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Federal COVID-19 Response Actions Affecting Older Adults and Persons with Disabilities


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[PDF] The Universal Assessment Tool: Improving Care for Recipients of Home- and Community-Based Services

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.

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The 2021-22 California Spending Plan: Home- and Community-Based Services Spending Plan

November 1, 2021 - This post summarizes the state’s 2021-22 spending package for Home- and Community-Based Services. It is part of our Spending Plan series, which contains posts focused on each major sector of the state budget.

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The 2022-23 Budget: Update on Home- and Community- Based Services Spending Plan

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.

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The 2022-23 Budget: In-Home Supportive Services

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.

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[PDF] Enhancing Federal Financial Participation for Consumers Served by the Department of Developmental Services

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.

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Nutrition Programs in COVID-19 Recovery Actions

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.

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[PDF] The 2013-14 Budget: Coordinated Care Initiative Update

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.

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[PDF] The 2017-18 Budget: Analysis of the Department of Developmental Services Budget

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.

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Enhancing Federal Financial Participation for Consumers Served by the Department of Developmental Services—An Interim Update

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.

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The 2021-22 Budget: CalAIM: New Directions for Services for Seniors and Persons With Disabilities

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.)

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COVID-19: American Rescue Plan’s Major Health-Related Funding Provisions

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.

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The 2019-20 Budget: California Spending Plan—Health and Human Services

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.