Health and Human Services Publications

The 2018-19 Budget: Analysis of the Governor's 340B Medi-Cal Proposal

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March 21, 2018 - This budget brief analyzes the Governor’s 2018-19 budget proposal to eliminate the use of the 340B Drug Pricing Program in Medi-Cal. The Governor’s proposed statutory changes are intended to generate state savings and reduce the administrative complexity of complying with federal law on duplicate discounts when 340B prescriptions drugs are dispensed to Medi-Cal enrollees. We find that the Governor’s proposal merits serious consideration from the Legislature since, among other benefits, it would likely result in state savings that the Legislature could, in turn, use to fund its priorities. We note, however, that these savings would be in place of savings currently enjoyed by eligible healthcare providers. Before making a decision on the Governor’s proposal, we recommend that the Legislature ask the administration to provide the following key information on the Governor’s proposal: (1) the amount of Medi-Cal savings that would be generated, (2) the impact on healthcare providers currently participating in the 340B Program, and (3) the trade-offs of alternative policy approaches to addressing the challenges that are present due to the use of the 340B Program in Medi-Cal.

The Potential Effects of Ending the SSI Cash-Out

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March 14, 2018 - Presented to Assembly Budget Subcommittee No. 1 on Health and Human Services

Sequestering Savings From the Closure of Developmental Centers

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March 7, 2018 - Presented to Assembly Budget Subcommittee No. 1 on Health and Human Services

The 2018-19 Budget: The Administration’s Proposition 55 Estimates

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March 1, 2018 - Proposition 55 (2016) aimed to increase funding for Medi-Cal under a formula administered by the Department of Finance. In 2018-19, the first year of implementation of this calculation, the administration’s interpretations and estimates result in no additional funds to Medi-Cal. Two key choices lead to this result. First, the administration’s decision to subtract $3.5 billion from available revenues to account for its proposed optional reserve deposit significantly reduces the calculation’s starting point, eliminating a surplus that would have directed funds to Medi-Cal. Second, the administration’s workload budget approach is based on a broad definition of currently authorized services, which also has the effect of reducing the amount of potential funds for Medi-Cal under the measure. Different decisions about these two features of the measure could result in more or less funding for Medi-Cal by hundreds of millions—or even billions—of dollars in the future.

The 2018-19 Budget: Analysis of the Health and Human Services Budget

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February 16, 2018 - In this report we provide a broad overview of the Governor's health and human services budget, highlighting major year-over-year changes. We then provide a more in-depth analysis of select programmatic areas.

Financing Considerations for Potential State Healthcare Policy Changes

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February 5, 2018 - Assembly Select Committee on Health Care Delivery Systems and Universal Coverage.

2/5/18: Correction to Figure 3.

Fiscal Outlook: Medi-Cal

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November 15, 2017 - This online post discusses the major factors that we project will impact General Fund spending in Medi-Cal from 2017-18 to 2021-22.

This is part of a collection of material for The 2018-19 Budget: California’s Fiscal Outlook. See a complete list of this year's fiscal outlook material on our fiscal outlook budget page.

Fiscal Outlook: In-Home Supportive Services (IHSS)

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November 15, 2017 - In this fiscal outlook post, we discuss our near- and long-term costs projections for the In-Home Supportive Services (IHSS) Program and significant cost drivers and savings.

This is part of a collection of material for The 2018-19 Budget: California’s Fiscal Outlook. See a complete list of this year's fiscal outlook material on our fiscal outlook budget page.

Health and Human Services Agenda Item 4260-101-3305—Proposition 56 Medi-Cal Spending

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June 7, 2017 - Presented to Budget Conference Committee

Item 4140-101-0001—OSHPD—Funding for Health Care Workforce Development Item 6440-001-0001—UC—Graduate Medical Education and Base Allocation

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June 2, 2017 - Presented to Budget Conference Committee

The 2017-18 Budget: Overview of the Governor's May Revision Medi-Cal Budget Proposal

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May 17, 2017 - In this Budget and Policy Post, we provide an overview of several of the key factors driving the changes in estimated and proposed Medi-Cal spending in 2016-17 and 2017-18; our evaluation of the Governor’s updated caseload estimates; and an update on several key proposals from the January budget, some of which have been modified at May Revision. During continuing budget deliberations, we recommend that the Legislature ask for clarity from the Department of Health Care Services on how the Major Risk Medical Insurance Program will be funded in the future under the Governor’s proposal if Health Care Services Plans and Penalties Fund revenues are insufficient to cover the costs of the program. We also recommend that the Legislature, should it approve the Governor’s plan to cancel the planned transition of Newly Qualified Immigrants from Medi-Cal to Covered California, consider trailer bill language that repeals existing state statutory language that calls for the transition. Finally, we recommended a downward technical adjustment of $62 million General Fund to the 2017-18 May Medi-Cal Estimate.

The 2017-18 Budget: The Governor's May Revision In-Home Supportive Services Cost-Sharing Proposal

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May 16, 2017 - Rather than return to the original 1991 realignment cost-sharing ratios for In-Home Supportive Services (IHSS) as initiated by the Governor in January (described in our report: The Coordinated Care Initiative: A Critical Juncture), the administration proposes establishing a new Maintenance of Effort (MOE) for counties’ share of IHSS cost. The new MOE would include both services and administration using 2017-18 costs. The new MOE would significantly increase costs to counties in 2017-18 relative to 2016-17. While the MOE shifts significant costs to counties, the proposal provides state General Fund support and additional realignment revenue to partially offset this increase. In this analysis, we lay out the various components of this complex proposal. We also raise key questions for Legislative consideration and provide our recommendation for how to move forward.

AHCA: Medicaid as a Per Capita Capped Allotment and the CBO’s Analysis

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March 22, 2017 - Presented to: Assembly Budget Subcommittee No. 1 on Health and Human Services and Assembly Health Committee

What the Patient Protection and Affordable Care Act (ACA) Means for California

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March 22, 2017 - Presented to Assembly Budget Subcommittee No. 1 On Health and Human Services and Assembly Health Committee

The 2017-18 Budget: Analysis of the Medi-Cal Budget

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March 9, 2017 - In California, the federal‑state Medicaid program is administered by the Department of Health Care Services (DHCS) as the California Medical Assistance Program (Medi‑Cal). Medi‑Cal is by far the largest state‑administered health services program in terms of annual caseload and expenditures. In this report, we provide an analysis of the administration’s caseload projections, including a discussion of the projected increases in ACA optional expansion caseload. We also provide an assessment of several aforementioned major factors affecting projected changes in Medi‑Cal spending in 2017‑18 and other policy changes proposed by the administration. These include the Governor’s proposed uses of Proposition 56 revenues, the proposal to shift additional New Qualified Immigrants (NQIs) to Covered California in 2017‑18, assumptions around federal CHIP funding, and the proposed abolition and transfer of the Major Risk Medical Insurance Fund (MRMIF).