Health and Human Services Publications

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Major Potential State Fiscal Risk Averted Following Withdrawal of Proposed Federal Medicaid Financing Regulation

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September 21, 2020 - This Budget and Policy post is intended to notify the Legislature of the federal government’s recent decision to withdraw the proposed Medicaid Fiscal Accountability Regulation (MFAR), proposed in 2019. If finalized as proposed, MFAR could have resulted in the loss of billions of dollars in non-General Fund funding for Medi-Cal on annual basis. Withdrawal of the regulation means that a major, near-term state fiscal risk has been averted.

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The 2020-21 May Revision: Analysis of 2020-21 May Revision IHSS Budget

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June 9, 2020 - In this post, we (1) explain the differences between the Governor’s January and May Revision budget estimates for In-Home Supportive Services (IHSS); (2) describe the administration’s IHSS caseload, hours per case, and hourly wage projections; (3) compare the May Revision monthly estimates for coronavirus disease 2019 (COVID-19) costs in IHSS to April 2020 actuals; (4) recommend a downward adjustment of at least a $20 million General Fund in 2019-20 to reflect lower-than-estimated utilization and cost of IHSS COVID-19-related response efforts in April 2020; and (5) recommend the Legislature request actual May 2020 utilization data to determine whether additional adjustments to COVID-19 cost estimates are warranted for May 2020 and possibly June 2020.

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The 2020-21 May Revision: CalWORKs Caseload-Driven Costs in the 2020-21 May Revision

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June 2, 2020 - The 2020-21 May Revision projects California Work Opportunity and Responsibility to Kids (CalWORKs) caseload to reach historic highs in response to the novel coronavirus disease 2019 pandemic and subsequent public health emergency. In this post, we describe this projection, assess it in light of recent data and historical trends, and recommend an alternative set of assumptions.

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

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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.

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Overview of Major Health Proposals in 2020-21 May Revision

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

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

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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

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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

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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.

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

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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

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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

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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.

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Overview of Community Care Licensing and Board and Care Facilities

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

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The 2020-21 Budget: Department of Social Services

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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.

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

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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

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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.