Health and Human Services Publications

The 2020-21 Budget: Analysis of the Department of Developmental Services Budget

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February 7, 2020 - The following report assesses the Governor’s proposed 2020‑21 budget for the Department of Developmental Services (DDS), which currently serves about 350,000 individuals with qualifying developmental disabilities in California. We first provide an overview of the budget proposal, including caseload projections and changes in year‑over‑year spending. We then consider four key new policy proposals. First, and most significantly, we consider the Governor’s proposal for a performance‑incentive program, which appears to represent a new direction for the DDS system. Second, we assess the Governor’s proposal to provide supplemental rate increases in additional service categories in 2020‑21. Third, we review a proposal to reduce the caseloads of service coordinators who work with children ages 3, 4, and 5. Finally, we examine the Governor’s proposed additions to DDS’ crisis and safety net services.

Background on the Department of Developmental Services Rate Study

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January 22, 2020 - Senate Budget Subcommittee No. 3 on Health and Human Services

The 2020-21 Budget: Overview of the Governor's Budget

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January 13, 2020 - This report presents our office’s initial assessment of the Governor’s budget. We estimate the Governor had a $6 billion surplus to allocate to discretionary purposes in 2020-21. The Governor allocates most of the surplus toward one-time purposes, including maintaining a positive year-end balance in the state’s discretionary reserve. Under the administration’s estimates, total reserves would reach $20.5 billion at the end of 2020-21—this represents a $1.7 billion increase from the 2019-20 enacted level. California continues to enjoy a healthy fiscal situation. Despite its positive near-term picture, the budget’s multiyear outlook is subject to considerable uncertainty. In addition to describing the condition of the budget under the Governor’s proposal, this report discusses tools the Legislature can use to mitigate against these heightened risks.

January 20, 2020: Upon further review, one item included in the original version of Appendix Figure 3 on discretionary on health spending should not have been included (specfically, use of the Medi-Cal drug rebate fund to offset General Fund costs). Removing this item—which reduces General Fund spending—from the list of discretionary choices made in the Governor’s budget increases our calculation of the surplus to $6 billion. The document is updated to reflect these changes.

Update 1/24/20: Adjusted Judicial Branch items in Appendix Figure 1 to reflect ongoing spending.

The Mental Health Services Act: Issues for Legislative Consideration

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December 9, 2019 - Presented to: Assembly Budget Subcommittee No. 1 on Health and Human Services

The 2020-21 Budget: Medi-Cal Fiscal Outlook

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November 20, 2019 - This web post provides detail on our projections and assumptions related to General Fund spending in Medi-Cal for the years 2019-20 through 2023-24. In the near term, we project Medi-Cal spending to grow to $23.5 billion in 2020-21. Over the long term, we project General Fund spending in Medi-Cal to grow to up to $27.6 billion.

In addition to this report, you can find the main California's Fiscal Outlook report along with a collection of other fiscal outlook material on our fiscal outlook budget page.

The 2019-20 Budget: California Spending Plan—Health and Human Services

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October 17, 2019 - From the General Fund, the 2019-20 spending plan provides $26.4 billion for health programs and $15.5 billion for human services programs—an increase of 18 percent and 12.6 percent, respectively, over estimated 2018-19 General Fund spending in these two policy areas. Major health-related policy actions include the reauthorization of a tax on managed care organizations (which will reduce the above-noted General Fund health spending by $1 billion, pending federal approval) and over $400 million General Fund for state-funded subsidies for health insurance purchased on the individual market through Covered California. Major human services-related policy actions include General Fund support to increase CalWORKS cash grants and most developmental services provider rates, and to restore previously reduced service hours in the In-Home Supportive Services program. The spending plan also reflects the deposit of $700 million into a safety net reserve (bringing its balance to $900 million) that can be used for future CalWORKs and/or Medi-Cal expenditures.

Overview of Public Community Mental Health Services Funding and the Mental Health Services Act

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August 21, 2019 - Assembly Committee on Accountability and Administrative Review and Assembly Committee on Health

Item 4260-101-3305 Proposition 56 Medi-Cal Spending

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June 3, 2019 - Presented to: Budget Conference Committee

The MCO Tax Item 4260-101-0001

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June 3, 2019 - Presented to: Budget Conference Committee

Stabilizing Services for Consumers in the DDS System Item 4300-101-0001

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June 3, 2019 - Presented to: Budget Conference Committee

The 2019-20 May Revision: Update to Governor's 1991 Realignment Proposals

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May 29, 2019 - In this web post, we describe the update to the Governor’s 1991 realignment proposal introduced in January. Additionally, we assess whether the changes included in the Governor’s May Revision align with our realignment principles and address the issues we raised for Legislative consideration in January.

The 2019-20 May Revision: Analysis of the Governor’s January and May Mental Health Workforce Proposals

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May 16, 2019 - In January, the Governor proposed a $50 million one-time General Fund augmentation for existing mental health workforce programs that are administered by OSHPD. In the May Revision, the Governor proposes an additional $100 million in MHSA funding for mental health workforce. This post (1) provides background on the state’s mental health workforce, (2) gives an overview of existing programs and funding aimed at improving the state’s mental health workforce, (3) summarizes and assesses the Governor’s proposals, and (4) provides options for legislative consideration.

Governor’s May Revision Update: Health Insurance Affordability Proposals

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May 15, 2019 - With the May Revision (and prior to the May Revision with the release of proposed implementing legislation), the administration has provided additional details on its January proposal to impose a state individual mandate and use penalty revenues from the mandate to fund health insurance subsidies. In this post, we summarize key updates to the Governor’s proposals and raise some issues for the Legislature’s consideration.

The 2019-20 May Revision: Governor's May Revision Medi-Cal Budget

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May 14, 2019 - The Governor’s May Revision includes Medi-Cal spending of $19.7 billion from the General Fund ($93.4 billion total funds) in 2018-19 and $23 billion from the General Fund ($102.2 billion total funds) in 2019-20. As will be described in this post, about half of the reduction in estimated spending in 2018-19 reflects a shift of costs in Medi-Cal to a different budget item, rather than a true reduction in estimated program costs. After accounting for this shift, the May Revision is about $350 million below January estimates across 2018-19 and 2019-20.

The 2019-20 Budget: Assessing the Governor’s Primary Care Physician Residency Proposals

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May 9, 2019 - To obtain a license to practice medicine, California law requires all medical school graduates to complete three years of postgraduate training. Most physician‑trainees fulfill this requirement by completing a residency program. The state currently funds two initiatives to support residency programs for primary care physicians. The first initiative is named after its legislative authors, Song‑Brown, and is administered by the Office of Statewide Health Planning and Development (OSHPD). The second initiative is authorized by Proposition 56 and is administered by the University of California (UC). The Governor proposes making certain limited‑term funding for these initiatives ongoing. In this brief, we provide background on residency programs, describe the Governor’s two associated budget proposals, assess those proposals, and make associated recommendations.