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September 2017 Advocacy Update - The Maddy Fund: Chapter Advocacy at the Lo
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11/22/2017 at 7:27:38 PM GMT
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September 2017 Advocacy Update - The Maddy Fund: Chapter Advocacy at the Lo

The Maddy Fund: Chapter Advocacy at the Local Level

By Elena Lopez-Gusman & Kelsey McQuaid-Craig, MPA


Typically when we write about the Chapter’s advocacy efforts, we talk about actions taken in the legislative arena, but we also advocate at the local level.

Over the years, California ACEP has dedicated advocacy resources to establishing and renewing the Maddy Emergency Medical Services Fund (Maddy Fund). These efforts continue outside of the Legislature and into your communities.


The Maddy Fund was established to reimburse providers, hospitals, and emergency medical services for uncompensated care. Funding of the Maddy Fund was initially provided through the passage of SB 12 (Maddy). The law permits counties to levy an additional penalty upon every fine, penalty, or forfeiture imposed and collected by the courts in violation of the Vehicle Code. Each county may elect to assess up to $2 per $10 in fines, penalties, or forfeitures for purposes of supporting emergency medical services. This portion of the fund has no sunset date, however counties who did not elect to create a Maddy Fund under this authorizing statute prior to 1991 are no longer eligible to do so. Approximately $50 million is generated throughout the state annually by the 49 counties who have implemented this portion of the Maddy Fund.


The passage of SB 1773 (Alarcón) in 2006 enacted Government Code §76000.5 to allow county boards of supervisors to levy an additional penalty of $2 for every $10 upon every fine, penalty, or forfeiture imposed and collected by the courts involving a violation of the Vehicle Code. SB 1773 (Alarcón) also allocated 15% of the funds collected for pediatric trauma care – known as “Richie’s Fund”. Richie’s Fund is the only source of funding for pediatric trauma. The SB 1773 portion of the Maddy Fund was reauthorized in 2016 and will sunset on January 1, 2027, unless continued by the Legislature by passage of future legislation. Approximately $50 million is generated annually by this portion of the Maddy Fund. Over 30 counties have implemented this portion of the Maddy Fund – some of which have implemented both portions of the fund, others who have only implemented this provision.

As you well know, despite the implementation of the Affordable Care Act (ACA), visits to the ED are up, and millions of Californians remain uninsured. Millions more remain underinsured by Medi-Cal, making it difficult to adequately finance the emergency care system. The Maddy Fund is critical to maintaining access to quality emergency care for all Californians.


SB 612 enacted Health and Safety Code Section 1797.98a which specifies a maximum 10% of these revenues can be used for administration of the funds by the counties. 


The remaining 90% is allocated as follows:

  • 58% to physicians who provide emergency services and care to patients who have no insurance coverage or who are unable to pay for their emergency care including the undocumented;
  • 25% to hospitals providing disproportionate trauma and emergency medical services;
  • 17% to counties for EMS purposes as determined by the county.

SB 1773 also specifies that by law a maximum 10% of these revenues can be used for administration of funds. An additional 15% is dedicated to pediatric trauma care. The remaining 75% is then distributed as above (58% to physicians, 25% to hospitals, 17% to local EMS).


California ACEP was recently successful in convincing the Sacramento County Board of Supervisors to implement the SB 1773 portion of the Maddy Fund. We’ve engaged in discussions with Sacramento County for over 10 years, but were recently successful due to a change in county leadership, clarification by the State Controller about how fines and penalties are distributed, and the continued persistence of local emergency physicians, like Dr. Doug Brosnan.

In July 2017, the Sacramento County Board of Supervisors voted to implement the second half of the Maddy Fund. The Courts have asked to delay implementation until January 2018 to better align with a software update they are currently undergoing. Based on historical data, we are hopeful that the Board’s action will result in additional Maddy Fund revenues in excess of $2 million. This will be a major investment in Sacramento’s emergency care safety net!

In late August, a Chapter member approached us for help implementing the Maddy Fund in Imperial County. Imperial County has one of the highest uninsured rates in the state and, unlike neighboring counties, has not implemented the Maddy Fund. We’ve just started participating in discussions with stakeholders and are committed to our advocacy efforts…for however long it takes.

Additionally, we’ve noticed a vast variation in how much money counties collect and how much is disbursed to physicians, hospitals, and emergency medical services. We are comparing historical data to get a better understanding of counties’ behavior and policies and, if we discover that these variations are as a result of something improper, we will be engaging in more local advocacy to ensure that these dollars go to their intended recipients and strengthen the emergency care system.

Ultimately, the key to strengthening the Maddy Fund is our partnership with you. If you notice changes to your reimbursement, or think that the county isn’t  paying out its full share, please let the Chapter office know. We’ll work with you to ensure that Maddy Funds are being spent on their intended purpose.

Similarly, if you’re in a county that has not fully implemented both portions of the Maddy Fund, let us know. We’re here to help you establish these funds. Despite the implementation of the ACA, California still has millions of uninsured residents and that will only get worse if Congress repeals or alters Medicaid expansion under the ACA.

With leadership and help from Drs. Perlroth, Fenton, Pao, Jones, Richard, Ludlow, and Sugarman, California ACEP is currently working on a tool kit to help our members hold their county accountable and fully establish the Maddy Fund. We will be announcing more details about the release of the toolkit in the months to come. 

If you have any questions, please contact us at or by calling the Chapter office at (916) 325- 5455.

Kelsey McQuaid-Craig, MPA
Director of Policy and Programs
California ACEP

 Attached Files: 

Last edited Thursday, January 4, 2018
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