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March 15, 2005 - The Medicare Prescription Drug, Improvement and Modernization Act, also referred to as the Medicare Modernization Act (MMA) makes significant changes to the federal Medicare program. The implementation of the Medicare drug benefit component of MMA, known as Part D, is likely to cause significant net financial losses to the state for years and have other major programmatic impacts on Medi-Cal. We recommend some limited actions and strategies the Legislature can take to address these potential problems.
March 9, 2005 - Presented to Assembly Budget Subcommittee No. 1
February 24, 2005 - Index of Information Technology Issues in the Analysis of the Budget Bill, 2005-06
February 24, 2005 - We recommend the Legislature approve the Governor’s budget proposal for Proposition 99-funded programs, which shifts allocations of tobacco tax revenues to maximize resources for health programs and achieve General Fund savings. We further recommend that the Legislature begin this year to address the long-term issues posed by the present structure of Proposition 99.
February 24, 2005 - Our analysis finds that the way the state sets rates for vendors who provide community services for the developmentally disabled on the whole lacks a rational and consistent approach. We review how rates are set for these services and offer an improved and systematic approach that could achieve significant state savings.
February 24, 2005 - The state’s hospital system continues to face a variety of fiscal challenges that weigh particularly heavily on public hospitals. The administration is negotiating with the federal government for a comprehensive redesign of hospital financing as part of its Medi-Cal redesign package. Our review of the plan now under development suggests that it could help preserve the financial stability of public hospitals but also raises some significant fiscal and policy issues.
February 24, 2005 - The seven-part administration redesign proposal would result in broad changes in Medi-Cal managed care as well as some more limited changes in benefits, cost-sharing, and eligibility administration. Overall, we find that the Governor’s proposals are conceptually sound but that the Legislature needs more information about some aspects of the package and that some refinements are warranted.
February 24, 2005 - The Governor proposes a number of significant reforms to California’s subsidized child care system including eligibility restrictions, a new waiting list system, and tiered reimbursement rates. With certain qualifications, we support proposed eligibility and waiting list changes. Although tying reimbursement rates to quality makes sense, the Legislature may wish to consider alternative approaches which increase reimbursement rates for higher quality care rather than simply reducing reimbursement rates (as the Governor proposes) for lower quality care.
February 24, 2005 - The Governor proposes to lower the grants for all working CalWORKs recipients, by reducing the amount of earned income which is disregarded (not counted) when determining a family’s grant. This proposal results in savings of $80 million and is likely to have minimal impact on the work incentive. We present alternative approaches which are likely to increase the work incentive but result in less budgetary savings.
February 24, 2005 - In 2000, a legislatively mandated study found that it was difficult for social workers to provide services or maintain meaningful contact with children and their families because of the excessive numbers of cases they were expected to carry. Our analysis indicates California now meets or is approaching the three of the five workload standards in child welfare services.
February 24, 2005 - The Governor proposes to consolidate the state’s two largest data centers into the Department of Technology Services. A consolidated data center should ultimately result in improved services and reduced costs. A number of specific components of the proposal, however, would preempt the Legislature’s appropriation and oversight roles. For instance, the department’s expenditures would be controlled by administration officials outside the purview of the Legislature. Consequently, we recommend that the Legislature approve the consolidation but modify some key components.
February 24, 2005 - The state lacks a unified strategic approach to homeland security. The Office of Homeland Security and the Department of Health Services have not sufficiently coordinated their efforts. We make a number of recommendations to address these problems, including the development of a strategic plan and annual expenditure report.
February 23, 2005 - Presented to Senate Budget and Fiscal Review Subcommittee No. 3
February 17, 2005 - State agencies purchase about $4.2 billion annually in prescription and nonprescription drugs as part of their responsibilities to deliver health care services to their program recipients. Our review—which focused on 10 percent of these purchases—found several deficiencies in the state's procurement of drugs which lead to it paying higher costs than necessary. We make a number of recommendations to correct these procurement and administrative deficiencies which would, if implemented, generate savings totaling tens of millions of dollars annually.