January 22, 2015 - In 2012, the Legislature authorized the development and pilot implementation of a universal assessment tool (UAT) to streamline eligibility and level-of-need determinations for three home- and community-based services (HCBS) programs that provide care to seniors and people with disabilities. Our analysis finds that the benefits of a UAT likely outweigh the costs associated with its development. To ensure the UAT achieves the benefits of creating a more effective and efficient approach to HCBS assessment, we recommend: (1) legislation specifying intent to eventually use the UAT on a statewide basis, (2) development of an automated UAT customized to fit within California’s programmatic and policy environment, (3) piloting of county welfare departments and managed care plans as administrators of the UAT, and (4) a formal evaluation of the UAT pilot.
February 10, 2022 - This post provides an update on the state's home- and community-based services spending plan, which was conditionally approved by the federal government in January 2022. We describe the quarterly updates the state will need to provide the federal government and ways to ensure legislative oversight over implementation of HCBS spending plan.
February 2, 2022 - This post describes the Governor’s budget assumptions and proposals related to the In-Home Supportive Services program and offers relevant issues for Legislative consideration.
Update (2/7/22): Time requirement for incentive payment to IHSS providers in the state’s HCBS spending plan has been updated.
March 2, 2023 - This post describes the Governor’s 2023-24 budget assumptions and proposals related to the In-Home Supportive Services program and offers relevant issues for legislative consideration.
November 9, 2021 - Examines Medi-Cal enrollment of Department of Developmental Services (DDS) consumers and the fiscal effect that additional Medi-Cal enrollment would have on the DDS budget and on state costs overall.
Correction 11/19/21: Corrected average annual per person fee-for-service cost in Medi-Cal.
March 25, 2020 - This post describes key actions taken to increase Californians' access to food in the wake of the coronavirus disease 2019 (COVID-19). We focus on key actions taken by the state and federal government through April 10, 2020.
February 29, 2024 - In this post, we provide some background on the In-Home Supportive Services (IHSS) program, an overview of the Governor's 2024-25 budget proposals and assumptions for IHSS, and offer relevant issues for legislative consideration.
February 24, 2017 - In this report, we discuss the Governor’s budget proposals for Department of Developmental Services (DDS), providing our assessment of the budget package for DDS and analyzing one of the proposed trailer bills, which we find raises a number of issues. Also in this report, we describe the general nature of shifts in both policy and practice in the field of developmental services, detailing the relevant state and federal policies and their implications for the future developmental services program in the state, and discussing issues for the Legislature to consider as DDS implements these changes.
February 27, 2013 - In 2012, the Legislature authorized the Coordinated Care Initiative (CCI) as an eight-county pilot to demonstrate the integration of Medi-Cal and Medicare benefits for "dual eligibles"--beneficiaries eligible for both benefits. The CCI will also integrate long-term services and supports (LTSS) under Medi-Cal managed care in the eight counties for dual eligibles and seniors and persons with disabilities covered only by Medi-Cal. The Governor's budget delays the start date of CCI implementation to September 1, 2013, resulting in lower 2013-14 savings than initially anticipated. Joint federal-state decisions regarding key financing and operational aspects of CCI are pending, creating uncertainty regarding the timely and successful implementation of CCI. We recommend that the Legislature clarify the legal status of CCI to go forward and consider authorizing CCI to test greater integration of In-Home Supportive Services--a particular LTSS--under managed care.
March 15, 2021 - The California Advancing and Innovating Medi-Cal (CalAIM) proposal is a far-reaching set of reforms to expand, transform, and streamline Medi-Cal service delivery and financing. This post—the fourth in a series assessing different aspects of the Governor’s proposal—analyzes CalAIM proposals targeted at seniors and persons with disabilities, including new benefits and structural changes to how long-term services and supports (LTSS) are administered. (LTSS include, among other supports and services, institutional care in nursing homes and home- and community-based services such as home care and personal care services.)
May 6, 2021 - On March 11, 2021, the President signed into law the American Rescue Plan Act of 2021 (ARP Act)—a $1.9 trillion coronavirus disease 2019 relief package. This post highlights the health-related provisions of the ARP Act that provide significant funding directly to state/local health care and public health agencies, rural hospitals, home- and community-based services programs, subsidized individual market health coverage programs, and public behavioral health services. Where possible, based on currently available information, we provide an estimate of the funding allocations to California governments and other entities in the state. While this post reflects our best understanding of the high-level content and implications of this legislation as of late April, we will update the post as new information and clarifications become available.
April 19, 2021 - The Supplemental Report of the 2020-21 Budget Act requires our office to evaluate options for enhancing federal financial participation through Medi-Cal for consumers served by the Department of Developmental Services. This post provides an interim update of our initial findings and preliminary assessment. A final report will be delivered to the Legislature in the late summer.
May 14, 2020 - In this post, we discuss actions the federal and state governments have taken to assist K-12 schools and child care providers in responding to coronavirus disease 2019 (COVID-19).