In order to better use community service as a bridge to nonsubsidized employment, allow counties to use private for-profit organizations as community service employers.
California Work Opportunity and Responsibility to Kids (CalWORKs) recipients must begin community service after two years on aid if they have not found a job. Under current law, such community service must be performed in the public and private nonprofit sectors. Excluding the for-profit private sector from participating in community service employment, however, (1) significantly reduces the number of potential employers and (2) increases the difficulty of finding high-quality work slots, particularly in jobs that might closely resemble those in the private sector.
Please see CalWORKs Community Service, What Does It Mean for California? February 1999, page 18.
Lisa Folberg: 319-8358
Set payment levels at amounts that recognize the adoptive parents' financial responsibility for their adoptive children and better tie benefit levels to the needs of adoptive children.
The current Adoptions Assistance Program (AAP) provides the maximum foster care grant for virtually every child who is adopted from the foster care program, including children who could be placed in an adoptive home without financial incentives. This policy has turned AAP into one of the fastest growing social services programs in terms of caseload and cost. To remedy this situation, the AAP benefits should be limited to those children who would truly be hard to place without ongoing financial assistance. Following placement, the level of AAP benefits should be tied to the needs of the child. This approach to adoptions assistance payments would recognize that adoptive parents take on the same responsibilities as parents who give birth to their own children (including financial responsibility). Many people become foster parents as a route to adoption. Therefore, the "incentive" provided by AAP may be unnecessary for many families.
Please see Reforming the Adoptions Assistance Program in our 2004-05 Analysis, page C-255.
Julie Salley-Gray: 319-8352
Establish a state-funded voluntary matching grant program for (1) early childhood programs that have been shown to be cost-effective and/or (2) demonstration programs that are potentially cost-effective, based on existing research.
Proposition 10 provides county commissions with a significant increase in funding for programs related to early childhood development. The Legislature has no direct control over the expenditure of Proposition 10 funds, but does have an opportunity to influence decisions taken by the state and, more importantly, the county commissions. A variety of early childhood programs, typically small-scale demonstration programs, have been evaluated as being effective according to outcome measures such as school achievement and health status. Enacting a matching grant program would create a fiscal incentive to encourage the county commissions to use their funds in a cost-effective manner.
Please see Proposition 10: How Does It Work? What Role Should the Legislature Play in Its Implementation? January 1999.
Julie Salley-Gray: 319-8352
Enact legislation to improve the existing realignment arrangements and consider expanding realignment to additional state programs.
In 1991, the state enacted a major change in the state and local government relationship, known as realignment. Mental health, social services, and health program were transferred from the state to county control, and counties were provided with dedicated tax revenues to pay for these and other changes. Our analysis found that realignment has been a largely successful experiment, but that some aspects could be improved. Our analysis has also identified additional state programs that merit consideration for realignment. Under the California Constitution, as recently amended by Proposition 1A, the transfer of additional program responsibility to local government would have to be accompanied by commensurate offsetting revenues or program savings.
Please see Realignment Revisited: An Evaluation of the 1991 Experiment in State-County Relations, February 2001 and The 2003-04 Budget: Perspectives and Issues, Realignment and the 2003-04 Budget, page 123.
Todd Bland: 319-8353, Dan Carson: 319-8350, and Marianne O'Malley: 319-8315
Enact legislation directing the Department of Health Services to prepare and implement a plan to gradually shift certain aged and disabled Medi-Cal beneficiaries (in counties where Medi-Cal health plans already exist) into managed care.
Today, the Medi-Cal Program offers a paradox: aged and disabled beneficiaries who would benefit the most from the improved health care that can come from receiving the coordinated care offered by managed care have largely been excluded from the Medi-Cal managed care program. To improve health care for this group and reduce annual Medi-Cal expenditures by an estimated $100 million in 2007-08, about 330,000 aged or disabled persons could be shifted from the fee-for-service system to Medi-Cal managed care. The aged and disabled represent one of the most costly groups, in terms of health care, for whom the state has the greatest opportunity for containing Medi-Cal expenditures. However, the aged and disabled have not been targeted for managed care programs.
Please see Better Care Reduces Health Care Costs for Aged and Disabled Persons, March 2004.
Shawn Martin: 319-8362 and Farra Bracht: 319-8355
Enact legislation that would require the Department of Health Services to implement measures to control increasing costs and preserve General Fund resources in the California Children's Services (CCS) program.
The CCS program provides medical treatment and therapy services to eligible children and young adults under 21 years of age with certain debilitating medical conditions or major traumatic injuries. Our analysis, Missed Opportunities for General Fund Savings in the CCS Program, indicates that CCS caseload and costs are continuing to rise. Our review emphasizes the need to evaluate cost control measures, or to slow the further increase in these costs in ways that will not undercut the provision of health care for some of the state's most medically fragile children. Our analysis also indicates that, in a number of ways, the state is not taking full advantage of available federal funds to support the program. We propose specific steps to improve the operation of CCS that could free-up General Fund resources.
Please see our 2003-04 Analysis, page C-20.
Celia Pedroza: 319-8354
Enact legislation directing the Department of Health Services to adopt a broader definition of the services that can be provided by Intermediate Care Facilities for the Developmentally Disabled (ICF/DDs) and modify the ICF/DD rate structure accordingly.
Our analysis indicates that the state has the option of drawing down additional federal funds of up to $50 million annually within a few years to offset the state costs of services provided to residents of ICF/DDs. Federal regulations allow for a broad definition of the services that can be provided in ICF/DDs with reimbursement under the Medi-Cal program. Other states have been successful in defining their ICF/DD programs more broadly than California to cover the services and support for clients with developmental disabilities, thereby increasing their federal reimbursement under Medicaid.
Please see our 2004-05 Analysis, pages C-185 and C-186.
Shawn Martin: 319-8362
Enact legislation to encourage HMOs to return to rural areas and to foster locally controlled health care systems in those counties where HMOs may be unwilling or unable to operate.
Chapter 208, Statutes of 2001 (AB 532, Cogdill), directed our office to examine the reasons why a number of HMOs have discontinued operations in rural areas, and further directed us to offer recommendations to address this situation. Our report, HMOs and Rural California, provided the Legislature with a number of options to restore managed care to rural California. Our analysis indicates that HMOs are withdrawing coverage because of a combination of circumstances that makes it difficult for them to operate profitably, including shortages of health care providers, differences in rural medical practices, and the state's lack of support for managed care in rural areas. We propose specific steps to create a more attractive health care marketplace for HMOs in rural counties. We also identify ways the state can help communities that may not be able to attract HMOs to develop their own health care systems that may provide some of the potential benefits of managed care.
Please see HMOs and Rural California, August 2002.
Celia Pedroza: 319-8354
Reinstate statutory language that clarifies that parents of children with developmental disabilities, and not state taxpayers, should be financially responsible for the purchase of goods and services that would normally be purchased by the parents of a child without developmental disabilities.
The Lanterman Act states the intent of the Legislature to ensure the provision of services to developmentally disabled individuals and their families. Services and supports may include, but are not limited to, more than 20 specific services that are listed in the Lanterman Act. However, the Lanterman Act is not as specific regarding which services, if any, the state is not responsible for providing to developmentally disabled individuals. At one time, state law was clear that the state is not obligated to pay for services for a client that parents would typically be responsible for purchasing for any children. This statutory language was allowed to sunset in 2002.
Please see our 2004-05 Analysis, pages C-184 and C-185.
Shawn Martin: 319-8362
Enact legislation allowing the Department of Mental Health (DMH) to contract with the Department of Corrections (CDC) for the supervision of sexually violent predators (SVPs) who have been released into the community.
In 2003, the state experienced the first court-approved releases to the community of individuals deemed to be SVPs who had been committed and treated in state mental hospitals. The DMH arranged for supervision and treatment of SVPs through a contract with a private vendor after a number of counties had declined to provide these services in the community. Our analysis of the budget requests to implement this new contract indicated that SVP supervision could be provided by the state at a much lower cost and with greater public safety if DMH instead entered into an interagency agreement with CDC to use its existing system of parole agents to provide these same services.
May 2003 letter to the Joint Legislative Budget Committee.
Dan Carson: 319-8350
Enact legislation that would shift various state funding allocations for drug or alcohol treatment services to counties and contain methadone costs.
Our office was directed by the Supplemental Report of the
2002-03 Budget Act to conduct a review of the Drug Medi-Cal Program, which provides substance abuse treatment services for an estimated 45,000 persons annually. Among other concerns, we found significant inconsistencies in the resources being provided to support different modes of treatment, and that a disproportionately small share of the program budget was spent on services for children and female beneficiaries.
We recommended a series of actions to remodel the program to provide counties with broad new authority under a new financial structure to decide the modes of treatment provided within their jurisdiction and to determine exactly how such services would be provided. We further recommended that the state take over direct responsibility statewide for the provision of narcotic treatment services as part of a strategy to help contain the fast-rising costs of methadone maintenance treatment.
Please see Remodeling the Drug
Dan Carson: 319-8350
Enact legislation directing the Office of Statewide Health Planning and Development (OSHPD) to review statewide hospital bed occupancy rates and determine, on a regional basis, if there is an undersupply or oversupply of hospital beds.
The availability of such information would help the Legislature to determine where there is a shortage or potential shortage of hospital beds and if state assistance is warranted to prevent the closure of hospitals needed to maintain access to services for Medi-Cal patients and the uninsured. In addition, if there is evidence of excess bed capacity in some areas of the state, OSHPD could use the occupancy rate data and financial information that it collects to identify opportunities for hospital consolidation.
Please see our 2002-03 Analysis, pages C-38 through C-47.
Farra Bracht: 319-8355
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