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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
February 29, 2012 - Presented to Assembly Budget Subcommittee No. 1 on Health and Human Services, Hon. Holly J. Mitchell, Chair
February 21, 2012 - Presented to: Joint Oversight Hearing of the Assembly and Senate Health Committees and Assembly and Senate Budget Subcommittees on Health and Human Services Hons. Bill Monning and Ed Hernandez, Chairs, Assembly and Senate Health Committees Hons. Holly Mitchell and Mark DeSaulnier, Chairs, Assembly and Senate Budget Subcommittees on Health and Human Services
February 21, 2012 - Presented to: Joint Oversight Hearing of the Assembly and Senate Health Committees and Assembly and Senate Budget Subcommittees on Health and Human Services
February 17, 2012 - As part of the 2012-13 budget, the Governor proposes to reduce the negotiated rates paid to Healthy Families Program (HFP) managed care plans and shift the children enrolled in HFP to Medi-Cal over a nine-month period. In this report, we provide background information on HFP and Medi-Cal and how they will be affected by implementation of federal health care reform. We discuss the potential merits of the Governor’s proposal, but raise several implementation issues and concerns. Specifically, the savings in the budget year may be less than the administration’s estimates, and the proposal will disrupt healthcare services for some HFP enrollees and may impact access to providers. Finally, we make recommendations that encourage the consideration of alternatives to the Governor’s plan.
February 17, 2012 - California’s system for providing health and social services to low-income seniors and persons with disabilities (SPDs) receiving Medicare and/or Medi-Cal is not coordinated. This lack of care coordination may lead to SPDs being unnecessarily hospitalized or placed in skilled nursing facilities rather than remaining in their own homes—resulting in poor outcomes for recipients and higher costs for the federal and state governments. As part of the 2012-13 budget, the Governor attempts to address this issue by proposing to integrate health and social services into managed care for most SPDs. In this report, we provide background information on the Medi-Cal and Medicare Programs and describe recent federal and state legislation to address fragmented care delivery. We discuss the potential merits of the Governor’s proposal, but raise several implementation issues and concerns. Finally, we make recommendations that encourage care coordination for SPDs by first completing and evaluating a currently authorized integrated care demonstration project in four counties rather than expanding the demonstration statewide as proposed by the Governor— an action that we think is premature. We also encourage the consideration of other ways to test the integration of benefits for SPDs.
January 3, 2012 - Over the past several years, the state has experienced waitlists in county jails to transfer those deemed incompetent to stand trial (IST) to state hospitals for treatment. In response to the waitlist, which averages between 200 and 300 individuals a month, the Department of Mental Health began a pilot program in San Bernardino County to treat ISTs in county jail instead of at a state hospital. This report finds that the pilot program has greater flexibility to hold down costs and has been able to restore ISTs to competency in a shorter amount of time than state hospitals. We find that if the pilot program is expanded, it has the potential to significantly reduce the waitlist, as well as reduce costs to the public sector.
September 29, 2011 - An Overview of Federal Funding in California
February 1, 2011 - Total expenditures for the regional center system that provides services for persons with developmental disabilities more than doubled between 1999-00 and 2009-10, leading to a series of actions by the Legislature to slow down the growth in the program. In this report, we describe and assess proposals in the Governor’s 2011-12 budget plan to achieve further cost containment in programs administered by the Department of Developmental Services, including community services. We recommend approval of the Governor’s budget proposals to (1) extend the 4.25 percent provider payment reduction and the commensurate reduction to regional center (RC) operations, and (2) obtain additional federal funds for services provided through the developmental centers and the RCs. We also recommend the Legislature either expand the existing Family Cost Participation Program or implement means testing to determine who is eligible to receive these state services.These changes, we would acknowledge, represent a significant departure from the policies originally adopted in the Lanterman Act but would help ensure the long-term sustainability of the program for those consumers with the greatest financial need for its services.