By: Shirley Lam, MPH

California’s latest immigration-related bills present bold strides forward and troubling setbacks. While some proposals aim to protect and support the rights of undocumented individuals and immigrant communities from federal threats, others roll back key coverage gains and cut state funding for vital services. As new immigration bills emerge, we’re breaking down both sides of the debate and decoding the potential impact on California’s immigrant population. We also note which bills ITUP believes would be detrimental to California’s coverage gains.

Note: This blog features selected legislation this session showcasing key proposals that either protect or threaten California’s undocumented and immigrant population. Have questions about a bill not listed? Email us at info@itup.org.  

Notable Highlights:

• ITUP is monitoring immigration-related bills that could impact California’s health coverage expansion. Legislative bills including AB 18 and AB 1012 threaten to roll back key coverage gains by eliminating state-funded health care for undocumented residents.
• California lawmakers are considering legislation that both supports and challenges immigrant rights. For example, SB 1 provides crucial funding for immigration services, while AB 18 seeks to cut vital health and social services.

Budget Act of 2024:

The newest statutes of 2025 allocate funding to protect the State of California. This support is intended to protect taxpayers and residents from federal actions that are unconstitutional and unlawful. SB 1 amends the 2024 Budget Act for three existing state programs that service immigrant communities. Dig into the details below!

$25 million (one-time General Fund) allocated to immigration services. More specifically:

• $10 million to the Legal Services Trust Fund to provide legal aid to vulnerable persons at risk of detention, deportation, eviction, wage theft, intimate partner violence, and more, as a result of potential or actual federal action.
• $10 million to the Department of Social Services (CDSS) Immigration Services Funding program.
• $5 million to the Judicial Council to be distributed through the California Access to Justice Commission to nonprofit providers of legal services.
• Up to 2.5% of these funds can be used for administrative expenses and require reporting to the Joint Legislative Budget Committee.

Bills That Undermine Coverage and Services

California Secure Borders Act of 2025: AB 18 (DeMaio)
AB 18 could take California a step backward when it comes to supporting undocumented communities. This bill aims to address illegal immigration by repealing laws that currently allow state funds to be used for essential services such as welfare, health care, and housing for undocumented immigrants. The bill also mandates public reports on illegal immigration’s impact on crime rates and local services. Additionally, AB 18 offers training for local law enforcement to assist with federal border security efforts and sets guidelines for deploying the State Guard to establish border security.

ITUP Hot Take: At its core, AB 18 is all about reducing the state’s support for undocumented immigrants and enhances efforts to secure the border. This would be detrimental to California’s health coverage gains. Repealing state-funded health care for undocumented immigrants would lead to higher uninsured rates and reduced access to essential health services. Ultimately, this will widen existing health disparities and undermine the state’s progress toward equitable health coverage.

Medi-Cal Immigration Status: AB 1012 (Essayli) 
AB 1012 promises the creation of the Serving Our Seniors Fund, making individuals without legal immigrant status ineligible for Medi-Cal benefits. It transfers funds previously used for undocumented residents’ Medi-Cal Coverage into this new fund. AB 1012 appropriates its funding cover Medicare Part B premiums for eligible individuals and would be available on an ongoing basis, without restrictions tied to specific fiscal years.

ITUP Hot Take: AB 1012 is a step in the wrong direction. By eliminating Medi-Cal coverage for undocumented individuals, this bill could lead to a spike in the uninsured rate and put added pressure on already strained emergency health systems. It would also roll back the strides California has made to build a more equitable and inclusive health care system for everyone who calls this state home.

Bottom Line: California’s 2025 legislative session is a battleground for immigrant rights and health equity. While some bills continue to build an inclusive safety net, others threaten to unravel years of progress. We’ll be watching. Will you?

Bills That Support and Protect Immigrant and Undocumented Communities

Health Facilities Immigration and Patient Privacy: AB 894 (Carrillo)

Looking for more protection in health care? AB 894 states the Legislature’s intent to create laws dedicated to protecting the privacy of undocumented Californians in hospitals. For a similar proposal, check out SB 81 (Arreguin) in ITUP’s 2025-26 Introduced Bills Blog which prohibits health care facilities from working with immigration authorities or sharing patient information.

Immigration Enforcement School Sites Prohibitions on Access, Sharing Information and Law Enforcement Collaboration: SB 48 (Gonzalez)

SB 48 prohibits Immigration and Customs Enforcement (ICE) and other federal agents from entering school districts, county offices of education, or charter schools and their staff to allow officers or other federal immigration officials to enter a school campus without a court-issued warrant. This bill requires school staff to witness and document denials of entry from immigration officials and restricts schools from sharing educational records or personal information of students, family, or faculty information with ICE or other federal immigration authorities without a court warrant or written consent of a student’s parent or guardian for. In addition, SB 48 prohibits local law enforcement from sharing any information about students, families, or faculty with immigration officials in school zones.  While this bill may lead to extra costs, SB 48 creates additional responsibilities for local law enforcement and schools and would take effect immediately as an urgent law.

Immigration Enforcement Prohibitions on Access, Sharing Information and Law Enforcement Collaboration: AB 421 (Solache) AB 421 strengthens the California’s Value Act and limits local law enforcement technical support for immigration enforcement. Specifically, AB 421 prohibits California law enforcement agencies from collaborating with immigration authorities or sharing any information about immigration enforcement actions within one mile of institutional facilities including childcare centers, daycare facilities, religious institutions, or medical offices.

School sites and Day Care Centers Entry Requirements Immigration Enforcement: AB 49 (Muratsuchi) AB 49 sets clear boundaries when it comes to immigration enforcement in educational spaces. This bill prohibits school officials and staff from allowing ICE officers or employees to enter a school site unless they meet several conditions. Officers must present valid identification, submit a written statement of purpose, and provide a valid judicial warrant. ICE authorities must also receive approval from the district superintendent, county superintendent, charter school principal, or a designated administrator.

Additionally, AB 49 requires local educational agencies to limit access to areas where students are not present. For daycare centers, the rules are similar. ICE officers may not enter the premises unless they meet the same identification, warrant, and approval requirements. Even when approved, their access must be limited to areas where children are not present.

State Government Immigrant and Refugee Affairs Agency Office of Immigrant and Refugee Affairs: SB 12 (Gonzalez) SB 12 lays the foundation for a new state agency dedicated to uplifting immigrant and refugee communities. The bill creates the Immigrant and Refugee Affairs Agency, which will focus on helping individuals integrate into California’s social, cultural, economic, and civic life by identifying and removing systemic barriers.

The agency will be led by a secretary appointed by the Governor and confirmed by the Senate. The Office of Immigrant and Refugee Affairs will take the lead on coordinating and managing services across the state. This office will also absorb related programs, staff, and funding from other agencies to ensure services are centralized, effective, and accessible.

To support its mission, SB 12 establishes the Immigrant and Refugee Integration Fund, which will provide ongoing financial support for community programs. The office will manage this fund and use it to strengthen service delivery for immigrant and refugee communities. The bill also defines the role of the Statewide Director of Immigrant and Refugee Inclusion, who will oversee these efforts, ensure programs meet their goals, and deliver a comprehensive statewide plan to the Legislature by January 1, 2027.

Importantly, SB 12 sets strict guidelines around privacy. It limits how personal information about immigrants and refugees can be shared and bans the use of agency resources for immigration enforcement. To sum it up, this bill is about expanding support, increasing access, and safeguarding the rights and dignity of immigrants and refugees throughout California.

As California navigates a pivotal legislative season, one thing is clear: the stakes are high for immigrant and undocumented communities. While some bills push us forward by protecting rights and expanding access to care, others risk unraveling years of equity-driven progress. ITUP will continue monitoring these proposals and advocating for policies that build a healthier, more inclusive future for all Californians.

For more information, reach out to us at info@itup.org or visit our website to read more about ITUP’s legislative analysis.

The post ITUP Mini Blog: Progress or Setbacks? Weighing Policies That Impact Undocumented Communities appeared first on ITUP.

Did you know California has long been at the forefront of progressive policies, especially when it comes to women’s health? Let’s dig in. This year, state lawmakers are introducing a series of new groundbreaking legislative bills that can change the landscape of reproductive health. These measures are designed to close the gaps in health care access, improve outcomes and treatment, and ensure that women from all backgrounds receive the care and support they need through the critical stages of their health journey.  

From expanding reproductive rights to advancing maternal health care, these policies are all about making sure women receive care, but the right care. California is actively working toward a future where every woman, regardless of race, income, or location, has the opportunity to thrive. Here’s a look at some of the post impactful bills shaping women’s health this year. 

Note: The bills listed below are not a comprehensive list of all the health and health care related legislative bills introduced this year, but rather a selection of key measures that highlight the state’s commitment to address these priority areas. If you have questions about a bill not listed here, please feel free to contact us at info@itup.org.  

Notable Highlights:

• California is introducing groundbreaking legislation to improve reproductive and maternal health equity, ensuring better access to care and resources for all women. 
• New CA legislative bills focus on underserved communities by addressing disparities in health care access, funding, and treatment, aiming to create a future where every woman receives the support they need. 

Medi-Cal Diapers: AB 636 (Ortega)  

Imagine needing supplies for your child, only to find out it’s not covered by insurance. AB 636 addresses these discrepancies by ensuring Medi-Cal covers diapers as a benefit for children over three years old with medical conditions that cause incontinence. This bill also extends coverage for anyone under the age of 21 to treat or improve a medical condition. The diapers provided would be limited to an appropriate amount based on the person’s condition and age. While it’s a big step forward, AB 636 will only take effect if federal approval and funding are secured.  

Pharmacists Furnishing Contraceptives: AB 50 (Bonta)  

Need birth control? California has your back! AB 50 expands access to contraceptive care, ensuring more women can receive the reproductive services they need by reducing the requirements and procedures for pharmacists to follow when providing hormonal birth control. The goal? Faster, easier access to contraception without the arbitrary hurdles. AB 50 narrows these requirements to only apply to prescription-only hormonal contraceptives, giving pharmacists the ability to provide over-the-counter contraceptives. By the way, AB 50 also implements essential updates to onset these changes and takes effect immediately as an urgent law. 

Alternative Birth Centers: Licensing and Medi-Cal Reimbursement: AB 55 (Bonta)  

For expectant mothers looking for alternative birth options, AB 55 will give you the flexibility you need. This bill removes the requirement that alternative birth centers must provide comprehensive perinatal services defined by Medi-Cal. In addition, AB 55 removes the proximity rule to be located near hospitals and instead requires birth centers to have transfer policies in place. To keep it short and sweet, AB 55 makes a technical change to an outdated reference in the current law, supporting greater choice in maternity care while maintaining safety standards. 

Emergency Services and Care: AB 40 (Bonta)  

What is considered an emergency? Under AB 40, reproductive health services, including abortions, are officially part of emergency care. This means the definition of “emergency services and care” will also include reproductive health services, such as abortion. By expanding this definition, health facilities, service providers, and insurers must provide or cover these services, holding them accountable for meeting patient’s urgent needs. Because this bill is considered urgent, it will take effect immediately.

School and Community College Employees: Paid Disability and Parental Leave: AB 65 (Aguiar-Curry) 

Educators shouldn’t have to choose between their health and their paycheck. AB 65 removes school boards’ ability to set their own leave policies and mandates up to 14 weeks of paid leave for public school and community college employees needing time off due to pregnancy, miscarriage, childbirth, or recovery. This leave applies to both certificated and classified employees, can begin before childbirth, and does not reduce other leave benefits. Employees will also retain their group health coverage while on leave and won’t need to meet eligibility requirements like minimum hours worked or length of service. AB 65 ensures financial stability while prioritizing health and recovery.  

Sexual and Reproductive Health Care: AB 260 (Aguiar-Curry)  

California has potential to be a safe haven for reproductive rights! AB 260 strengthens this commitment to ongoing access to essential reproductive health services in the state, including abortion and gender-affirming care—including remote or online methods, if needed. 

Attorney General Reproductive Privacy Act Enforcement: AB 67 (Bauer-Kahan)  

Protecting reproductive rights isn’t just about passing laws, it’s about enforcing them. AB 67 gives the Attorney General the authority to investigate and take legal action against violations of the Reproductive Privacy Act. This means the Attorney General can file a case in court to stop illegal activity and make sure the law is followed. AB 67 also allows the Attorney General to investigate by gathering evidence, interviewing witnesses, and subpoenaing documents. Violators could face fines of up to 25,000 with penalties helping to fund further enforcement of the Reproductive Privacy Act. 

Menopause: AB 432 (Bauer-Kahan)  

Menopause care is long overdue for an update. AB 423 requires the Medical Board of California to include specialized training for continuing education. With this, doctors treating patient populations where at least 25% of their patients are women must complete a course on perimenopause, menopause, and postmenopausal care. AB 432 also requires health care plans and insurance policies issued or updated after January 1, 2026, to cover evaluation and treatment for perimenopause and menopause. So, by 2026, clinical care guidelines for hormone therapy must be in place for primary care providers. Certain costs related to these new requirements will not be eligible for reimbursement. 

Comprehensive Perinatal Services Program: SB 228 (Cervantes)  

California is restructuring maternal health programs for more efficient care. SB 228 transfers the oversight of perinatal services of the Comprehensive Perinatal Services Program from the California Department of Public Health (CDPH) to the California Department of Health Care Services (DHCS) —aiming for better coordination and funding. SB 228 sets the stage for future improvements, with the Legislature planning additional reforms based on recommendations from a California State Auditor report. This includes requiring the DHCS to develop a new tracking form for perinatal services and improve data collection to enhance maternal health care. 

Access to Safe Abortion Care Act: AB 54 (Krell & Aguiar-Curry)  

With abortions rights under attack nationwide, California is doubling down! AB 54 reinforces legislative support for medication abortion, particularly the drugs mifepristone and misoprostol, ensuring continued access in the state. To sum it up, AB 54 expresses the legislature’s intent to pass laws that will ensure Californians can continue to access medicated abortions. This move solidifies California as a stronghold for reproductive rights. 

Reproductive Health Emergency Preparedness Program: AB 551 (Krell & Petrie-Norris)  

Emergencies shouldn’t stand in the way of reproductive health care. AB 551 establishes the Reproductive Health Emergency Preparedness Program (RHEPP) dependent on funding availability from the state or through private sources. This provides grants to improve access to emergency reproductive and sexual health. Additionally, AB 551 requires the Department of Health Care Access and Information (HCAI) to award grants and administer the program in partnership with California-based organizations that provide technical assistance. HCAI must also establish guidelines for grant distribution, partner organization qualifications, and fund usage, with these provisions set to expire on January 1, 2030. 

Pregnancy As a Recognized Event for Nondiscriminatory Treatment (PARENT) Act: SB 257 (Wahab) 

Pregnancy is life-changing and now, health plans must recognize this benchmark as a qualifying event. SB 257 allows individuals to enroll in or change health plans due to pregnancy. SB 257 prohibits health care plans issued, amended, or renewed on or after January 1, 2026, from denying or limiting maternity, newborn, or pediatric care based on how pregnancy occurred. This includes cases involving gestational carriers or surrogates. Any health care plan that violates this rule would be considered a crime. 

Maternal Health Screenings and Treatment: SB 626 (Smallwood-Cuevas)  

Mental health is just as important as physical health during pregnancy. SB 626 mandates health care providers to screen, diagnose and treat maternal mental health conditions while requiring insurers to cover at least one medication and one digital therapy option for maternal mental health issues. In addition, SB 626 requires health care plans to provide case management and care coordination for pregnant and postpartum patients.  

California is setting the standard for women’s health care policies, ensuring that reproductive rights, maternal health, and equitable access remain top priorities. With these bills in motion, the state is actively working toward a future where every woman has the health care support she needs no exceptions.  

For more on California’s legislative efforts supporting women’s health, visit the California Legislative Women’s Caucus homepage: https://womenscaucus.legislature.ca.gov. 

The post ITUP Mini Blog: Advancing Women’s Health in California appeared first on ITUP.

2025-26 Introduced Bills

Overview: The deadline for introducing legislation for the first year of the 2025-2026 legislative session was February 21, 2025. Legislation introduced this year focuses on improving access to equitable and affordable health care, transforming the health care delivery system with a focus on reproductive, perinatal, behavioral health care, and the future of health with technological innovations.

Summary and Policy Areas: This blog summarizes introduced legislation that proposes solutions relating to ITUP’s three priority policy issues: health care coverage and access, delivery system transformation, and the future of health.

Additionally, we noted with icons which bills address:

• Health Equity
• Behavioral & Mental Health
• Delivery System Transformation
• Consumer Protections
• Artificial Intelligence (AI)

Legislative Bill Process Guide: At the end of this blog, we also include important information on the legislative bill process, helpful links, and a timeline with dates that can be used to follow these bills throughout the years.

Note: This is not a comprehensive list of all the health and health care-related bills that were introduced. If you have questions about a bill not listed here, please feel free to contact us at info@itup.org

Additionally, we noted with icons which bills address:

Health Care Coverage and Access:

Health Care Coverage Essential Health Benefits: AB 224 (Bonta) and SB 62 (Menjivar) aim to have the Legislature review and update the list of essential health benefits and create a new benchmark plan starting in 2027. AB 224 and SB 62 limit the applicability of the current benchmark plan to health plans until 2027.

Health Care Coverage Cost Sharing: AB 298 (Bonta) prohibits health care plans and disability insurance policies from charging out-of-pocket expenses like deductibles, copayments, or coinsurance for services provided to Californians under 21 years old, starting January 1, 2026. AB 298 prohibits individuals or companies from charging or seeking payment for services given to patients under 21 years of age; if a health care plan breaks this rule, it could be treated as a crime.

Covered California Expansion: AB 4 (Arambula) expands access to Covered California by allowing all Californians, regardless of immigration status, to purchase health insurance through the marketplace. AB 4 requires Covered California to execute a mirror exchange program on its own to expand coverage to undocumented people under existing federal rules and subsidies if they are available. In addition, AB 4 requires Covered California to promote the program and help Californians get enrolled beginning October 1, 2028, and creates the Covered California for All Fund to manage money from fees, appropriations, and other sources to fund the program. See ITUP’s Issue Brief on Expanding Health Coverage for California Farmworkers for more details on the impact of AB 4.

Health Care Delivery System Transformation:

Medi-Cal Home and Community-Based Alternatives (HCBA) Waiver: AB 315 (Bonta) removes the rule in the HCBA Waiver that allows adding up to 5,000 more slots for the waiver and instead requires enrollment of all eligible individuals who applied for the HCBA Waiver. AB 315 requires the Department of Health Care Services (DHCS) to submit a report by March 1, 2026, examining how well the current rates for the waiver program work, including an evaluation of how the services are being paid for, and to consider sustainability and effectiveness factors.

Medi-Cal Adverse Childhood Experiences (ACEs) Trauma Screenings Providers: AB 29 (Arambula) requires DHCS to allow community-based organizations, local health groups that use community health workers (CHWs), and doulas to provide ACES trauma screenings if they are enrolled Medi-Cal providers. These providers will also be eligible to be paid for offering such screenings. In addition, AB 29 requires DHCS to make changes to state plans and seek any federal approvals necessary to implement these services. AB 29 requires DHCS to update its website and the ACEs Aware website to reflect the addition of new Medi-Cal providers now authorized to provide ACEs screenings.

Homeless Pupils California Success, Opportunity, and Academic Resilience (SOAR) Guaranteed Income Program: SB 33 (Cortese) establishes a statewide guaranteed income pilot program titled the California SOAR Guaranteed Income Program. SB 33 aims to provide students experiencing homelessness with direct cash assistance to support their transition out of high school and their access to employment and post-secondary education.

Medi-Cal Street Medicine: AB 543 (González) introduces and integrates street medicine into Medi-Cal , complementing existing programs like CHWs, enhanced care management (ECM) and Community Supports (CS) to provide health services directly to unhoused Californians. In addition, AB 543 allows unhoused Californians to automatically qualify for full-scope Medi-Cal benefits during the eligibility process. In addition, unhoused individuals will have access to any Medi-Cal provider, with Medi-Cal managed care plans (MCPs) covering costs and setting reasonable rules aligned with service areas. AB 543 requires MCPs to allow members to report whether they are experiencing homelessness online, in person, or by phone. In addition, DHCS is required to inform MCPs if a member has indicated they are experiencing homelessness based on their Medi-Cal application. AB 543 requires DHCS to ensure the Medi-Cal program and the California Statewide Automated Welfare System (CalSAWS) mutually share information about Californians applying for or receiving Medi-Cal who are experiencing homelessness but will ensure privacy protections are in place.

Medi-Cal Enhanced Care Management and Community Supports: SB 324 (Menjivar) requires Medi-Cal MCPs that offer ECM or CS services to prioritize working with local community providers, as long as those providers are available in the area and have experience in offering ECM or CS services. In addition, SB 324 mandates ECM and CS providers to be involved in the planning process and requires DHCS to create simple, standardized forms for MCPs to use and give instructions on how local providers can work together by subcontracting with one another. SB 324 requires DHCS to annually update payment guidelines for MCPs to reimburse for ECM and CS services.

Workforce

Residential Care Facilities for the Elderly – Direct Care Ratios: AB 508 (Aguiar-Curry) requires residential care facilities for the elderly (RCFEs) to calculate and keep records of how many caregivers are available for residents and to keep those records for a minimum of 12 months. In addition, AB 508 requires RCFEs to disclose these ratios with residents or their representatives upon move in or any time there is a price increase. AB 508 requires each RCFE to make the direct care ratio publicly accessible on their websites and in common areas like lunchrooms or lobbies. In addition, the website and promotional materials must clearly explain that the ratios are calculated daily and are available for anyone to request, covering the past 12 months.

Workforce Development Poverty-Reducing Labor Standards: Funds, Programs, Reporting and Analyses: SB 21 (Durazo) creates the Equity, Climate Resilience, and Quality Jobs Fund and requires 1% of federal money to be transferred into this fund. In addition, SB 21 states that these funds would be used to support workforce programs that meet certain labor standards aimed at reducing poverty, ensuring fair wages, and encouraging climate resilience. SB 21 requires all state agencies administering these funds to develop and adopt poverty-reducing labor standards and to generate reports on the progress. In addition, SB 21 requires the California Workforce Development Board to contract with a research institution to analyze how well these programs are creating fair, sustainable jobs and helping the environment.

Mental Health Black Mental Health Navigator Certification:  AB 73 (Jackson) requires the California Department of Health Care Access and Information (HCAI) to create a special certification program and training for Black Mental Health Navigators to help guide and support individuals in accessing mental health services in Black communities. In addition, AB 73 requires HCAI to track and publish data annually on the number of people certified through this program and how many are working in community health roles. See ITUP’s Fact Sheet California Health Care Specialty Workforce Shortages for more information.

Community Health Workers: AB 96 (Jackson) expands the definition of CHWs to include peer support specialists, who are people with personal experience with a particular health issue and help others going through the same thing. In addition, AB 96 states that if a peer support specialist is certified, they will be considered to have completed all the education and training needed to be certified as a CHW. ITUP’s Fact Sheet Community Health Workers and the Health Care Delivery System to learn more about the integral role CHWs play in closing equity gaps for the health of Californians.

Medi-Cal Community Health Worker Services: AB 403 (Carrillo) requires DHCS to annually review outreach and education efforts conducted by Medi-Cal MCPs and conduct an annual analysis of the CHW services benefit beginning July 1, 2027, of how CHW services are being utilized by Medi-Cal members. The analysis will include data on how many CHWs are available, what the needs of Medi-Cal members are, disaggregation of information by location, race, ethnicity, language, age, etc., and include data on how much Medi-Cal pays for the CHWs benefit.

Mental Health and Substance Use Disorders (SUDs)

Health Care Coverage and Mental Health and Substance Use Disorders Inpatient Admissions: AB 384 (Connolly) prohibits health insurance plans, beginning on January 1, 2027, from requiring prior authorization before admitting someone to a hospital for a mental health or substance use disorder (SUD) treatment, as long as it’s medically necessary. In addition, AB 384 states that no approval will be needed for any necessary health care services given while the person is in the hospital. AB 384 prohibits the requirement of prior authorization for Medi-Cal members for medically necessary admission to a hospital for 24-hour care for mental health or SUD treatment.

Alcohol and Drug Recovery or Treatment Facilities Discharge and Continuing Care Planning: AB 423 (Davies) requires DHCS to create rules that require alcohol and drug recovery or treatment facilities to ensure patients have a continuous care plan following discharge. This includes helping patients return to their community after treatment and ensuring they have a scheduled follow-up appointment with a mental health or substance use professional within seven days following discharge.

Veterans Mental Health: AB 81 (Ta) requires the Department of Veterans Affairs (VA) to create a program to fund a study on mental health issues among women veterans in California. In addition, AB 81 requires the VA to submit a report to the Legislature with the study’s findings and recommendations by June 30, 2029. These requirements will sunset on January 1, 2030. See ITUP’s Policy Toolkit Behavioral Health in California for more information.

Future of Health

Artificial Intelligence (AI)

Health Care Professions Deceptive Terms or Letters Artificial Intelligence: AB 489 (Bonta) prohibits the use of specified terms, letters, or phrases in AI technology that suggests it has a health care license or certification, especially if the AI is being used to give medical advice or information. In addition, if AI is used to communicate patient information, it must also include a clear disclaimer that the communication was generated by AI and provide instructions on how to contact a real health care provider. See ITUP’s Fact Sheet Catalyzing AI to Advance Health Equity in California Communities and ITUP’s Policy Toolkit The Emergence of Artificial Intelligence and It’s Application in Health for more information about the impact of AI in health care.

Broadband & Telehealth

Communications Broadband Internet Service Providers Affordable Home Internet: AB 353 (Boerner) requires internet service providers (ISPs) to offer affordable home internet to people living in California. ITUP’s Issue Brief Addressing Digital Equity for Equitable, Accessible Health Care and ITUP’s Fact Sheet Snapshot: Addressing Digital Equity for Equitable and Accessible Health Care for more information on the role that broadband access plays in the health of Californians.

Telehealth for All Act of 2025: AB 688 (González) requires DHCS to publish a report every 2 years, beginning in 2028, that analyzes how telehealth is being used in the Medi-Cal program. The report will utilize Medi-Cal data to look at how telehealth is helping people get care, the quality of care, and the costs, while also disaggregating the data based on location, race, and social determinants of health (SDoH) categories to identify disparities in accessibility of telehealth services. In addition, AB 688 requires DHCS to identify additional data elements to better understand and improve access to telehealth for everyone. See ITUP’s Fact Sheet Telehealth and COVID-19 to learn more about telehealth policies that were put into place during the public health emergency.

Specialty Care Network Telehealth and Other Virtual Services: AB 257 (Flora) requires the California Health and Human Services Agency (CalHHS), in collaboration with HCAI and DHCS to establish a demonstration project for a telehealth and other virtual services specialty care network that is designed to serve patients of safety-net providers consisting of qualifying providers, defined to include, among others, rural health clinics and community health centers.

Privacy Protection & Data Sharing

California Health and Human Services Data Exchange Framework: SB 660 (Menjivar) requires, by January 1, 2026, with designated funds in the state budget, the Center for Data Insights and Innovation (CDII) to manage and expand the CalHHS Data Exchange Framework (DxF) to share important health and social services data between various organizations. SB 660 expands the mandated entities required to sign the data sharing agreement (DSA) and authorizes CDII to decide which additional organizations will be required to join. In addition, SB 660 requires CDII to establish a process by July 1, 2025, to designate qualified health information organizations (QHIOs) as data-sharing intermediaries. SB 660 requires CDII to publish an annual report to the Legislature, including compliance with data sharing agreements. In addition, SB 660 expands membership of the stakeholder advisory group that helps guide the program and creates a CalHHS Data Exchange Board, composed of 12 members who will review and approve changes to the data sharing rules and agreements. See ITUP’s Issue Brief Leveraging Data to Advance Health Equity and Success in CalAIM, ITUP’s Fact Sheet California Data Exchange Framework 101, and complimentary Policy Toolkit for more information.

Medi-Cal Behavioral Health Data Sharing: AB 618 (Krell) requires each Medi-Cal MCPs, county specialty mental health plan, Drug Medi-Cal certified program, and the Drug Medi-Cal organized delivery system (DMC-ODS) program, to electronically share data to improve patient care. The data shared will help track and support the care of individuals. In addition, AB 618 requires DHCS to determine minimum data elements and the frequency and format of data sharing through a stakeholder process and guidance, with final guidance published by January 1, 2027.

Health Facilities Information Sharing: SB 81 (Arreguin) states the intent of the Legislature to prohibit health care facilities from working with immigration authorities or sharing patient information, including medical records, with them.

Privacy Health Care Data: AB 45 (Bauer-Kahan) aims to make it illegal to use geofencing (tracking a specific location) around health care places that provide in-person services, like clinics. In addition, it would also stop health care providers from sharing medical research or information about someone seeking an abortion if it’s requested by another state that has laws that interfere with a person’s right to privacy under the Reproductive Privacy Act.

What’s Next: Legislative Process Information

Here is a timeline with key events and deadlines that are useful for tracking legislation.

Below, we provide a detailed explanation of the timeline above and the California legislative process. The 2025 Legislative calendars for the California Assembly, and Senate include all deadlines that must be met for bills to be signed into law. The ‘house of origin’ or the ‘first house’ is the branch of the Legislature where the bill was introduced (ABs = Assembly Bills, the Assembly is the first house the bill must pass through; SBs = Senate Bills, the Senate is the first house the bill must pass through). Bills can be amended throughout the process.

Committee Hearings

Policy committees begin hearing bills in March 2025. The committees are made up of a subset of assemblymembers or senators to hear bills on a specific policy topic, such as health. The committee chairs set bills for hearing dates throughout March and April, and public hearings are recorded and can be watched live, typically in person, but live stream video is available and was preferred during the public health emergency. Assembly and Senate Health Committee hearing dates, agendas that list the bills being heard, and a link to where you, the public, can watch the hearings are found on each policy committee’s website. The deadline for bills to be discussed in committees is May 2, 2025, for fiscal bills (legislation that has a cost to the state), and May 9, 2025, for non-fiscal bills.

• Assembly Health Committee: Meets on Tuesdays at 1:30 p.m. PST
• Senate Health Committee: Meets on Wednesdays at 1:30 p.m. PST

Appropriations Committee Hearings

Once a bill passes in policy committee(s), the next step in the legislative process for most bills is a hearing in the Appropriations Committee. The Appropriations Committee reviews all bills that have a designated fiscal impact, and the deadline for bills to be heard in the house of origin appropriations committee is May 23, 2025. At this point in the Legislative process, many bills will be ‘held on suspense,’ which effectively means they will not move forward in the process. In the Assembly, any bill that has an annual cost of $150,000 or more, from any fund, gets placed on the suspense file. In the Senate, legislation with an annual cost of $50,000 General Fund or $150,000 federal funds or special funds, gets placed on the suspense file. Like the policy committees, the Appropriations Committees hold public hearings. Most bills get placed on the suspense file and are heard in committee close to the May 23, 2025, deadline.

• Assembly Appropriations Committee: Meets on Wednesdays at 9:00 a.m. PST
• Senate Appropriations Committee: Meets on Mondays at 10:00 a.m. PST

House of Origin Floor Vote

The last stop for a bill before the opposite house begins to weigh in on the policy is the ‘floor vote’. This is where all Assemblymembers vote on AB bills and all Senators vote on SB bills. The deadline for bills to be voted on the house of origin floor this year is June 6, 2025.

Following a bill’s successful passage out of its house of origin, the entire process listed above is repeated in the opposite house (Ex. Abs will then go through the Legislative process in the Senate). The last day of this year’s legislative session, and subsequently, the last day a bill can pass through the entire process, is September 12, 2025. Bills that successfully pass through the Legislature will either be signed or vetoed by Governor Newsom no later than October 12, 2025.

The post ITUP Blog: 2025-26 Introduced Bills appeared first on ITUP.

Governor’s Fiscal Year 2025-26 Budget Proposal

On January 10, 2025, Governor Gavin Newsom released his Fiscal Year (FY) 2025-26 Budget proposal of $322 billion total funds (TF) (). Health and Human Services makes up a large portion of the budget with proposed expenditures of $296.1 billion ($83.7 billion General Fund).

Since the signing of the 2024 Budget Act, the state’s economy, stock market, and tax revenues have outperformed expectations, leading to an upward revision in the revenue forecast. Over the next three fiscal years, California now anticipates an additional $16.5 billion in revenue compared to earlier projections. In its November 2024 report, the California Legislative Analyst’s Office (LAO) indicated that the state is on track for a “roughly balanced” budget, although a $2 billion shortfall is projected for the 2025–2026 fiscal year.

It is estimated that General Fund spending on health programs will decrease by $3.8 billion (9%) in 2024-25, totaling $40.1 billion. The majority (87%) of this funding is allocated to Medi-Cal, California’s Medicaid program, which is expected to see a 6% reduction from the previous year. Most health departments are facing budget cuts, with the exception of the California Health and Human Services Agency (CalHHS), which is projected to grow due to the transfer of grants to its Office of Youth and Community Restoration. While some modest increases in health programs are expected, most budget actions are focused on addressing the state’s General Fund deficit.

Source: 2025-26 Governor’s Budget

Following the key budget highlights summary, we discuss what to expect during the months between now and the May Revision, when the Governor will release a revised budget before it is ultimately signed into law this upcoming July. We also include advocacy opportunities and resources on budget change proposals, trailer bill language, department-specific budget highlights, and more.

Key FY 2025 – 26 Proposed Budget Highlights

This ITUP blog highlights key health and human services proposals in the FY 2025-26 proposed budget. The highlighted proposals are those that build upon California’s commitment to creating an equitable, accessible health care delivery system and addressing the social determinants of health.

1. Coverage and Access Proposals

Medi-Cal Fiscal Outlook: The budget allocates a total of $180.1 billion for the Department of Health Care Services (DHCS) in 2024-25 ($38.5 billion GF). For 2025-26, the total increases to $193.4 billion ($42.8 billion GF). DHCS is responsible for providing Californians with access to affordable, integrated, high-quality health care, including medical, dental, behavioral health, and long-term care services. The budget also includes $178.6 billion in local assistance for 2024-25, primarily for the Medi-Cal program ($38 billion GF). For 2025-26, local assistance totals $192.1 billion ($42.4 billion GF). [i]

Department of Developmental Services (DDS): The 2025-26 budget allocates $19 billion for the DDS ($12.4 billion GF). This funding is expected to support services for approximately 505,000 individuals, with an anticipated increase of nearly 40,000 individuals due to children transitioning out of the Early Start program. The Administration also plans to release the Master Plan for Developmental Services in March 2025, which will incorporate recommendations from workgroups focused on enhancing lifelong services for individuals with intellectual and developmental disabilities. [i] The 2024-25 budget allocates $15.9 billion ($10.3 billion GF) and estimates that around 465,000 individuals will receive services during that year. [v]

Managed Care Organization (MCO) Tax: The FY 2025-26 budget includes $4.4 billion in revenue from the Managed Care Organization (MCO) Tax, consistent with the passage of Proposition 35 in November 2024. As a result, previous investments authorized under the 2024 Budget Act—such as Medi-Cal continuous coverage for children aged 0 to 5 and community health worker investments—are rendered void. Proposition 35 requires that the allocation of MCO Tax revenues be developed in consultation with a stakeholder advisory committee, presenting a significant opportunity for advocacy to shape the spending plan.

Universal Coverage: Expansion of Medi-Cal to All Adults Regardless of Immigration Status: The 2024-25 budget totals $174.6 billion ($37.6 billion GF), reflecting a $2.8 billion increase in GF spending due to higher enrollment and pharmacy costs. The 2025-26 budget is $188.1 billion ($42.1 billion GF), a $4.5 billion increase. The governor’s proposed budget builds on recent Medi-Cal investments that have expanded access, improved coverage, and increased eligibility, including providing comprehensive Medi-Cal coverage to eligible adults, regardless of immigration status. The 2025-2026 California state budget continues this expansion, ensuring coverage for all income-eligible Californians, regardless of age or immigration status, while also tackling the growing cost of health care. [vi]

Covered California Health Care Affordability Reserves (HCARF): The Health Care Affordability Reserve Fund (HCARF) supports the California Premium Subsidy Program and other initiatives aimed at making health care more affordable. The 2024 budget package allocated $82.5 million from HCARF to Covered California for a financial assistance program. According to the budget agreement, funding for the program is set to increase to $165 million starting in coverage year 2025. [vii]

Home and Community-Based Services (HCBS) Spending Plan: The 2021 Budget Act allocated funds from the American Rescue Plan (ARP) to enhance and expand the Home and Community-Based Services (HCBS). The HCBS Spending Plan covers initiatives across six departments aimed at supporting individuals with disabilities who prefer home or community living. Originally, ARP funds had to be spent by March 31, 2024, but Centers for Medicare & Medicaid Services (CMS) extended the deadline to March 31, 2025. California’s deadline was then extended to December 31, 2024, and later to January 31, 2025, to allow time for finalizing revenues, expenditures, and any necessary corrections before reporting to CMS. [viii]

2. The Future of Health: Proposals to Advance Health Equity and Address the Social Determinants of Health

Behavioral Health

Proposition 1: Behavioral Health Infrastructure Bond Act of 2024: Approved by voters in November 2024, this $6.4 billion bond measure aims to modernize California’s behavioral health care system, addressing critical gaps in mental health and substance use disorder treatment infrastructure.

Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) Demonstration: Effective January 1, 2025, the federal government approved $8 billion (state, local, and federal funds) for the BH-CONNECT Demonstration through December 31, 2029. This initiative, administered by the Department of Health Care Services, Department of Developmental Services, and the Department of Health Care Access and Information, aims to strengthen the behavioral health continuum for Medi-Cal members. Focus areas include children and youth, individuals experiencing or at risk of homelessness, and justice-involved populations. The program offers statewide and county opt-in components to expand access to critical behavioral health services.

Health Care Services for Incarcerated Individuals

The Budget allocates $4.1 billion General Fund in 2025-26 to ensure incarcerated individuals have access to medical, mental health, and dental care services that meet appropriate custodial care standards.

• Suicide Watch Resources: $13.6 million ongoing General Fund to address increased suicide watch workload through overtime and temporary staffing.
• COVID-19 Mitigation Costs: $12.8 million one-time General Fund in 2025-26 to sustain essential COVID-19 prevention and mitigation measures.
• Mental Health Crisis Facility Staffing: $3 million General Fund and 13.4 positions in 2025-26, increasing to $4.4 million and 20.4 positions ongoing, to staff a 50-bed Mental Health Crisis Facility at the California Institution for Men, expected to open in October 2025.

Prescriptions

AIDS Drug Assistance Program (ADAP): The Budget allocates $8.5 million annually from the ADAP Special Fund, starting in January 2025, for program enhancements, including reimbursement of Medicare Part B premiums and expansion of employer-based health insurance premium payment support for enrollees. Compared to revised 2024-25 expenditures, the ADAP program sees a $42.3 million total funding increase in 2025-26.

Prescription Drug Affordability: To address rising pharmacy costs, the Administration will evaluate drivers of cost growth, including the role of pharmacy benefit managers. Efforts will build on the goals of the Office of Health Care Affordability and CalRx, exploring increased transparency in the pharmacy supply chain and strategies to improve drug affordability statewide.

Child Health

Diaper Initiative: The Budget includes up to $7.4 million General Fund in 2025-26 and $12.5 million in 2026-27 for a program providing a three-month supply of diapers at no cost to California families with newborns, distributed via hospital systems. This initiative aims to improve maternal and newborn health outcomes.

Social Determinants of Health Investments

Broadband Infrastructure Investments: Federal investments through the Infrastructure Investment and Jobs Act (IIJA) and the American Rescue Plan Act (ARPA) will allocate partial funding to broadband infrastructure. As of November 2024, California anticipates receiving a portion of the $61.8 billion allocated for transportation, broadband, and climate resilience projects under the IIJA. This includes $46.7 billion in formula funding and $15.1 billion in competitive funding, some of which will be directed toward expanding broadband infrastructure. California allocated over $2 billion from ARPA to expand affordable broadband, develop housing for the unhoused, and maintain state-owned infrastructure. Investments in broadband aim to improve digital connectivity and bridge the digital divide, supporting equitable access to high-speed internet across the state.

Advocacy Opportunities

Last year, health centers successfully advocated to restore funding for the clinic-based health navigator program, but significant budgetary losses still impacted community health navigator programs statewide. Navigators play a critical role in helping patients understand complex coverage rules, dispel misinformation, and enroll in Medi-Cal. Without sufficient funding, communities across California will face gaps in enrollment support, leaving many to navigate the system alone.
The passage of Prop 35 by voters in November rolled back some key investments made in the 2024 Budget Act. The Governor’s budget proposal does not include funding for continuous Medi-Cal coverage for children 0-5, a policy delayed in 2022 due to funding shifts. This presents an opportunity to restore funding for continuous coverage, support community health workers, and reauthorize programs like ACEs Aware. ACEs Aware provides Medi-Cal providers with training and resources to screen for Adverse Childhood Experiences, helping identify, address health risks early, and connect families to community resources. These investments are important to ensure California children and families, especially from underserved communities, have access to necessary care and support.

Key Government Resources

Below, we’ve provided key places to find both summary-level and detailed information on the state budget, as well as links to budget bill language (BBL), trailer bill language (TBL), and budget change proposals (BCPs).

Administration/Executive Branch Resources:

A. 2025-26 Governor’s Budget/Department of Finance (DOF): This is the official page for the Governor’s Budget, which includes both detailed fiscal information (“budget detail”) and summary level information (also known as “summary” or “A Pages”), and is updated at the January Budget Release, May Revision, and upon signature of the Final Budget Act; you can also find past budgets here.

B. 2025-26 Administration/DOF Health and Human Services Budget Summary: This is the summary of the Health and Human Services programs in the budget. There are also summary charts for the entire budget, as well as some topic-specific summary chapters, such as Homelessness and Labor and Workforce Development, that may be tangentially related to Health and Human Services. Note: there is more detail in individual departments’ budgets, see the links provided below, than is summarized here.

C. Department-Specific Highlights: Some departments release a “highlights” document that delves further into their department-specific budget proposals and changes.

1. 1. 2025-26 Department of Health Care Services (DHCS) Budget Highlights
   2. 2025-26 California Department of Public Health (CDPH) Budget Highlights
   3. 2025-26 California Department of Social Services (CDSS) Local Assistance Summary Highlights

D. Proposed Trailer Bill Language (TBL)

E. 2025-26 Proposed Budget Change Proposals (BCPs)

  Legislative Resources:

A. Legislative Analyst’s Office (LAO) 2025-26 Budget: California’s Fiscal Outlook

B. Assembly Committee on Budget

a. Highlights of the Governor’s Proposed Budget 2025-26

b. Subcommittee No. 1 on Health

C. Senate Budet and Fiscal Review Committee

a. Summary of Governor’s Proposed Budget 2025-2026

b. Subcommittee 3 on Health and Human Services

D. How to Read Budget Bill Language (BBL)

Stay tuned for our next update at the May Revision!

[i] Summary of the Governor’s Proposed 2025-26 Budget

[ii] Department of Health Care Services, FY 2023-24 DHCS Budget Highlights, January 2023.

[iii] California Pan-Ethnic Health Network, State Budget Update, January 2023.

[iv] California Public Utilities Commission, Last Mile Federal Funding Account, January 2023.

[v] CALIFORNIA STATE BUDGET 2024-2025

[vi] Understanding the Governor’s 2025-26 State Budget Proposal

[vii] Covered California Plans 2024 Cost-Sharing Reduction Program

[viii] 2025-26 Governor’s Budget

The post ITUP Blog: Governor’s Fiscal Year 2025-26 Budget Proposal appeared first on ITUP.

2024 Legislation Round Up

This year, Governor Newsom signed 84 percent of the bills that crossed his desk by the September 30, 2024, deadline. Here is a round-up of some significant health and health-related bills signed into law and some vetoed (shown in italics). We have grouped them into ITUP’s three policy focus areas: health care coverage and access, delivery system transformation (workforce), and the future of health.

Note: This blog is not a comprehensive list of all the health and health-related bills that went to the Governor’s desk this year. If you have any questions about a bill not listed here, please get in touch with us at info@itup.org.

Additionally, we noted with icons which bills address:

Health Care Coverage and Access

Health Care Coverage Cost Sharing: AB 2258 (Zbur), Chapter 708, Statutes of 2024—Effective January 1, 2025, this bill prohibits non-grandfathered health care plans or health insurance policies, issued, amended, or renewed on or after January 1, 2025, from charging patients out-of-pocket costs or cost-sharing requirements for preventive care services and screenings. Preventive care services and screenings include home test kits for sexually transmitted, cervical cancer, and colorectal cancer screenings, and prophylaxis for HIV infection. In addition, AB 2258 states the violation of this law would constitute a crime, and authorizes the Commissioner of the Department of Insurance to fine a health insurance plan up to $5,000 for each rule they break. AB 2258 states that if the health insurance plan breaks the rule on purpose, the fine can go up to $10,000 for that violation.

Social Determinants of Health Screening and Outreach: AB 2250 (Weber)(Vetoed), this bill would have required health care plans or health insurance policies issued, amended, or renewed on or after January 1, 2027, to cover screenings that look into social determinants of health. In addition, this bill would have required doctors to use standard codes to record patients’ answers during their screenings and follow established guidelines for conducting them. AB 2250 would have required health care plans to ensure primary care doctors have access to support from allied health workers (i.e., peer support specialists, social workers, or community health workers) in areas where their patients live.

In addition, AB 2250 stated that violating these requirements would be considered a crime and would have established a program to enforce this. AB 2250 would have made social determinants of health screenings a covered benefit for Medi-Cal members, ensuring they get reimbursed for them. However, AB 2250 would have only gone into effect if the state allocates funds for it.  

Hospital and Emergency Physician Fair Pricing Policies: AB 2297 (Friedman), Chapter 511, Statutes of 2025—Effective January 1, 2025, this bill authorizes emergency doctors to offer discounts to patients with incomes over 400% of the federal poverty level (FPL). In addition, AB 2297 clarifies that “high medical costs” include any out-of-pocket expenses not covered by insurance, like copays.

AB 2297 prohibits hospitals from considering both income and assets to determine eligibility for charity care and the discount payment policies but authorizes hospitals to look at any health savings accounts. In addition, AB 2297 revises the definition of a patient’s family and requires that eligibility be assessed based on recent income documents. In addition, AB 2297 prohibits hospitals or emergency physicians from setting deadlines for applying for discounts or denying eligibility based on when a patient applies. AB 2297 authorizes a hospital or emergency physician to waive certain costs for Medi-Cal and Medicare patients.

AB 2297 also eliminates the ability for hospitals and emergency physicians to consider monetary assets when deciding how much debt they can recover from eligible patients. In addition, AB 2297 expands existing rules to prevent hospitals or emergency physicians from placing liens on any property to collect unpaid bills, meaning they cannot threaten to take a patient’s property over medical debt.

AB 2297 clarifies what “charity care” and “discount payment” mean and would allow hospitals to refund patients if it turns out they qualified for financial help when first billed. In addition, AB 2297 requires the Department of Health Care Access and Information (HCAI) to also enforce these provisions for violations from January 1, 2024, onward, and they will handle penalties for violations occurring from January 1, 2022, onward, if they stem from the same investigation.

AB 2297 includes additional changes related to another bill, SB 1061, that would only take effect if both bills are passed and this one is enacted last.

Delivery System Transformation

Licensed Physicians and Dentists from Mexico Programs: AB 2860 (Garcia), Chapter 246, Statutes of 2024—Effective January 1, 2025, this bill repeals the existing Licensed Physicians and Dentists from Mexico Pilot Program and establishes two new programs: the Licensed Physicians from Mexico Program and the Licensed Dentists from Mexico Pilot Program. In addition, this bill revises requirements, removing the mandate for Mexican physicians to enroll in English classes and instead requiring them to complete the Test of English as a Foreign Language or Occupational English Test. The orientation program duration is no longer fixed at six months and must include training on electronic medical records and medical chart standards. The externship requirement is also removed, along with the provision for a program evaluation funded by philanthropic foundations.

Starting January 1, 2025, this bill authorizes the Medical Board of California to issue a limited number of nonrenewable three-year licenses to eligible physicians. Federally qualified health centers employing these physicians must adhere to specific peer review protocols and collaborate with approved medical schools or residency programs. The bill outlines the roles of various entities in candidate recruitment and program compliance and imposes associated fees. In addition, the bill makes legislative findings supporting the need for this special statute.

Licensed Physicians and Dentists from Mexico Pilot Program Extension of Licenses: AB 2864 (Garcia), Chapter 247, Statutes of 2024—Effective immediately, this bill requires the Medical Board of California to extend the license of eligible physicians from Mexico for an additional three years upon request from both the physicians and the Chief Executive Officer of their employing community health clinic. To qualify for the extension, the physician must have an active license at the time of the request and must pay a specified fee. In addition, the bill makes legislative findings regarding the necessity of this special statute which will be repealed on January 1, 2025. This bill declares it is designated as an urgency statute.

Healing Arts Expedited Licensure Process: SB 1067 (Smallwood-Cuevas) (Vetoed), Effective March 1, 2025, this bill would have required the Board of Behavioral Sciences, the Board of Registered Nursing, the Board of Vocational Nursing and Psychiatric Technicians of the State of California, the California State Board of Pharmacy, the Dental Board of California, the Dental Hygiene Board of California, and the Podiatric Medical Board of California, and the Physician Assistant Board to speed up licensing processes for applicants who plan to work in areas that lack enough medical services or serve underserved populations. To qualify for this faster review, applicants needed to demonstrate their intent to work in these areas by providing a letter from their employer with specific information. In addition, this bill would have required the employer to sign the letter to confirm that the details are accurate. The sunset date for SB 1067 would have been on January 1, 2029.  

Healing Arts Expedited Licensure Process: Gender-Affirming Health Care and Gender-Affirming Mental Health Care: AB 2442 (Zbur) (Vetoed), this bill would have required the Medical Board of California, the Osteopathic Medical Board of California, the Board of Registered Nursing, and the Physician Assistant Board to speed up the licensing process for an applicant who demonstrates intent to provide gender-affirming health care and gender-affirming mental health care. In addition, this bill would have outlined how these applicants need to show their intention to practice in this area. The sunset date for AB 2442 will be on January 1, 2029.

Medi-Cal Call Centers Standards and Data: SB 1289 (Roth), Chapter 792, Statutes of 2024—Effective January 1, 2026, this bill requires counties with call centers to gather and send data about their operations every month. This includes information about call volume, waiting times, and how often calls are dropped.

In addition, SB 1289 requires the Department of Health Care Services (DHCS) to create a report with call center data, ensuring no personal information is included. SB 1289 requires DHCS to post this report online every three months, with the first one due by May 15, 2026. DHCS will be required to implement these rules without any extra steps at first, by sending a letter to all counties, however, they will establish more detailed regulations later.

Transforming California’s Behavioral Health and Substance Use Disorder System

Psychological Associates at Federally Qualified Health Centers and Rural Health Clinics: AB 2703 (Aguiar-Curry), Chapter 638, Statutes of 2024—Effective January 1, 2025, this bill allows licensed professional clinical counselors to be included among the list of providers serving at Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). In addition, AB 2703 allows FQHCs and RHCs to add marriage and family therapy services without needing to file for a change in their service scope, removing the prior requirement and streamlining the process. AB 2703 adds a psychological associate or associate professional clinical counselor and requires DHCS to seek federal approvals that allow FQHCs and RHCs to bill DHCS for their services under similar conditions. In addition, AB 2703 makes adjustments to ensure proper supervision by licensed behavioral health professionals as required by the associate’s applicable clinical licensing board.

Medi-Cal Behavioral Health Services Documentation Standards: AB 1470 (Quirk-Silva) (Vetoed), this bill, as part of a larger initiative, California Advancing and Innovating Medi-Cal (CalAIM), would have required DHCS to standardize the information needed for paperwork related to mental health services, including criteria for what is considered medically necessary. In addition, AB 1370 would have required DHCS to create standard forms to help process claims. Additionally, by July 1, 2025, AB 1370 would have required DHCS to hold regional training sessions for staff and provider networks, including county mental health plans and Medi-Cal managed care plans, and entities within the fee-for-service delivery system, to teach them how to fill out these standard forms correctly. AB 1370 would have required each organization to share the training materials and forms with their networks and start using them by the same deadline. In addition, AB 1370 would have authorized DHCS to limit extra paperwork requirements beyond what’s included on standard forms.

AB 1370 would have required DHCS to analyze how well these forms are being used and how effective the training has been. A report on these findings would have been due by July 1, 2026, with a follow-up report by July 1, 2028, both of which would have been shared with the Legislature and posted online.

Mental Health and Substance Use Disorder Treatment: SB 1320 (Wahab), Chapter 135, Statutes of 2024—Effective January 1, 2025, this bill mandates that health plans and insurers establish a process to reimburse providers for integrated mental health and substance use disorder treatment services linked to primary care, effective for contracts or policies issued, amended, or renewed after July 1, 2025. Willful violations by health care service plans would be considered a crime, creating a state-mandated local program. While the California Constitution requires the state to reimburse local agencies for certain costs, this bill specifies that no reimbursement is necessary for certain reasons outlined within the act.  

Healing Arts Continuing Education Maternal Mental Health: AB 2581 (Maienschein), Chapter 836, Statutes of 2024—Effective January 1, 2025, this bill requires the Board of Registered Nursing, the Board of Psychology, the Physician Assistant Board, and the Board of Behavioral Sciences to consider adding a course on maternal mental health when they set their continuing education requirements. In addition, AB 2581 includes changes to certain sections of the Business and Professions Code, which will take effect only if this bill and other specific bills (AB 2270 (Maienschein) and SB 639 (Limón) are passed, and this bill is the last one to be signed into law.   

Improving Women’s Health/Reproductive Health Care Delivery

California Dignity in Pregnancy and Childbirth Act: AB 2319 (Wilson & Weber), Chapter 621, Statutes of 2024—Effective January 1, 2025, this bill states that the Legislature acknowledges and supports all birthing people, including nonbinary and transgender individuals, and requires certain health care providers in hospitals, birth centers, and primary care clinics to undergo training to address implicit bias in their care. In addition, AB 2319 requires current providers to complete this training by June 1, 2025, while new providers must complete it within six months of their start date unless they are exempt.

Starting in 2026, specified facilities must provide proof of compliance to the Attorney General by February 1 of each year; failure to comply authorizes the Attorney General to impose fines. In addition, AB 2319 requires the Attorney General to be awarded all attorney’s fees and costs from these cases and authorizes the Attorney General to publish a list of facilities that don’t comply on their website, along with other relevant compliance information. Every two years, AB 2319 authorizes the Attorney General to publish a report on compliance with these requirements. In addition, if any part of this bill is found to be invalid, AB 2319 deems the other sections will still stand.

Practice of Medicine Arizona Physicians Abortions and Abortion-Related Care of Arizona Patients: SB 233 (Skinner), Chapter 11, Statutes of 2024—Effective through November 30, 2024, SB 233 authorizes Arizona doctors who meet certain requirements to practice medicine in California to provide abortions and abortion-related care to patients who are Arizona residents traveling from Arizona to California for these services. In addition, SB 233 requires Arizona doctors to apply for registration with the California Medical Board or the Osteopathic Medical Board before practicing abortion and abortion-related care in California. Before practicing in California, Arizona doctors must submit certain information, including proof from the Arizona Medical Board that their medical license is valid and allows them to perform abortion and abortion-related care. In addition, SB 233 requires a signed declaration affirming compliance with all registration requirements, with any false statements constituting a misdemeanor offense.

SB 233 has a sunset date of January 1, 2025, and states the California Boards must keep registrants’ information private and treat registered doctors as if they have a California license, allowing the boards to enforce rules against them.

Sexual Health: SB 954 (Menjivar) (Vetoed), this bill would have required the State Department of Education to annually monitor if schools comply with the requirements of the California Healthy Young Act. In addition, SB 954 would have made, by the start of the 2025-26 school year, all public high schools (grades 9 to 12) provide free internal and external condoms to students. SB 954 would have required schools to inform students at the beginning of each year about where to get condoms and post notices with information on how to use them. In addition, SB 954 would have required schools serving grades 7 to 12 to distribute condoms during the course of educational or public health programs and initiatives. In addition, SB 954 would have authorized the Department of Education and public schools to accept donations, including condoms from manufacturers. SB 954 would have encouraged public schools to explore partnerships with local health departments, community health centers, nonprofit organizations, and the California Department of Public Health (CDPH). In addition, SB 954 would have required schools to designate one staff member to oversee the implementation of these provisions to ensure that school-based health centers can provide condoms without restrictions.

Medi-Cal Providers Family Planning: SB 1131 (Gonzalez), Chapter 880, Statutes of 2024—Effective January 1, 2025, this bill requires that a site certifier (a clinician overseeing Family PACT services) at primary care clinics be a qualified clinician and authorizes certain clinic groups to enroll up to 10 locations under one certifier. In addition, SB 1131 requires any orientation or training that DHCS requires to be offered online and at least every other month.

SB 1131 authorizes DHCS to choose not to disenroll someone if the suspension is based on behavior that is not considered unprofessional in California. In addition, changes outlined in SB 1131 will only take effect if federal approval is received and funding is available.

Maternal Mental Health Screenings: , Chapter 815, Statutes of 2024—Effective January 1, 2025, this bill requires maternal mental health programs designed by health care plans and health insurers to include at least one mental health screening during pregnancy and another screening within the first six weeks after giving birth. AB 1936 requires additional screenings to be completed later if the health care provider believes they are necessary.

Addressing Social Determinants of Health

Homeless Multidisciplinary Personnel Teams: AB 1948 (Rendon), Chapter 95, Statutes of 2024—Effective January 1, 2025, this bill authorizes the County of San Mateo to expand the objectives of its multidisciplinary team for homeless adults and families. It also removes the January 1, 2025, repeal date, making these provisions effective indefinitely. In addition, this bill includes legislative findings supporting the need for a special statute for several counties, including Los Angeles, Orange, Riverside San Bernardino, San Diego, San Mateo, Santa Clara, and Ventura.

The California Guaranteed Income Statewide Feasibility Study Act: AB 2263 (Friedman) (Vetoed), this bill would have required the Department of Social Services (CDSS) to contract one or more organizations to conduct a study on the feasibility of a statewide Guaranteed Income Program. This study would have looked at whether it’s possible to expand guaranteed income programs to help California’s most vulnerable populations, especially in high-cost areas, and would have considered lessons learned from earlier pilot programs. AB 2263 would have required various state departments to share important data with CDSS and include a steering committee comprised of various stakeholders. In addition, AB 2263 would have required that by July 1, 2027, CDSS publish a report on its website and provide it to the Governor and the Legislature. This report would have had to cover the feasibility and benefits of expanding the Guaranteed Income Program across California based on the study’s findings.

AB 2263 would have authorized CDSS to implement, interpret, or specify the Guaranteed Income Statewide Feasibility Study Act without needing to go through additional regulatory steps, and accept and spend funds to help implement this program, as long as the money is allocated in the budget.

Medi-Cal Diapers: AB 2446 (Ortega) (Vetoed), this bill would have established diapers as a covered Medi-Cal benefit for children over 3 years old who have a medical condition causing incontinence, as well as for individuals under 21 if it’s needed to improve their condition. In addition, AB 2446 would have limited the number of diapers provided based on the person’s age and their specific medical needs.

AB 2446 would have required DHCS to seek any necessary federal approvals to implement this new benefit. The implementation of these benefits would have been dependent on receiving those approvals, getting federal funding, and securing funding from the Legislature.

Older Adults and Adults with Disabilities Housing Stability Act: SB 37 (Caballero) (Vetoed), this bill, upon appropriation of funding from the Legislature, would have required the Department of Housing and Community Development (HCD) on January 1, 2025, to start a pilot program to help older adults and adults with disabilities who are homeless or at risk of becoming homeless.

In addition, SB 37 would have required HCD to offer competitive grants to nonprofit organizations, public housing authorities, and agencies that work with older adults. These grants would have funded housing subsidies in up to five areas or counties where older renters struggle with high rent costs. SB 37 would have required HCD to prioritize communities where a larger number of older adult renters are facing severe financial burdens related to rent. In addition, SB 37 would have created the Older Adults and Adults with Disabilities Housing Stability Fund from which funds would be allocated by HCD to selected recipients for three years.

SB 37 would have required organizations receiving these grants to use the funds for various activities, including providing housing subsidies to help cover rent until participants can get longer-term support, no longer need assistance, or the funding period ends. Organizations could have also used some of the funds to help with relocation costs if a landlord decided to evict a tenant or leave the program. In addition, this bill would have authorized grantees to spend up to 15% of their funding on recruiting landlords, offering incentives, and providing services to help tenants transition to stable housing.

SB 37 would have required HCD to oversee the program, requiring grant recipients to report on their activities and hire an independent evaluator to assess the programs and report the findings to the Legislature.

Unemployment Excluded Workers Program: SB 227 (Durazo), Chapter 11, Statutes of 2024—Through November 30, 2024, this bill authorizes a physician licensed to practice medicine in Arizona, who meets certain requirements, to practice medicine in California for the purpose of providing abortions and abortion-related care to patients who are Arizona residents traveling from Arizona, upon application for registration with the Medical Board of California or the Osteopathic Medical Board of California, as applicable.

Community and Rural Health Clinics Building Standards: SB 1382 (Glazer), Chapter 796, Statutes of 2024—Effective January 1, 2025, this bill requires the Department of Health Care Access and Information (HCAI) set construction standards for community clinics and rural health clinics that meet safety and accessibility requirements to qualify for federal Medicare and Medicaid programs. If these standards are changed, SB 1382 prohibits the amended standards from being stricter than the existing ones. In addition, SB 1382 requires HCAI to hold at least two public meetings to gather feedback on the proposed new standards.

SB 1382 removes the existing restriction prohibiting building standards for construction or alteration from being more restrictive or comprehensive than comparable building standards, thus allowing for more flexibility in the construction standards for clinics.

Future of Health

Telehealth:

Medi-Cal Telehealth: AB 2339 (Aguiar-Curry) (Vetoed), this bill would have expanded existing Medi-Cal definitions and exceptions to allow the use of asynchronous telehealth modalities to establish a new patient relationship when related to sensitive services. The bill would also have removed the requirement that a patient must attest to not having access to video when requesting the modality. In addition, AB 2339 would have stated that for purposes of Medi-Cal, asynchronous store and forward also includes asynchronous electronic transmission initiated directly by patients, including through mobile telephone applications.

Artificial Intelligence:

Artificial Intelligence Training Data Transparency: AB 2013 (Irwin), Chapter 817, Statutes of 2024—Effective January 1, 2025, this bill requires developers to post information on their websites about the data used to train any generative artificial intelligence (AI) system released on or after January 1, 2022. This must be done by January 1, 2026, and for every new AI system or significant update made available to Californians thereafter. The posted information must include a high-level summary of the datasets used to develop the AI system.

Generative Artificial Intelligence Accountability Act: SB 896 (Dodd), Chapter 928, Statutes of 2024—Effective January 1, 2025, this bill requires the California Department of Technology (CDT), under the guidance of the Government Operations Agency, the Office of Data and Innovation, and the Department of Human Resources, to update a report for the Governor, as mandated by Executive Order No. N-12-23.

SB 896 requires the Office of Emergency Services to assess potential risks that generative AI might pose to California’s critical infrastructure, especially threats that could lead to large-scale emergencies. SB 896 requires an annual high-level summary of the risk analysis be presented to the Legislature.

In addition, SB 896 any state agency or department that uses generative AI to communicate with Californians about government services must (1) include a disclaimer stating that the message was generated by AI and (2) provide information on how the person can contact a human of the state agency or department.

Artificial Intelligence Services: Safety, Privacy, and Nondiscrimination Standards SB 892 (Padilla): this bill would have required CDT to develop and adopt regulations for purchasing automated decision systems (ADS). In addition, SB 892 would have required CDT to consider guidelines and industry standards related to managing AI risks.

SB 892 would have required the ADS procurement standard to include a detailed process for assessing risks linked to these systems, methods for controlling those risks, and procedures for monitoring any negative incidents. In addition, SB 892 would have required CDT to collaborate with specified organizations to develop the ADS procurement standard and review and update the procurement standard and related regulations.

Starting January 1, 2027, SB 892 would have prohibited state agencies from buying an ADS or entering into contracts for services that use an ADS until CDT has established these procurement standards. Any contract for an ADS also would have included a completed risk assessment, ensure that appropriate risk controls are implemented, and specify how to monitor for potential adverse incidents.

Safe and Secure Innovation for Frontier Artificial Intelligence Systems Act SB 1047 (Wiener): this bill would have required developers to meet certain safety and security requirements before training new AI models, ensuring the ability to quickly shut down the model and have a written safety protocol. SB 1047 would have required developers to keep a complete unredacted copy of the safety and security protocol for five years after the model is available and would have allowed the Attorney General to access it.

In addition, SB 1047 would have prohibited developers from using AI models in ways that pose an unreasonable risk of harm. Starting January 1, 2026, SB 1047 would have required developers to hire an independent auditor each year to check their compliance with these rules and keep a record of the audit for five years—which would have also been accessible to the Attorney General.

SB 1047 would have required developers submit a compliance statement to the Attorney General and report any safety incidents related to their AI models. Additionally, if someone runs a computing service that could train an AI model, SB 1047 would have required they have policies to assess customers’ intentions for using the service.

In addition, SB 1047 would have authorized the Attorney General to take legal action if necessary and also included protections for whistleblowers ensuring that employees can report compliance issues without fear of retaliation. SB 1047 would have established a Board of Frontier Models to oversee these regulations and require annual updates to definitions related to AI models.

SB 1047 would have required a consortium within the Government Operations Agency to develop a public cloud computing system called “CalCompute,” aimed at promoting safe and ethical AI development. In addition, SB 1047 would have required a report on this framework be submitted back to the Legislature by January 1, 2026. However, SB 1047 would only take effect if there were allocated funds within the budget. SB 1047 would also have required official statements be explicitly stated to justify any limits on public access to meetings or documents related to these regulations.

Health Care Coverage Utilization Review: SB 1120 (Becker), this bill requires insurers utilizing algorithms, artificial intelligence, and other software tools used for utilization review or utilization management functions to comply with specified requirements, including that they be fairly and equitably applied.  

Health Care Services Artificial Intelligence: AB 3030 (Calderon),  This bill would require any entity, such as a health facility, clinic, physician’s office, or group practice that uses a generative artificial intelligence tool to assist health care providers in communicating with patients, to ensure that those communications include (1) a disclaimer that indicates to the patient that a communication was generated by artificial intelligence and (2) clear instructions for the patient to access direct communications with a health care provider. In addition, this bill would exempt from this requirement communication read and reviewed by a human licensed or certified health care provider.

Data

Data Collection Sexual Orientation, Gender Identity, and Intersex Status: SB 957 (Wiener), This bill requires CDPH to collect sexual orientation, gender identity, and variations in sex characteristics/intersex status (SOGISC) data from third-party entities, including local health jurisdictions, on any forms or electronic data systems unless prohibited by federal or state law. In addition, SB 957 only requires health care providers to disclose SGOISC information that is voluntarily self-identified and prohibits disclosures for individuals under 18 years of age.

Latino and Indigenous Disparities Reduction Act: SB 1016 (Gonzalez), Chapter 873, Statutes of 2024—Effective January 1, 2028, requires CDPH to categorize and report data on Hispanic or Latino groups separately when reporting on major disease and leading causes of death using standardized federal race and ethnicity categories from the federal Office Management and Budget’s Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity. In addition, SB 1016 requires CDPH to use a separate collection category for each major Latino group and Mesoamerican Indigenous nation if that group or nation is not included in the standardized federal race and ethnicity categories. SB 1016 requires CDPH to include specified languages while collecting the preferred language of program participants.

In addition, SB 1016 requires CDPH to include collected data in every demographic report on ancestry, ethnic origins, or language of California residents that CDPH publishes or releases on or after July 1, 2029. SB 1016 requires CDPH to make the data publicly available, except for personal information, which remains confidential. SB 1016 requires CDPH to update their data collection to reflect additional Latino groups, Mesoamerican Indigenous nations, and language groups as reported by the U.S. Census Bureau.

CDPH is authorized to continue collecting and reporting demographic data in the format it was submitted if it was gathered through federal programs, or by other state or third-party entities. In addition, SB 1016 brings legislative findings to that effect.

Communicable Diseases HIV Reporting: SB 1333 (Eggman & Roth), Chapter 472, Statutes of 2024—Effective January 1, 2025, this bill requires employees and contractors to sign confidentiality agreements every year but removes the requirement for annual reviews of the agreements—increasing the responsibility for local health departments and thus creating a state-mandated program.

In addition, SB 1333 authorizes disclosure of confidential information when said information is necessary for the coordination of, linkage to, or re-engagement in care for a person. While current law allows local health agency staff to share information with state and federal agencies to improve reporting to the CDC about people with both HIV and other diseases, SB 1333 repeals that authority.

SB 1333 makes legislative findings and declarations about the benefits of sharing HIV-related data and states the intent of the Legislature to enhance these data-sharing practices.

What’s Next: Legislative Process Information

This year was the second year in California’s two-year legislative cycle. The next Legislative Session begins Monday, December 2, 2024.

This fall, stakeholders and Legislative offices are putting together ideas for bills that will be introduced in the next Legislative Session. While the exact date is not released by the Senate and the Assembly, the bill introduction for the first year of a Legislative Session is typically in mid-February 2025.

The post ITUP Blog: 2024 Legislative Round Up appeared first on ITUP.

Snapshot: Examining Behavioral Health in California

This ITUP blog highlights landmark legislative bills that have set the foundation for the transformation of the behavioral health policy landscape in California. Following the summary of key state-led initiatives, we have compiled a list of behavioral health resources available across each ITUP-specified region.

Note: this is not a comprehensive list of all the behavioral health bills and behavioral health resources that are available. If you have questions about a bill not listed here or behavioral health resources not listed, please feel free to contact us at info@itup.org.

Behavioral Health in California

Behavioral health refers to the behaviors that affect an individual’s well-being, encompassing mental, emotional, and social aspects.[i] Behavioral health care refers to the prevention, diagnosis, and treatment of those conditions, such as mental health, substance use, substance use disorders, etc.[ii]

Californians have faced an unprecedented rise in behavioral health crisis, following the effects and impacts the COVID-19 pandemic has had on mental health. Rising rates of depression, anxiety, and substance use, coupled with the impacts of economic stress, have heightened demand for behavioral health care.[iii][iv] In addition, many Californians face significant barriers to accessing behavioral health care services, including long wait times, insufficient availability of providers, and geographic disparities.[v] The historic workforce shortage in California, particularly with mental health professionals, including psychiatrists, psychologists, and licensed therapists, exacerbates wait times and limits the capacity of the behavioral health care delivery system to meet the growing demand and need for services.[vi]

A significant portion of the unhoused population in California struggles with behavioral health issues. The intersection of homelessness and mental health or substance use disorders presents a critical challenge, with many individuals lacking access to the necessary support and treatment.[vii] Behavioral health services in California are often fragmented with care spread across various public and private systems resulting in gaps in service delivery and difficulties in care coordination.[viii]

Addressing California’s behavioral health crisis requires a comprehensive approach involving increased investment, improved coordination, and a focus on expanding access to care for all Californians, especially those in historically marginalized and underserved communities. California has made strides in continually evolving the behavioral health care delivery system to meet the needs of its diverse populations through landmark legislative bills and initiatives like Mental Health for All.

Key Legislative Bills

• Health Care Coverage: Timely Access to Care: SB 221 (Wiener), Chapter 724, Statutes of 2021 — Guarantees Californians the right to timely follow-up mental health and substance use disorder therapy appointments; Health Maintenance Organizations (HMOs) and health insurers are required to provide these sessions within 10 business days unless otherwise indicated by the treating therapist.
• Health Coverage: Mental Health or Substance Use Disorders: SB 855 (Wiener), Chapter 151, Statutes of 2020 – Requires commercial health plans and insurers to fully cover the treatment of all mental health conditions and substance use disorders.
• Mental Health: Involuntary Commitment: AB 2275 (Wood & Stone), Chapter 960, Statutes of 2022 – Strengthens safeguards for those involuntarily detained for mental health treatment.
• Community Assistance, Recovery, and Empowerment (CARE) Court Program: SB 1338 (Umberg & Eggman), Chapter 319, Statutes of 2022 – Establishes the Community Assistance, Recovery, and Empowerment (CARE) Act, which provides community-based behavioral health services for Californians living with untreated psychotic disorders.
• Mental Health: 988 Suicide and Crisis Lifeline (Bauer-Kahan, Berman, Gipson, Quirk-Silva, Ramos & Ting), Chapter 747, Statutes of 2022 – Enacts the Miles Hall Lifeline and Suicide Prevention Act and expands services for Californians experiencing a behavioral health crisis.
• California Ethical Treatment for Persons with Substance Use Disorder Act: SB 349 (Umberg), Chapter 15, Statutes of 2022 – Creates the Ethical Bill of Rights for substance abuse patients to be made available by treatment providers and additionally, creates further liability for treatment programs and patient brokers.

Key Major State-Led Behavioral Health Initiatives:

• Mental Health Services Act (MHSA) – Enacted in 2004, also known as Proposition 63, MHSA is a landmark piece of California legislation designed to enhance mental health services throughout the state. The MHSA Act aims to transform the mental health system by improving services and support for individuals with mental health issues and supports a variety of community-based programs and services. The majority of the funds are allocated to counties, allowing them to tailor mental health programs to meet the specific needs of their communities.
• California Advancing and Innovating Medi-Cal (CalAIM) – Launched in 2022 and led by California’s Department of Health Care Services (DHCS), CalAIM is a comprehensive reform aimed at transforming California’s Medi-Cal program focused on improving the quality of care, reducing health disparities, and enhancing the overall effectiveness of the Medi-Cal health care delivery system. CalAIM represents a significant shift towards a more integrated, person-centered approach in Medi-Cal, aiming to enhance health care service delivery, address social determinants of health, and reduce health disparities in California communities. For more information about CalAIM, see ITUP’s CalAIM Summary and Timeline (2022 Update) Fact Sheet.
• Children and Youth Behavioral Health Initiative (CYBHI) – Announced in 2021, the CYBHI seeks to create a more accessible, equitable, and effective behavioral health system for young Californians. The initiative is a multi-year, multi-department investment plan focused on enhancing mental health services and support structures for children and youth across California. The CYBHI represents a comprehensive strategic effort to improve mental health support for Californians aged 0-25 years old, addressing both immediate needs and long-term goals for better mental health outcomes.
• Proposition 1 (Prop 1) – A ballot measured that appeared on the November 2022 ballot designed to address affordable housing and homelessness issues in California. Officially known as the Affordable Housing and Homelessness Prevention Bond Act of 2022, Prop 1 authorizes $4.4 billion in bonds to address the state’s urgent housing needs, improve living conditions for vulnerable populations, and support efforts to prevent homelessness.
• Behavioral Health Continuum Infrastructure Program (BHCIP) – Under DHCS, the BHCIP is a key initiative designed to enhance and expand the infrastructure supporting mental health and substance use disorder services. The BHCIP aims to improve the availability and quality of behavioral health services by investing in physical infrastructure, service capacity, and innovative service models.
• California Behavioral Health Community-Based Organization Networks of Equitable Care and Treatment (BH-CONNECT) Demonstration – Introduced in 2021, the BH-Connect Demonstration is a Medicaid Section 1115 Demonstration designed to enhance the integration and coordination of behavioral health services, particularly targeting individuals with complex needs. The demonstration focused on developing and testing innovative service delivery models to improve the quality and efficiency of behavioral health care across the state.
• Medi-Cal Mobile Crisis – Housed as a component of California’s Medi-Cal program, the Medi-Cal Mobile Crisis offers rapid, in-person response to individuals facing mental health emergencies. This community-based intervention aims to stabilize the situation on-site, reduce the need for emergency room visits, and connect individuals to appropriate care and resources.

Behavioral Health Resources in California

The annual ITUP Equity Collaboratives convene a variety of stakeholders, ranging from local health care delivery systems and public health partners to key health care stakeholders and community champions from across California to discuss challenges impacting the health care delivery system and opportunities to address those issues. This year, ITUP is focusing on creating an equitable health care workforce, including participant-led discussions on innovative strategies to leverage behavioral health providers and other allied health professionals. Register for the in-person Los Angeles and Orange County Collaboratives here to join the conversation in determining how the health care workforce can better reflect the communities it serves!

The following section below incorporates ITUP-specified regional behavioral health resources. Additionally, learn more about regional health coverage through our 2024 Regional Health Coverage Fact Sheets linked to their respective regions.

Note: this is not a comprehensive list of all behavioral health resources available across each ITUP-specified region. If you have questions about a behavioral health resource not listed, please feel free to contact us at info@itup.org.

San Diego/Imperial Counties

• San Diego County Behavioral Health Services
• Imperial County Behavioral Health Services

North Rural Counties (Butte, Colusa, Del Norte, Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Nevada, Plumas, Shasta, Sierra, Siskiyou, Sutter, Tehama, Trinity, Yuba)

• Northern California Behavioral Health System
• Healthy Rural California NorCal Project
• Mendocino County Behavioral Health and Recovery Services

Central Coast Counties (Monterey, San Benito, San Luis Obispo, Santa Barbara, Santa Cruz, Ventura)

• Central Coast Hotline
• San Luis Obispo Behavioral Health Resource Center

Orange County

• Orange County Behavioral Resources
• National Alliance on Mental Illness (NAMI) Orange County

Central Valley Counties (Fresno, Inyo, Kern, Kings, Madera, Mariposa, Merced, Mono, San Joaquin, Stanislaus, Tulare, Tuolumne)

• Fresno County Behavioral Care and Services
• San Joaquin County Behavioral Health Services

Inland Empire Counties (Riverside, San Bernardino)

• Inland Empire Health Plan Mental Health and Wellness Resources
• Riverside County Behavioral Health
• San Bernardino County Behavioral Health

North Central Counties (Alpine, Amador, Calaveras, El Dorado, Napa, Placer, Sacramento, Solano, Sonoma, Yolo)

• Sacramento County Behavioral Health Services
• Napa County Mental Health Services

Bay Area Counties (Alameda, Contra Costa, Marin, San Francisco, San Mateo, Santa Clara)

• Bay Area Mental Health Resources
• Bay Area Community Health
• Bay Area Community Services

LA County

• LA County Mental Health
• LA County Department of Mental Health

Next Steps

As policies and initiatives continue to be introduced and implemented across the state, it will be imperative to assess how the behavioral health crisis in California evolves continually. This blog is meant to provide a succinct overview of the current landscape, introduce important actions that have been taken thus far, and provide resources as they pertain to ITUP Regional Equity Collaborative counties.

ITUP has released an in-depth Behavioral Health Policy Toolkit providing more nuanced information regarding present and proposed policies. Read it here!

References

[i] Williams, N., What Is Behavioral Health: A Comprehensive Guide, Community Health Centers, April 2024, Accessed: July 19, 2024.

[ii] American Medical Association, What Is Behavioral Health?, August 2022, Accessed: July 19, 2024.

[iii] Holt, W. & Hahn, T., Mental Health in California: Waiting for Care, California Health Care Foundation (CHCF), July 2022, Accessed: July 29, 2024.

[iv] Valentine, A. & Brassil, M., Substance Use in California: Prevalence and Treatment, California Health Care Foundation (CHCF), January 2022, Accessed: July 29, 2024.

[v] California Hospital Association (CHA), Key Messages: Learn What’s Driving Challenges in Behavioral Health Care, 2024, Accessed: July 29, 2024.

[vi] Wiener, J., Unanswered Cries: Why California Faces a Shortage of Mental Health Workers, CalMatters, September 2022, Accessed: August 2, 2024.

[vii] Streeter, J. L., Homelessness in California: Causes and Policy Considerations, Stanford Institute for Economic Policy Research (SIEPR), May 2022, Accessed: August 2, 2024.

[viii] Department of Health Care Services, Assessing the Continuum of Care for Behavioral Health Services in California: Data, Stakeholder Perspectives, and Implications, Accessed: August 2, 2024.

The post ITUP Blog: Snapshot: Examining Behavioral Health in California appeared first on ITUP.

On June 29^th 2024, Governor Newsom and the California Legislature reached an agreement on the Budget Act of 2024.[i] The Budget Act aims to address the budget deficit of $46.8 billion and includes total expenditures of $297.9. billion in 2024-25, with $211.5 billion from the General Fund (GF).[ii] Note: The spending allocations highlighted below are not comprehensive and highlight key parts of the health and human services budget expenditures.

Here are 5 Key Highlights from the Governor’s FY 2024 – 25 Final Budget Act [i]:

1. Coverage and Access
   • Maintains funding for Medi-Cal Expansion and the In-Home Supportive Services program, regardless of immigration status, continuous coverage for children 0-5, coverage for striking workers, and the Indian Health Program.
   • Discontinues the Major Risk Medical Insurance Program.
2. Behavioral Health
   • As part of the Children and Youth Behavioral Health Initiative, the Budget Act includes funding to establish the wellness coach benefit.
   • Includes funding for behavioral health initiatives that are part of California Advancing and Innovating Medi-Cal (CalAIM).
   • Reduces funding for the Behavioral Health Bridge Housing Program.
   • Includes funding for Proposition 1.
3. Health Care Workforce
   • Although the Budget Act maintains funding for specific health care workforce initiatives, it substantially reduces funding for various other health care workforce initiatives.
   • Delays implementation of the $25 minimum wage for health care workers to October 15, 2024, pending funding. Without enough funding, the Budget Act pushes the implementation to January 1, 2025, at the latest.
   • Delays rate increases for providers at the Department of Developmental Services to January 1, 2025.
4. Addressing the Social Determinants of Health
   • Maintains funding initiatives that address homelessness, food insecurity, access to broadband, and access to early childhood programs.
   • Regardless of the reduced funding for the CalWORKs Home Visiting Program, the Budget Act maintains funding for this program.
   • Reduces funding for the housing supplement for foster youth.
   • Delays expanding food assistance programs to undocumented individuals 55 years and older to October 1, 2027, and delays funding to Broadband Last Mile to 2027-28.
5. Public Health
   • Maintains funding for public health. Although there is a reduction in state and local public health infrastructure in the Budget Act, the reduction is less than in the May Revise.

Below we highlight key health and human services proposals in the Final Budget Act by five topics: Coverage and Access, Behavioral Health, Health Care Workforce, Addressing the Social Determinants of Health, and Public Health. We describe budget items that maintain and provide access to coverage for Californians and key health and human services reductions that would hinder and interfere with efforts to improve health outcomes and health equity for Californians, especially communities of color and people with disabilities.

Coverage and Access

Medi-Cal: In 2024-25, the Budget Act includes $161 billion for Medi-Cal with $35 billion from the GF.[i] The Budget Act estimates that, in 2024-25, Medi-Cal will cover approximately 14.5 million Medi-Cal members which equates to over one-third of the state’s population.[i] Moreover, the Budget maintains acupuncture benefits for Medi-Cal members.[iii]

Medi-Cal Expansion and In Home Supportive Services Program (IHSS), Regardless of Immigration Status: The Budget Act maintains funding for Medi-Cal Expansion, regardless of immigration status.[i] This funding includes $3.3 billion in 2024-25 ($2.8 billion GF) and approximately $3.4 billion ($2.9 billion GF) in ongoing budget years to make this expansion permanent.[i] This expansion will provide coverage to an expected 764,000 adult enrollees.[iv]

Part of the Medi-Cal expansion funding will go towards providing IHSS services, regardless of immigration status.[i] The Budget Act includes $25 billion ($9 billion GF) for IHSS services in 2024-25.[i] IHSS provides crucial services that allow eligible aged, blind, and disabled Californians to avoid nursing facilities and receive essential care at home with their families.[v] The Budget Act estimates that IHSS will serve 703,921 Californians in 2024-25.[i] However, despite the preservation of funding for the IHSS program, to address the budget shortfall, there is a reduction of $3 million one-time GF in 2024-25 to the In-Home Supportive Services Permanent Backup Provider System (BUPS). The permanent BUPS allows any eligible IHSS recipient to receive temporary IHSS from a backup provider. This is available when a recipient has an urgent need for a backup related to personal care services that cannot be met by an existing provider or is transitioning to home-based care and does not yet have an identified provider.

Continuous Medi-Cal Coverage for Children Aged 0-5: Over half of California children, 56.5%, rely on Medi-Cal for health coverage.[vi] This percentage equates to 5.7 million kids on Medi-Cal. [vi] Unlike the May Revise, the Budget Act includes funding for Continuous Medi-Cal Coverage for Children Aged 0-5.[i] Continuous coverage keeps children covered by removing the administrative burden of reapplying for Medi-Cal coverage every year.

Indian Health Program: The Budget Act maintains funding for the Indian Health Program[iii], an essential program that aims to improve health equity for Native Americans who live in urban, rural, reservation, or rancheria communities.[vii]

Health Care Coverage for Striking Workers: The Budget Act includes an increase of $3 million to provide health care coverage to striking workers through Covered California.[i][iii]

Major Risk Medical Insurance Program: The Budget Act officially discontinues the Major Risk Medical Insurance Program, effective December 31, 2024.[i] This program provides subsidized coverage to uninsured Californians who cannot obtain coverage through the marketplace due to their pre-existing conditions.[viii] Although the Budget Act states that Californians currently enrolled in the Major Risk Medical Insurance Program will transition to other health care coverage options[i], it is unclear how this process will happen.

Behavioral Health

As part of the Children and Youth Behavioral Health Initiative, which maintains $4.1 billion[i], the Budget Act includes $9.5 million ($4.1 million GF) in 2024-25 to establish the Medi-Cal wellness coach benefit, effective January 1, 2025.[i] The $9.5 million amount will increase to $78 million ($33.8 million GF) starting in 2027-28.[i] Wellness coaches will be trained to support children and youth’s behavioral health care needs through wellness promotion, education, screening, care coordination, individual and group support, and crisis referral.[ix]

The Budget Act includes $202.6 million ($77.9 million GF, $29.3 million Behavioral Health Services Fund, $31.6 million Opioid Settlements Fund, and $63.8 million federal funds) and $6.4 billion in bonds for the implementation of Proposition 1, which was passed by voters in March 2024.[i] Proposition 1 enacts the Behavioral Health Services Act, formerly the Mental Health Services Act, to provide behavioral health services for Californians with the most serious behavioral health needs, with specific funding for veterans.[i]

The Budget Act includes $7.7 billion ($351.5 million GF, $87.5 million Behavioral Health Services Fund, $2.6 billion Medi-Cal County Behavioral Health Fund, and $4.6 billion federal funds) for the Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-Connect) Demonstration.[i] BH-Connect are CalAIM behavioral health initiatives that require federal waiver approval. The Budget Act states that BH Connect services will be effective January 1, 2025.[i]

California’s youth are facing a behavioral health crisis amplified by the pandemic with incidents of youth causing self-harm increasing by 50% between 2009-2018, a triple increase in opioid-related overdoses among youth aged 15-19 from 2019-2020, and a double increase in the Black youth suicide rate between 2014 and 2020.[x] The Budget Act reduces funding for the Children and Youth Behavioral Health Initiative by $72.3 million GF in 2023-24 and by $313.9 million GF in 2024-25.[i] This funding would have gone towards school-linked partnership and capacity grants, services and supports platform, evidence-based and community-defined grants, and a public education and change campaign.[i]

Nearly 1 in 7 California adults have experienced mental illness [xi], almost a third, 31.7%, of California adults, experience anxiety and/or depression, and drug overdose death rates have increased in California from 10.7 per 100,000 in 2011 to 26.6 per 100,000 in 2021 [xii]. The Budget Act reduces funding for the CalWORKs Mental Health and Substance Abuse Services program by $37 million GF in 2024-25 and $26 million GF in 2025-26, leaving this program with $89 million.[i]

Furthermore, the Budget Act reduces funding for the Behavioral Health Bridge Housing Program by $250 million, leaving this program with $1.25 billion ($1.2 billion GF).[i] The last round of grants includes $132.5 million GF in 2024-25 and $117.5 million ($27.5 million GF and $90 million Behavioral Health Services Fund) in 2025-26.[i]

Health Care Workforce

The Budget maintains $98.4 million GF committed funding for Song-Brown residencies and nursing in 2023-24, $2.1 million GF in 2023-24 for work education training, and $8.4 million from 2024-25 through 2026-27 for the California Medicine Scholars program.[i] Song Brown Residencies aim to increase the primary care health care workforce and the California Medicine Scholars program aims to develop a more culturally competent health care workforce.[xiii][xiv] The Budget Act maintains funding from previous health care workforce investments including:[i]

• California Medicine Scholars Program
• Nursing
• Children and Youth Behavioral Health Initiative
• Community Health Workers
• Addiction psychiatry fellowships
• Psychiatry graduate medical education.

The Budget Act includes $133 million in 2024-25, $728 million in 2025-26, and $1.2 billion in 2026-27 for increased Medi-Cal provider rates, created with revenue from the Managed Care Organization Tax (MCO).[i] Furthermore, the Budget Act includes $40 million one-time funding in 2026-27 for the development and retention of the Medi-Cal workforce.[i] This funding will go towards the Medi-Cal Workforce Pool – Labor Management committees.[xv] The Budget Act does not provide details as to how these labor committees plan to develop and retain the Medi-Cal workforce.

The COVID-19 pandemic amplified significant stressors that California’s health care workforce has endured for far too long, including workforce shortages, a lack of diversity, and persistent burnout. The ongoing health care workforce shortage and crisis have resulted in over 7 million Californians living in provider shortage areas.[xvi] To meet the critical and urgent need for providers, California will need an additional 4,100 primary care providers by 2030 to meet projected provider demand.[xvii]

The Budget Act reduces $746.1 million for various health care workforce programs over 5 years[i]:

• $200.6 million in 2023-24,
• $299.9 million in 2024-25
• $213.6 million in 2025-26
• $16 million in 2026-27 and ongoing.

These reductions will harm all Californians, but will significantly impact communities of color and people with disabilities the most. It is vital that future budgets include significant investments in health care workforce initiatives to fully meet California’s health care needs.

Enacted into law on October 13, 2023, SB 525 (Durazo) implemented a progressive increase of the minimum wage to $25 for California’s lowest-paid health care workers. The minimum wage increase was originally supposed to start June 1, 2024.[xviii] The deadline was then pushed to July 1, 2024.[xviii] The Budget Act further delays implementing SB 525 to October 15, 2024, only if there is enough money in the first quarter of 2024-25.[i] If there is not enough money, the Budget Act states that wages will not increase until at the latest January 1, 2025.[i] In addition, the Budget Act delays increased pay for providers at the Department of Developmental Services to January 1, 2025, by reducing $510.4 million ($306.2 million GF) in previously allocated funding.[i]

The Budget Act reduces $280 million one-time funding over multiple years for grants that seek to improve quality, health equity, and primary care infrastructure through funding Medi-Cal providers.[i] The Budget Act maintains $140 million ($70 million GF) for these grants from the 2022 Budget Act.[i]

Addressing the Social Determinants of Health

Broadband. The Middle Mile Broadband Initiative (MMBI) and the Last Mile are key initiatives to addressing the disproportionate impact the digital divide has across California communities. The MMBI is the “internet superhighway” that enables last mile connections to entire communities including homes, businesses, schools, libraries and health clinics. While the May Revision proposed eliminating $700 million of the committed $750 million from the Loan Loss Revenue account for broadband, the Legislature pushed back and restored all by $125 million.[i] The fund provides credit enhancement for bonds, loans, and letters of credit to help finance local broadband infrastructure development. In addition, the Budget Act includes $250 million one-time GF in 2024-25 to expand and improve the fiber-optic network in key segments of the Middle-Mile Network.[i] In addition, the Budget Act includes provisional authority allowing up to $250 million GF in 2024-25 to build out additional segments provided the California Department of Technology Office of Digital Literacy provides a report to the Joint Legislative Budget Committee with a breakdown of stand-alone California Department of Transportation projects related to the MMBI.[i]

Despite the preservation of some funds for the MMBI, the Budget Act delays $550 million for last-mile projects, which connects the network to homes, until the 2027 budget year.[i]

Homelessness. The Budget Act includes $1 billion one-time funding for local governments to combat homelessness in California.[i] Given that this funding comes with increased accountability measures from the state[i], it is important that local governments use this funding to create policies throughout California that provide care to our unhoused communities through housing and support services. Check out ITUP’s statement discussing the U.S Supreme Court’s Recent Rulings.

The Budget Act reduces the housing supplement for foster youth in Supervised Independent Living Placements by $200,000 GF in 2024-25 and $18.8 million GF in 2025-26 leaving many foster youths to face increased housing insecurity.[i]

Food Assistance. The Budget Act includes $17.2 billion ($4.9 billion in state funding and $12.3 billion in federal funding) for CalFresh, a federally funded food assistance program, that is estimated to feed over three million households in 2024-25.[i] Furthermore, the Budget Act includes an increase of one-time $10 million GF funding for the CalFresh Fruit and Vegetable EBT Pilot to continue operating.[i] In 2024-25, the Budget Act includes $146.8 million with $73.4 million from the GF that permits California to implement federal food assistance through the Summer Electronic Benefit Transfer Program for Children (SUN Bucks) program.[i] The SUN Bucks program will provide food benefits to children who lose access to free and reduced-price meals during the summer school closure period.[i] The SUN Bucks funding of $146.8 million will focus on outreach, automation, and administration. It is estimated that this program will allow California to provide an estimated $1 billion in federal food assistance.[i]

Although the Budget Act maintains funding for Medi-Cal Expansion, it delays the California Food Assistance Program expansion to undocumented individuals aged 55 years and older to October 1, 2027 instead of October 1, 2025.[i]

Early Childhood. The Budget Act includes an increase of $228.6 million ($117.4 million GF) in 2024-25, $304.8 million ($260.8 million GF) in 2025-26, and ongoing funds in future budget years for 11,000 new childcare slots beginning October 1, 2024.[i] However, it also pauses any additional childcare slots for two years until 2026-27.[i] The Budget Act states that new childcare slots are subject to appropriation in future state budgets.[i] If there is appropriation in future state budgets for childcare slots, the Budget Act includes an additional 44,000 childcare slots in 2026-27 and 33,000 slots in 2027-28.[i] Although the May Revise proposed adding a total of 119,000 childcare slots, the Budget Act goes a step further and plans to add a total of 200,000 childcare slots by 2028.[iii]

The CalWORKs Home Visiting Program provides essential, early intervention activities for California families.[xix] The Budget Act reduces funding for the CalWORKs Home Visiting Program by $25 million GF in 2024-25 and $25 million GF in 2025-26.[i] In addition, the Budget Act includes an increase of $9 million one-time GF for diaper and wipe distribution for low-income families with infants and toddlers.[i] In addition, the Budget Act eliminates the Los Angeles County Child Welfare Services Public Health Nursing Program by $8.3 million starting in 2024-25.[xv] This program provides and coordinates essential health care services for foster children and youth.[xx]

Public Health

The May Revise proposed a large reduction of $300 million for ongoing public health funding. The Budget Act maintains $276.1 million GF funding in 2024-25 and is ongoing for state and local public health infrastructure[i]. However, the Budget Act reduces funding in 2024-25 for state and local public health by $8 million ongoing funds in state public health infrastructure and $15.9 million ongoing funds in local public health infrastructure.[ii]

The COVID-19 pandemic highlighted the historic underfunding of our public health system. To build a responsive, rather than reactive, public health and health care system, we must continue making significant investments in our systems to protect the health of all Californians.

Budget Process: What’s Next

Although the Budget has been finalized, the budget can still be amended until August 31, the last day the legislature is in session before recess.

This coming November, Californians will vote on ten ballot initiatives.[xxi] One ballot initiative, Proposition 35, that ITUP publicly supports is focused on Medi-Cal health care spending. If passed, Proposition 35 would ensure that all revenue generated from the MCO tax would fund Medi-Cal and raise Medi-Cal provider rates.[xxii] Although the MCO tax was initially designed to help fund Medi-Cal, historically, past budgets have used MCO tax money to fund other budget initiatives not related to health care, leaving less money for Medi-Cal members’ health care needs.[xxii] There is a shortage of health care providers who accept Medi-Cal resulting in limited and inequitable health care access for California’s most marginalized communities.[xxii] Proposition 35 offers the opportunity to address this issue and becomes a first step toward creating a more accessible and equitable health care delivery system for Californians.[xxiii]

Key Government Resources

Administration/Executive Branch Resources:

• • Budget Act of 2024 – Budget Summary
  • Budget Act of 2024 – Key Takeaways

Legislative Resources:

• • California Assembly Floor Report of the 2024-25 Budget
  • Senate Committee on Budget and Fiscal Review Budget Act of 2024 – Key Highlights
  • List of Budget-Related Bills

Tools to Understand the California State Budget Process:

• • California and Budget Policy Center Guide to the California State Budget Process

References

[i] Department of Finance (DOF), Budget Act of 2024, July 2024.

[ii] Department of Finance (DOF), Budget Act of 2024: Key Takeaways , June 2024.

[iii]Senate Budget and Fiscal Review Committee, Senate Committee on Budget and Fiscal Review Budget Act of 2024 – Key Highlights, June 2024.

[iv]Legislative Analyst’s Office, Health Care Access and Affordability, February 2022.

[v]California Department of Social Services, In-Home Supportive Services (IHSS) Program,2024.

[vi]The Children’s Partnership, How Medi-Cal Continuous Coverage Protects California Kids, March 2023.

[vii]California Department of Health Care Services, Indian Health Program.

[viii]California Department of Health Care Services, Major Risk Medical Insurance Program.

[ix]California Department of Health Care Access and Information, Certified Wellness Coach,2024.

[x] CalMatters, When children suffer: California to funnel billions into mental health overhaul, March 2022.

[xi]California All, California’s Mental Health Movement, October 2023.

[xii]KFF, Mental Health in California, 2024.

[xiii]California Department of Health Care Access and Information, Song-Brown Healthcare Workforce Training Programs,2024.

[xiv] California Medicine Scholars Program, California Medicine Scholars Program. 2023.

[xv]Assembly Budget Committee, Floor Report of the 2024-25 Budget, June 2024.

[xvi]California Future Health Workforce Commission, Meeting the Demand for Health: Fact Sheet on California’s Looming Workforce Crisis, February 2019.

[xvii] Healthforce Center at the University of California, San Francisco, California’s Primary Care Workforce: Forecasted Supply, Demand, and Pipeline of Trainees, 2016-2030, August 2017.

[xviii]CalMatters, Update: California’s new health care minimum wage is changing. Here are answers to your questions, June 2024.

[xix]California Department of Social Services, CalWORKs Home Visiting Program, 2024.

[xx] County of Los Angeles Public Health, Child Welfare Public Nursing Program.

[xxi]CalMatters, 2024 California ballot measures: What you need to know, July 2024.

[xxii]CalMatters, California voters will decide who wins on health care tax: Gavin Newsom or doctors, July 2024.

[xxiii]Yes on Prop 35, Yes on Prop 35 Protect Access to Care.

The post ITUP Blog: Key Highlights in California’s Final FY 2024 – 25 Budget Act appeared first on ITUP.

On May 10, 2024, Governor Newsom released the May Revision (May Revise) of the Fiscal Year (FY) 2024-25 budget which estimates that California is facing a total budget deficit of $27.6 billion.[i] Read ITUP’s full statement on the May Revision of California’s FY 2024-25 Budget here.

Below we highlight key health and human services proposals in the FY 2024-25 May Revise that maintain and provide access to coverage for Californians. In addition, we describe key health and human services reductions that would hinder and interfere with efforts to improve health outcomes and health equity for Californians, especially communities of color and people with disabilities.

Budget Items that Maintain Coverage and Provide Access to Coverage for Californians

Medi-Cal Expansion, Regardless of Immigration Status: The May Revise maintains funding for the Medi-Cal Expansion, regardless of immigration status. This expansion will provide coverage to an expected 764,000 adult enrollees.[ii] In addition, it includes $9.7 billion in revenue from the Managed Care Organization (MCO) tax to support Medi-Cal.[i]

Middle Mile Broadband Initiative (MMBI): The MMBI is an important initiative that would allow more Californians to access telehealth. The May Revise proposes allowing the Director of Finance to increase funding to the MMBI by $1.5 billion or 38.5%.[i] Currently, the MMBI has $3.9 billion in funding.[i]

Budget Reductions, Delays, and Pauses That Pose a Threat to Health Equity for Californians

Behavioral Health: California’s youth are facing a behavioral health crisis amplified by the pandemic with incidents of youth causing self-harm increasing by 50% between 2009-2018, a triple increase in opioid-related overdoses among youth aged 15-19 from 2019-2020, and a double increase in the Black youth suicide rate between 2014 and 2020.[iii] The May Revise reduces $72.3 million one-time in 2023-24, $348.6 million in 2024-25, and $5 million in 2025-26 for the Children Behavioral Health Initiative.[i]

Nearly 1 on 7 California adults have experienced mental illness [iv], almost a third, 31.7%, of California adults experience anxiety and/or depression, and drug overdose death rates have increased in California from 10.7 per 100,000 in 2011 to 26.6 per 100,000 in 2021 [v]. The May Revise eliminates $189.4 million Mental Health Services funds for proposed programs that would have been introduced during the 2025-26 budget and eliminates $450.7 million one-time funding from the last round of the Behavioral Health Continuum Infrastructure Program leaving this infrastructure program with $30 million in one-time general funding.[i]

Furthermore, the May Revise reduces funding for the Behavioral Health Bridge Housing Program by $132.5 million in 2024-25 and $207.5 million in 2025-26, leaving this housing program with $132.5 million General Fund (GF) funding in 2024-25 and $117.5 million ($90 million Mental Health Services Fund and $27.5 million GF) in 2025-26.[i] In addition, the May Revise reduces ongoing funding for the CalWORKs Mental Health and Substance Abuse Services by $126.6 million.[i]

Healthcare Workforce: The COVID-19 pandemic amplified significant stressors that the California health care workforce has endured for far too long, including workforce shortages, a lack of diversity, and persistent burnout. The ongoing healthcare workforce shortage and crisis have resulted in over 7 million Californians living in provider shortage areas.[vi] To meet the critical, urgent need for providers, California will need an additional 4,100 primary care providers by 2030 to meet projected provider demand.[vii]

The May Revise reduces $6.7 billion of revenue from the MCO tax over multiple years that would have increased Medi-Cal provider rates, funded Graduate Medical Education, and funded the Medi-Cal labor workforce. [i] To address the budget deficit, the May Revise proposes to increase the MCO tax to increase revenue for the GF by $689.9 million in 2024-25, $950 million in 2025-26, and $1.3 billion in 2026-27.[i]

The May Revise eliminates $300.9 million in 2023-24, $302.7million in 2024-25, $216 million in 2025-26, $19 million 2026-27, and $16 million in 2027-28 for critical and essential health care workforce initiatives including [i]:

• Community Health Workers;
• Nursing;
• Social Work;
• Song-Brown residencies;
• Health Professions Career Opportunity Program; and the,
• California Medicine Scholars Program.

The May Revise eliminates $280 million one-time funding over multiple years for grants that seek to improve quality, health equity, and primary care infrastructure through funding Medi-Cal providers.[i] The May Revise maintains $70 million for these grants from the 2022 Budget Act.[i]

Continuous Medi-Cal Coverage for Children Aged 0-4: Over half of California children, 56.5%, rely on Medi-Cal for health coverage. [viii] This percentage equates to 5.7 million kids on Medi-Cal. [viii] The May Revise explicitly states that continuous Medi-Cal coverage for Children Aged 0-4 will not be included in the 2024 Budget Act.[i]

 Public Health Funding: The COVID-19 pandemic highlighted the historic underfunding of our public health system. To respond to current threats and prepare for future threats to public health, we need to continue investing in our systems.   The May Revise eliminates $52.5 million in 2023-24 and $300 million ongoing funding for state and local public health funding.[i] According to this, public health funding would have gone toward [ix]:

• Additional staffing;
• Infrastructure;
• Prevention;
• Infectious disease control;
• Population health; and,
• Emergency preparedness.

 Addressing Social Determinants of Health: The May Revise reduces ongoing funding for the CalWORKs Home Visiting Program by $47.1 million.[i] In addition, it pauses efforts to subsidize childcare that could have benefited the families of 119,000 children[i]. Based on the state’s fiscal conditions, government officials will determine when they end the pause.[i] The CalWORKs Home Visiting Program provides essential, early intervention activities for California families. With the passage of Proposition 1, there is now less money for these activities, further eroding health equity investments for pregnant and parenting families ages 0-5.

The May Revise delays $200 million for Broadband Last Mile from 2025-26 to 2027-28.[i] Furthermore, April 30^th marked the last day of funding for the Affordability Connectivity Program, an essential, federal program that helped reduce the digital divide across California.[x] The May Revise does not include any state solutions to subsidize broadband services for low-income Californians furthering the digital divide.

The In Home Supportive Services Program (IHSS) provides crucial services that allow eligible aged, blind, and disabled Californians to avoid nursing facilities and receive essential care at home with their families.[xi] According to a poll conducted by the California Health Care Foundation, nearly three-fourths of Californians, 72%, say they want to live and stay at home if they ever need ongoing, living assistance. [xii] Even though the May Revise maintains funding for the Medi-Cal expansion, regardless of immigration status, it eliminates IHSS expansion for undocumented individuals of all ages and delays the California Food Assistance Program expansion to undocumented individuals aged 55 years and older to 2027-28, instead of 2026-27.[ix]

Budget Process: What’s Next

A Balanced Budget: The Legislature is required to produce a “balanced budget” and send it to the Governor by Saturday, June 15, 2024. Due to the requirement that a bill be in print for at least 72 hours before legislative action, watch for the budget bill to be in print by Wednesday, June 12, 2024. The Budget Bill requires a majority vote from both houses of the Legislature to be advanced to the Governor for enactment.

Final Budget Enactment: After the budget bill passes through the Legislature, the Governor then has 15 days to sign it into law by the start of the new fiscal year, which begins July 1, 2024.

“Budget Bill Junior” and Trailer Bills:

• While there is a requirement that the Legislature sends the main budget bill to the Governor for signature by June 15, the Legislature also typically uses additional policy-area-specific bills called “trailer bills” to provide additional details about the expenditures contained in the budget bill.
• These bills do not need to be sent to the Governor by June 15 and may be passed throughout the summer and before the Legislative Session ends in August.
• Similarly, the Legislature may choose to revise the main budget bill with a “budget bill junior” before the Legislative Session ends in August.

Key Government Resources

Administration/Executive Branch Resources:

• Governor Newsom’s Press Release on the FY 2024-25 May Revision
• Newsom Administration Fact Sheet on the May Revision
• Department of Finance 2024-25 May Revision General Fund Solutions
• Department of Finance 2024-25 Proposed May Revision Health and Human Services Adjustments
• Department of Health Care Services Stakeholder News Regarding the May Revision

Legislative Resources:

• Assembly Budget Committee Preliminary Summary of Governor’s Proposed 2024-25 May Revision
• Senate Committee on Budget and Fiscal Review Overview of the May Revision

Tools to Understand the California State Budget Process:

• California and Budget Policy Center Guide to the California State Budget Process

Stay tuned for our next update at the Final Budget Act!

References

[i] Department of Finance (DOF), May Revision, May 2024.

[ii] Legislative Analyst’s Office, Health Care Access and Affordability, February 23, 2022.

[iii] CalMatters, When children suffer: California to funnel billions into mental health overhaul, March 17, 2022.

[iv]California All, California’s Mental Health Movement, October 2023.

[v]KFF, Mental Health in California.

[vi]California Future Health Workforce Commission, Meeting the Demand for Health: Fact Sheet on California’s Looming Workforce Crisis, 2019.

[vii] Healthforce Center at the University of California, San Francisco, California’s Primary Care Workforce: Forecasted Supply, Demand, and Pipeline of Trainees, 2016-2030, 2017.

[viii]The Children’s Partnership, How Medi-Cal Continuous Coverage Protects California Kids, March 2023.

[ix] Senate Committee on Budget, Senate Committee on Budget and Fiscal Review Overview of the May Revision, May 2024.

[x]Federal Communications Commission, Affordable Connectivity Program, April 2023.

[xi]California Department of Social Services, In-Home Supportive Services (IHSS) Program.

[xii]California Health Care Foundation, New CHCF Poll Shows Californians’ Concerns About Obtaining Home-Based Supports, February 2023.

The post ITUP Blog: Governor’s FY 2024-25 Budget: Key Highlights in the May Revision appeared first on ITUP.

2024 Introduced Legislation

Overview: The deadline for introducing legislation for the second year of the 2023-2024 legislative session was February 16, 2024. Legislation introduced this year focuses on improving access to equitable and affordable health care, transforming the health care delivery system with a focus on reproductive, perinatal, behavioral health care, and the future of health with technological innovations.

Summary and Policy Areas: This blog summarizes introduced legislation that proposes solutions relating to ITUP’s three priority policy issues: health care coverage and access, delivery system transformation, and the future of health.

Additionally, we noted with icons which bills address:

Legislative Bill Process Guide: At the end of this blog, we also include important information on the legislative bill process, helpful links, and a timeline that can be used to follow these bills throughout the year.

Note: this is not a comprehensive list of all the health and health care-related bills that were introduced. If you have questions about a bill not listed here, please feel free to contact us at info@itup.org

Health Care Coverage and Access

Covered California Expansion: AB 4 (Arambula) expands access to Covered California by allowing all Californians, regardless of immigration status, to purchase health insurance through the marketplace. AB 4 requires Covered California to execute a mirror exchange program on its own to expand coverage to undocumented people under existing federal rules and subsidies if they are available. See ITUP’s Issue Brief on Expanding Health Coverage for California Farmworkers for more details on the impact of AB 4.

Health Care Immigration: AB 1783 (Essayli) removes all taxpayer funding for healthcare benefits for undocumented residents from the California State Budget. See ITUP’s fact sheet reviews existing health care programs for immigrants in California.

Office of Tribal Affairs in Public Health: AB 1965 (Blanco Rubio) establishes the Office of Tribal Affairs within California’s Department of Public Health (CDPH) led by an appointed Tribal Health Liaison to assist in addressing the public health disparities impacting Tribal communities. In addition, the appointed Liaison will serve at the pleasure of the State Public Health Officer and requires regular consults and consideration of input and information by the Liaison.

Health Care Coverage Cost Sharing: AB 2258 (Zbur) prohibits non-grandfathered health care plans or health insurance policies, issued, amended, or renewed on or after January 1, 2025, from charging patients out-of-pocket costs or cost-sharing requirements for preventive care services and screenings. Preventative care services and screenings include home test kits for sexually transmitted diseases, cervical cancer and colorectal cancer screenings, and prophylaxis for HIV infection. In addition, AB 2258 states the violation of this law would constitute a crime and that the Commissioner of the Department of Insurance is responsible for enforcing the implementation of this bill.

Social Determinants of Health Screening and Outreach: AB 2250 (Weber) requires health plans renewed or amended on or after January 1, 2027, provide social determinants of health (SDOH) screenings as a covered benefit for members. In addition, AB 2250 requires health plans to provide primary care physicians who administer SDOH screenings access to peer support specialists, health workers, social workers, or community health workers.

Medi-Cal Nonmedical and Nonemergency Medical Transportation: AB 2043 (Boerner) authorizes the Department of Health Care Services (DHCS) to require Medi-Cal Managed Care Plans (MCPs) to contract with public paratransit service operators for nonemergency medical transportation trips. This allows public paratransit service operators to be reimbursed by MCPs at DHCS’ fee-for-service transportation rate.

Medi-Cal Federally Qualified Health Centers and Rural Health Clinics: SB 282 (Eggman & McGuire) authorizes DHCS to reimburse federally qualified health centers (FQHCs) and rural health centers (RHCs) for a maximum of two same-day in-person and/or telehealth-based visits. Reimbursement for two same-day visits occurs if the Medi-Cal patient endures illness or injury after the first visit that signifies, they need further medical diagnosis or treatment or if the Medi-Cal patient has a medical visit and either a mental health visit, dentist visit, or acupuncture visit. In addition, SB 282 requires DHCS to submit a state plan amendment showcasing these policy changes to the Center for Medicare and Medicaid Services by July 1, 2024.

Health Care Delivery System Transformation

Medi-Cal: Adverse Childhood Experiences Trauma Screenings: AB 2110 (Arambula) expands provider definitions for Adverse Childhood Experiences (ACEs) screenings to include Medi-Cal enrolled community-based organizations (CBOs) and local health jurisdictions who provide services through community health workers, and doulas. This allows these providers to receive Medi-Cal payments for ACEs trauma screenings.

Language Access: SB 1078 (Min) intends to create an Office of Language Access to provide oversight, accountability, and cross-coordination amongst state agencies to ensure limited-English-proficient Californians have meaningful access to government programs and services. (hE)

Bilingual-Oriented Social Equity Services Grant Program: AB 2155 (Ting) requires, beginning with the 2025-26 fiscal year, the California Department of Social Services (CDSS) to establish the Bilingual-Oriented Social Equity Services Grant Program Fund and administer the Bilingual-Oriented Social Equity Services Grant Program to distribute funds to community-based nonprofit organizations providing equitable language access to social services. In addition, AB 2155 requires CDSS to prioritize funding to organizations who are current state program grantees. AB 2155 requires 40% of funds to be awarded as Multilingual Success Grants to CBOs serving limited-English-proficient Californians whose language communities represent 2% or more of California’s total population. In addition, AB 2155 requires 60% of funds to be awarded as Multilingual Access Grants to CBOs serving limited-English-proficient populations that do not meet that threshold.

Transforming California’s Behavioral Health and Substance Use Disorder System

Prisons Mental Health: AB 2142 (Haney) requires the California Department of Corrections and Rehabilitation (CDCR) to establish a three-year pilot program at two or more institutions to provide access to specified mental health therapy for incarcerated persons. In addition, AB 2142 requires the California Correctional Health Care Services to house treatment records generated under the pilot program. AB 2142 requires CDCR to report information to the fiscal and appropriate policy committees of the Legislature, from March 1, 2025, to March 1, 2027. (MH)

Psychological Associates at Federally Qualified Health Centers and Rural Health Clinics: AB 2703 (Aguiar-Curry) requires DHCS to seek federal approvals that would allow FQHCs and RHCs to bill DHCS for a visit between a psychological associate and a Medi-Cal patient. For this to happen, specific conditions must be met, including that a licensed psychologist supervises the psychological associate and bills for that visit under their name, not the name of the psychological associate. In addition, AB 2703 states that the definition of supervising a psychological associate will change depending upon what is required by the Board of Psychology.

Improving Women’s Health/Reproductive Health Care Delivery

California Dignity in Pregnancy and Childbirth Act: AB 2319 (Wilson & Weber) requires all hospitals providing perinatal or prenatal care to participate in evidence-based implicit bias training, including recognition of intersecting identities and potential associated biases. AB 2319 requires initial basic training for the implicit bias program to be completed by June 1, 2025, for current health care providers, and within six months of their start date for new health care providers. In addition, AB 2319 requires by February 1 of each year, facilities provide CDPH proof of compliance; failure or violation of provisions authorizes CDPH to issue an administrative penalty. AB 2319 requires CDPH to annually share publicly on their website a list of facilities that did not submit timely proof of compliance and have been issued administrative penalties. In addition, AB 2319 vests CDPH with full administrative power, authority, and jurisdiction to implement and enforce the California Dignity in Pregnancy and Childbirth Act.

Future of Health

Broadband

Affordable Internet and Net Equality Act of 2024: AB 1588 (Wilson) requires the California Department of Technology (CDT), in coordination with the California Public Utilities Commission (CPUC) and the California Department of General Services (DGS) to develop and establish the Net Equality Program. In addition, AB 1588 requires the state to only contract with internet service providers (ISPs) offering affordable internet services, costing no more than $40 per month to households participating in certain public assistance programs, or the federal Affordable Connectivity Program (ACP). AB 1588 requires CDT to provide a publicly accessible list of ISPs that meet the requirements on their website.

Affordable Internet and Net Equality Act of 2024: SB 1179 (Durazo) requires CDT, in coordination with the CPUC, and DGS to develop and establish the Net Equality Program. In addition, SB 1179 requires the state to contract with ISPs offering affordable internet service to households participating in certain public assistance programs. SB 1179 defines affordable home internet service as costing no more than $30 per month and that it meets specified minimum speed requirements. In addition, SB 1179 requires ISPs to establish a phone number to sign up eligible households and requires ISPs to advertise the availability of affordable internet service. SB 1179 requires CDT to annually update and provide a list of ISPs that meet the requirements on their website.

Defining Digital Discrimination of Access: AB 2239 (Bonta) intends to adopt the definition of “digital discrimination access” that conforms to the definition adopted by the Federal Communications Commission (FCC) into state law.

Telehealth

Medi-Cal Telehealth: AB 2339 (Aguiar-Curry) expands existing Medi-Cal definitions and exceptions to allow the use of asynchronous telehealth modalities to establish new patient relationships when related to sensitive services and requested by patients. In addition, AB 2339 states that for purposes of Medi-Cal, asynchronous store and forward also includes asynchronous electronic transmission initiated directly by patients, including through mobile telephone applications. AB 2339 removes the option of patients attesting to no video access in audio-only establishment exception.

Health Information: AB 1943 (Weber) establishes the identification and collection of telehealth data in the Medi-Cal program to measure individual patient health and population health outcomes. Data elements collected include outcomes, access, effectiveness, and morbidity and mortality and will be used to measure outcomes of the Medi-Cal population for medical care, public health interventions, social determinants, physical environments, genetics, and individual behavior.

Healing Arts Counseling: AB 2566 (Wilson) enters California into the Interstate Counseling Compact (the Compact), an interstate licensing compact legally binding among multiple states facilitating interstate practice of licensed professional counselors. In addition, AB 2566 requires the Compact to establish a joint public agency, the Counseling Compact Commission to provide development, maintenance, operation, and utilization of a coordinated database and reporting system containing licensure, adverse action, and investigative information on all licensed individuals in Member States.

Artificial Intelligence

Artificial Intelligence Disclosure: AB 1824 (Valencia) creates a disclosure requirement for content generated through artificial intelligence (AI).

Artificial Intelligence Training Data Transparency: AB 2013 (Irwin) requires, on or before January 1, 2026, developers of artificial intelligence systems to post on their websites documentation regarding the data used to train the artificial intelligence system or service.

California Interagency AI Working Group: SB 721 (Becker) creates the California Interagency AI Working Group, until January 1, 2030 to deliver a report to the Legislature concerning AI. In addition, SB 721 requires working group members to be Californians with expertise in at least two of the following areas: computer, artificial intelligence, and data privacy. SB 721 requires the report to include a recommendation of a definition of artificial intelligence for use in legislation.

Automated Decision Systems: AB 2058 (Weber) states the intent of the Legislature to enact legislation relating to commercial algorithms and artificial intelligence-enabled medical devices.

Artificial Intelligence Accountability Act: SB 896 (Dodd) requires the Government Operations Agency, CDT, and the Office of Data and Innovation to produce a State of California Benefits and Risk of Generative Artificial Intelligence Report. In addition, SB 896 requires the report to include an examination of the most significant, potentially beneficial uses for deployment of generative artificial intelligence (GenAI) tools by the state and requires those entities to update the report. SB 896 requires the California Cybersecurity Integration Center and the State Threat Assessment Center to perform a joint risk analysis of potential threats posed by the use of GenAI to California’s critical energy infrastructure. In addition, SB 896 requires a state agency that uses GenAI to clearly disclose their use of AI during person interactions, whether through an online platform or telephonically. SB 896 requires an automated decisionmaking system used by a state agency or department to be evaluated for risk potential before adoption.

Artificial Intelligence Services: Safety, Privacy, and Nondiscrimination Standards: SB 892 (Padilla) requires CDT to establish safety, privacy, and nondiscrimination standards for AI services and to report to the Legislature the standards established. In addition, on August 1, 2025, SB 892 prohibits contracts for artificial intelligence unless the provider meets those standards set by CDT.

California Artificial Intelligence Research Hub: SB 893 (Padilla) requires the Government Operations Agency, the Governor’s Office of Business and Economic Development, and CDT, to collaborate and establish the California Artificial Intelligence Research Hub (hub) in the Government Operations Agency. In addition, SB 893 requires the hub to serve as a centralized entity facilitating collaboration across multi-disciplinary partners to advance artificial intelligence research and development that seeks to harness the technology’s full potential for public benefit while safeguarding privacy, advancing security, and addressing risks and potential harms to Californians.

Artificial Intelligence Technology: SB 970 (Ashby) determines the use of synthetic, AI-generated audio, video, and images, is deemed as false personation of a person’s likeness. In addition, SB 970 requires the Judicial Council to develop and implement screening procedures to identify synthetic records. SB 970 requires the Judicial Council to create educational materials to aid in identifying AI-tampered evidence. In addition, SB 970 requires any person or entity selling or providing access to artificial intelligence technology designed to create synthetic images, video, or voice to provide a consumer warning that misuse of such technology may result in civil or criminal liability for the user.

Safe and Secure Innovation for Frontier Artificial Intelligence Systems Act: SB 1047 (Wiener) enacts the Safe and Secure Innovation for Frontier Artificial Intelligence Systems Act to require a developer of a covered model to determine safety regulations for large-scale AI models to ensure they do not cause harm to society. Before training of an AI model starts, SB 1047 requires developers, or people who are responsible for the creation and ownership of an AI model, to make a positive safety determination determining their large AI systems do not have or come close to having hazardous capabilities to harm society. If an AI model does not have a positive safety determination, developers must ensure they know how to fully shut down the AI model, if needed. In addition, SB 1047 establishes the Frontier Model Division within CDT. Developers of AI models that do not have a positive safety determination must submit annual certifications of compliance regarding the harms presented to society and reports describing any safety incidents that occur. SB 1047 requires the Frontier Model Division publicly release reports summarizing the findings of the certifications of compliance. In addition, SB 1047 mandates CDT to create CalCompute, a public cloud computer cluster that aims to spur innovation in researching, developing, and deploying large-scale AI models safely, securely, and equitably. SB 1047 protects whistleblowers who report developers who do not comply with the law and states that the violation of this law constitutes a civil violation that is made enforceable by the California Attorney General.

Health Care Coverage Utilization Review: SB 1120 (Becker) requires health care plans or health insurers to ensure that a licensed physician supervises the use of AI decision making tools used for prior authorization. SB 1120 requires licensed physician oversight when AI tools are used to inform decisions to approve, deny, or modify prior authorization requests.

Data

California Health and Human Services Data Exchange Framework: AB 1331 (Wood) requires the Center for Data Insights and Innovation (CDII), a division of CalHHS to oversee CalHHS DxF on or before January 1, 2025, and establish a CalHHS Data Exchange Board. The Board will review, modify, and approve modifications to the existing Data Sharing Agreement (DSA), which oversees the sharing of health information among health care organizations and government agencies in California. The Board will develop a process for designating qualified health information organizations (QHIOs) and report DSA signatory compliance, consumer experiences with data exchange, and evaluation of technical programs and grants to the legislature annually.  See ITUP’s California Data Exchange Framework 101 Fact Sheet & Policy Toolkit for more information.

Social Care Data Privacy: AB 1011 (Weber) prohibits entities from selling, renting, or otherwise disclosing social care information used within a closed-loop referral system (CLRS), unless required by law. In addition, AB 1011 prohibits the use of social care information stored in CLRSs for any purpose other than the purpose for which the information was collected. AB 1011 defines social care information as any care, services, goods, administrative, or payment information related to an individual’s social needs.

What’s Next: Legislative Process Information

This is a timeline with key events and deadlines useful for tracking legislation. Below, we provide a detailed explanation of the timeline and the California legislative process.

The 2024 Legislative calendars for the California Assembly, and Senate include all deadlines that must be met for bills to be signed into law. The ‘house of origin’ or the ‘first house’ is the branch of the Legislature where the bill was introduced (ABs = Assembly Bills, the Assembly is the first house the bill must pass through; SBs = Senate Bills, the Senate is the first house the bill must pass through). Bills can be amended throughout the process.

Committee Hearings

Policy committees began hearing bills in March 2024. The committees are made up of a subset of assemblymembers or senators to hear bills on a specific policy topic, such as health. The committee chairs set bills for hearing dates throughout March and April, and public hearings are recorded and can be watched live, typically in person, but live stream video is available and was preferred during the public health emergency. Assembly and Senate Health Committee hearing dates, agendas that list the bills being heard, and a link to where you, the public, can watch the hearings are found on each policy committee’s website. The deadline for bills to be discussed in committees is April 26, 2024, for fiscal bills (legislation that has a cost to the state), and May 3, 2024, for non-fiscal bills.

• Assembly Health Committee: Meets on Tuesdays at 1:30 p.m. PST
• Senate Health Committee: Meets on Wednesdays at 1:30 p.m. PST

Appropriations Committee Hearings

Once a bill passes in policy committee(s), the next step in the legislative process for most bills is a hearing in the Appropriations Committee. The Appropriations Committee reviews all bills that have a designated fiscal impact, and the deadline for bills to be heard in the House of Origin appropriations committee is May 17, 2024. At this point in the Legislative process, many bills will be ‘held on suspense,’ which effectively means they will not move forward in the process. In the Assembly, any bill that has an annual cost of $150,000 or more, from any fund, gets placed on the suspense file. In the Senate, legislation with an annual cost of $50,000 General Fund or $150,000 federal funds or special funds, gets placed on the suspense file. Like the policy committees, the Appropriations Committees hold public hearings. Most bills get placed on the suspense file and are heard in committee close to the May 17, 2024, deadline.

• Assembly Appropriations Committee: Meets on Wednesdays at 9:00 a.m. PST
• Senate Appropriations Committee: Meets on Mondays at 10:00 a.m. PST

House of Origin Floor Vote

The last stop for a bill before the opposite house begins to weigh in on the policy is the ‘floor vote’. This is where all Assemblymembers vote on AB bills and all Senators vote on SB bills. The deadline for bills to be voted on the House of Origin floor this year is May 24, 2024.

Following a bill’s successful passage out of its house of origin, the entire process listed above is repeated in the opposite house (Ex. Abs will then go through the Legislative process in the Senate). The last day of this year’s legislative session, and subsequently, the last day a bill can pass through the entire process is August 31, 2024. Bills that successfully passed through the Legislature will either be signed or vetoed by Governor Newsom no later than September 30, 2024.

The post ITUP Blog: 2024 Introduced Legislation appeared first on ITUP.

2023 Legislation Round Up

This year, Governor Newsom signed 85 percent of the bills that crossed his desk by the October 14, 2023, deadline. Here is a round-up of some significant health and health-related bills that were signed into law and some that were vetoed (shown in italics). We have grouped them into ITUP’s three policy focus areas: health care coverage and access, delivery system transformation, and the future of health.

Note: This blog is not a comprehensive list of all the health and health-related bills that went to the Governor’s desk this year. If you have any questions about a bill not listed here, please contact us at info@itup.org.

Health Care Coverage and Access

Health Care: Unified Health Care Financing: SB 770 (Weiner), Chapter 412, Statutes of 2023—Effective January 1, 2024, this bill requires the California Health and Human Services Agency (CalHHS) to research, develop, and pursue discussions with the federal government to develop a unified health care system in California that guarantees medical, behavioral, pharmaceutical, dental, and vision benefits without cost-sharing for essential services that do not vary by age, employment status, disability, income, immigration status, or other demographics.

Health Care Coverage for Hearing Aids: SB 635 (Menjivar & Portantino) (Vetoed)—This bill would have mandated health plans to include coverage, up to $3000 per individual without any cost sharing, for hearing aids for all their members under 21 years old, if deemed medically necessary. The inclusion of hearing aids would have applied to health care plans and policies issued, amended, or renewed on or after January 1, 2025. The Governor’s veto message stated progress and strategies for increasing provider participation and uptake in the existing program from hearing aids, Hearing Aid Coverage for Children Program (HACCP) to ensure that children have access to the hearing supports and services they need.

Addressing Surprise Billing for Ambulance Services: AB 716 (Boerner), Chapter 454, Statutes of 2023—Effective January 1, 2024, this bill requires the Emergency Medical Services Authority to annually report the allowable maximum rates of ground ambulance transportation services in each county. In addition, this bill requires health plans to pay locally set rates for ambulance services when a contract is not present and prevents ambulance providers from billing patients more than the in-network cost-sharing. AB 716 protects consumers from being sent to collections and having an adverse credit report for an unpaid bill or being sued. This bill also ensures that those without insurance will not be charged more than the Medi-Cal or Medicare rate for the service, whichever is greater.

Minor Consent for Substance Use Disorder: AB 816 (Haney), Chapter 456, Statutes of 2023—Effective January 1, 2024, this bill mandates that minors 16 years of age and older can consent to replacement narcotic abuse treatment with buprenorphine at a physician’s office, clinic, or health facility from a qualified health care provider, including licensed physicians, licensed surgeons, or other health care providers. If deemed appropriate, parent or guardian involvement in the treatment plan will still be required. The bill also mandates that minors 16 years of age and older can consent to treatment for opioid use disorder using medications prescribed by a licensed narcotic treatment program as replacement narcotic therapy. AB 816 specifies that as long as providers abide by federal law, parents’ consent will no longer be required.

Social Determinants of Health: Screening and Outreach: AB 85 (Weber) (Vetoed)—This bill would have mandated health plans, on or after January 1, 2027, to include screenings for social determinants of health as a covered benefit. This bill would have also deemed screenings of social determinants of health as a covered benefit under Medi-Cal, subject to reimbursement from the Department of Health Care Services (DHCS) or a Medi-Cal managed care plan. The bill also would have mandated health plans to provide primary care providers access to community health workers, peer support specialists, lay health workers, community health representatives, or social workers in counties where Medi-Cal members reside. The bill would have mandated the Department of Health Care Access and Information to assemble a working group that would have researched and provided best practices to document data, best-standardized model, and practices to refer patients to community resources, and gaps in research and data that would have helped policymakers address and take action on the social determinants of health. The Governor’s veto message states that while the Administration supports work to address the social determinants of health, this bill would have duplicated other efforts to do so.

Health Care Delivery System Transformation

Housing Support Services in Medi-Cal: AB 1085 (Maienschein) (Vetoed) – This bill would have deleted the requirement for an independent analysis of housing provider network adequacy and instead would have officially added housing support services as a covered Medi-Cal benefit, following a mandated evaluation under the California Advancing and Innovating Medi-Cal (CalAIM) Waiver Special Terms and Conditions and an appropriation from the Legislature for housing support services. Housing support services include housing transition and navigation services, housing deposits, and housing tenancy and sustaining services. The bill would have required DHCS to seek federal approval to add housing support services as a covered Medi-Cal benefit from January 1, 2025, to July 1, 2026. The Governor’s veto message cites the fiscal constraints of the Fiscal Year (FY) 2023-24 budget and future budget uncertainty as the reason for vetoing this bill.

Patient Choice in Telehealth: AB 1241 (Weber), Chapter 172, Statutes of 2023—Effective, January 1, 2024, this bill authorizes providers to meet DHCS patient choice requirements by either offering their health care services in person or arranging a referral to and facilitating in-person care needed by an individual. In addition, this bill specifies the referral and facilitation arrangement need not require a provider to schedule an appointment with a different provider on behalf of a patient.

Out-of-State Physicians and Surgeons: Telehealth License Exemption: AB 1369 (Bauer-Kahan), Chapter 837, Statutes of 2023—Effective, January 1, 2024, this bill authorizes an eligible out-of-state physician or surgeon to practice medicine in California without a license if the practice is limited to delivering health care via telehealth to an eligible patient who has a disease or condition that is immediately life-threatening.  

Health Information on Abortion Care: AB 352 (Bauer-Kahan), Chapter 255, Statutes of 2023—Effective January 1, 2024, this bill prohibits any health care provider, health plan, contractor, or employee from providing individually identifiable medical information related to abortion or abortion-related services to an individual or agency from another state. This bill also prohibits a health care provider, health plan, pharmaceutical company, contractor, or employee from sharing this information via electronic health records or health information exchanges with an individual or agency from another state, unless authorized. This bill also requires businesses that electronically store medical information to segregate information for sensitive services from the rest of the patient’s medical record, prevent disclosure outside of the state, and automatically disable access to this information by unauthorized individuals as well as entities in another state.

Minimum Wages for Health Care Workers: SB 525 (Durazo), Chapter 890, Statutes of 2023—Effective January 1, 2024, this bill establishes five separate minimum wage schedules for covered health care employees. In addition, this bill prohibits local governments from enacting local laws related to wages or compensation for health care facility employees. Provisions in this bill include:

• Organizations with 10,000 full-time equivalent workers or more will pay a minimum wage of $23/hour on June 1, 2024, to May 31, 2025, $24/hour on June 1, 2025, to May 31, 2026, and $25/hour on June 1, 2026.
• Starting on June 1, 2024, the specified hospitals will have to pay workers $18/hour, and the minimum wage after 2024 will be increased by 3.5% annually until it reaches $25 in June 2033:
• Starting on June 1, 2024, specified clinics that meet certain requirements will have to pay covered health care employees $21/hour until May 31, 2026, $22/hour on June 1, 2026, to May 31, 2027, and $25/hour on June 1, 2027.
• Starting on June 1, 2024, all other covered health care facility employers will have to pay covered health care employees $21/hour until May 31, 2026, $23/hour on June 1, 2026, to May 31, 2028, and $25/hour on June 1, 2028.
• Starting on June 1, 2024, licensed skilled nursing facilities will have to pay covered health care employees $21/hour until May 31, 2026, $23/hour on June 1, 2026, to May 31, 2028, and $25/hour on June 1, 2028.

Transforming California’s Behavioral Health System

Minors: Consent to Mental Health Services: AB 665 (Carillo), Chapter 338, Statutes of 2023—Effective July 1, 2024, this bill authorizes minors aged 12 years and older covered by Medi-Cal, to consent to mental health treatment, counseling, or residential shelter services as they long as they demonstrate they have enough maturity to participate in these services. AB 665 aligns Medi-Cal policy for mental health treatment consent with private insurance requirements.

Mental Health Services Act Reform: SB 326 (Eggman), Chapter 790, Statutes of 2023—Effective upon voter approval, the bill will have phased implementation dates from January 2025 through January 2027. If approved by voters, SB 326 revises and recasts the Mental Health Services Act (MHSA) as the Behavioral Health Services Act (BHSA). This bill permits county behavioral health programs to use BHSA funds to treat primary substance use disorder conditions by implementing a new funding structure completely different than the existing and longstanding MHSA structure, changing the county planning process, and including more services counties and the state can fund. Among other provisions, the bill includes $36 million for a behavioral health workforce (BH-CONNECT) and requires counties to administer evidence-based practices. The bill authorizes DHCS to implement monetary sanctions or temporarily withhold funds for non-compliant county mental health programs that do not abide by contracts detailing the behavioral health services provided. This bill, paired alongside AB 531 (described below), will be on the ballot on March 5, 2024, as Proposition 1.

The Behavioral Health Infrastructure Bond Act of 2023: AB 531 (Irwin), Chapter 789, Statues of 2023— Effective upon voter approval, this bill will be, alongside SB 326, on the ballot on March 5, 2024 as Proposition 1. If approved by voters, DHCS will provide implementation guidance by July 1, 2025. Paired alongside SB 326, BHSA, this bill includes $6.38 billion of general obligation bonds that aim to serve veterans and people experiencing homelessness and behavioral health challenges through building permanent supportive housing units, behavioral treatment resources, and behavioral treatment residential settings funded from the Department of Housing and Community Development (HCD), the Department of Veterans Affairs (DVA), and the Behavioral Health Continuum Infrastructure Program (BHCIP). The construction of these housing units will not need to be approved under the California Environmental Quality Act. This bill will mandate that BHCIP, which awards grants to fund behavioral health treatment resources, continues indefinitely. The bill also establishes the Behavioral Health Infrastructure Finance Committee, which will authorize the issuing and selling of the general obligation bonds.

Pupil Health: Social-Emotional, Behavioral, and Mental Health Supports: AB 1479 (Garcia) (Vetoed)—This bill would have established the Pupil Social-Emotional, Behavioral, and Mental Health Program, which would have provided state funding for local educational agencies to provide evidence-based, holistic social-emotional, behavioral, and mental health supports (referred to as Model Tier 1 supports) to pupils and families. The supports would have been delivered by school staff or community-based organizations. Schools within a district or county office, as well as certain charter schools. The Governor’s veto message cites fiscal uncertainty as the reason for vetoing this bill.

Urgent and Emergency Mental Health and Substance Use Disorder Treatment: AB 1451 (Jackson) (Vetoed)—This bill would have required health coverage issued, amended, renewed, or delivered on or after January 1, 2024, to provide coverage for treatment of urgent and emergency mental health and substance use disorders. This bill would have required the treatment to be provided without preauthorization and be reimbursed in a timely manner. The Governor’s veto message cites fiscal uncertainty as the reason for vetoing this bill.

Improving Reproductive, Perinatal Health Care Delivery

Advancing Equity for Black Birthing Californians with Doulas: AB 904 (Calderon), Chapter 349, Statutes of 2023—Effective January 1, 2024, this bill requires health plans, by January 1, 2025, to form a maternal and infant health equity program to address racial health disparities in maternal and infant health outcomes by means of doulas. This bill will authorize Medi-Cal managed care plans to be compliant with this requirement as long as the doula services are a covered Medi-Cal benefit. This bill requires the Department of Managed Health Care (DMHC), in consultation with the Department of Insurance (CDI), to submit a report to the Legislature on doula coverage and the health equity program by January 1, 2027.

Medi-Cal Presumptive Eligibility for Pregnant People: AB 1481 (Boerner), Chapter 372, Statutes of 2023— Effective January 1, 2024, this bill updates and renames the Presumptive Eligibility for Pregnant Women as the Presumptive Eligibility for Pregnant People Program (PE4PP) to make the name more inclusive for eligible people who are pregnant but do not identify as women, including the non-binary and trans community. For pregnant people who apply to Medi-Cal at any time during a specific time period, this bill ensures they maintain coverage under the PE4PP program until DHCS accepts or denies their Medi-Cal application.

Menstrual Equity for All Act of 2021: AB 230 (Reyes), Chapter 421, Statutes of 2023—Effective July 1, 2024, this bill mandates that all public schools, with any combination of classes from grades 3-12, provide free, available, and accessible menstrual products in all girls’ bathrooms, all-gender restrooms, and in at least one boy’s restroom. This bill also mandates that schools post a notice of this requirement in all restrooms with the contact information of a person responsible for keeping the restroom stocked with free, available, and accessible menstrual products.

Expanding the Black Infant Health Program: AB 1701 (Weber), Chapter 174, Statutes of 2023—Effective January 1, 2024, this bill expands the Black Infant Health Program (BIH), as part of the California Perinatal Equity Initiative (PEI), to include city health departments rather than just county health departments. AB 1701 removes statutory barriers to PEI funding that can be leveraged to enhance the reach of BIHs.

Medi-Cal: Comprehensive Perinatal Services: AB 608 (Schiavo) (Vetoed)—This bill would have expanded comprehensive perinatal services coverage in Medi-Cal from 60 days to one year post-pregnancy. This bill also would have required DHCS to cover comprehensive perinatal services by non-licensed perinatal health workers in a non-medical setting such as members’ home or other community settings as long as the non-licensed perinatal health worker is supervised by a community-based organization or local health jurisdiction contracted with a comprehensive perinatal services program provider. The Governor’s veto message cites fiscal uncertainty as the reason for vetoing this bill.

Future of Health

Health Information Exchange: SB 582 (Becker) (Vetoed)—This bill would have required CalHHS Data Exchange Framework (DxF) stakeholder advisory group to consider creating standards for including electronic health record (EHR) vendors in the DxF requirements. It also would have required CalHHS to impose fines and penalties on EHR vendors charging fees for information exchanges that are non-compliant with regulations. The Governor’s veto message states that the state should focus on implementing the DxF before modifications like the one proposed in this bill. See ITUP’s California Data Exchange Framework 101 Fact Sheet & Policy Toolkit for more information.

Privacy of Reproductive or Sexual Health Application Information: AB 254 (Bauer-Kahan), Chapter 254, Statutes of 2023—Effective January 1, 2024, this bill revises the Confidentiality of Medical Information Act (CMIA) definition of “medical information” to include reproductive or sexual health application, which the bill defines as information related to a consumer’s reproductive or sexual health collected by a reproductive or sexual health digital service. In addition, this bill designates businesses that provide such services/applications to be deemed a “provider of health care.”

Legally Protected Health Care Activities in California: SB 345 (Skinner), Chapter 260, Statutes of 2023—Effective January 1, 2024, this bill states that California law governs in any action against a person who provides or receives by any means, including telehealth, reproductive health care services or gender-affirming health care services, as specified if the care was legal in the state in which it was provided at the time of the challenged conduct. In addition, this bill prohibits a person or business from collecting, using, disclosing, or retaining the personal information of a person who is physically located at, or within a precise geolocation of, a family planning center, except as necessary to perform the services or provide the goods requested. This bill prohibits the sale or sharing of this information.

Digital Equity Bill of Rights: AB 414 (Reyes), Chapter 436, Statutes of 2023—This bill establishes the Digital Equity Bill of Rights, stating that it is the principle of the state to ensure digital equity for all residents of the state, that residents shall have access to broadband that meets specific requirements, and that broadband internet subscribers benefit from equal access to broadband, as those terms are defined.

Telecommunications: The Digital Equity in Video Franchising Act of 2023: AB 41 (Holden) (Vetoed) –This bill would have revised the Digital Infrastructure and Video Competition Act of 2006 (DIVCA) to be renamed as the Digital Equity in Video Franchising Act. This bill would have established a policy of the state that subscribers and potential subscribers of a state video franchise holder should benefit from equal access, as defined, to video service within the franchise service area, and expand the prohibition on certain cable operators or video service providers from discriminating against, or denying access to service to, any group of potential residential subscribers to include denial of equal access, as specified. The Governor’s veto message indicates that the bill, as it was passed by the Legislature, does not go far enough to reform DIVCA.  

Broadband Infrastructure: Mapping: AB 286 (Wood), Chapter 645, Statutes of 2023—Effective January 1, 2024, requires the California Public Utilities Commission (CPUC) publicly accessible broadband service map to identify:

• Each provider of broadband services, and,
• The maximum speed of broadband services offered by each provider at each address.

This bill requires the map to include features to receive self-reported data and to refute the broadband speed and/or technology that an internet service provider (ISP) claims to provide at an address via end-user-run speed tests. In addition, AB 286, makes self-reported data publicly available by address and requires the CPUC to obtain consent from an individual before publicly disclosing information submitted. This bill also prohibits the CPUC from accepting certain self-reported information by the commission as evidence in a commission proceeding unless the self-reported information is validated for accuracy.

Noteworthy Two-Year Bills

California Health and Human Services Data Exchange Framework: AB 1331 (Wood) – This bill requires the Center for Data Insights and Innovation (CDII), a division of CalHHS to oversee CalHHS DxF and establish a DxF Governing Board. The Governing Board will review, modify, and approve modifications to the existing Data Sharing Agreement (DSA), which oversees the sharing of health information among health care organizations and government agencies in California. CDII will also investigate Data Sharing Agreement Policies & Procedures (DSA P&Ps) violations, enforce compliance, and report noncompliance.  AB 1331 is currently in the Senate Appropriations Committee and is a two-year bill meaning that it may move through the rest of the Legislative session no sooner than January 2024. See ITUP’s California Data Exchange Framework 101 Fact Sheet & Policy Toolkit for more information.

Public Utilities: Broadband Service Providers: AB 1714 (Wood)–This bill defines “public utility” to include broadband service providers, outing broadband services, and regulation under the CPUC. See ITUP’s Snapshot: Addressing Digital Equity for Equitable and Accessible Health Care for more information on California’s current broadband landscape.

Covered California Expansion: AB 4 (Arambula) – This bill expands access to Covered California by allowing all Californians, regardless of immigration status, to purchase health insurance through the marketplace. AB 4 requires Covered California to execute a mirror exchange program on its own to expand coverage to undocumented people under existing federal rules and subsidies if they are available. See ITUP’s Issue Brief on Expanding Health Coverage for California Farmworkers for more details on the impact of AB 4.

What’s Next: Legislative Process Information

This year was the first year in California’s two-year legislative cycle. This means that although the year’s legislative session is completed, some of the bills introduced this year can be taken up by the Legislature this winter. Such bills are known as two-year bills.

If you or your organization are tracking two-year bills and may want to engage on them during the process in January, now is the time to reach out to the Senate and Assembly Health and the Senate and Assembly Appropriations Committees to ask questions, find out when/if a two-year bill will be set for a hearing in January, and provide additional information to the committee consultants on why you believe the bill should or should not move forward.

The post ITUP Blog: 2023 Legislation Round Up appeared first on ITUP.