Health and Human Services Publications

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Housing and Homelessness Funding Impacting Children

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March 25, 2019 - These materials were prepared for an informational hearing about housing challenges and their impact on the well-being of children by the Senate Select Committee on the Social Determinants of Children’s Well-Being.

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The 2019-20 Budget: The Governor's Proposal for a New Office of Digital Innovation

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March 22, 2019 - In this post, we describe the Governor’s 2019-20 budget proposal to create a new office within California’s Government Operations Agency—the Office of Digital Innovation. We then provide issues for legislative consideration, including key questions about the office’s implementation and legislative oversight of its activities.

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Older Youth Access to Foster Care

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March 22, 2019 - The Supplemental Report of the 2018-19 Budget Act directed our office to submit a report to the Legislature reviewing data on the reporting of child abuse or neglect incidents among children who are aged 14 to 17 compared to younger children. In this report, we (1) describe how the state’s Child Welfare Services (CWS) system processes child abuse and neglect reports, (2) discuss observed similarities and differences in reporting outcomes between older and younger youth based on available data, (3) specify limitations in our ability to come to definitive conclusions regarding the treatment of reports for older youth compared to younger youth in the CWS system based on available data, and (4) provide recommendations for the collection of additional data to better understand the potential reasons for differences in outcomes between older and younger youth accessing foster care and determine whether policy interventions are appropriate.

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The 2019-20 Budget: Aligning the State’s IT Project Approval Process With the Annual Budget Process

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March 14, 2019 - In this post, we describe how the California Department of Technology’s (CDT) information technology (IT) project approval process—known as the Project Approval Lifecycle (PAL)—does not always align with the state’s annual budget process. We identify seven funding requests in the Governor’s 2019-20 proposed budget for IT project proposals that are currently in various stages of the PAL process. We then describe how these requests for project funding prior to the completion of the PAL planning process may inhibit the Legislature from fully realizing the anticipated benefits of the PAL process, discuss how some project-specific factors can cause misalignment of the budget cycle and PAL, and provide issues for legislative consideration.

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The 2019-20 Budget: Assessing the Governor's 1991 Realignment Proposals

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March 8, 2019 - This report evaluates the changes the Governor proposes and assesses whether the changes better position 1991 realignment to achieve its intended benefits and meet the principles of a successful state-county fiscal partnership we identified in our October report.

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Considering Options to Expand Paid Family Leave in California

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March 7, 2019 - California's current paid family leave program, implemented in 2004, provides up to six weeks of partial wage replacement to workers who take time off to bond with a new child or care for an ill family member. In the 2019-20 Governor's Budget, the Governor included a conceptual proposal to expand paid family leave and make the program more flexible. In this handout, we describe the major features of the state's current paid family leave program and compare it to programs in other states and countries. We then outline potential options to expand paid family leave. Finally, we provide a preliminary assessment of the potential effects of such expansions.

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The 2019-20 Budget: Governor's Proposals for Infants and Toddlers With Special Needs

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February 28, 2019 - In this report, we evaluate three Governor's budget proposals related to early intervention services for infants and toddlers with special needs. These include: (1) $60 million ongoing (split between Proposition 56 tobacco tax revenues and federal Medicaid funding) to provide supplemental payments to physicians who screen children covered by Medi-Cal for developmental delays, (2) four new positions (at a cost of $446,000 General Fund) to increase state oversight of Regional Center early intervention services, and (3) possible forthcoming trailer bill language to improve transitions for children aging out of early intervention services and into preschool special education. We recommend rejecting the proposed supplemental payments and approving the other two proposals and further recommend the Legislature consider broader reforms to address longstanding weaknesses in the state's early intervention system.

Update (3/4/19): Figure 3 totals adjusted.

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Overview of Funding for Medi-Cal Mental Health Services

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February 26, 2019 - Presented to: Assembly Committee on Health and Senate Committee on Health

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The 2019-20 Budget: Analysis of the Department of Developmental Services Budget

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February 25, 2019 - In this report, we evaluate the Governor's budget proposals for the Department of Developmental Services (DDS). The proposed 2019-20 DDS budget is projected to reach $7.8 billion ($4.8 billion General Fund), with the caseload of individuals with developmental disabilities served mostly in community-based programs projected to reach nearly 350,000. The total increase in spending is offset somewhat by declining spending on general treatment Developmental Centers, which are scheduled to close by the end of 2019. The Governor's budget proposes to reorganize DDS, based in part on these closures as well as on DDS’ evolving responsibilities as it serves individuals in community settings and adjusts to meeting related upcoming federal requirements that significantly impact the service delivery model. The budget also proposes enhancement of "safety net" and crisis services for individuals in crisis and at risk of displacement from their regular homes or needing temporary residential placements.

Correction (3/6/19): Safety net and crisis home capacity numbers have been updated in Figure 4.

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The 2019-20 Budget: Using Proposition 56 Funding in Medi-Cal to Improve Access to Quality Care

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February 22, 2019 - This report analyzes the use of Proposition 56 (2016) funding in Medi‑Cal to improve access to quality care. First, we provide background on how Medi‑Cal services are financed within Medi‑Cal’s multiple delivery systems. Then, we review how access and quality are monitored, primarily within Medi‑Cal’s managed care delivery system. We summarize how Proposition 56 funding in Medi‑Cal has been used to date, and the changes proposed under the Governor’s 2019‑20 budget. Next, we assess Medi‑Cal managed care plans’ performance on selected state access and quality standards. Finally, we provide issues for consideration and recommendations on how to use Proposition 56 funding in Medi‑Cal going forward to improve access to quality care.

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The 2019-20 Budget: Proposition 56 Revenues: Reductions in Fixed Allocations

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February 14, 2019 - In this post, we review the administration’s reductions to certain allocations of Proposition 56 tobacco tax revenue. In our view, the administration’s approach for 2019-20 is reasonable. However, the administration has not yet decided how these adjustments will be determined in 2020-21 and beyond. These future choices could have substantial fiscal effects, and some would be more logically consistent with the administration’s current approach than others.

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The 2019-20 Budget: Analysis of the Medi-Cal Budget

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February 13, 2019 - In this report, we describe the major changes and proposals in the Governor's proposed $100.7 billion (all funds) Medi-Cal budget. Specifically, we advise the Legislature to seriously consider renewing the managed care organization tax, despite the Governor not proposing to do so; present issues for consideration related to the Governor's proposed expansion of comprehensive Medi-Cal coverage for young adults regardless of immigration status; and provide an initial assessment of the Governor's proposals to use Proposition 56 funding in Medi-Cal to extend and expand provider payment increases. We recommend approval of the Governor's proposals to improve fiscal oversight of the Medi-Cal budget, and also recommend that the Legislature require the administration provide additional information to the Legislature in an effort to improve fiscal oversight and transparency of this very large, complex budget going forward.

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Proposition 64 Youth Account: Issues for Legislative Consideration

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February 13, 2019 - Presented to: Senate Committee on Health and Senate Committee on Education

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Funding and Implementing Individual Health Insurance Market Affordability Policies

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February 12, 2019 - Presented to: Assembly Health Committee, Assembly Budget Subcommittee No. 1 on Health and Human Services, Senate Committee on Health, and Senate Budget and Fiscal Review Subcommittee No. 3 on Health and Human Services

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The 2019-20 Budget: The Governor's Individual Health Insurance Market Affordability Proposals

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February 7, 2019 - This report provides our assessment of the Governor's proposals to (1) create a state requirement that most Californians purchase health insurance coverage (referred to as an "individual mandate") or pay a financial penalty and (2) use the revenues from this penalty to fund additional health insurance subsidies for households purchasing coverage through Covered California.