October 14, 2022

By Olivia Bundschuh and Katie Heidorn

California’s Final 2022-23 Budget

In June 2022, Governor Newsom and the Legislature reached an agreement on the Budget Act of 2022 (Budget Act), which went into effect July 1, 2022. The total FY 2022-23 budget is $307.9 billion total funds (TF) ($234.4 billion General Fund (GF)). This publication highlights key health and human services spending allocations in the FY 2022-23 Budget Act as well as investments that improve health equity and address the social determinants of health.

Following the summary of key budget highlights, we include links to resources on where to find budget summaries and analysis from the Newsom Administration and the Legislature.

Key Highlights from the Governor’s FY 2022 – 23 Final Budget Act

Health and Human Services budget allocations make up a large portion of the overall budget with total funding of $231.3 billion TF ($68 billion GF and $163.2 billion other funds (OF)). Note: The spending allocations highlighted below are not comprehensive and highlight key parts of the health and human services budget expenditures.

1. Budget Investments Advancing Coverage and Access

Expansion of Full-Scope Medi-Cal Coverage to All Adults Regardless of Immigration Status[i]: The Budget Act expands Medi-Cal coverage to over 700,000 adults aged 26 through 49 years, regardless of immigration status, no sooner than January 1, 2024. This coverage expansion was formally enacted through a trailer bill, SB 184, Chapter 47, Statutes of 2022. The Budget Act[ii] and the outyears include allocations to support several of the recent expansion efforts:

• Approximately $67 million TF ($53 million GF) in FY 2021-22 and $745 million TF ($628 GF) in FY 2022-23 in costs to expand full-scope Medi-Cal for eligible older adults.
• $287 million TF ($197 million GF) in FY 2021-22 and $334 million TF ($226 million GF) in FY 2022-23 for the undocumented young adult population.
• $834 million TF ($625 million GF) in FY 2023-24 and $2.6 billion ($2.1 billion GF) at full implementation and annually thereafter.

See ITUP’s “Who are the Remaining Uninsured?” Fact Sheet and a report from the UC Berkeley Labor Center for more information about who these coverage expansions potentially impact.

Increasing Access to Safe, Equitable Reproductive Health Care[iii]: The Budget Act includes over $200 million in investments to maintain and improve safe and accessible reproductive health care. Key allocations from the 2022 Budget Act include:

• Uncompensated Care Funding: One-time, $40 million GF over six years for the Department of Health Care Access and Information (HCAI) to award grants to reproductive health care providers to offset the cost of providing care to low-and middle-income individuals without coverage for abortion care services.
• Covered California Subsidies: $20 million GF for Covered California to support the One-Dollar Premium Subsidy program which subsidizes the cost of Covered California consumers for health plans due to federal policy concerning abortion coverage.
• California Reproductive Justice and Freedom Fund: One-time, $15 million GF for the California Department of Public Health (CDPH) to award grants to community-based reproductive health, rights, and justice organizations for outreach and education activities.
• Comprehensive Reproductive Rights Website and Research on Unmet Needs: One-time, $2 million GF for CDPH to develop and maintain a public website on the right to abortion care under state law, information about providers, and coverage options for reproductive services, including state-funded coverage and programs, and to conduct research on barriers for accessing reproductive health care services.

Continuous Medi-Cal Coverage for Children Commitment[iv]: The Budget Act commits to prioritize providing continuous Medi-Cal coverage for children aged zero through four and aligning the monthly maintenance income level to the income limit for Medi-Cal without a share of cost for older and disabled adults if a determination is made in the spring of 2024 that General Fund over the multiyear forecast is available to support these ongoing augmentations.

Supporting Aging Well for California Seniors[v]: The Department of Aging is transforming aging for California communities by administering programs and advocating for policy change. The budget includes:

• Community-Based Adult Services (CBAS) COVID-19 Mitigation & Resilience: One-time, $61.4 million GF to support CBAS provide adult day services amid COVID-19.
• Modernizing the Older Californians Act: $59.3 million GF one-time funding to pilot local aging programs such as Community-Based Support Programs, Family and Caregiver Support, Aging in Place, and Senior Volunteer Development.

For more information on Medicare, dual eligibles, benefits, and enrollment in California, as well as programs to address the social determinants of health for California’s older adults, see ITUP’s “Medicare and Health for Aging Californians” fact sheet.

2. Budget Proposals Impacting Delivery System Transformation

Equity and Practice Transformation Payments[vi]: The Budget Act includes $700 million TF ($350 million GF), available through June 20, 2027, for equity and practice transformation payments to qualifying Medi-Cal providers with the goals of closing equity gaps, promoting value-based care, addressing gaps in preventative, maternity, and behavioral health care measures, and gaps in care due to the COVID-19 pandemic. Of these funds, $140 million TF ($70 million GF) are available for Medi-Cal managed care plans or providers in FY 2022-23.

Behavioral Health Bridge Housing Program[vii]: The Budget Act includes funding for behavioral health bridge housing, totaling $1.5 billion GF ($1 billion in FY 2022-23 and $500 million in FY 2023-24), to address the immediate housing and treatment needs of people experiencing unsheltered homelessness with serious behavioral health conditions by providing time-limited operational supports in various bridge housing settings.

California Advancing and Innovating Medi-Cal (CalAIM) Initiative[viii]: The Budget Act includes $3.1 billion TF ($1.2 billion GF) in FY 2022-23 and an estimated $1.9 billion TF ($698.5 million GF) in FY 2024-25 to continue the implementation of the CalAIM initiative.

Medi-Cal Community-Based Mobile Crisis Intervention Services[ix]: The Budget Act includes $1.4 billion TF ($335 million GF) over five-years to add qualifying community-based mobile crisis intervention services no sooner than January 1, 2023, as a Medi-Cal covered benefit through the Medi-Cal behavioral health delivery system.

9-8-8 National Suicide Prevention Lifeline Augmentation[x]: The Budget Act allocates $8 million one-time GF to support the capacity of call centers to launch and operate the 9-8-8 National Suicide Prevention Lifeline, effective July 16, 2022.

Community Assistance, Recovery and Empowerment (CARE) Court[xi]: The Budget Act allocates $64.7 million GF in FY 2022-23 and roughly $49 million GF ongoing for DHCS, the Judicial Branch, and the Department of Aging to administer CARE Court, contingent on adoption of statutory changes. The Administration continues to work with Judicial Council and counties to estimate costs associated with this new court process.

3. Budget Investments to Advance the Future of Health

CalRX Biosimilar Insulin Initiative[xii]: The Budget Act includes $100.7 million GF in FY 2022-23 and $700,000 GF annually between FY 2023-24 and FY 2025-26 to develop low-cost insulin products, including $50 million for the development of low-cost interchangeable biosimilar insulin products, $50 million for a California-based insulin manufacturing facility, and $700,000 ($2.8 million over four years) for state operations to fulfill requirements of the contract partnership, including monitoring, oversight, and legal compliance.

Health Care Workforce Investments[xiii]: The Budget Act includes $1.06 billion TF one-time ($1.05 billion GF) over three years to HCAI to strengthen and expand the state’s health and human services workforce, including nurses, community health workers, and the behavioral health workforce.

Office of Health Care Affordability[xiv]: The Budget Act includes a reappropriation of $30 million GF from the 2021 Budget Act to create the Office of Health Care Affordability within HCAI with the intent of increasing price transparency, developing specific cost targets for different sectors of the health care industry, and imposing financial consequences for entities that fail to meet the targets. The Budget Act also includes $13 million GF in FY 2022-23, $31.6 million GF in FY 2024-25, and $31.5 million GF in FY 2025-26 and annually thereafter to support implementations activities of the Office of Health Care Affordability.

Public Health Funding[xv]: The Budget Act includes an additional $1.8 billion to implement California’s SMARTER plan to continue addressing the evolving conditions of the COVID-19 virus and allow the state to be prepared to mitigate the effects of the ongoing public health concern into the future. This funding includes proposals for staffing, testing, vaccinations, future therapeutics, and more.

Income-Based Tax Rebates[xvi]: The Budget Act includes a $9.5 billion broad-based relief package to provide over 17 million California families a one-time refund of up to $1,050 to individual filers earning up to $250,000 and joint filers earning up to $500,000 with adjustments for certain conditions.

Key Government Resources

Below, we’ve provided key places to find both summary level and detailed information on the state budget

Administration/Executive Branch Resources:

A. 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. Administration/DOF Health and Human Services Budget Summary: This is the summary for the Health and Human Services programs in the budget. There are also summary charts for the entire budget, as well as a few 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 much more detail available in individual departments’ budgets, also located on the DOF ebudget.ca.gov webpage.

  Legislative Resources:

A. Legislative Analyst’s Office (LAO) The 2022-23 Budget: Overview of the Spending Plan

B. Assembly Committee on Budget

1. Subcommittee #1 on Health and Human Services

C. Senate Committee on Budget and Fiscal Review

2. Subcommittee #3 on Health and Human Services

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References:

[i] Department of Health Care Services, 2022-23 Budget Act Highlights, July 2022.

[ii] Department of Finance, Enacted Budget Health and Human Services Summary, July 2022.

[iii] Department of Finance, Enacted Budget Health and Human Services Summary, July 2022.

[iv] Department of Finance, Enacted Budget Health and Human Services Summary, July 2022.

[v] Department of Finance, Enacted Budget Health and Human Services Summary, July 2022.

[vi] Department of Finance, Enacted Budget Health and Human Services Summary, July 2022.

[vii] Department of Health Care Services, 2022-23 Budget Act Highlights, July 2022.

[viii] Department of Finance, Enacted Budget Health and Human Services Summary, July 2022.

[ix] Department of Finance, Enacted Budget Health and Human Services Summary, July 2022.

[x] Department of Finance, Enacted Budget Health and Human Services Summary, July 2022.

[xi] Department of Finance, Enacted Budget Health and Human Services Summary, July 2022.

[xii] Department of Finance, Enacted Budget Health and Human Services Summary, July 2022.

[xiii] Department of Finance, Enacted Budget Health and Human Services Summary, July 2022.

[xiv] Department of Finance, Enacted Budget Health and Human Services Summary, July 2022.

[xv] Department of Finance, Enacted Budget Health and Human Services Summary, July 2022.

[xvi] Department of Finance, Broad-Based Relief, July 2022.