Building California’s Behavioral Health Infrastructure: Progress Update and Opportunities for the Proposition 1 Bond

Feb 5, 2025 - Proposition  1 (2024) changed how revenue from the BHSA is spent by the state and counties. The BHSA requires that up to 3  percent of annual revenue (up to about $100  million) is spent on statewide behavioral health workforce initiatives administered by HCAI.
https://lao.ca.gov/Publications/Report/4954

Mental Health Services Act: Revenue Volatility and the Governor’s Proposal to Reduce Allowable County Reserves

Jul 13, 2023 - Generally speaking, a revenue source with an AD of 10  percentage points over a given time period would be twice as volatile as a revenue source with an AD of 5  percentage points. See “Measuring Volatility ” in our February 2017 report, Volatility of the Personal Income Tax Base , for a detailed description and hypothetical calculation of AD.
https://lao.ca.gov/Publications/Report/4780

The 2026-27 Budget: Medi-Cal Analysis

Mar 2, 2026 - One possible reason for our higher estimate is that our model reflects not only disenrollment among current enrollees, but also reduced enrollment flows over time and a persistent risk of disenrollment among eligible individuals due to added administrative burden.
https://lao.ca.gov/Publications/Report/5146

The 2025-26 Budget: Understanding Recent Increases in the Medi-Cal Senior Caseload

Mar 6, 2025 - In the paragraphs that follow, we provide our analysis that results in ou r estimate of at least 165,000 seniors being added due to eligibility expansions since 2020. (As a consequence of this estimate, it follows naturally that we estimate up to 60,000  seniors being added due to the effects of continuous coverage, the unwinding, and unwinding flexibilities, for a total increase of 225,000 seniors due to policy changes.)
https://lao.ca.gov/Publications/Report/5010

The 2026-27 Budget: Department of Developmental Services

Mar 13, 2026 - Future metrics should be sufficiently robust to reinforce quality, but not so stringent that a large share of providers fail to meet the standards across multiple years and potentially risk ongoing revenue losses due to reduced payments.
https://lao.ca.gov/Publications/Report/5157

The 2024-25 Budget: Department of Health Care Access and Information

Feb 27, 2024 - While hospitals, on average, remained profitable during the pandemic, in 2022, average profits fell considerably. According to HCAI data, hospital margins (that is, the share of revenues available as profits, after netting out expenses) were 1  percent in 2022, considerably below the level in 2021 (9  percent).
https://lao.ca.gov/Publications/Report/4860

Considering Medi-Cal in the Midst of a Changing Fiscal and Policy Landscape

Oct 24, 2025 - …But Potentially With Added Complexity. Adding more flexibilities also could come with the potential downside of more complexity for beneficiaries and counties. For example, exempting high unemployment counties from work requirements could create more volatility.
https://lao.ca.gov/Publications/Report/5083

The 2022-23 California Spending Plan: Health

Oct 24, 2022 - Beginning January 1, 2023, Doula services will be added as a preventative service in Medi-Cal. The spending plan includes $377,000 General Fund ($974,000 total funds) for this benefit. Reduce Medi-Cal Premiums to Zero.
https://lao.ca.gov/Publications/Report/4642

The 2023-24 Budget: Medi-Cal Fiscal Outlook

Nov 16, 2022 - For over a decade and following multiple renewals, the state has imposed a tax on MCOs (managed care health plans that arrange and pay for the services of their beneficiaries) and used the revenues to offset General Fund costs in Medi‑Cal.
https://lao.ca.gov/Publications/Report/4649

Mental Health Services Act: Proposed Bond to Fund Behavioral Health Facilities and Veterans Housing

Aug 17, 2023 - These sources include (1)  dedicated vehicle license fee and sales tax revenue streams known as “realignment ” funds, (2)  revenues from the Mental Health Services Fund (MHSF) —established by the MHSA and funded through a 1  percent tax on incomes over $1  million, and (3)  federal funding accessed through Medi-Cal.
https://lao.ca.gov/Publications/Report/4790