July 29, 2020 - The Supplemental Report of the 2020-21 Budget Act contains statements of legislative intent that were adopted during deliberations on the 2020-21 budget package.
October 30, 2014 - The integration of eligibility and enrollment processes of health and human services (HHS) programs has long been an important issue for the state. In this report, we focus on the integration of three key HHS programs: the California Medical Assistance Program (Medi-Cal), CalFresh, and the California Work Opportunity and Responsibility to Kids (CalWORKs) program. We also raise several issues for legislative consideration, including (1) determining the appropriate balance between local control and standardized statewide processes, (2) considering whether automation systems currently under development could be leveraged to strengthen integration, and (3) considering whether additional programs should be integrated.
February 11, 2016 - In this report, we provide an analysis of the administration’s caseload projections, as well as a discussion of the impacts of the ACA on the ability to project caseload. We also provide an assessment of several General Fund cost pressures on the horizon in Medi–Cal, including the sunset of the hospital QAF.
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.
February 20, 2014 - The report analyzes the Governor's 2014-15 health budget proposals. In it, we (1) provide an analysis of the impact the implementation of the Patient Protection and Affordable Care Act (ACA)--known as federal health care reform--is having on the Medi-Cal program; (2) analyze the Governor's budget proposal to exempt certain, but not all, classes of Medi-Cal providers and services from retroactive recoupments of payment reductions; and (3) assess the fiscal outlook for the California Health Benefit Exchange, also known as Covered California.
May 3, 2010 - Through Chapter 7, Statutes of 2009, the Legislature has directed the Department of Health Care Services and the Department of Social Services to implement a statewide eligibility and enrollment determination process for the California Work Opportunity and Responsibility to Kids (CalWORKs), Food Stamp, and Medi-Cal programs. The new statewide process is intended to achieve two primary outcomes: (1) providing better service to people applying for these programs and (2) lowering administrative costs through better use of technology. We identify possible improvements and cost-savings in the eligibility and enrollment process. We also recommend a general approach that the Legislature may wish to consider when making difficult decisions about how to proceed with Chapter 7.
September 29, 2023 - The Supplemental Report of the 2023-24 Budget Act contains statements of legislative intent and requests for studies that were adopted by the Legislature during deliberations on the 2023-24 budget package.
November 4, 2013 - The LAO’s annual California Spending Plan publication details the 2013-14 budget package, including legislative and gubernatorial actions through October 2013. (Our office released a preliminary electronic version of the report on July 30, 2013 that summarized legislative and gubernatorial actions through that date.) Major features of the 2013-14 budget plan include $2.1 billion for a new formula to distribute funding amongst schools, a state-based plan to expand Medi-Cal to cover more than one million additional low-income adults, and selected program augmentations.
February 13, 2012 - Currently, three automation systems make up California’s Statewide Automated Welfare System (SAWS). These systems support some of the state’s major health and human services programs by providing eligibility determination, case maintenance, and reporting functions at the county level. Chapter 13, Statutes of 2011 (ABX1 16, Blumenfield) directs the administration to reduce this number to two by migrating, or moving, counties on an existing system to Los Angeles County’s new system. In this report, we identify several issues for the Legislature to consider as the administration pursues legislative goals for SAWS consolidation. We offer alternative procurement approaches for the migration that would encourage greater vendor competition. Finally, we make several recommendations to enhance legislative oversight and clarify legislative priorities for SAWS consolidation.
May 5, 2015 - Oversight of the quality of care provided by Medi-Cal Managed Care (MMC) plans is an increasingly important issue for the Legislature to examine, as MMC enrollment and the geographic reach of MMC have grown significantly over the past decade. In this report, we analyze the quality of MMC plans and current DHCS efforts to improve MMC plan quality, and consider additional steps and alternative approaches, such as P4P, the state could take to monitor plans and stimulate quality improvement in MMC.
February 11, 2022 - In this post, we analyze the Governor’s proposal to provide food assistance to currently ineligible immigrants aged 55 and older. First, we provide some essential background on California’s food assistance programs, then we describe the Governor’s proposed expansion, and finally provide an analysis of the proposal as well as issues for legislative consideration.
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 10, 2016 - In this report, we describe the FI$Cal Project, provide an update on the project’s status, and describe the events that triggered the development of a sixth special project report (SPR 6). We also describe the Governor’s 2016–17 budget proposals to: (1) allow the project to implement the changes proposed in SPR 6 and (2) establish a new state department to maintain and operate the FI$Cal System. Finally, we make associated findings and recommendations.