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.
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 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.
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.
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).
October 17, 2019 - From the General Fund, the 2019-20 spending plan provides $26.4 billion for health programs and $15.5 billion for human services programs—an increase of 18 percent and 12.6 percent, respectively, over estimated 2018-19 General Fund spending in these two policy areas. Major health-related policy actions include the reauthorization of a tax on managed care organizations (which will reduce the above-noted General Fund health spending by $1 billion, pending federal approval) and over $400 million General Fund for state-funded subsidies for health insurance purchased on the individual market through Covered California. Major human services-related policy actions include General Fund support to increase CalWORKS cash grants and most developmental services provider rates, and to restore previously reduced service hours in the In-Home Supportive Services program. The spending plan also reflects the deposit of $700 million into a safety net reserve (bringing its balance to $900 million) that can be used for future CalWORKs and/or Medi-Cal expenditures.
February 17, 2012 - California’s system for providing health and social services to low-income seniors and persons with disabilities (SPDs) receiving Medicare and/or Medi-Cal is not coordinated. This lack of care coordination may lead to SPDs being unnecessarily hospitalized or placed in skilled nursing facilities rather than remaining in their own homes—resulting in poor outcomes for recipients and higher costs for the federal and state governments. As part of the 2012-13 budget, the Governor attempts to address this issue by proposing to integrate health and social services into managed care for most SPDs. In this report, we provide background information on the Medi-Cal and Medicare Programs and describe recent federal and state legislation to address fragmented care delivery. We discuss the potential merits of the Governor’s proposal, but raise several implementation issues and concerns. Finally, we make recommendations that encourage care coordination for SPDs by first completing and evaluating a currently authorized integrated care demonstration project in four counties rather than expanding the demonstration statewide as proposed by the Governor— an action that we think is premature. We also encourage the consideration of other ways to test the integration of benefits for SPDs.
March 7, 2012 - Presented to Joint Oversight Hearing on Long-Term Care Integration and Medi-Cal Managed Care, Assembly Budget Subcommittee No. 1 on Health and Human Services and Assembly Committee on Aging and Long-Term Care
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.
May 18, 2020 - Assembly Budget Subcommittee No. 1 on Health and Human Services
February 20, 2014 - In this report, we analyze the Governor's 2014-15 human services budget proposals. In it, we (1) recommend that the Legislature consider modifications to the Governor's proposed response to new federal regulations concerning overtime in the In-Home Supportive Services (IHSS) programs; (2) find that although the Governor's California Work Opportunity and Responsibility to Kids (CalWORKs) budget proposal raises valid concerns, the Legislature should reject the proposal; and (3) recommend several modifications to the Governor's comprehensive proposal to reform the Community Care Licensing (CCL) program in light of recent health and safety issues discovered at residential care and other CCL-licensed facilities.
February 12, 2015 - This report analyzes the Governor's 2015-16 human services budget proposals. First, we review major trends in human services programs since 2007-08 (the last state budget developed before the major recession) and find that total spending is up by 11 percent (in inflation-adjusted terms), with major changes in how programs are funded. Our report also analyzes the budgetary impacts and issues for the Legislature to consider given the uncertain legal status of new federal labor regulations affecting In-Home Supportive Services (IHSS) and the Department of Developmental Services. The report includes an analysis of the future of the state's developmental centers (DCs) and an analysis of the Governor's budget proposal to further reform the Community Care Licensing (CCL) program that oversees the licensing of child care, children's residential, and adult and senior care facilities. Finally, the report analyzes the Governor's budget proposal to implement 2 of 19 recommendations of a working group established by the Legislature to recommend reforms to the foster care system.
Proposed SSI/SSP figures corrected 3/11/15
March 26, 2010 -
In 2009-10, expenditures for health and social services programs in California are estimated to be about $25 billion or 29 percent of statewide General Fund spending. Spending on health and social services programs accounts for 36 percent of total spending when special funds, federal funds, and the General Fund are included. This primer provides an understanding of the overall health and social services expenditures, the workings of major health and social services programs, spending trends in major programs, and the major funding sources for health and social services programs.
This primer and the companion piece The 2010-11 Budget: Health and Social Services—A Restricted Environment provide a framework for policymakers as they make very difficult budget decisions in health and social services.
February 27, 2017 - In this report we provide (1) background on the health care and Long‑Term Services and Supports (LTSS) issues that the Coordinated Care Initiative (CCI) was intended to address, (2) an update on the CCI’s results and challenges to date, (3) an assessment of the Governor’s elimination of the CCI and budget proposal to extend certain CCI components, and (4) options for the Legislature on how to move forward. As ending the In‑Home Supportive Services (IHSS) has major, and rather complex, implications for 1991 realignment, we include a technical appendix at the end of this report that provides an in‑depth analysis of these implications.