CSAC Institute:
Realignment Workshop
Health Services
June 4, 2010
Judith Reigel, CHEAC Executive Director
Margaret Szczepaniak, Assistant Director, Health Care Services
San Joaquin County
Realignment Health Account
Public Health
Indigent Health Care
(Former AB 8 and MISP/CMSP Programs)
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History of County Health Funding
Leading up to 1991 Realignment
1971 – Creation of state only MIA Medi-Cal category
1978/79 – Aftermath of Prop 13: AB 8
 MOE Requirement
1982/83 – Transfer of MIA’s to counties (MISP/CMSP)
1991/92 – Realignment
AB 8
MISP/CMSP
Local Health Services
SLIAG
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Health Allocations Chart
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How are Health Realignment
 Public Health Funds Used?
Health and Safety Code Section 101025
“The board of supervisors of each county shall take
measures as may be necessary to preserve and protect the
public health in the unincorporated territory of the county,
including, if indicated, the adoption of ordinances, regulations
and orders not in conflict with general laws, and provide for
the payment of all expenses incurred in enforcing them.”
 Though mandate precedes Realignment, it is the primary
funding source for county public health
 Used to pull down federal matching funds (e.g. MAA/TCM)
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How are Health Realignment
Funds Used?
 Indigent Health Care
Helps meet Welfare and Institutions Section 17000
mandate
Supports County Hospitals and clinics
Medi-Cal waiver: Non-federal share of hospital
inpatient
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California Children’s Services
(CCS)
 Serves children with serious
illness or traumatic
injury through Medi-Cal, Healthy Families and the CCSonly program
 Realignment changed state/county sharing ratio for
non-Medi-Cal diagnosis/treatment/therapy from 75/25
to 50/50
 Placed in Social Services Account since it is a caseload
driven program
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Local Revenue Fund
Sales Tax
Source: ½% sales tax
Sales Tax Growth Account
Sales Tax Base Account
Social Services Account
Health Account
(Revenues in Excess of Base Payments)
Caseload Subaccount
Mental Health Account
CMSP Growth
Health Account
County Allocations
CMSP
General Growth Subaccount
Social Services Account
Health Account
Mental Health Account
Vehicle License Fee
Source: 74.9% Vehicle License Fees
VLF Growth Account
VLF Base Account
(Revenues in Excess of Base Payments)
CMSP Growth
Social Services Account
CMSP
Health Account
Mental Health Account
Health Account
County Allocations
Social Services Account
General Growth Account
Health Account
Mental Health Account
Revenue Sources
Percentages by Revenue Source
08/09 Base Distribution
Account
Sales Tax
VLF
Health
15%
74%
Mental Health
29%
22%
Social Services
56%
4%
Percentages by Account
08/09 Base Distribution
Account
Health
Mental Health
Social Services
Sales Tax
25%
69%
96%
VLF
75%
31%
4%
 Percentages change yearly due to Growth Distribution
Sales Tax Revenue History
3,500,000,000
3,000,000,000
2,500,000,000
Sales Tax Revenue Summary Health
Sales Tax Revenue Summary Mental Health
2,000,000,000
Sales Tax Revenue Summary Social
Services
Sales Tax Revenue Summary Total Sales
Tax
1,500,000,000
1,000,000,000
500,000,000
0
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Vehicle License Fee Revenue
History
1,800,000,000
1,600,000,000
1,400,000,000
1,200,000,000
1,000,000,000
VLF Revenue Summary Health
VLF Revenue Summary Mental Health
800,000,000
VLF Revenue Summary Social Services
600,000,000
VLF Revenue Summary Total VLF
400,000,000
200,000,000
0
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Maintenance of Effort (MOE)
 In order to be eligible for the receipt of Realignment Sales Tax Funds each month, a
county must:
 Deposit into its health account an amount of general funds which is equal to
1/12 of the amount specified in section 17608.10 of the Welfare & Institutions
code for the county.
 Note: Section 17608.10 refers to old AB 8 MOE.
 Deposit an amount of county general funds at least equal to the Vehicle
License Fee (VLF) amount of funds transferred by the State Controller’s Office
(SCO) each month.
 Deposit local matching funds each month that are sufficient to permit local
Health and Welfare trust fund disbursements that are equivalent to the growth
of revenues in Sales Tax and VLF allocated to the county.
 Constitutionally, VLF is considered county general funds; therefore, MOE’s were created to
assure that VLF Health Realignment funds are actually spent on health.
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MOE Chart
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Benefits of Realignment to
County Health Services
 Stable,
relatively predictable (until recently) funding
source has allowed counties to plan across fiscal years
 Flexibility has allowed local health departments to target
resources as needed to address local community health
needs
 Realignment funds have been used to supplement
categorical grant funding that has not kept up with need
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Challenges
 No Sales Tax growth since FY 05/06; no VLF growth
since FY 06/07
 VLF has been extremely volatile past two years
 Demand for local health services has increased at
same time revenues have decreased
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What Will Health Care Reform
Bring?
 2014: Medi-Cal expansion
to childless adults to 133% FPL
(100% federally funded first 3 years)
 State likely to want to recoup Health Realignment funds as
early as 2014
 Need to preserve public health funding
 Section 17000 – Not likely to go away
 County hospitals and clinics will still have uninsured to serve
 Health Care Reform does not serve the undocumented
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