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March 18, 2013 - Letter to the Honorable Bill Emmerson Regarding Bridge Plan.
March 18, 2013 - Presented to Assembly Environmental Safety and Toxic Materials Committee
March 13, 2013 - Letter to the Honorable Luis Alejo, Chair, Assembly Environmental Safety and Toxic Materials Committee, evaluating the administration and peformance of the Safe Drinking Water State Revolving Fund (SDWSRF).
February 27, 2013 - The Governor's budget proposes $28.3 billion in expenditures from the General Fund for health and human services programs in 2013-14. This reflects a 3.4 percent increase for health programs and a 7.9 percent increase for human services programs over 2012-13 estimated expenditures. For the most part, the year-over-year budget changes reflect caseload changes, technical budget adjustments, and the implementation of previously enacted policy changes, as opposed to new policy proposals. In the report, we find that the budget does not reflect the fiscal impact of the proposed Medi-Cal expansion, nor does it reflect potential costs and savings related to various other provisions of federal health care reform. We find that the Governor's Medi-Cal budget proposal assumes General Fund savings that are subject to significant uncertainty. We also provide a status update on the transition of the Healthy Families Program enrollees to Medi-Cal, finding that the transition is generally proceeding as planned, with some delays. We discuss problems in the operation of the state's Developmental Centers (DCs) by the Department of Developmental Services, and recommend that oversight of the DCs be strengthened by the creation of an independent Office of the Inspector General. We discuss the recent major program changes to the California Work Opportunity and Responsibility to Kids (CalWORKs) that are reflected in the budget, and recommend that the Legislature augment CalWORKs employment services funding--a Governor's budget proposal--to a level of funding it deems appropriate in light of its priorities for the program. We raise various fiscal and policy concerns about the Governor's budget assumption that a 20 percent across-the-board reduction in In-Home Supportive Services service hours will be implemented beginning on November 1, 2013. In light of these concerns, we recommend that the Legislature repeal the 20 percent reduction and instead continue a 3.6 percent across-the-board reduction that would otherwise sunset at the end of the 2012-13 fiscal year.
February 27, 2013 - In 2012, the Legislature authorized the Coordinated Care Initiative (CCI) as an eight-county pilot to demonstrate the integration of Medi-Cal and Medicare benefits for "dual eligibles"--beneficiaries eligible for both benefits. The CCI will also integrate long-term services and supports (LTSS) under Medi-Cal managed care in the eight counties for dual eligibles and seniors and persons with disabilities covered only by Medi-Cal. The Governor's budget delays the start date of CCI implementation to September 1, 2013, resulting in lower 2013-14 savings than initially anticipated. Joint federal-state decisions regarding key financing and operational aspects of CCI are pending, creating uncertainty regarding the timely and successful implementation of CCI. We recommend that the Legislature clarify the legal status of CCI to go forward and consider authorizing CCI to test greater integration of In-Home Supportive Services--a particular LTSS--under managed care.
February 19, 2013 - Under the Patient Protection and Affordable Care Act, also known as federal health care reform, the state has the option to expand its Medicaid program (known as Medi-Cal) to cover over one million low-income adults who are currently ineligible. Currently counties have the fiscal and programmatic responsibility for the care of the low-income adult population that would be covered by the expansion. The Governor has proposed to adopt the optional expansion, but has outlined two distinct approaches to implementing the expansion—a state-based approach and a county-based approach—and has not indicated a preference for either approach. Under both approaches, the Governor indicates that the expansion will require a reassessment of the state-local fiscal relationship. We find that the expansion would have significant policy benefits, including improved health outcomes for the newly eligible Medi-Cal population. We estimate that fiscal savings to the state as a whole are likely to outweigh the cost of the expansion for at least a decade, although these estimates are subject to significant uncertainty. Despite the significant uncertainty about long-term costs and savings, on balance, we believe the policy merits of the expansion and fiscal benefits to the state as a whole likely will outweigh the costs and potential fiscal risks. We therefore recommend the state adopt the expansion. We also find that the state is in a better position to effectively deliver health services to the newly eligible population. Therefore, we recommend the Legislature adopt a state-based expansion, shifting the fiscal and programmatic responsibility of providing physical health care to the expansion population from counties to the state. Given this shift of responsibility, we further recommend the Legislature redirect a portion of funding currently allocated to counties under 1991 realignment for indigent health care.
November 9, 2012 - Presented to Assembly Budget Subcommittee No. 1 on Health and Human Services, Hon. Holly J. Mitchell, Chair
October 23, 2012 - Senate Budget and Fiscal Review Subcommittee No. 3 on Health and Human Services, Hon. Mark DeSaulnier, Chair and Senate Human Services Committee, Hon. Carol Liu, Chair
May 1, 2012 - Presented to: Assembly Health Committee, Hon. William W. Monning, Chair and Assembly Revenue and Taxation Committee, Hon. Henry T. Perea, Chair
April 11, 2012 - Presented to Assembly Accountability and Administrative Review Committee, Hon. Roger Dickinson, Chair
March 7, 2012 - Presented to Joint Oversight Hearing on Long-Term Care Integration and Medi-Cal Managed Care, Assembly Budget Subcommittee No. 1 on Health and Human Services and Assembly Committee on Aging and Long-Term Care
March 7, 2012 - Presented to Joint Oversight Hearing on Long-Term Care Integration and Medi-Cal Managed Care, Assembly Budget Subcommittee No. 1 on Health and Human Services and Assembly Committee on Aging and Long-Term Care
March 1, 2012 - The Governor’s budget plan proposes to eliminate DMH and create a new Department of State Hospitals (DSH), shifting the remaining community mental health programs to various departments. This new structure would allow the administration to better focus on the fiscal and programmatic issues unique to state hospitals. In 2008-09, the Office of State Audits and Evaluations (OSAE) conducted an audit which outlined the problems state hospitals experienced, concluding that staffing did not adequately reflect hospital workload, funding was not sufficient for annual operating expenditures, and that state hospitals were not efficiently using their staff. Similarly in a 2011 self-audit, DMH found that many of the same problems from the 2008 audit remained. We concur with both audit teams’ assessments. In this brief report, therefore, we recommend an audit be conducted that looks at a number of issues, including state hospital budgeting practices, the fiscal controls being put in place, and the level of vacancies and their impact on the state budget and on hospital performance. We recommend this added oversight with respect to state hospitals should take place regardless of the Legislature’s decision on the creation of a new DSH.
March 1, 2012 - Over the three-year period from 2009-10 to 2011-12, the Department of Developmental Services’ (DDS) General Fund spending has remained relatively flat. This has been the case in spite of rapidly growing caseloads and other cost pressures. In this brief, we discuss the measures adopted by the Legislature over these three years to reduce General Fund costs in both Developmental Centers (DCs) and Regional Centers (RCs).
March 1, 2012 - Presented to Senate Budget and Fiscal Review Committee, Hon. Mark Leno, Chair