Health and Human Services Publications

Report

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).

Report

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.

Handout

California’s Homelessness Challenges in Context

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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

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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.

Report

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

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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.

Handout

Background on the Department of Developmental Services Rate Study

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January 22, 2020 - Senate Budget Subcommittee No. 3 on Health and Human Services

Report

The 2020-21 Budget: Overview of the Governor's Budget

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January 13, 2020 - This report presents our office’s initial assessment of the Governor’s budget. We estimate the Governor had a $6 billion surplus to allocate to discretionary purposes in 2020-21. The Governor allocates most of the surplus toward one-time purposes, including maintaining a positive year-end balance in the state’s discretionary reserve. Under the administration’s estimates, total reserves would reach $20.5 billion at the end of 2020-21—this represents a $1.7 billion increase from the 2019-20 enacted level. California continues to enjoy a healthy fiscal situation. Despite its positive near-term picture, the budget’s multiyear outlook is subject to considerable uncertainty. In addition to describing the condition of the budget under the Governor’s proposal, this report discusses tools the Legislature can use to mitigate against these heightened risks.

January 20, 2020: Upon further review, one item included in the original version of Appendix Figure 3 on discretionary on health spending should not have been included (specfically, use of the Medi-Cal drug rebate fund to offset General Fund costs). Removing this item—which reduces General Fund spending—from the list of discretionary choices made in the Governor’s budget increases our calculation of the surplus to $6 billion. The document is updated to reflect these changes.

Update 1/24/20: Adjusted Judicial Branch items in Appendix Figure 1 to reflect ongoing spending.

Report

FI$Cal IT Project Update—Special Project Report 8

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January 8, 2020 - This report analyzes how the most recent project plan for the Financial Information System for California (FI$Cal) information technology (IT) project—that has been under development since 2005—changes the project's cost, scope, and schedule. We also discuss what work is anticipated to remain even after the project is deemed by the administration to be "complete." Lastly, we make associated findings and recommendations.

Handout

The Mental Health Services Act: Issues for Legislative Consideration

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December 9, 2019 - Presented to: Assembly Budget Subcommittee No. 1 on Health and Human Services

Post

The 2020-21 Budget: Medi-Cal Fiscal Outlook

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November 20, 2019 - This web post provides detail on our projections and assumptions related to General Fund spending in Medi-Cal for the years 2019-20 through 2023-24. In the near term, we project Medi-Cal spending to grow to $23.5 billion in 2020-21. Over the long term, we project General Fund spending in Medi-Cal to grow to up to $27.6 billion.

In addition to this report, you can find the main California's Fiscal Outlook report along with a collection of other fiscal outlook material on our fiscal outlook budget page.

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The 2019-20 Budget: California Spending Plan—Health and Human Services

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October 17, 2019 - From the General Fund, the 2019-20 spending plan provides $26.4 billion for health programs and $15.5 billion for human services programs—an increase of 18 percent and 12.6 percent, respectively, over estimated 2018-19 General Fund spending in these two policy areas. Major health-related policy actions include the reauthorization of a tax on managed care organizations (which will reduce the above-noted General Fund health spending by $1 billion, pending federal approval) and over $400 million General Fund for state-funded subsidies for health insurance purchased on the individual market through Covered California. Major human services-related policy actions include General Fund support to increase CalWORKS cash grants and most developmental services provider rates, and to restore previously reduced service hours in the In-Home Supportive Services program. The spending plan also reflects the deposit of $700 million into a safety net reserve (bringing its balance to $900 million) that can be used for future CalWORKs and/or Medi-Cal expenditures.

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The 2019-20 Budget: California Spending Plan—Other Provisions

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October 17, 2019 - The 2019-20 budget included significant augmentations and statutory changes in various other programs, including to support emergency services, the regulation of cannabis and alcoholic beverages, and construction and maintenance of state infrastructure.

Handout

Overview of Public Community Mental Health Services Funding and the Mental Health Services Act

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August 21, 2019 - Assembly Committee on Accountability and Administrative Review and Assembly Committee on Health

Handout

The Financial Information System for California (FI$Cal)

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June 27, 2019 - Assembly Accountability and Administrative Review and Assembly Budget Subcommittee No. 6 on Budget Process, Oversight and Program Evaluation

Handout

Item 7100-001-0588—Employment Development Department Paid Family Leave (PFL)

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June 4, 2019 - Presented to: Budget Conference Committee