How Will the Changing Landscape Affect California’s Health Care System?

May 4, 2026 - Under the 1991 realignment formula, a portion of sales tax and vehicle license fee funds are allocated among various subaccounts that support certain county health and social service programs. The Health Subaccount supports county indigent health and public health programs.
https://lao.ca.gov/Publications/Report/5180

The 2026-27 California Spending Plan: Health

Oct 19, 2026 - Adopts Minimum Expenditure Levels for County Behavioral Health Funding. This year ’s health trailer bill legislation requires DHCS to establish a minimum spending level for county Behavioral Health Services Act (BHSA) funds.
https://lao.ca.gov/Publications/Report/5210

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

Oct 24, 2025 - Impact to Counties Counties Will Face Costs From New Workload Demands … Counties are the primary administrators of eligibility determinations in Medi ‑Cal and will be responsible for implementing many of the eligibility changes in H.R.  1.
https://lao.ca.gov/Publications/Report/5083

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

Feb 17, 2021 - These sources include ( 1)  d edicated vehicle license fee and sales tax revenue streams known as “realignment ” funds, ( 2)  r evenues from the Mental Health Services Fund (MHSF) —funded through a 1  p ercent tax on incomes over $ 1  m illion, and ( 3)  f ederal funding accessed through Medi ‑Cal (California ’s state Medicaid program).
https://lao.ca.gov/Publications/Report/4379

How Will the Changing Landscape Affect California’s Health Care System? [Publication Details]

May 4, 2026 - In this report, we analyze how the changing fiscal and policy landscape will affect California’s health care system, including health coverage, hospitals, clinics, private health insurance, and county programs. We also provide key issues to consider regarding these effects.
https://lao.ca.gov/Publications/Detail/5180

The 2017-18 Budget: The Governor's May Revision In-Home Supportive Services Cost-Sharing Proposal

May 16, 2017 - Figure 2 Main Features of the Proposal 2017-18 General Fund support to partially offset increased county IHSS costs $400  million Realignment revenue growth to partially offset increased county IHSS costs a All sales tax and VLF growth All sales tax and VLF growth All sales
https://lao.ca.gov/Publications/Report/3671

The 2026-27 Budget: Medi-Cal Analysis

Mar 2, 2026 - Like community engagement requirements, more frequent renewals are also expected to increase administrative workload for county eligibility systems, at least in the short run. Federal Changes for Certain Immigrant Groups Create State Fiscal Pressure.
https://lao.ca.gov/Publications/Report/5146

The 2020-21 Budget: Analysis of the Medi-Cal Budget

Feb 14, 2020 - DHCS further proposes to implement a county performance monitoring dashboard that makes information on county performance relative to County Performance Standards and other potential measures yet to be identified public.
https://lao.ca.gov/Publications/Report/4161

The 2017-18 Budget: The Coordinated Care Initiative: A Critical Juncture

Feb 27, 2017 - Other 1991 Realignment Programs Will Not Receive Sales Tax Growth. Due to the increased costs in IHSS, likely no sales tax growth will be available for programs downstream of the Social Services and Caseload Subaccounts for many years.
https://lao.ca.gov/Publications/Report/3585

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

Jul 13, 2023 - MHSA and Revenue Volatility MHSA Tax Is an Extremely Volatile Revenue Source. Figure  1 compares the annual percent change in revenues from the MHSA tax, the state General Fund share of PIT, and the sales and use tax (SUT).
https://lao.ca.gov/Publications/Report/4780