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December 1, 2008 - The role of the Legislative Analyst's Office is to review state programs and make recommendations to the Legislature as to how the state can operate more effectively and efficiently. This report summarizes various changes to law that we have recommended in recent years. Recommendations in this report include, among many others: (a) Simplify and Consolidate K-12 General Purpose Funding, (b) Promote the Adoption of Health Information Technology in California, (c) Fund Inmate Education Programs Based on Actual Attendance, and (d) Increase and Index the State Gas Tax.
September 16, 2008 - Presented to Assembly and Senate Health Committees
June 16, 2008 - We analyzed SB 840 (Kuehl), which would establish in California a single-payer health care system and its companion financing mechanism.
June 13, 2008 - Item 5225-002-0001 and 4440-011-0001 of the 2008 Budget Conference Committee (pages 285, 325).
June 12, 2008 - LAO Alternative: for Items 4260 and 4265 of the 2008 Budget Conference Committee (various issues and pages).
June 12, 2008 - Informational: Medi-Cal Provider Payment Reductions for the 2008 Budget Conference Committee, various pages (219-224)
June 11, 2008 - LAO Compromise for Item 4260 of the 2008 Budget Conference Committee (page 232).
February 20, 2008 - The cost of mental health drugs in the Medi-Cal Program continues to grow. We estimate the state can save about $5 million General Fund annually by reducing inappropriate prescribing practices. Accordingly, we recommend the Legislature consider the following two options: (1) encourage county participation in the California Mental Health Care Management (CalMEND) Program and (2) expand the use of fixed annual allocations to counties that include the cost of prescription drugs. We further recommend the Legislature approve the Governor’s CalMEND proposal to support three limited-term positions and expand program activities.
February 20, 2008 - The Legislature relies on departments to promulgate regulations to implement laws. The Department of Public Health is slow to promulgate such regulations and consequently, state laws are not being enforced or applied consistently across the state. We recommend the department report at budget hearings on the status of the development and promulgation of unissued regulations.
February 20, 2008 - The state’s current process for administration and funding of over 30 public health programs at the local level is fragmented, inflexible, and fails to hold local health jurisdictions (LHJs) accountable for achieving results. This reduces the effectiveness of these programs because these services are not coordinated or integrated and LHJs cannot focus on meeting the overall goal of improving the public’s health. We recommend (1) the consolidation of certain public health programs into a block grant. and (2) the enactment of legislation that would direct the Department of Public Health (DPH) to develop a model consolidated contract for these and other public health programs (which are not consolidated into the block grant). In addition, we recommend that outcome measures for these programs be developed and that DPH work with counties in using a consolidated contract.
February 20, 2008 - As health care costs continue to face upward cost pressures, many federal, state and private health care programs have turned to pay-for-performance programs as a way of both ensuring the practice of effective and efficient medicine and of controlling costs. Our analysis indicates that the implementation of pay-for-performance program in Medi-Cal could eventually reduce General Fund costs by as much as tens of millions of dollars annually and significantly improve care for patients.
February 20, 2008 - The Governor’s budget proposes to reduce provider reimbursements by $688 million General Fund in 2008-09. We review the potential effects of this proposal and generally find that the proposed reductions might reduce patient access to care or cause patients to obtain care through other more costly access points such as emergency rooms. We recommend that the Legislature reject the proposed reductions for all providers except hospitals. We also recommend additional actions to generate savings in certain areas.
January 25, 2008 - Elizabeth Hill's Senate Testimony on ABX1 and its related initiative.
January 22, 2008 - We analyzed certain fiscal issues related to the health care reform (HCR) plan currently under consideration by the Legislature. We estimated the fiscal impact of HCR using two different assumptions of premiums: $250 per month per person and $300 per month per person. Under the $250 premium scenario there are sufficient revenues to support the program in the first year of operation (2010-11). However, by the fifth year of the program, annual costs exceed revenues by $300 million. Despite annual costs exceeding revenues in the fifth year, the program still has a positive cumulative fund balance because the collection of tobacco tax and employer fees start before program costs are incurred. Under the $300 premium assumption, costs exceed revenues by $122 million in the first year of operation and this shortfall increases to $1.5 billion by the fifth year of the program. In addition, the fund balance shows a deficit of almost $4 billion by the end of that period, even with the early collection of the tobacco tax and employer fees. In addition to the premium level, we have identified a number of other fiscal risks and uncertainties which could negatively affect the fiscal solvency of the plan by more than an additional $1.5 billion annually.