February 11, 2020 - The Governor’s budget proposes $2.3 billion for the Department of State Hospitals (DSH) in 2020‑21—an increase of $232 million (11 percent) from the revised 2019‑20 level. In this report, we assess three specific DSH proposals and offer recommendations for legislative consideration.
February 9, 2015 - This report examines the budget of the Department of State Hospitals (DSH), which provides inpatient mental health services to patients in DSH’s eight facilities. It provides an overview of the various components of the department’s budget, and details how the department develops its annual budget requests. The report finds several shortcomings with the current budgeting process. To address these, the report provides recommendations for the Legislature to consider.
February 22, 2017 - In this web post, we provide an overview of the Department of State Hospitals (DSH) and the level of funding proposed for the department in the Governor’s 2017-18 budget. We also assess and make recommendations on four specific DSH budget proposals: (1) a $250 million shift in inpatient psychiatric programs from DSH to the California Department of Corrections and Rehabilitation, (2) a $10.5 million proposal to activate 60 beds for Incompetent to Stand Trial patients in the Kern County Jail, (3) an $ 8 million dollar funding increase to staff units designed specifically for violent patients, and (4) a $6.2 million General Fund loan for DSH-Napa earthquake repairs.
March 1, 2012 - The Governor’s budget plan proposes to eliminate DMH and create a new Department of State Hospitals (DSH), shifting the remaining community mental health programs to various departments. This new structure would allow the administration to better focus on the fiscal and programmatic issues unique to state hospitals. In 2008-09, the Office of State Audits and Evaluations (OSAE) conducted an audit which outlined the problems state hospitals experienced, concluding that staffing did not adequately reflect hospital workload, funding was not sufficient for annual operating expenditures, and that state hospitals were not efficiently using their staff. Similarly in a 2011 self-audit, DMH found that many of the same problems from the 2008 audit remained. We concur with both audit teams’ assessments. In this brief report, therefore, we recommend an audit be conducted that looks at a number of issues, including state hospital budgeting practices, the fiscal controls being put in place, and the level of vacancies and their impact on the state budget and on hospital performance. We recommend this added oversight with respect to state hospitals should take place regardless of the Legislature’s decision on the creation of a new DSH.
February 12, 2015 - This report analyzes the Governor's 2015-16 state health program budget proposals. In the report, we review trends in the major health programs since 2007-08 (the last budget developed before the most recent recession), analyze the Governor's proposed restructuring of the managed care organization (MCO) tax, and describe the uncertainty regarding continued federal funding for the Children's Health Insurance Program (CHIP). The report also includes an analysis of the Department of State Hospitals budget and an analysis of the Governor's proposals to improve quality and increase staffing for the Licensing and Certification (L&C) Program administered by the Department of Public Health.
March 1, 2017 - In this web post, we provide an overview of the California Department of Corrections and Rehabilitation (CDCR) and the level of funding proposed for the department in the Governor's 2017-18 budget. We also assess and make recommendations on various CDCR budget proposals, including a $12.6 million proposed augmentation related to changes in the adult inmate and parolee populations. In addition, we assess and provide recommendations on three proposals related to inmate mental health care: a $250 million shift of inpatient psychiatric programs from the Department of State Hospitals to CDCR, an $11.4 million proposal to convert 74 existing outpatient mental health beds into inpatient psychiatric program beds, and a $112 million proposal to construct 100 additional Mental Health Crisis Beds. Finally, we assess and provide recommendations on five other CDCR proposals: an $11.7 million proposal to install video surveillance cameras, the delayed activation of an infill facility, a proposal to reduce the department’s budget by $8.3 million to reflect housing unit conversions and the reallocation of health care access staff, a $299,000 proposal to modify a fence at a minimum support facility, and proposed budget trailer legislation related to California Prison Industry Authority employee retiree health benefits.
January 5, 2017 - To increase capacity in its nursing programs during the nursing shortage in the late 1990's, the California State University (CSU) cited a need to increase the number of nursing faculty holding a doctoral degree (required for tenured/tenure-track positions) and expressed interest in establishing its own Doctor of Nursing Practice (DNP) program to prepare such faculty. In response, the state enacted Chapter 416 of 2010 which temporarily allows CSU to offer an independent DNP on a pilot basis. Related legislation requires our office to evaluate the pilot program and make a recommendation regarding its extension. For a variety of reasons, we recommend the Legislature allow the CSU DNP pilot to sunset.
February 27, 2013 - The Governor's budget proposes $28.3 billion in expenditures from the General Fund for health and human services programs in 2013-14. This reflects a 3.4 percent increase for health programs and a 7.9 percent increase for human services programs over 2012-13 estimated expenditures. For the most part, the year-over-year budget changes reflect caseload changes, technical budget adjustments, and the implementation of previously enacted policy changes, as opposed to new policy proposals. In the report, we find that the budget does not reflect the fiscal impact of the proposed Medi-Cal expansion, nor does it reflect potential costs and savings related to various other provisions of federal health care reform. We find that the Governor's Medi-Cal budget proposal assumes General Fund savings that are subject to significant uncertainty. We also provide a status update on the transition of the Healthy Families Program enrollees to Medi-Cal, finding that the transition is generally proceeding as planned, with some delays. We discuss problems in the operation of the state's Developmental Centers (DCs) by the Department of Developmental Services, and recommend that oversight of the DCs be strengthened by the creation of an independent Office of the Inspector General. We discuss the recent major program changes to the California Work Opportunity and Responsibility to Kids (CalWORKs) that are reflected in the budget, and recommend that the Legislature augment CalWORKs employment services funding--a Governor's budget proposal--to a level of funding it deems appropriate in light of its priorities for the program. We raise various fiscal and policy concerns about the Governor's budget assumption that a 20 percent across-the-board reduction in In-Home Supportive Services service hours will be implemented beginning on November 1, 2013. In light of these concerns, we recommend that the Legislature repeal the 20 percent reduction and instead continue a 3.6 percent across-the-board reduction that would otherwise sunset at the end of the 2012-13 fiscal year.