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The 2021-22 Budget: Analysis of CalAIM Financing Issues


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The 2020-21 Budget: Re-Envisioning Medi-Cal—The CalAIM Proposal

February 28, 2020 - In this report, we provide an overview and assessment of the Governor's California Advancing and Innovating Medi-Cal (CalAIM) proposal, also known as Medi-Cal Healthier California for All. CalAIM would make far-reaching reforms to Medi-Cal that would increase the program’s focus on its high-cost and high-needs enrollee populations, transform and streamline Medi-Cal managed care, extend components of a current federal waiver, and rethink how behavioral health services are financed and delivered.

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The 2021-22 Budget: CalAIM: Equity Considerations

March 12, 2021 - The California Advancing and Innovating Medi-Cal (CalAIM) proposal is a set of reforms to expand, transform, and streamline Medi-Cal service delivery and financing. This post—the third in a series assessing different aspects of the Governor’s proposal—analyzes CalAIM’s potential to reduce health disparities, and therefore promote health equity.

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The 2021-22 Budget: CalAIM: The Overarching Issues

February 9, 2021 - The California Advancing and Innovating Medi-Cal (CalAIM) proposal is a set of reforms to expand, transform, and streamline Medi-Cal service delivery and financing. This post—the first in a series assessing different aspects of the Governor’s proposal—provides a brief overview of CalAIM, summarizes key changes from last year’s withdrawn proposal, and analyzes overarching issues related to CalAIM.

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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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The 2021-22 Budget: Analysis of the Medi-Cal Budget

February 16, 2021 - This post analyzes the major adjustments to the Medi-Cal budget in 2020-21 and 2021-22, with a focus on the technical adjustments such as the administration’s caseload estimates. We will further analyze the major discretionary Medi-Cal proposals in separate publications and communications to the Legislature.

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The 2021-22 Budget: Behavioral Health: Continuum Infrastructure Funding Proposal

February 17, 2021 - This post analyzes the Governor’s proposal in the Department of Health Care Services to provide $750 million General Fund—on a one-time basis—in competitive grants to counties to acquire or renovate facilities for community behavioral health services.

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The 2021-22 Budget: Behavioral Health: Community Care Demonstration Project

February 19, 2021 - This post analyzes the Governor’s proposal in the Department of State Hospitals to provide $233.2 million General Fund in 2021-22 and $136.4 million General Fund in 2022-23 and ongoing to establish a demonstration project—that would be optional for counties to participate in—in which responsibility for treating individuals found incompetent to stand trial and facing a felony charge would be realigned to participating counties.

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The 2021-22 Budget: Behavioral Health: Medi-Cal Student Services Funding Proposal

February 17, 2021 - This post analyzes the Governor’s proposal in the Department of Health Care Services to provide $200 million General Fund ($400 million total funds) one time to provide incentive payments to Medi-Cal managed care plans to increase the number of students receiving behavioral health services.

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Improving Parolee Substance Use Disorder Treatment Through Medi-Cal

April 14, 2021 - This report provides background on the ways parolees access substance use disorder treatment (SUDT) through providers who are typically either funded by the California Department of Corrections and Rehabilitation or through Medi-Cal (the state’s Medicaid program). It assesses the trade-offs between these two approaches and recommends steps to improve the quality of service and create savings by increasing the utilization of Medi-Cal for parolee SUDT.

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The 2020-21 Budget: The Governor’s Homelessness Plan

February 11, 2020 - In this report we provide the Legislature context for the state’s homelessness crisis, provide an update on major recent state efforts to address homelessness, assess the Governor’s 2020‑21 homelessness plan, propose a framework to help the Legislature develop its own plan and funding allocations, and offer an alternative to the Governor’s 2020‑21 budget proposal.

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The 2020-21 Budget: Medi-Cal Fiscal Outlook

November 20, 2019 - This web post provides detail on our projections and assumptions related to General Fund spending in Medi-Cal for the years 2019-20 through 2023-24. In the near term, we project Medi-Cal spending to grow to $23.5 billion in 2020-21. Over the long term, we project General Fund spending in Medi-Cal to grow to up to $27.6 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.

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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.