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August 8, 2013 - This report provides an overview of child abuse and neglect trends, explains the state and county roles in the Child Welfare Services (CWS) system, and examines the outcomes of children involved with the CWS system. In general, CWS outcomes have improved since the last decade. Foster children spend, on average, less time in foster care (which is generally considered a positive trend), are more quickly reunified with their families, and have more permanency in their living situations. However, this report raises several issues for the Legislature to consider in improving outcomes for children in the CWS system. In the report, we discuss how child well-being is not adequately measured in the CWS system and we suggest options for improving the evaluation of child well-being. We also raise issues related to improving group home quality through provider rate reform and accreditation standards. Finally, we make suggestions for how the current 2011 Realignment growth funding allocation process could be modified to provide county incentives for improved performance.
August 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.
June 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).
June 5, 2013 - Presented to Budget Conference Committee
May 15, 2013 - Presented to Senate Environmental Quality Committee
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.
April 15, 2013 - Presented to: Assembly Budget Subcomittee No. 1 on Health and Human Services
March 21, 2013 - Presented to Senate Budget Subcommittee No. 3 on Health and Human Services
March 18, 2013 - Letter to the Honorable Bill Emmerson Regarding Bridge Plan.
March 18, 2013 - Presented to Assembly Environmental Safety and Toxic Materials Committee
March 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).
March 13, 2013 - Presented to Assembly Budget Subcommittee No. 1 on Health and Human Services, Hon. Holly J. Mitchell, Chair
February 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.
February 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.
February 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.