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March 26, 2019 - When facing budget problems in the past, the state has “deferred” payments from one fiscal year into the next, providing significant one-time budgetary savings. While the state has already addressed many of its outstanding deferrals, there are still three major categories of deferrals remaining. These are related to: (1) state employee payroll, (2) pension payments, and (3) Medi-Cal payments. The Governor proposes using $1.7 billion to undo the payroll and pension deferrals. We find this would improve the state’s fiscal position and moderately improve the state’s budgetary practices, however, this approach has shortcomings relative to alternatives. This post recommends an alternative approach to the Governor’s proposal.
February 28, 2019 - In this report, we evaluate three Governor's budget proposals related to early intervention services for infants and toddlers with special needs. These include: (1) $60 million ongoing (split between Proposition 56 tobacco tax revenues and federal Medicaid funding) to provide supplemental payments to physicians who screen children covered by Medi-Cal for developmental delays, (2) four new positions (at a cost of $446,000 General Fund) to increase state oversight of Regional Center early intervention services, and (3) possible forthcoming trailer bill language to improve transitions for children aging out of early intervention services and into preschool special education. We recommend rejecting the proposed supplemental payments and approving the other two proposals and further recommend the Legislature consider broader reforms to address longstanding weaknesses in the state's early intervention system.
Update (3/4/19): Figure 3 totals adjusted.
February 26, 2019 - Presented to: Assembly Committee on Health and Senate Committee on Health
February 25, 2019 - In this report, we evaluate the Governor's budget proposals for the Department of Developmental Services (DDS). The proposed 2019-20 DDS budget is projected to reach $7.8 billion ($4.8 billion General Fund), with the caseload of individuals with developmental disabilities served mostly in community-based programs projected to reach nearly 350,000. The total increase in spending is offset somewhat by declining spending on general treatment Developmental Centers, which are scheduled to close by the end of 2019. The Governor's budget proposes to reorganize DDS, based in part on these closures as well as on DDS’ evolving responsibilities as it serves individuals in community settings and adjusts to meeting related upcoming federal requirements that significantly impact the service delivery model. The budget also proposes enhancement of "safety net" and crisis services for individuals in crisis and at risk of displacement from their regular homes or needing temporary residential placements.
Correction (3/6/19): Safety net and crisis home capacity numbers have been updated in Figure 4.
February 22, 2019 - This report analyzes the use of Proposition 56 (2016) funding in Medi‑Cal to improve access to quality care. First, we provide background on how Medi‑Cal services are financed within Medi‑Cal’s multiple delivery systems. Then, we review how access and quality are monitored, primarily within Medi‑Cal’s managed care delivery system. We summarize how Proposition 56 funding in Medi‑Cal has been used to date, and the changes proposed under the Governor’s 2019‑20 budget. Next, we assess Medi‑Cal managed care plans’ performance on selected state access and quality standards. Finally, we provide issues for consideration and recommendations on how to use Proposition 56 funding in Medi‑Cal going forward to improve access to quality care.
February 14, 2019 - In this post, we review the administration’s reductions to certain allocations of Proposition 56 tobacco tax revenue. In our view, the administration’s approach for 2019-20 is reasonable. However, the administration has not yet decided how these adjustments will be determined in 2020-21 and beyond. These future choices could have substantial fiscal effects, and some would be more logically consistent with the administration’s current approach than others.
February 13, 2019 - In this report, we describe the major changes and proposals in the Governor's proposed $100.7 billion (all funds) Medi-Cal budget. Specifically, we advise the Legislature to seriously consider renewing the managed care organization tax, despite the Governor not proposing to do so; present issues for consideration related to the Governor's proposed expansion of comprehensive Medi-Cal coverage for young adults regardless of immigration status; and provide an initial assessment of the Governor's proposals to use Proposition 56 funding in Medi-Cal to extend and expand provider payment increases. We recommend approval of the Governor's proposals to improve fiscal oversight of the Medi-Cal budget, and also recommend that the Legislature require the administration provide additional information to the Legislature in an effort to improve fiscal oversight and transparency of this very large, complex budget going forward.
February 12, 2019 - Presented to: Assembly Health Committee, Assembly Budget Subcommittee No. 1 on Health and Human Services, Senate Committee on Health, and Senate Budget and Fiscal Review Subcommittee No. 3 on Health and Human Services
February 7, 2019 - This report provides our assessment of the Governor's proposals to (1) create a state requirement that most Californians purchase health insurance coverage (referred to as an "individual mandate") or pay a financial penalty and (2) use the revenues from this penalty to fund additional health insurance subsidies for households purchasing coverage through Covered California.
January 14, 2019 - This report presents our office’s initial assessment of the Governor’s Budget. The budget’s position continues to be positive. With $20.6 billion in discretionary resources available, the Governor’s budget proposal reflects a budget situation that is even better than the one our office estimated in the November Fiscal Outlook. The Governor’s Budget allocates nearly half of these discretionary resources to repaying state liabilities. Then, the Governor allocates $5.1 billion to one-time programmatic spending, $3 billion to reserves, and $2.7 billion to ongoing spending. Although the Governor’s allocation to discretionary reserves represents a smaller share of resources than recent budgets, the Governor’s decision to use a significant share of resources to pay down state debts is prudent. The Governor’s ongoing spending proposal is roughly in line with our November estimate of the ongoing capacity of the budget under an economic growth scenario. This was just one scenario, however. Recent financial market volatility indicates revenues could be somewhat lower than either we or the administration estimated.
December 21, 2018 - This post describes recent national developments pertinent to the reauthorization of California’s managed care organization (MCO) tax. The state’s prospects for receiving federal approval—which initially were uncertain—appear to be improved following the recent federal approval of a health insurer tax in Michigan that is structured similarly to California’s MCO tax.
December 14, 2018 - In this post, we (1) explain how the scheduled state minimum wage increases impact IHSS wages and state and county costs, (2) describe the recent temporary and permanent changes to the state and county cost-sharing structure for IHSS wage and benefit increases, and (3) explain how these changes could impact county wage decisions and costs for the state.
December 6, 2018 - With a state as big, as populous, and as complex as California, quickly summarizing how its economy or state budget works is impossible. Instead, Cal Facts is a visual guide—using a variety of different charts—to the state's economy, revenues, and major program trends.
November 14, 2018 - Senate Health Committee and Senate Budget and Fiscal Review Subcommittee No. 3 on Health and Human Services
November 14, 2018 - In this web post we discuss our near- and long-term costs projections for the In-Home Supportive Services (IHSS) Program and significant cost drivers and savings.
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.