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The MCO Tax: A Flat Versus Tiered Structure


Hearing Handout

[PDF] The MCO Tax: A Flat Versus Tiered Structure

August 18, 2015 - Presented to: Senate Committee on Public Health and Developmental Services.

Hearing Handout

[PDF] MCO Tax Overview

December 1, 2015 - Conference Committee on SB X2 2 and AB X2 1, Second Extraordinary Session

Hearing Handout

[PDF] Overview of MCO Tax, Selected Other Tax Increase Options, and IHSS Issues

July 2, 2015 - Presented to Senate Committee on Public Health and Developmental Services Second Extraordinary Session

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Federal Approval of a Reauthorized Managed Care Organization Tax Now Appears More Likely

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.

Hearing Handout

[PDF] The MCO Tax Item 4260-101-0001

June 3, 2019 - Presented to: Budget Conference Committee

Report

[PDF] The 2019-20 Budget: Analysis of the Medi-Cal Budget

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.

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The 2015-16 Budget: Analysis of the Health Budget

February 12, 2015 - This report analyzes the Governor's 2015-16 state health program budget proposals. In the report, we review trends in the major health programs since 2007-08 (the last budget developed before the most recent recession), analyze the Governor's proposed restructuring of the managed care organization (MCO) tax, and describe the uncertainty regarding continued federal funding for the Children's Health Insurance Program (CHIP). The report also includes an analysis of the Department of State Hospitals budget and an analysis of the Governor's proposals to improve quality and increase staffing for the Licensing and Certification (L&C) Program administered by the Department of Public Health.

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The 2014-15 Budget: California's Fiscal Outlook

November 20, 2013 - The 19th annual edition of the LAO's Fiscal Outlook--a forecast of California's state General Fund revenues and expenditures over the next six years--reflects continued improvement in the state's finances. A restrained budget for 2013-14, combined with our updated forecast of increased state revenues, has produced a promising budget situation for 2014-15. Our forecast indicates that, absent any changes to current laws and policies, the state would end 2014-15 with a multibillion-dollar reserve. Continued caution is needed, however, given that these surpluses are dependent on a number of assumptions that may not come to pass. For example, as we discuss in this report, an economic downturn within the next few years could quickly result in a return to operating deficits. In this report, we outline a strategic approach for allocating potential surpluses that prepares for the next economic downturn while paying for past commitments, maintaining existing programs, and making new budgetary commitments incrementally to address other public priorities.

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The 2015-16 Budget: California's Fiscal Outlook

November 19, 2014 - The 20th annual edition of the LAO's Fiscal Outlook—a look at possible state revenue and spending trends over the next five years—reflects anticipated progress in building budget reserves under the recently approved Proposition 2. Specifically, absent new budget commitments, we estimate the state would end 2015-16 with $4.2 billion in total reserves, $2 billion of which would result from Proposition 2's new reserve rules. A $4 billion reserve would mark significant progress for the state, but maintaining such a reserve in 2015-16 would mean little or no new spending commitments outside of Proposition 98, the funding formula for schools and community colleges. Our higher General Fund revenue estimates translate to $6.4 billion available in 2015-16 for the state's Proposition 98 priorities. The report also discusses choices facing the state in implementing Proposition 2, such as choices about which budgetary and retirement debts to repay with dedicated Proposition 2 funds over the next 15 years.

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[PDF] The 2019-20 Budget: Overview of the California Spending Plan (Final Version)

October 17, 2019 - Each year, our office publishes California Spending Plan, which summarizes the annual state budget. In July, we published a preliminary version of the report. This, the final version, provides an overview of the 2019‑20 Budget Act, then highlights major features of the budget approved by the Legislature and signed by the Governor. In addition to this publication, we have released a series of issue‑specific, online posts that give more detail on the major actions in the budget package.

Correction (10/29/19): Figure 4 total.

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

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.

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[PDF] The 2019-20 Budget: Overview of the Governor's Budget

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.

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Upcoming Changes in Medi-Cal Create Fiscal and Policy Uncertainty

October 9, 2015 - This is the first in a series of policy posts on upcoming changes in Medi-Cal and the fiscal and policy uncertainty the changes create. In this post, we briefly highlight four upcoming major changes: (1) the renewal of the state’s Section 1115 waiver, (2) proposed modifications to the federal government’s regulations for Medicaid managed care plans, (3) the phase-in of state’s share of cost for the Affordable Care Act’s optional expansion population, and (4) the need to restructure the managed care organization tax to meet federal requirements. In the coming weeks and months, we will provide more detail and updates on these changes and their potential implications for the Medi-Cal program and the state’s budget in future policy posts similar to this one and in budget analyses.

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The 2015-16 Budget: Overview of the Governor's Budget

January 13, 2015 - In the Governor's 2015-16 budget proposal, the administration raises its revenue estimates, and this results in a multibillion-dollar influx of new funds for schools and community colleges under the Proposition 98 minimum funding guarantee. The Governor's plan identifies cost pressures and budget risks in health and human services programs, and new program commitments outside of Proposition 98 are limited. The Governor's proposal to pay off the state's retiree health liabilities over the next few decades would, if funded, address the last of state government's large unaddressed liabilities. We conclude the state likely will collect more tax revenue in 2014-15 than the administration now estimates. Barring a sustained stock market drop, an additional 2014-15 revenue gain of $1 billion to $2 billion seems likely in addition to the Governor's budget projection. Even bigger gains of a few billion dollars more are possible in 2014-15. These additional 2014-15 revenues will go largely or entirely to schools and community colleges and could result in a few billion dollars of higher ongoing state payments to schools. Whether tax revenues grow further, stagnate, or, in the worst case, decline in 2015-16 will depend in large part on trends in volatile capital gains and business income.

Hearing Handout

[PDF] Funding and Implementing Individual Health Insurance Market Affordability Policies

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

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Fiscal Outlook: Medi-Cal

November 14, 2018 - This web post provides detail on our projections and assumptions related to General Fund spending in Medi-Cal for the years 2018-19 through 2022-23. In the near term, we project Medi-Cal spending to grow to $23.9 billion in 2019-20. Over the long term, we project General Fund spending in Medi-Cal to grow to up to around $28 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.