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February 23, 2006 - The federal Deficit Reduction Act of 2005 significantly raises the required work participation rates for California’s low-income families in the CalWORKs program. Failure to meet these higher participation rates would result in annual federal penalties which begin in 2008-09 at $173 million We present a range of strategies for meeting this challenge including: increasing participation among existing recipients, bringing former recipients who are employed back into the participation calculation, and establishing separate programs for those who may face substantial barriers to work.
February 23, 2006 - The budget plan includes a package of proposals to encourage the enrollment of uninsured children in state health coverage. Some of the proposals are reasonable, but we recommend others be rejected or modified because they are overbudgeted or are likely to be ineffective.
February 23, 2006 - The administration is proposing changes to the way the state conducts licensing and certification of providers of certain health and social services. We concur in some proposals, recommend others be reduced to correct overbudgeted staffing and funding, and propose further changes to improve the way these functions are carried out.
February 23, 2006 - Proposition 36 provided annual appropriations from the General Fund through 2005-06 to implement a voter-approved initiative requiring drug treatment instead of incarceration in prison or jail for certain nonviolent drug possession offenders. The guaranteed appropriations for Proposition 36 are expiring, giving the Legislature discretion now to determine the level of funding for this measure. We comment on how the funding level should be set and proposals for making policy changes in the Proposition 36 law.
February 23, 2006 - Medi-Cal’s lack of accurate information about the prices of prescription drugs means that the program is reimbursing pharmacies much more than appears to be reasonable. We recommend legislation to ensure that reimbursement for drugs is set at more appropriate levels.
February 23, 2006 - An increasing portion of long-term care spending is for community-based services rather than institutional care. We examine the “cost-drivers” behind the growth in these costs and recommend that administration budget requests for long-term care projects be modified.
February 23, 2006 - A new federal hospital financing waiver is estimated to result in a net increase in Medi-Cal costs of $39 million over its first two years. We recommend that the waiver instead be implemented in a manner that avoids these costs and generates significant state savings.
February 23, 2006 - Future uncertainty about reauthorization of federal funding and the eventual exhaustion of unspent federal funds pose a risk of significant future increases in state costs for the Healthy Families Program (HFP). We present alternatives to hold down increases in overall HFP costs and to obtain additional financial support for the program.
February 23, 2006 - Spending for some specific services and supports for persons with developmental disabilities varies so widely among regional centers (RCs) as to raise concerns about the fiscal controls over these expenditures. We recommend an audit to evaluate the situation.
February 23, 2006 - The Legislature should take steps to deter costly nonemergency visits to emergency rooms (ERs) and to improve access to care and quality of care in community settings. This should be accomplished by establishing effective copayments on the inappropriate use of ERs and by seeking available federal funds to improve access to primary care.
February 23, 2006 - We review the state’s response to problems in the rollout of the new federal Medicare Part D prescription drug benefit and recommend Medi-Cal reductions of almost $335 million over two years to adjust for this rapidly changing situation.
February 22, 2006 - State costs for reimbursing counties for two state-mandated programs to provide mental health services for school children have grown significantly in recent years. Moreover, serious weaknesses are evident in the system for delivering these services for children in special education programs. To help guide legislative policy-making in this area, we provide background information on these two mandates, assess the Governor’s budget and policy proposals relating to them, and outline the Legislature’s options for addressing these issues.
December 7, 2005 - Chapter 794, Statutes of 2002 (AB 1401, Thomson), directed the Legislative Analyst’s Office (LAO) to evaluate the effectiveness of the measure in providing heath care coverage to individuals who are otherwise unable to obtain health benefits (the "hard-to-insure"). While we found there is now only limited information available to assess the outcome of various aspects of AB 1401, we concluded the measure has increased the state’s capacity to help hard-to-insure individuals access health coverage using the same level of state resources. Based upon our evaluation, we present several recommendations to improve the program by potentially reducing its costs to enrollees and the state.