To browse all LAO publications, visit our Publications page.
March 5, 2008 - Presented to Senate Budget and Fiscal Review Committee
February 20, 2008 - The cost of mental health drugs in the Medi-Cal Program continues to grow. We estimate the state can save about $5 million General Fund annually by reducing inappropriate prescribing practices. Accordingly, we recommend the Legislature consider the following two options: (1) encourage county participation in the California Mental Health Care Management (CalMEND) Program and (2) expand the use of fixed annual allocations to counties that include the cost of prescription drugs. We further recommend the Legislature approve the Governor’s CalMEND proposal to support three limited-term positions and expand program activities.
February 20, 2008 - The Legislature relies on departments to promulgate regulations to implement laws. The Department of Public Health is slow to promulgate such regulations and consequently, state laws are not being enforced or applied consistently across the state. We recommend the department report at budget hearings on the status of the development and promulgation of unissued regulations.
February 20, 2008 - The state’s current process for administration and funding of over 30 public health programs at the local level is fragmented, inflexible, and fails to hold local health jurisdictions (LHJs) accountable for achieving results. This reduces the effectiveness of these programs because these services are not coordinated or integrated and LHJs cannot focus on meeting the overall goal of improving the public’s health. We recommend (1) the consolidation of certain public health programs into a block grant. and (2) the enactment of legislation that would direct the Department of Public Health (DPH) to develop a model consolidated contract for these and other public health programs (which are not consolidated into the block grant). In addition, we recommend that outcome measures for these programs be developed and that DPH work with counties in using a consolidated contract.
February 20, 2008 - As health care costs continue to face upward cost pressures, many federal, state and private health care programs have turned to pay-for-performance programs as a way of both ensuring the practice of effective and efficient medicine and of controlling costs. Our analysis indicates that the implementation of pay-for-performance program in Medi-Cal could eventually reduce General Fund costs by as much as tens of millions of dollars annually and significantly improve care for patients.
February 20, 2008 - The Governor’s budget proposes to reduce provider reimbursements by $688 million General Fund in 2008-09. We review the potential effects of this proposal and generally find that the proposed reductions might reduce patient access to care or cause patients to obtain care through other more costly access points such as emergency rooms. We recommend that the Legislature reject the proposed reductions for all providers except hospitals. We also recommend additional actions to generate savings in certain areas.
February 20, 2008 - Although IHSS wages represent a significant cost to the state, current law grants local county boards the flexibility to establish IHSS wage levels and requirements for providers who choose to be listed on county registries. In order to improve the IHSS labor force and services to recipients, we recommend, prior to 2010-11, enactment of legislation to modify the structure for state participation in wages to reflect the training and tenure of IHSS providers.
February 20, 2008 - The Governor’s budget proposes to delete the June 2008 and 2009 state statutory COLAs and pass-through the federal COLAs. The Governor estimates that the deletion of these COLAs will result in savings of $23.3 million in 2007-08, and $300.3 million in 2008-09. Based on more recent data, we estimate savings in 2008-09 will increase by $5.3 million to a total of $305.6 million in the budget year. As part of the LAO budget alternative, we recommend reducing grants for couples to 125 percent of the federal poverty level.
February 20, 2008 - The budget proposes to reduce CWS county allocations, resulting in General Fund savings of $83.7 million in 2008-09. We describe the potential impact of this proposed reduction on social worker caseloads and possible subsequent policy consequences resulting from fewer resources. We provide three alternatives to the Governor’s proposal that more narrowly target the reductions in CWS expenditures.
February 20, 2008 - Pre-assistance programs focusing on preparing recipients to enter the labor force within four months and a community service requirement for adults who have received five years of assistance are two policies which would increase participation with less budgetary savings than the Governor. We discuss these alternatives, estimate their impacts, and present an alternative package of CalWORKs reforms which meet the anticipated work participation shortfall.
February 20, 2008 - In order to increase work participation and achieve budgetary savings, the Governor proposes a series policy changes for the CalWORKs program. These are (1) a graduated full-family sanction that increases to 100 percent of the grant after one year in sanction status, (2) a five-year time limit on children whose parents cannot meet federal work participation requirements, (3) a nutritional supplement for working poor families, and (4) a five-year time limit for other child-only cases. We review the Governor’s proposals and comment on them.
February 20, 2008 - Index of Information Technology Issues in the Analysis of the 2008-09 Budget Bill
January 25, 2008 - Elizabeth Hill's Senate Testimony on ABX1 and its related initiative.