The start to the 2023-2024 Legislative Session was anything but slow, with a trove of 2,632 bills introduced by the February 17, 2023 bill introduction deadline. The Legislature is currently on spring break, having departed after floor sessions concluded on Thursday, March 30. Members will return to Sacramento on Monday, April 10 to face two major legislative deadlines. By Friday, April 28, all policy committees must have dispensed with bills that have a fiscal impact, and by the following Friday, May 5, committees must have taken up all non-fiscal measures. These hard deadlines make for a busy few weeks and lengthy policy committee hearings in the Legislature's days ahead.
Contra Costa County has three sponsored bills in progress at this time: AB 592 (Wilson), the County's illegal dumping bill; SB 511 (Blakespear), the bill we are co-sponsoring with CivicWell related to greenhouse gas emissions inventories; and AB 540 (Wicks), a bill we are co-sponsoring with Choice in Aging related to accessible transportation services. Talking Points for these and other significant policy matters are in development for the Supervisors' use at advocacy meetings with legislators during the CSAC Legislative Conference and will be discussed at the Legislation Committee meeting. (Attachment C)
As for other measures of significant interest, the Urban Counties of California has provided its member counties with the following updates:
Highlights of High-Profile Health and Human Services Bills
SB 43 (Eggman) – Conservatorships
SB 43, Senator Susan Eggman’s latest attempt to change the definition of gravely disabled used for conservatorships, was heard March 29 in Senate Health Committee.
A bipartisan, bicameral group of legislators has signed on to co-author the measure.Senate Health Committee passed the measure 12-0; the Senate Judiciary Committee will hear the measure in April.
Specifically, the bill seeks to expand the definition of “gravely disabled” to also include a condition that will result in substantial risk of serious harm to the physical or mental health of a person due to a mental health disorder or a substance use disorder (SUD). The bill would define “serious harm” for purposes of these provisions to mean significant deterioration, debilitation, or illness due to a person’s inability to carry out specified tasks, including, among other things, attend to needed personal or medical care and attend to self-protection or personal safety. Finally, the bill adds language specifying that, for purposes of an expert witness in a proceeding relating to the appointment or reappointment of a conservator, the statements of a health practitioner or a social worker included in the medical record are not hearsay.
SB 43 is being co-sponsored by the Big City Mayors Coalition, the California State Association of Psychiatrists, NAMI California, and Psychiatric Physicians Alliance of California. The bill is supported by several individual cities, the Los Angeles County Board of Supervisors, and Govern for California.
The County Behavioral Health Directors Association (CBHDA) is opposed to SB 43 on the basis that the proposed expansion of LPS is overly broad and ultimately would not benefit the clients and communities they serve. CBHDA asserts that changes would also further stigmatize behavioral health conditions and frustrate clients and the public who want to see real action to meaningfully address mental health and SUD needs. More broadly, opponents express additional concerns about involuntarily detaining and treating those with SUDs, including concerns that involuntary SUD treatment could result in overrepresentation of people of color, LGBTQ+, and other historically marginalized people being forced into more coercive treatment. CBHDA also cites a peer reviewed body of research from indicating that coerced and involuntary treatment is in fact less effective in terms of long-term substance use outcomes, and more dangerous in terms of overdose risk, and voluntary treatment is more effective. Finally, CBHDA makes the point that (1) a build out of delivery networks to support this policy change would take years and (2) to do so would require new, sustained and dedicated state resources above and beyond investments already made by the state, with a significant increase in residential and inpatient SUD treatment capacity.
A coalition of other opponents, largely comprised of disability rights as well as racial and ethnic minority group advocates, echo some of the arguments made by the behavioral health director. The coalition further argues that voluntary, community-based treatment and services, as well as the expansion of choices, rights, and liberties for people living with MH disabilities are what the state needs. The coalition encourages the Legislature to instead invest in evidence-based programs and services that are proven to meet the needs of Californians and urges the state to exercise greater oversight over local jurisdictions to ensure that unhoused people are offered and placed in appropriate affordable, accessible housing with voluntary supports. Finally, the group points out that despite recent state investments in programs like BHCIP, the infrastructure will not be available soon enough to absorb additional involuntary detentions that will result if the expanded definition of “gravely disabled” is enacted.
AB 4 (Arambula) – Covered California
AB 4, by Assembly Member Joaquin Arambula, would continue California’s efforts to expand health care coverage to all by focusing on Covered California eligibility. Specifically, AB 4 would authorize Covered California to apply for a federal waiver to allow undocumented residents to obtain coverage through the Exchange. Under the bill, undocumented individuals would be able to purchase coverage through Covered California beginning in plan year 2026. The Assembly Health Committee is hearing the bill on April 11.
SB 525 (Durazo) – Health Care Minimum Wage
SB 525, by Senator Maria Elena Durazo, would create a health care minimum wage of $25 per hour and set a new floor for salaried health workers of $104,000. The sponsor, SEIU State Council, has focused their messaging around the lowest wage health care workers – who are primarily women of color – and the health care workforce shortage.
Several organizations are opposing the bill or taking oppose unless amended positions, including the California Nurses Association, the California Hospital Association, the California Primary Care Association, the California Medical Association, Urban Counties of California (UCC), the California State Association of Counties (CSAC), and the Rural County Representatives of California (RCRC).
SB 525 will be heard in Senate Labor Committee on April 12.
AB 1168 (Bennett) – Emergency Medical Services
AB 1168 by Assembly Member Bennett was recently amended to overturn an extensive statutory and case law record that has repeatedly affirmed county responsibility for the administration of emergency medical services and with that the flexibility to design systems to equitably serve residents throughout their jurisdiction.
AB 1168 seeks to abrogate unsuccessful legal action that attempted to challenge an agency’s .201 authorities – that is, the regulation that allows agencies that have continuously served a defined area since the 1980 EMS Act to continue serving that area as the sole provider. In the case of the City of Oxnard v. County of Ventura, the court determined that their case “would disrupt the status quo, impermissibly broaden Health and Safety Code section 1797.201’s exception in a fashion that would swallow the EMS Act itself, fragment the long-integrated emergency medical system, and undermine the purposes of the EMS Act.”
Proponents of the bill include the League of California Cities, California Fire Chiefs Association, and the California Professional Firefighters. Opponents include UCC, CSAC, RCRC, the County Health Executives Association of California, the Health Officers Association of California, ambulance providers, and the American Federation of State, County and Municipal Employees (AFSCME). The Contra Costa County Board of Supervisors has taken an Oppose position on the bill.
AB 1168 is set for hearing April 11 in Assembly Health Committee.
Bills Related to 2011 Public Safety Realignment
AB 702 (Jackson) – Redirection of JJCPA Resources
AB 702, by Assembly Member Corey Jackson, would redirect Juvenile Justice Crime Prevention Act (JJCPA) funds, revise the composition of local Juvenile Justice Coordinating Councils (JJCC), and recast various elements of required multiagency juvenile justice plans. This measure largely mirrors previous legislative efforts – AB 1007 (Jones-Sawyer, 2020) and SB 943 (Bradford, 2021).
UCC, RCRC, and CSAC have weighed in as a coalition in opposition to this measure, primarily because of provisions that would require redirection of 95 percent of JJCPA funds, which today are – in many instances – dedicated to staffing and personnel costs that make up the backbone of our juvenile probation departments. These expenditures have been and continue to be wholly eligible and lawful under JJCPA. Most problematic about this approach is that the proposed redirection appears to ignore constitutional protections enacted under Proposition 30 (2012) that ensure certainty and stability for all programs realigned in 2011, including JJCPA. The proposal also is troubling given that counties are working diligently toward full implementation of SB 823, which shifted responsibility for the care and custody of all system-involved youth to county responsibility, and will be working to support the transition of and subsequent care for several hundred young people who will remain in the jurisdiction of the Department of Juvenile Justice (DJJ) once all state facilities close on June 30, 2023.
This measure awaits hearing in the Assembly Public Safety Committee.
AB 1080 (Ta) – Criminal Justice Realignment (AB 109) Evaluation
AB 1080, by Assembly Member Tri Ta, would require the Legislative Analyst’s Office to prepare a report – due to the Legislature by June 30, 2026 – that would evaluate results over a period of 10 years of AB 109 (2011) implementation. The bill, as recently amended, would require that the report address the following fiscal and programmatic data elements:
- Funding received by county for AB 109 implementation (i.e., funds into the local Community Corrections Subaccount) and how those funds were deployed locally;
- Details on local sentencing practices, including the use of straight sentencing, split sentencing, probation, diversion, and other custody alternatives;
- Changes to the county jail population, including any amendments to jail release policies and whether the county was subject to a court-ordered population cap;
- Information on post-release community supervision practices, including probation caseloads, responses to supervision violations, and programming and services offered; and
- Recidivism outcomes, as defined.
AB 1080 would authorize the LAO to prepare the report based on data from every county, or alternatively, a multicounty study using data from at least 15 counties representative of the state.
The measure passed the Assembly Public Safety Committee on the consent calendar and now awaits a fiscal review before the Assembly Appropriations Committee. AB 1080 is supported by the California District Attorneys’ Association, the Peace Officers Research Association of California, and more than a dozen local peace officer associations; no opposition to the bill has been recorded.
Additional Details Emerge on Governor’s MHSA Modernization and Bond Proposal
In the days following the Governor’s announcement, more details have been released regarding the Administration’s plans to modernize the Mental Health Services Act (MHSA) and to seek bond funding to support behavioral health treatment capacity. Although specific language has yet to be drafted, the Governor’s Office released a fact sheet, and the California Health and Human Services Agency (CalHHS) hosted a webinar as part of its initial rollout of information.
The Administration is planning for a November 2024 ballot measure that will include three primary elements:
1. Address the current shortage of nearly 6,000 behavioral health treatment beds through a $3 to $5 billion general obligation bond to fund behavioral health care expansion in distinct community residential settings:
- Multi-property: unlocked and community-based, campus-like settings with robust onsite supportive services.
- Cottage style: smaller residential settings with access to existing community benefits and services.
- Home-like: Permanent Supporting Housing and Scattered Site Housing, which would include home-like or single units to integrate individuals into the community and offer long-term housing stability.
- Veterans: Some unspecified portion of the bond funds would be used to address housing for homeless veterans.
2. Propose reforms to the Mental Health Services Act (MHSA) of 2004 to:
- Redirect up to 30 percent annually to pay for housing and other community-based residential solutions and serve as an ongoing source of funding for new and existing housing and residential settings, with a focus on homeless individuals.
- Recast local categorical funding buckets and focus 35% of funding on Full-Service Partnerships and other services for the most seriously ill.
- Require counties to bill Medi-Cal first, prior to MHSA, for reimbursable services.
- Expand target population to include those with substance use disorders.
- Make various changes to county accountability and overall transparency, including (1) paring back the Three-Year County Plan, (2) reducing the “prudent reserve” (from 33% to 20% for large counties and 25% for small counties), and (3) moving the Mental Health Services Oversight Act Oversight and Accountability Commission (MHSAOAC) under CalHHS.
3. Seek reforms to stabilize and strengthen core behavioral health systems:
- Align behavioral health benefits across all health plans.
- Increase accountability for services provided and outcomes achieved through increased reporting by county behavioral health plans.
The proposals are still in development, and the Administration will be seeking input on how various mechanisms are structured.
Attachments
Attachment A: Contra Costa County Master List of Bills
Attachment B: Contra Costa County Advocacy Letters 2023
Attachment C: Draft Talking Points |