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LAO 2001-01 Budget Analysis: Health and Social Services Issue-By-Issue TOC Analysis of the 2001-02 Budget Bill
Health and Social Services Issue-By-Issue Contents

Overview

Expenditure Proposal and Trends

Caseload Trends

Spending by Major Program

Major Budget Changes

Crosscutting Issues

Health Insurance Portability and Accountability Act (HIPAA)

The Governor's Budget Provides Funding for Compliance With Federal Law

Background

Organizational Challenges Posed by HIPAA

Major Fiscal Issues

What Is the State Currently Doing?

Weaknesses in the Administration's Approach

Recommendations to Improve Legislative Oversight of HIPAA Activities

Implementation of Proposition 36

Background

Issues, Challenges, and Opportunities

Initial Implementation Actions

Proposition 36 Budget Issues

Budget Actions in DADP and CDC

Funding Options For Implementing Proposition 36

Conclusion

California Spending on Long-Term Care Services

Summary of Spending and Caseloads

Background

Characteristics of Long-Term Care

Delivery of Long-Term Care Services

Long-Term Care Expenditures and Caseloads

Long-Term Care Spending Is Increasing

Coordination of Long-Term Care Services

Long-Term Care Budget Issues

Summary of the Governor's 2001-02 Proposals

Evaluating the Governor's Long-Term Care Proposals

State May Be Eligible for Federal Grants to Fund New Projects

Staffing Level of New Nursing Home Complaint Unit Not Justified

New Tobacco Settlement Fund

Tobacco Settlement Funds Earmarked for Health Programs

Tobacco Settlement Fund Not A Reliable Long-Term Funding Stream

Child Health and Disability Prevention Program

Program Fails as Gateway to Affordable Health Care

Background

The LAO Findings

Recommendations for Improving the CHDP Gateway

Conclusion

 Departmental Issues

California Medical Assistance Program (Medi-Cal) (4260)

Medi-Cal Benefits and Eligibility

What Benefits Does Medi-Cal Provide?

How Medi-Cal Works

Who Is Eligible for Medi-Cal?

Most Medi-Cal Spending Is For the Elderly or Disabled

Medi-Cal Expenditures

Rapid Spending Growth in the Current Year

$204 Million General Fund Deficiency in 2000-01

Budget-Year Expenditure Growth Significant

Medi-Cal Cost and Caseload Trends

Budget Forecasts Growing Caseloads, But Costs Drop Slightly

Overall Caseload Estimate Reasonable; One Component May Be Overestimated

Setting Medi-Cal Physician Rates—A More Rational Approach

Background

The Current Rate-Setting System

Reforming the Way Physician Rates Are Set

The Benefits of the LAO Approach

Other Issues

Los Angeles County Section 1115 Medicaid Demonstration Project

Medi-Cal Estimate Should Be Redesigned

Report Needed on Managed Care and Inpatient Rate Increases

Other Potential Rate Increases Not Included in the Budget

Antifraud Expansion Should Increase Savings

Public Health

Breast and Cervical Cancer Prevention and Treatment Act

Background

Options for Developing an Expanded Cancer Treatment Program

Options for Improving Cancer Screening Services

Conclusion

Tobacco Prevention Program Expansion

Background

Governor's Proposal Is Flawed

Managed Risk Medical Insurance Board (4280)

Healthy Families Program

Expansion of the Healthy Families Program to Parents

Background

California's Proposed SCHIP Waiver

Proposal Misses Opportunities to Improve Health Coverage

Options for Improving the SCHIP Expansion

Healthy Families Caseload Overestimated in the Budget Year

Department of Developmental Services (4300)

Community Services Program

Early Start Coordination Not Clear

Developmental Centers Program

Report on DC Restructuring Due

Administrative Issues

The DDS Proposal to Comply With Health Insurance Portability and Accountability Act (HIPAA)

Department of Mental Health (4440)

The EPSDT Program Costs Still Soaring

Background

Rising EPSDT Costs a Continuing Concern

State Could Take Steps to Address Rapid Growth in Program Costs

Conclusion

Community Services Program Issues

Realignment Revisited—An Evaluation of the1991 Experiment in State-County Relations

Report on Treatment Resources for Out-of-Home Placements Overdue

Institutions for Mental Diseases (IMDs) Project Could Be Funded With Federal Grant

State Hospital Issues

Other Funding Available for ADA Projects

Security and Alarm Proposal

Administrative Issues

Health Insurance Portability and Accountability Act (HIPAA)

Employment Development Department (5100)

Disability Insurance Tax Rate Now Complies With Current Law

Unemployment Insurance Benefits in California

Federal Welfare-to-Work Block Grant Program

Legislature Needs Spending Plan for Discretionary WIA Funds

National Emergency Grant Program

Department of Child Support Services (5175)

Total Automation Penalties Could Reach $1 Billion

Child Support Automation Penalties Overbudgeted

Child Support Automation Proposal Lacks Detail

Pre-Statewide Interim Systems Management (PRISM)

Permanent Positions Are Needed to Support Child Support Automation Activities

Department of Social Services State Operations (5180)

Department Should Develop eGovernment Plan

Department of Social Services CalWORKs Program

Caseload Decline Slowing

Budget Underestimates Cost of Providing Statutory Cost-of-Living Adjustment

Impact of MOE Requirement

Budget Proposes Reductions in County Performance Incentives

Proposal for Current-Year MOE Reduction Savings Should Be Incorporated Into 2001-02 Budget Process

Advance Drawdown of TANF Funds May Not Comply with Federal Law

Mental Health and Substance Abuse Spending Below Appropriations

Child Care Shortfall

Welfare-to-Work Match Deadline Extended

Welfare-to-Work Funds Should Be Incorporated Into County Budgeting Process

Over Half of Single-Parent Adults Will Reach Federal Time Limit in 2001-02

Legislative Oversight: Cal-Learn Final Report Overdue

Increase County Flexibility to Assist Working Recipients

Foster Care

Foster Care Length of Stay

Permanency for Foster Youth

Children Remain in FFA Placements Twice as Long as Other Placements

The FFA Placements Are the Fastest Growing Component of Foster Care

Reducing Children's Time in FFA Placements

Other Issues

Office of the Ombudsman for Foster Care

Budget Underestimates Foster Care COLA

Food Stamps Program

California Food Assistance Program

Recent Federal Changes Create Options

The Vehicle Asset Test

The Alternative Vehicle Allowance

The Transitional Benefit Alternative

Analyst's Recommendation

Electronic Benefits Transfer

Delays May Result in Federal Penalty

Supplemental Security Income/State Supplementary Program

Budget Underestimates Cost of Providing Statutory COLA

Supplemental Security Income/State Supplementary Program Grant Levels

Certain Legal Immigrants Face Benefit Termination

In-Home Supportive Services

Wage and Benefit Increases for Certain IHSS Workers

Budget Does Not Reflect Likely Savings

Child Welfare Services

Improving CWS Through Structured Decision Making

Background

Research Indicates SDM Improves Outcomes

California SDM Implementation Challenges

Analyst's Recommendations for Expanding SDM in California

Conclusion

The CWS/CMS Needs Strategic Plan