Health and Human Services Publications

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The 2020-21 May Revision: Recommend Reduction to Medi-Cal Caseload Costs

May 22, 2020 - This post provides our analysis of the Governor’s May Revision projections related to Medi-Cal caseload. The May Revision assumes significant General Fund cost increases related to projected increases in Medi-Cal caseload due to the deteriorating economic environment caused by the coronavirus disease of 2019 (COVID-19). As we describe below, we find that the administration’s assumed caseload costs in Medi-Cal are likely significantly overstated and recommend a downward reduction to the Medi-Cal budget of $750 million General Fund across 2019-20 and 2020-21.

Hearing Handout

Overview of Major Health Proposals in 2020-21 May Revision

May 19, 2020 - Assembly Budget Subcommittee No. 1 on Health and Human Services

Hearing Handout

Overview of Major Human Services Proposals in 2020-21 May Revision

May 18, 2020 - Assembly Budget Subcommittee No. 1 on Health and Human Services

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Federal COVID-19 Response Actions Affecting Older Adults and Persons with Disabilities

April 16, 2020 - This post summarizes key COVID-19 federal actions that affect aging- and disability-related state programs.

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COVID-19: Federal Health-Related Response

March 23, 2020 - This initial post highlights key federal actions in response to the coronavirus disease 2019 (COVID-19)—through March 19, 2020—relating to public health broadly and individual health care. We discuss three sets of federal actions—(1) a federal legislative package focused on public health infrastructure, (2) a declaration of national emergency that opened the door for the state to apply for increased flexibility in the delivery of Medicaid services, and (3) a federal legislative package that provides for increased federal Medicaid funding and universal coverage of COVID-19 testing without cost sharing.

Report

Analysis of California’s Physician-Supervision Requirement for Certified Nurse Midwives

March 11, 2020 - In an effort to ensure safety and quality, California state law places occupational licensing restrictions on who may provide childbirth and reproductive-related health care services to women. These restrictions include a requirement that nurse midwives may only practice under the supervision of a licensed physician. At the request of a member of the Legislature, this report analyzes whether this requirement is meeting its intended safety and quality objectives, without significantly increasing cost or decreasing access to health care services. Drawing on national research—that compares health care outcomes in states with and without a similar physician-supervision requirement for nurse midwives—we find that California's requirement is unlikely to improve safety and quality for low-risk pregnancies and births. Moreover, we find that the requirement could limit access to nurse-midwife services, and potentially health care services for women overall, while also raising the cost of care. We recommend that the Legislature consider removing the state’s physician-supervision requirement, while adding other safeguards to ensure safety and quality. Such safeguards could include, for example, requiring nurse midwives to maintain appropriate referral and consultative relationships with physicians and requiring that they maintain medical malpractice insurance.

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The 2020-21 Budget: Re-Envisioning Medi-Cal—The CalAIM Proposal

February 28, 2020 - In this report, we provide an overview and assessment of the Governor's California Advancing and Innovating Medi-Cal (CalAIM) proposal, also known as Medi-Cal Healthier California for All. CalAIM would make far-reaching reforms to Medi-Cal that would increase the program’s focus on its high-cost and high-needs enrollee populations, transform and streamline Medi-Cal managed care, extend components of a current federal waiver, and rethink how behavioral health services are financed and delivered.

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The 2020-21 Budget: Governor’s Information Security Proposals

February 25, 2020 - One of the priorities of the Governor’s proposed 2020‑21 budget is to improve information security (IS) across state government entities. The proposed budget includes resource requests for the entities that govern IS for the entire state to increase their operational capacity, as well as resource requests for individual government entities to expand and improve their IS programs. This budget and policy post provides relevant information about state IS strategy to help the Legislature consider each of these requests.

Hearing Handout

Overview of Community Care Licensing and Board and Care Facilities

February 24, 2020 - Presented to: Senate Human Services Committee Hon. Melissa Hurtado, Chair

Report

The 2020-21 Budget: Department of Social Services

February 24, 2020 - This brief provides information, analysis, and key issues to consider in evaluating the Governor’s 2020-21 budget proposals for the major programs in Department of Social Services.

Report

The 2020-21 Budget: The Governor's IT Project Proposals

February 20, 2020 - This report provides an overview of the proposed and approved IT projects in the Governor’s proposed 2020-21 budget. We first provide relevant background information on the state’s IT project approval process, approaches to development and implementation of projects once approved, maintenance and operation of IT systems once completed, and requirements for state government entities to request resources for projects through the budget process. We then identify and summarize the budget requests to plan proposed projects and to develop and implement projects (whether proposed or approved).

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The 2020-21 Budget: Analysis of the Medi-Cal Budget

February 14, 2020 - In this report, we provide high‑level background on the Medi‑Cal program and an overview of the major drivers of year‑over‑year spending changes in the Governor’s budget. We also discuss the administration’s recent submittal (late January 2020) of a modified managed care organization (MCO) tax proposal. We then provide analysis and recommendations on a series of key issues: (1) Recently proposed draft federal regulations referred to as the “Medicaid Fiscal Accountability Regulation;” (2) proposals related to the Medi‑Cal pharmacy services benefit; (3) the Governor’s proposal to expand comprehensive Medi‑Cal coverage to otherwise eligible seniors regardless of immigration status; (4) proposed changes to rate‑setting for skilled nursing facilities; (5) issues related to county administration of eligibility and enrollment functions in Medi‑Cal; and (6) the Governor’s proposal to end dental managed care in the current two pilot counties and instead provide dental care as a fee‑for‑service benefit statewide. We conclude this report with a summary of our recommendations.

Corrected 2/20/20: Corrected to remove Alameda County from the list counties participating in the Coordinated Care Initiative.

Hearing Handout

California’s Homelessness Challenges in Context

February 13, 2020 - Presented to Assembly Budget Subcommittee No. 6: Budget Process, Oversight, and Program Evaluation

Report

The 2020-21 Budget: Analysis of the Department of State Hospitals Budget

February 11, 2020 - The Governor’s budget proposes $2.3 billion for the Department of State Hospitals (DSH) in 2020‑21—an increase of $232 million (11 percent) from the revised 2019‑20 level. In this report, we assess three specific DSH proposals and offer recommendations for legislative consideration.

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The 2020-21 Budget: Analysis of the Department of Developmental Services Budget

February 7, 2020 - The following report assesses the Governor’s proposed 2020‑21 budget for the Department of Developmental Services (DDS), which currently serves about 350,000 individuals with qualifying developmental disabilities in California. We first provide an overview of the budget proposal, including caseload projections and changes in year‑over‑year spending. We then consider four key new policy proposals. First, and most significantly, we consider the Governor’s proposal for a performance‑incentive program, which appears to represent a new direction for the DDS system. Second, we assess the Governor’s proposal to provide supplemental rate increases in additional service categories in 2020‑21. Third, we review a proposal to reduce the caseloads of service coordinators who work with children ages 3, 4, and 5. Finally, we examine the Governor’s proposed additions to DDS’ crisis and safety net services.

Health and Human Services Staff

Mark Newton
(916) 319-8323
Deputy Legislative Analyst: Health, Developmental Services and IT
 
Ryan Anderson
(916) 319-8308
CalWORKs/CalFresh
 
Jackie Barocio
(916) 319-8333
In-Home Supportive Services/Aging Programs/Child Support/Veterans Affairs
 
Ben Johnson
(916) 319-8336
Medi-Cal/Hospital Finance/Managed Care
 
Brian Metzker
(916) 319-8354
Privacy, Security, and Technology
 
Sonja Petek
(916) 319-8340
Public Health/Developmental Services
 
Luke Koushmaro
(916) 319-8355
Medi-Cal/Long-Term Care/Family Health/Covered California
 
Angela Short
(916) 319-8309
Teachers' Retirement Policy/ Child Welfare/ Community Care Licensing
 
Corey Hashida
(916) 319-8315
Medi-Cal/Behavioral Health/State Hospitals/Health Planning and Development
 
Ginni Bella Navarre
(916) 319-8342
Deputy Legislative Analyst: Human Services and Governance