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The 2018-19 Budget: Meeting Workforce Demand for Certified Nursing Assistants in Skilled Nursing Facilities


[PDF] CDPH’s Licensing and Certification of SNFs

October 5, 2021 - Assembly Committee on Health


[PDF] Long-Term Health Care

February 21, 1990 - One of the Legislature's challenges over the next decade is to promote adequate access to nursing facility beds for the state's population. Our review suggests that it is possible that there will be a disparity between the need for nursing facility services and the growth of bed supply over the next decade. Furthermore, the current Medi-Cal reimbursement system may be (1) contributing to low supply growth, (2) causing access problems to nursing facility beds for Medi-Cal clients, and (3) providing incentives that encourage expansion of facilities that are more costly to operate.


[PDF] 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.


The 2022-23 Budget: Analysis of the Care Economy Workforce Development Package

March 10, 2022 - This post analyzes the Governor’s proposed Care Economy Workforce Development Package. We provide an assessment and recommendations for both the package as a whole and for two specific components of the package.


Proposed Changes to Veterans Home in Yountville

March 6, 2018 - The Governor’s 2018-19 budget proposes $15.7 million General Fund for the California Department of Veterans Affairs (CalVet) to conduct a preliminary study to construct a new skilled nursing and memory care facility at the Veterans Home of California in Yountville. In addition, the Governor’s budget proposes to convert double occupancy rooms to single occupancy rooms in the domiciliary care unit at the Yountville veterans home. In this analysis, we (1) provide a brief background on the veterans home system, (2) describe the Governor’s proposal, and (3) provide our recommendations.


The 2017-18 Budget: Federal Receiver for Inmate Medical Services

March 3, 2017 - In this web post, we provide an overview of the Federal Receiver for Inmate Medical Services, who maintains direct control over inmate medical care provided in California Department of Corrections and Rehabilitation (CDCR) facilities, and the level of funding proposed for inmate medical services in the Governor’s 2017-18 budget. We also assess and make recommendations on four specific Receiver budget proposals: (1) an $8.9 million augmentation related to medication management, (2) a $3.1 million augmentation related suicide watch, (3) a $5.4 million augmentation related to health care appeals, and (4) a $2 million augmentation related to managing health care equipment.


The 2013-14 Budget: Analysis of the Health and Human Services Budget

February 27, 2013 - The Governor's budget proposes $28.3 billion in expenditures from the General Fund for health and human services programs in 2013-14. This reflects a 3.4 percent increase for health programs and a 7.9 percent increase for human services programs over 2012-13 estimated expenditures. For the most part, the year-over-year budget changes reflect caseload changes, technical budget adjustments, and the implementation of previously enacted policy changes, as opposed to new policy proposals. In the report, we find that the budget does not reflect the fiscal impact of the proposed Medi-Cal expansion, nor does it reflect potential costs and savings related to various other provisions of federal health care reform. We find that the Governor's Medi-Cal budget proposal assumes General Fund savings that are subject to significant uncertainty. We also provide a status update on the transition of the Healthy Families Program enrollees to Medi-Cal, finding that the transition is generally proceeding as planned, with some delays. We discuss problems in the operation of the state's Developmental Centers (DCs) by the Department of Developmental Services, and recommend that oversight of the DCs be strengthened by the creation of an independent Office of the Inspector General. We discuss the recent major program changes to the California Work Opportunity and Responsibility to Kids (CalWORKs) that are reflected in the budget, and recommend that the Legislature augment CalWORKs employment services funding--a Governor's budget proposal--to a level of funding it deems appropriate in light of its priorities for the program. We raise various fiscal and policy concerns about the Governor's budget assumption that a 20 percent across-the-board reduction in In-Home Supportive Services service hours will be implemented beginning on November 1, 2013. In light of these concerns, we recommend that the Legislature repeal the 20 percent reduction and instead continue a 3.6 percent across-the-board reduction that would otherwise sunset at the end of the 2012-13 fiscal year.


[PDF] Considering the State Costs and Benefits: In-Home Supportive Services Program

January 21, 2010 - The In-Home Supportive Services (IHSS) program is the fastest–growing major social services program, providing care for over 430,000 recipients, at an annual total cost of about $5.5 billion. The program, which is available to low-income elderly and disabled persons, provides various services to recipients in their own homes and can enhance the quality of life for recipients by making it easier to live at home. For many recipients, the program allows individuals to live at home rather than in an institutional setting (typically, a nursing home). By preventing—or at least delaying—the move to a nursing home, the program can save money for the state. In this report we look at the net fiscal impact of the IHSS program on the public sector and conclude that the state maximizes its net fiscal impact by targeting IHSS services to those recipients who are most likely to enter a nursing home in the absence of the program. Given the state’s continuing fiscal problems, we offer additional options for the Legislature to consider that can achieve state savings through increased targeting.

(Short video introducing this report)


Improving Access to Dental Services for Individuals With Developmental Disabilities

September 27, 2018 - Individuals with developmental disabilities face a number of behavioral, cognitive, and physical challenges that can adversely affect their health. Oral health is no exception. Individuals with developmental disabilities often need extra appointments or special accommodations that dentists may be unwilling or unable to provide. This report analyzes the extent to which dental services are available and sufficient for individuals with developmental disabilities. Finding that access challenges exist, we consider options and make recommendations for improving access.


The 2017-18 Budget: Department of State Hospitals (DSH)

February 22, 2017 - In this web post, we provide an overview of the Department of State Hospitals (DSH) and the level of funding proposed for the department in the Governor’s 2017-18 budget. We also assess and make recommendations on four specific DSH budget proposals: (1) a $250 million shift in inpatient psychiatric programs from DSH to the California Department of Corrections and Rehabilitation, (2) a $10.5 million proposal to activate 60 beds for Incompetent to Stand Trial patients in the Kern County Jail, (3) an $ 8 million dollar funding increase to staff units designed specifically for violent patients, and (4) a $6.2 million General Fund loan for DSH-Napa earthquake repairs.


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

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.


The 2020-21 Budget: Analysis of the Medi-Cal Budget

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.


[PDF] The 2019-20 Budget: Department of State Hospitals

February 13, 2019 - The Governor’s budget proposes $2 billion for the Department of State Hospitals (DSH) in 2019‑20—an increase of $59 million (3 percent) from the revised 2018‑19 level. In this report, we assess four specific DSH proposals and offer recommendations for legislative consideration.