Health and Human Services Publications

The 2017-18 Budget: The Coordinated Care Initiative: A Critical Juncture

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February 27, 2017 - In this report we provide (1) background on the health care and Long‑Term Services and Supports (LTSS) issues that the Coordinated Care Initiative (CCI) was intended to address, (2) an update on the CCI’s results and challenges to date, (3) an assessment of the Governor’s elimination of the CCI and budget proposal to extend certain CCI components, and (4) options for the Legislature on how to move forward. As ending the In‑Home Supportive Services (IHSS) has major, and rather complex, implications for 1991 realignment, we include a technical appendix at the end of this report that provides an in‑depth analysis of these implications.

The 2017-18 Budget: Analysis of the Department of Developmental Services Budget

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February 24, 2017 - In this report, we discuss the Governor’s budget proposals for Department of Developmental Services (DDS), providing our assessment of the budget package for DDS and analyzing one of the proposed trailer bills, which we find raises a number of issues. Also in this report, we describe the general nature of shifts in both policy and practice in the field of developmental services, detailing the relevant state and federal policies and their implications for the future developmental services program in the state, and discussing issues for the Legislature to consider as DDS implements these changes.

Risks to Federal Health Care Funding

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February 22, 2017 - Assembly Budget Subcommittee No. 1 on Health and Human Services

The 2017-18 Budget: An Overview of the Governor's Proposition 56 Proposals

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February 22, 2017 - Proposition 56 was approved by voters in November 2016 to increase taxes on cigarettes and other tobacco products. Questions have been raised as to whether the Governor’s proposals for allocating Proposition 56 revenues meet the initiative’s requirement to supplement—and not supplant—existing spending in several areas. To examine these questions, we begin by reviewing the provisions of Proposition 56 and the Governor’s budget proposals. We then discuss whether the Governor’s proposals for Medi‑Cal could be viewed as supplanting General Fund resources and identify the relevant case law. We conclude by describing some trade‑offs for the Legislature to consider in allocating the Proposition 56 revenues.

The Uncertain Affordable Care Act Landscape: What It Means for California

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February 17, 2017 - Summarizes the major impacts that the ACA has had in California, explores what the ACA’s repeal could mean for the state, and assesses a collection of policy alternatives to the ACA that the new federal administration and Congress are currently considering.

Correction 3/6/17: Removed reference to Alpine County as having only one participating insurer.

A Long-Term Outlook: Disability Among California’s Seniors

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November 28, 2016 - This report presents the results of our projections to inform the Legislature and stakeholders about levels of disability and the potential need for long–term supports and services (LTSS) among California’s seniors over the next several decades. These projections provide a useful starting point in understanding how California’s changing population demographics will impact the LTSS delivery system. The results presented in this report can also be built upon with further analysis focused on utilization and financing of LTSS over the long term.

A companion video and infographic highlight key findings from the report.

Cigarette Tax Initiative

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June 14, 2016 - Presented to: Assembly Health Committee Assembly Revenue and Taxation Committee Senate Health Committee

State Fees on Hospitals. Federal Medi-Cal Matching Funds. Initiative Statutory and Constitutional Amendment.

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May 25, 2016 - Presented to: Assembly Health Committee and Senate Health Committee

State Prescription Drug Purchases. Pricing Standards. Initiative Statute.

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May 10, 2016 - Presented to: Assembly Health Committee and Senate Health Committee

The 2016-17 Budget: Analysis of the Department of Developmental Services Budget

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March 4, 2016 - The Governor’s 2016-17 budget proposes $3.8 billion from the General Fund for Department of Developmental Services (DDS) programs—a 7.5 percent increase over 2015-16 estimated expenditures. This report focuses on the Governor's major policy-driven spending augmentations in the community services program. This report also summarizes legislation enacted as part of the recent special session that provides significant additional funding to the community services program and considers the Governor’s January proposals in this context.

The 2016-17 Budget: Overview of Governor’s Proposals to Implement the Medical Marijuana Regulation and Safety Act

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February 18, 2016 - The 2016-17 Budget: Overview of Governor’s Proposals to Implement the Medical Marijuana Regulation and Safety Act

The 2016-17 Budget: Analysis of the Medi-Cal Budget

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February 11, 2016 - In this report, we provide an analysis of the administration’s caseload projections, as well as a discussion of the impacts of the ACA on the ability to project caseload. We also provide an assessment of several General Fund cost pressures on the horizon in Medi–Cal, including the sunset of the hospital QAF.

Effects of Cigarette Taxes on Smoking Behavior

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December 17, 2015 - Presented to: Conference Committee on SBX2 2 and ABX2 1, Second Extraordinary Session

MCO Tax Overview

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December 1, 2015 - Conference Committee on SB X2 2 and AB X2 1, Second Extraordinary Session

Section 1115 Waiver Renewal: Key Medi-Cal Financing Issues Remain Outstanding

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October 13, 2015 - Earlier this year, California submitted a proposal to renew its Section 1115 waiver, which is due to expire at the end of October. The state is currently negotiating with the federal government over the terms and conditions of this waiver renewal. In this post, we examine key issues and concerns related to the availability of federal funding for California’s proposal. The post provides a primer on how Section 1115 waivers are generally financed, an overview of California’s proposal, and a discussion of the challenges the proposal faces within that financing structure.