengthen existing integrated health care delivery systems that coordinate health services for individuals that are uninsured or underinsured. Examples of permissible use of funds include: increased outreach, improved case management, improved coordination of transportation to health facilities, recruitment/training/compensation of necessary personnel and acquisition of technology. To ensure that grants are used to improve the delivery system, no more that 15% of grant funds may be used to provide direct patient care and services.

I request your consideration of the attached resolution in support of this bill.

3.

Community College Restoration bills: Informational/Discussion Item

Last month Gov. Davis vetoed $126 million from the state budget which the legislature had appropriated for use by community colleges. This funding was intended for deferred maintenance, acquisition of instructional materials, and upgrading computer equipment.

When the legislature reconvened on August 20, several members denounced the cuts. Two members (Assemblymember Pacheco and Senator Scott) announced their intention to introduce legislation to restore this funding. Some have even discussed the possibility of a veto over-ride, although this strategy, which requires a 2/3 vote in each house, is considered less desirable for political reasons.

California has 108 community colleges, which enroll 1.6 million students, approximately 85% of all students who attend post-secondary educational programs in the state. For this reason they are often referred to as the "workhorses" of higher education. Community colleges charge much lower tuition, consequently, a large proportion of these students are minorities and/or come from economically disadvantaged backgrounds. Nevertheless, over the past 10 years, state aid has been reduced by approximately $200 million each year. As a result, many community colleges have serious problems related to deferred maintenance projects, inadequate library resources and outdated computers/software.

Representatives from Gov. Davis' office intimate that it is unlikely that he would sign a bill to restore the funding if passed by the legislature next week, maintaining the funds are necessary to build a $2.6 billion reserve. Community college advocates acknowledge the need to set aside sufficient reserves, however, they argue that they were particularly aggrieved in that the governor's veto was completely unanticipated and disproportionate, comprising almost one-quarter of the $554 million blue-penciled by the governor.

4.

State Legislative Schedule

The Legislature reconvened on August 20, 2001. Bills introduced in the 2001 session which have not passed out of fiscal committee as of August 31, 2001 will become two-year bills. At this time, only conference committees may meet as bills proceed to the floor for final consideration before the September 14 deadline. September 7 was the last day that bills could be amended on the floor. September 14 is the last day for each house to pass bills. The Governor has one month, until October 14, 2001, to sign or veto any bills in his possession. After September 14, 2001, the Legislature enters the Interim Study Recess and does not reconvene until January 7, 2002.

In Washington, the Legislature reconvened on September 4, 2001.

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