Amber Smith Didier
Subject Area Assignments
2013 Budget Recommendations
LAO Health Reports
Budget Analysis Issues
Health and Social Services
Long Term Care
Alcohol and Drugs
Rethinking PARIS Data Match: Connecting Veterans on Medi-Cal to Federal Benefits
(Aug 6, 2013)
Since 2009, the state has used a computer data matching process known as the Public Assistance Reporting Information System (PARIS) to identify certain military veterans who receive Medi-Cal services and may be able to voluntarily shift to health care services provided by the U.S. Department of Veterans Affairs (USDVA). We find that the fiscal and policy benefits from the state's current implementation of PARIS Veterans activities are limited, due to resource constraints and a problematic approach to outreach. We recommend that the Legislature provide additional resources to conduct a new pilot that tests a modified approach to PARIS Veterans outreach. We also find that the state has not pursued a major source of savings related to the PARIS Veterans match: counting a type of USDVA monetary benefit known as aid and attendance toward the costs of the In-Home Supportive Services program. We recommend that the Legislature require the administration to report on the rationale for current policies that prevent the state from realizing these savings.
Letter to Assembly Member Perea on the Potential Transfer of the Drinking Water Program (DWP)
(Jun 18, 2013)
Letter to the Honorable Henry T. Perea, Assembly Member, regarding the advantages and disadvantages of transferring the Drinking Water Program (DWP) from the Department of Public Health (DPH) to a newly created stand-alone entity under the California Environmental Protection Agency (Cal-EPA), as compared to transferring it to the State Water Resources Control Board (SWRCB).
The Safe Drinking Water State Revolving Fund and Drinking Water Program Governance
(May 15, 2013)
Presented to Senate Environmental Quality Committee
Letter to Honorable Bill Monning on Estimated Costs Related to Certain ACA Provisions
(May 1, 2013)
Letter to Honorable Bill Monning, Chair, Senate Subcommittee No. 3 on Health and Human Services, regarding the estimated costs related to provisions of the federal Patient Protection and Affordable Care Act (ACA) that will likely result in additional Medi-Cal enrollment from persons who are currently eligible for the program, but not enrolled.
Evaluating the Potential Transfer of Drinking Water Activities From DPH to SWRCB (Assembly Budget Subcomittee No. 1)
(Apr 15, 2013)
Presented to: Assembly Budget Subcomittee No. 1 on Health and Human Services
Evaluating the Potential Transfer of Drinking Water Activities From DPH to SWRCB (Assembly Environmental Safety and Toxic Materials Committee)
(Mar 18, 2013)
Presented to Assembly Environmental Safety and Toxic Materials Committee
Letter to the Honorable Bill Emmerson Regarding Bridge Plan
(Mar 18, 2013)
Letter to the Honorable Bill Emmerson Regarding Bridge Plan.
Letter to the Honorable Luis Alejo regarding SDWSRF
(Mar 13, 2013)
Letter to the Honorable Luis Alejo, Chair, Assembly Environmental Safety and Toxic Materials Committee, evaluating the administration and peformance of the Safe Drinking Water State Revolving Fund (SDWSRF).
The 2013-14 Budget: Analysis of the Health and Human Services Budget
(Feb 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.
The 2013-14 Budget: Coordinated Care Initiative Update
(Feb 27, 2013)
In 2012, the Legislature authorized the Coordinated Care Initiative (CCI) as an eight-county pilot to demonstrate the integration of Medi-Cal and Medicare benefits for "dual eligibles"--beneficiaries eligible for both benefits. The CCI will also integrate long-term services and supports (LTSS) under Medi-Cal managed care in the eight counties for dual eligibles and seniors and persons with disabilities covered only by Medi-Cal. The Governor's budget delays the start date of CCI implementation to September 1, 2013, resulting in lower 2013-14 savings than initially anticipated. Joint federal-state decisions regarding key financing and operational aspects of CCI are pending, creating uncertainty regarding the timely and successful implementation of CCI. We recommend that the Legislature clarify the legal status of CCI to go forward and consider authorizing CCI to test greater integration of In-Home Supportive Services--a particular LTSS--under managed care.
The 2013-14 Budget: Examining the State and County Roles in the Medi-Cal Expansion
(Feb 19, 2013)
Under the Patient Protection and Affordable Care Act, also known as federal health care reform, the state has the option to expand its Medicaid program (known as Medi-Cal) to cover over one million low-income adults who are currently ineligible. Currently counties have the fiscal and programmatic responsibility for the care of the low-income adult population that would be covered by the expansion. The Governor has proposed to adopt the optional expansion, but has outlined two distinct approaches to implementing the expansion—a state-based approach and a county-based approach—and has not indicated a preference for either approach. Under both approaches, the Governor indicates that the expansion will require a reassessment of the state-local fiscal relationship. We find that the expansion would have significant policy benefits, including improved health outcomes for the newly eligible Medi-Cal population. We estimate that fiscal savings to the state as a whole are likely to outweigh the cost of the expansion for at least a decade, although these estimates are subject to significant uncertainty. Despite the significant uncertainty about long-term costs and savings, on balance, we believe the policy merits of the expansion and fiscal benefits to the state as a whole likely will outweigh the costs and potential fiscal risks. We therefore recommend the state adopt the expansion. We also find that the state is in a better position to effectively deliver health services to the newly eligible population. Therefore, we recommend the Legislature adopt a state-based expansion, shifting the fiscal and programmatic responsibility of providing physical health care to the expansion population from counties to the state. Given this shift of responsibility, we further recommend the Legislature redirect a portion of funding currently allocated to counties under 1991 realignment for indigent health care.
Overview of Children's Dental Services in Medi-Cal and the Healthy Families Program
(Nov 9, 2012)
Presented to Assembly Budget Subcommittee No. 1 on Health and Human Services, Hon. Holly J. Mitchell, Chair
Funding and Oversight of State Developmental Centers
(Oct 23, 2012)
Senate Budget and Fiscal Review Subcommittee No. 3 on Health and Human Services, Hon. Mark DeSaulnier, Chair and Senate Human Services Committee, Hon. Carol Liu, Chair
Proposition 29: Imposes Additional Tax on Cigarettes for Cancer Research
(May 1, 2012)
Presented to: Assembly Health Committee, Hon. William W. Monning, Chair and Assembly Revenue and Taxation Committee, Hon. Henry T. Perea, Chair
Overview of Health Care Districts
(Apr 11, 2012)
Presented to Assembly Accountability and Administrative Review Committee, Hon. Roger Dickinson, Chair