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May 17, 2017 - In this Budget and Policy Post, we provide an overview of several of the key factors driving the changes in estimated and proposed Medi-Cal spending in 2016-17 and 2017-18; our evaluation of the Governor’s updated caseload estimates; and an update on several key proposals from the January budget, some of which have been modified at May Revision. During continuing budget deliberations, we recommend that the Legislature ask for clarity from the Department of Health Care Services on how the Major Risk Medical Insurance Program will be funded in the future under the Governor’s proposal if Health Care Services Plans and Penalties Fund revenues are insufficient to cover the costs of the program. We also recommend that the Legislature, should it approve the Governor’s plan to cancel the planned transition of Newly Qualified Immigrants from Medi-Cal to Covered California, consider trailer bill language that repeals existing state statutory language that calls for the transition. Finally, we recommended a downward technical adjustment of $62 million General Fund to the 2017-18 May Medi-Cal Estimate.
May 16, 2017 - Rather than return to the original 1991 realignment cost-sharing ratios for In-Home Supportive Services (IHSS) as initiated by the Governor in January (described in our report: The Coordinated Care Initiative: A Critical Juncture), the administration proposes establishing a new Maintenance of Effort (MOE) for counties’ share of IHSS cost. The new MOE would include both services and administration using 2017-18 costs. The new MOE would significantly increase costs to counties in 2017-18 relative to 2016-17. While the MOE shifts significant costs to counties, the proposal provides state General Fund support and additional realignment revenue to partially offset this increase. In this analysis, we lay out the various components of this complex proposal. We also raise key questions for Legislative consideration and provide our recommendation for how to move forward.
March 22, 2017 - Presented to: Assembly Budget Subcommittee No. 1 on Health and Human Services and Assembly Health Committee
March 22, 2017 - Presented to Assembly Budget Subcommittee No. 1 On Health and Human Services and Assembly Health Committee
March 9, 2017 - In California, the federal‑state Medicaid program is administered by the Department of Health Care Services (DHCS) as the California Medical Assistance Program (Medi‑Cal). Medi‑Cal is by far the largest state‑administered health services program in terms of annual caseload and expenditures. In this report, we provide an analysis of the administration’s caseload projections, including a discussion of the projected increases in ACA optional expansion caseload. We also provide an assessment of several aforementioned major factors affecting projected changes in Medi‑Cal spending in 2017‑18 and other policy changes proposed by the administration. These include the Governor’s proposed uses of Proposition 56 revenues, the proposal to shift additional New Qualified Immigrants (NQIs) to Covered California in 2017‑18, assumptions around federal CHIP funding, and the proposed abolition and transfer of the Major Risk Medical Insurance Fund (MRMIF).
February 27, 2017 - In this report we provide (1) background on the health care and Long‑Term Services and Supports (LTSS) issues that the Coordinated Care Initiative (CCI) was intended to address, (2) an update on the CCI’s results and challenges to date, (3) an assessment of the Governor’s elimination of the CCI and budget proposal to extend certain CCI components, and (4) options for the Legislature on how to move forward. As ending the In‑Home Supportive Services (IHSS) has major, and rather complex, implications for 1991 realignment, we include a technical appendix at the end of this report that provides an in‑depth analysis of these implications.
February 24, 2017 - In this report, we discuss the Governor’s budget proposals for Department of Developmental Services (DDS), providing our assessment of the budget package for DDS and analyzing one of the proposed trailer bills, which we find raises a number of issues. Also in this report, we describe the general nature of shifts in both policy and practice in the field of developmental services, detailing the relevant state and federal policies and their implications for the future developmental services program in the state, and discussing issues for the Legislature to consider as DDS implements these changes.
February 22, 2017 - Assembly Budget Subcommittee No. 1 on Health and Human Services
February 22, 2017 - Proposition 56 was approved by voters in November 2016 to increase taxes on cigarettes and other tobacco products. Questions have been raised as to whether the Governor’s proposals for allocating Proposition 56 revenues meet the initiative’s requirement to supplement—and not supplant—existing spending in several areas. To examine these questions, we begin by reviewing the provisions of Proposition 56 and the Governor’s budget proposals. We then discuss whether the Governor’s proposals for Medi‑Cal could be viewed as supplanting General Fund resources and identify the relevant case law. We conclude by describing some trade‑offs for the Legislature to consider in allocating the Proposition 56 revenues.
February 17, 2017 - Summarizes the major impacts that the ACA has had in California, explores what the ACA’s repeal could mean for the state, and assesses a collection of policy alternatives to the ACA that the new federal administration and Congress are currently considering.
Correction 3/6/17: Removed reference to Alpine County as having only one participating insurer.
November 28, 2016 - This report presents the results of our projections to inform the Legislature and stakeholders about levels of disability and the potential need for long–term supports and services (LTSS) among California’s seniors over the next several decades. These projections provide a useful starting point in understanding how California’s changing population demographics will impact the LTSS delivery system. The results presented in this report can also be built upon with further analysis focused on utilization and financing of LTSS over the long term.
A companion video and infographic highlight key findings from the report.
June 14, 2016 - Presented to: Assembly Health Committee Assembly Revenue and Taxation Committee Senate Health Committee
May 25, 2016 - Presented to: Assembly Health Committee and Senate Health Committee
May 10, 2016 - Presented to: Assembly Health Committee and Senate Health Committee
March 4, 2016 - The Governor’s 2016-17 budget proposes $3.8 billion from the General Fund for Department of Developmental Services (DDS) programs—a 7.5 percent increase over 2015-16 estimated expenditures. This report focuses on the Governor's major policy-driven spending augmentations in the community services program. This report also summarizes legislation enacted as part of the recent special session that provides significant additional funding to the community services program and considers the Governor’s January proposals in this context.