Health and Human Services Publications

The 2021-22 Budget: California Department of Public Health's COVID‑19 Response

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February 5, 2021 - This publication describes how coronavirus disease 2019 (COVID-19) spending is reflected in the California Department of Public Health’s budget. It offers options for how the Legislature can express its COVID-19-related goals and priorities in light of the administration’s reliance on midyear budget adjustments, provides an evaluative framework for assessing the administration’s proposals, and recommends an after-action review of the state’s public health response.

The 2021-22 Budget: Overview of the Governor's Budget

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January 10, 2021 - This report provides a brief summary and initial assessment of the proposed 2021-22 Governor’s Budget.

Correction 1/11/21: Totals for immediate and early action proposals have been corrected.

The 2021-22 Budget: Medi-Cal Fiscal Outlook

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November 18, 2020 - Medi‑Cal, the state’s Medicaid program, provides health care coverage to about 13 million of the state’s low‑income residents. Medi‑Cal costs generally are shared between the federal and state governments. In a typical year, the General Fund covers a little more than 20 percent of total Medi‑Cal costs, with federal funds and other state and local funds respectively covering the remaining 65 percent and 15 percent of total costs. In this web post, we describe the major factors that we expect to drive changes in General Fund spending in Medi‑Cal over the near term—in 2020‑21 and 2021‑22—and over the longer term through 2024‑25. We also describe a number of key assumptions that we made in our spending projections.

Update on COVID-19 Spending in California

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November 5, 2020 - This post provides a high-level summary of state and federal funds provided to date to respond to the coronavirus disease 2019 (COVID-19). In this post we discuss: (1) the authorities, at both the state and federal levels, for COVID-19 spending; (2) the state, federal, and other funding sources for COVID-19 spending; and (3) the amounts of COVID-19 spending authorized so far, organized by different purposes and program areas.

Updated 11/12/20: State and federal government spending on certain activities to control the spread of COVID-19 revised upward to $8.6 billion.

California Fiscal Impact of Overturning the ACA

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October 21, 2020 - Senate Health Committee

Updated 11/13/2020.

The 2020-21 Spending Plan: Health Budget and Policy

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October 15, 2020 - From the General Fund, the 2020-21 spending plan provides $26.7 billion for health programs—an increase of 3 percent over estimated 2019-20 General Fund spending for these programs. The year-over-year net increase in General Fund spending is largely due to the projected COVID-19-related increase in the Medi-Cal caseload. The post describes major health-related actions (both policy actions and various budget adjustments) adopted by the Legislature as part of its 2020-21 spending plan. These actions include the offsetting of what would otherwise be General Fund costs with (1) revenues from the federally approved reauthorized tax on managed care organizations and (2) federal Medicaid funds that are being provided to the state at an enhanced level during the term of the public health emergency.

Major Potential State Fiscal Risk Averted Following Withdrawal of Proposed Federal Medicaid Financing Regulation

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September 21, 2020 - This Budget and Policy post is intended to notify the Legislature of the federal government’s recent decision to withdraw the proposed Medicaid Fiscal Accountability Regulation (MFAR), proposed in 2019. If finalized as proposed, MFAR could have resulted in the loss of billions of dollars in non-General Fund funding for Medi-Cal on annual basis. Withdrawal of the regulation means that a major, near-term state fiscal risk has been averted.

The 2020-21 May Revision: Recommend Reduction to Medi-Cal Caseload Costs

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May 22, 2020 - This post provides our analysis of the Governor’s May Revision projections related to Medi-Cal caseload. The May Revision assumes significant General Fund cost increases related to projected increases in Medi-Cal caseload due to the deteriorating economic environment caused by the coronavirus disease of 2019 (COVID-19). As we describe below, we find that the administration’s assumed caseload costs in Medi-Cal are likely significantly overstated and recommend a downward reduction to the Medi-Cal budget of $750 million General Fund across 2019-20 and 2020-21.

Overview of Major Health Proposals in 2020-21 May Revision

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May 19, 2020 - Assembly Budget Subcommittee No. 1 on Health and Human Services

Federal COVID-19 Response Actions Affecting Older Adults and Persons with Disabilities

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April 16, 2020 - This post summarizes key COVID-19 federal actions that affect aging- and disability-related state programs.

COVID-19: Federal Health-Related Response

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March 23, 2020 - This initial post highlights key federal actions in response to the coronavirus disease 2019 (COVID-19)—through March 19, 2020—relating to public health broadly and individual health care. We discuss three sets of federal actions—(1) a federal legislative package focused on public health infrastructure, (2) a declaration of national emergency that opened the door for the state to apply for increased flexibility in the delivery of Medicaid services, and (3) a federal legislative package that provides for increased federal Medicaid funding and universal coverage of COVID-19 testing without cost sharing.

Analysis of California’s Physician-Supervision Requirement for Certified Nurse Midwives

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March 11, 2020 - In an effort to ensure safety and quality, California state law places occupational licensing restrictions on who may provide childbirth and reproductive-related health care services to women. These restrictions include a requirement that nurse midwives may only practice under the supervision of a licensed physician. At the request of a member of the Legislature, this report analyzes whether this requirement is meeting its intended safety and quality objectives, without significantly increasing cost or decreasing access to health care services. Drawing on national research—that compares health care outcomes in states with and without a similar physician-supervision requirement for nurse midwives—we find that California's requirement is unlikely to improve safety and quality for low-risk pregnancies and births. Moreover, we find that the requirement could limit access to nurse-midwife services, and potentially health care services for women overall, while also raising the cost of care. We recommend that the Legislature consider removing the state’s physician-supervision requirement, while adding other safeguards to ensure safety and quality. Such safeguards could include, for example, requiring nurse midwives to maintain appropriate referral and consultative relationships with physicians and requiring that they maintain medical malpractice insurance.

The 2020-21 Budget: Re-Envisioning Medi-Cal—The CalAIM Proposal

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February 28, 2020 - In this report, we provide an overview and assessment of the Governor's California Advancing and Innovating Medi-Cal (CalAIM) proposal, also known as Medi-Cal Healthier California for All. CalAIM would make far-reaching reforms to Medi-Cal that would increase the program’s focus on its high-cost and high-needs enrollee populations, transform and streamline Medi-Cal managed care, extend components of a current federal waiver, and rethink how behavioral health services are financed and delivered.

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.

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.